Better eating on the autism spectrum

Picky eating or challenging eating behaviour is common in children on the autism spectrum. Dietitian Katrina Pace looks at ways to help.

Many parents struggle at one time or another with their child’s eating behaviours. Whether it’s battling to get them to eat any vegetables or finding an entire week’s worth of bread and peanut butter has been scoffed for afternoon tea while dinner is left uneaten, the pain and frustration is very real.

But what about kids who have problems tolerating foods because of how they’re wired?

For many families who have a member on the autism spectrum, these challenges can be much more pronounced.

Healthy Food Guide takes a look at food selectivity or aversion in people with autism and practical ways to help.

What is autism?

According to the World Health Organization, it’s estimated around one in 160 children have an autism spectrum disorder (ASD). The group of conditions that ASD collectively refers to, covers a wide range of strengths and challenges to do with cognition and sensory and social on the spectrum processing.

Some people prefer not to use the term ‘autism spectrum disorder’ because of the negative connotations of the word ‘disorder’ so, where possible, from here on, we will refer to it as ‘autism’.  Additionally, an emerging preference for identity-first language among autistic people and their friends and family, means we will refer to people on the spectrum as ‘autistic’.

An autistic person can experience the world, and interact with others, uniquely. This means there is no ‘one size fits all’ when it comes to supporting autistic people, and support needs to be based on helping with individual challenges.

Autistic people can be highly sensitive or, conversely, undersensitive to stimuli. As food involves many of our senses, problems with accepting, tolerating or trying food and drink can be common. This type of sensory aversion to food is also called food selectivity.

Sensory food aversion or selectivity

Having over-responsive sensation reactions is thought to be a factor in sensory aversions to food. Miriam Belsham, principal occupational therapist at Sprouts Child Occupational Therapy Service explains: “Eating and drinking is the most complicated sensory task a child engages in. It’s the only daily activity for children that requires all eight of our sensory systems to work in coordination. Therefore, it’s understandable that if a child has challenges with their sensory processing, like in ASDs, this can impact their eating and drinking and mealtime participation.”

The eight sensory systems:

• sight
• hearing
• smell
• taste
• touch
• vestibular system
  (balance and orientation)
• proprioception
  (position, location and muscle balance in the body)
• interoception
  (status of internal organs, eg, hunger, thirst, breathing).

Food is also not always predictable. An apple may taste sweet one time or sour another, for example.

Children quickly learn they cannot trust or expect fruit or vegetables (typically) to taste exactly the same every time. Ms Belsham believes this is one of the main reasons we often see autistic children preferring predictable foods, such as processed meats and packaged foods, and avoiding fruit and veggies.

Studies have come back with varying results when measuring food selectivity in the autism community, ranging from 13 per cent in one study, to 87 per cent in another. The difference in rates of aversion is partly due to the lack of definition of this condition.

Studies have found that in food selectivity it’s texture that causes the most problems, followed by aversion to appearance, taste, smell or temperature. Although there’s no set definition of food selectivity, generally included are food refusal and/or a high intake of one specific food.

Other features included in food selectivity definitions are a limited range of acceptable foods, excessive intake of a few foods, limited intake of certain food groups, not liking foods touching on the plate and eating only specific brands.

Top tips everyone can try today:

• Don’t pressure your child to eat or restrict their eating. This generally has the opposite effect from what you intend.
• Avoid all-day grazing. Try to encourage three meals a day and snacks in between, so they’re generally eating every two hours.
• Children need regular no-pressure exposure to new foods in order to begin to learn to even think about eating them.
• Aim to have family meals as often as possible. Children learn by eating with you and seeing you eat. It also helps desensitise them to the food, as long as they have no-pressure exposure to it.
• Don’t be a short order cook. If you always allow your child to only eat their preferred foods they will begin to food jag (reduce their preference for preferred foods) and will potentially end up eating fewer foods and further restricting their diets.
• Offer foods in a smorgasbord style and allow your child to self-serve from what’s on offer, ensuring you include at least one food they generally eat.

From Rachael Wilson, dietitian at The Food Tree

The effect on nutrition

Research shows while autistic children and food aversions may have a good appetite for what they like, there is a risk of vitamin and mineral deficiencies. Low dietary intake of vitamins A, B12, C, D, and K, along with calcium, fibre, choline and potassium have been found. However, studies have also found frequent use of vitamin and mineral supplements in autistic children.

It’s not just the food

It’s important to note other factors may influence food intake. Working with an experienced team, including an occupational therapist, physiotherapist, speech and language therapist, psychologist and dietitian, will highlight strategies that may help. These might include seating technique, positioning when eating, making eating easier by having the right plate, cup or cutlery and managing stressors around mealtimes.

Although every child will be different, here are some strategies for parents to think about:

• Try to put yourself in the position of the child being presented with a new food. Imagine how a child must feel facing something new. Ask yourself how you would go about learning to eat eyeball stew or a plate of crickets.
• Protect the foods the child currently will eat, and prevent food ‘burn out’ which can narrow the range of accepted foods. Try to have a 48-hour menu so whatever food they have today is different from tomorrow.
• To help provide enough nutrients to support the child while they are still learning about other foods, choose foods fortified with iron, B vitamins, calcium and vitamin E. Consider yeast spreads as an option to boost iron and B vitamins. Margarine or butter on bread and toast are a source of vitamins A and E and, if fruit and vegetable intake is low, consider using sunflower oil for cooking as a source of vitamin E.

From Fiona Leighton, paediatric dietitian and food therapist at Canterbury District Health Board and the Children’s Specialist Centre.

For more information visit:

• autismnz.org.nz
• autismspeaks.org
• autismspectrum.org.au
• National Autistic Society