By: Rachel Christensen, Allison Salk & Suzi Naguib, Psy. D. Blog PDF
It happened again. My son, Jordan, who has been diagnosed with autism spectrum disorder (ASD) made a scene at a restaurant. I even researched this place to make sure it had macaroni and cheese. Apparently, it was not exactly how he had wanted, and he started gagging and crying in front of everyone. I was so embarrassed, and at a loss for what to do. Jordan won’t eat anything but macaroni and cheese, chicken nuggets and plain bagels: breakfast, lunch, and dinner. If I try to give him something else, he throws a fit. I know kids are picky eaters, but this is different. I am starting to worry about his health, especially because of some of the gastrointestinal (GI) issues he already has.
Many children with ASD have difficulty with eating certain foods or may have very specific food preferences 1. Research has shown that there are a variety of reasons why individuals with autism may have limited food choices. According to several studies, children may be “choosy” about certain types of food because they prefer sameness in their meals 2,3. Most children with ASD may also be severe picky eaters because they are overly sensitive to a food’s color, texture, smell, taste, or temperature 4. For example, some children with ASD will only eat white-colored foods or foods that are soft, like pudding or mashed potatoes. Their sensitivity may be exhibited by tantruming, gagging, or even vomiting if a parent or caregiver attempts to give them a new food 5, 6, 7, 8.
Not only can sensory characteristics of the food be a challenge, but also the sensory characteristics of the eating environment may cause difficulty for a child with ASD. If an environment is too noisy for a child who is overwhelmed by loud sounds, simply eating a meal may be a challenge 3. A child with ASD may also have difficulty with eating because he or she may have trouble sitting still for long periods of time 3. Lastly, socializing with others is often a large component of mealtime 9. Because social and communication concerns are characteristic of ASD, your little one may be selective of foods or throw a tantrum as a way to avoid or a means to cope with an anxiety-provoking situation.
What can I do to help?
Fortunately, there are several evidence-based treatment methods that can be effective in helping children with ASD overcome their severe picky eating. Because food and mealtime is a source of anxiety for children with ASD who are severe picky eaters, therapy includes hierarchical exposure to the anxiety-provoking stimulus (a food the child dislikes) with encouragement until the child is eventually desensitized to the stimulus 8. First, the therapist, along with the parent, will identify the reasons why particular foods are highly desirable to the child and why other foods may not be. For this first step, it is important to determine if the foods that the child likes and dislikes are based on temperature, color, taste, smell, or texture. Then, the child will be exposed to foods that he or she prefers most in terms of their sensory characteristics, followed by foods that he or she has more difficulty with 8.
Gastrointestinal (GI) issues often go hand-in-hand with food selectivity and eating difficulties in children with autism spectrum disorder (ASD). Several children with ASD are at higher risk for GI problems, and many suffer from chronic diarrhea, constipation, and abdominal pain 10. Although research is not yet conclusive, some studies have shown that children with ASD may act out or behave inappropriately in response to gastrointestinal distress 10. Some children with ASD may express GI distress as repetitive or self-injurious behaviors, irritability, tantrums, and disturbed sleep patterns 10. As children with ASD may be more likely to experience gastrointestinal symptoms than children without ASD, it is important to be aware of your child’s eating habits and to be sensitive to possible tummy troubles associated with mealtime 11.
Sunfield Center psychologists are available to help identify and treat severe picky eating in children and adolescents as well as other challenges faced by families whose children have mental health needs. To schedule an appointment, please call us at (734) 222-9277.
1 Ledford, J. R. & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders: A review. Focus on Autism and Other Developmental Disabilities, 21, 153–166. doi: 10.1077/10883576060210030401.
2 Beighley, J., Matson, J., Rieske, R., & Adams, H. (2013). Food selectivity in children with and without an autism spectrum disorder: Investigations of diagnosis and age. Research in Developmental Disabilities, 34(10), 3497-3603.
3 Bruns, D. & Thompson, S. (2011). Time to eat: Improving mealtimes of young children with autism. Young Exceptional Children, 14(3).
4 Dominick, K. C., Davis, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28, 145-162. doi: 10.1016/j.ridd.2006.02.003.
5 Gentry, J. A. & Luiselli, J. K. (2008). Treating a child’s selective eating through parent implemented feeding intervention in the home setting. Journal of Developmental and Physical Disabilities, 20, 63–70. doi: 10.1007/s10882-007-9080-6.
6 Johnson, C. R., Handen, B. L., Mayer-Costa, M., & Sacco, K. (2008). Eating habits and dietary status in young children with Autism. Journal of Developmental and Physical Disabilities, 20, 437–448. doi: 10.1007/s10882-008-9111-y.
7 Martins, Y., Young, R. L., & Robson, D. C. (2008). Feeding and eating behaviors in children with autism and typically developing children. Journal of Autism and Developmental Disorders, 38, 1878–1887. doi: 10.1007/s10803-008-0583-5.
8 Koegel, R. L., Bharoocha, A. A., Ribnick, C. B., Ribnick, R. C., Bucio, M. O., Fredeen, R. M., et al. (2012). Using individualized reinforcers and hierarchical exposure to increase food flexibility in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(8), 1574-1581.
9 Chater, A., Stein, S., & Chowdhury, U. (2012). Take note of the fuss: Selective eating and autistic spectrum disorders. Community Practitioner, 85(12), 37-39.
10 Maenner, M. J., Arneson, C. L., Levy, S. E., Kirby, R. S., Nicholas, J. S., & Durkin, M. S. (2011). Brief Report: Association between behavioral features and gastrointestinal problems among children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 42, 1520-1525. doi: 10.1007/s10803-011-1379-6.
11 Buie, T., Campbell, D. B., Fuchs III, G. J., Furuta, G. T., Levy, J, VandeWater, J., et al. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDS: A consensus report. Pediatrics, 125, S1-S18. doi: 10.1542/peds.2009-1878C.