Children with autism often have a variety of sensory issues. Sometimes they are very sensitive to certain sensations or, conversely, very insensitive to certain sensations. Understanding your child’s sensory needs can be a crucial component of treatment.
One of the most common sensory issues seems to revolve around food and eating. Specifically, many children on the autism spectrum have a particular palate that significantly limits what they will eat. This is known as food selectivity.
Food Selectivity vs. Picky Eating
Food selectivity is NOT just being a picky eater. Plenty of people are picky eaters. However, when push comes to shove (or when they are hungry enough), they will eat whatever food is available. When a child is a selective eater, he or she will eat only certain foods or strictly avoid foods and will not vary his/her diet without extraordinary intervention. It can get to the point that the child makes himself/herself sick. A child may not eat unless preferred foods are available. For parents of selective eaters, this can make mealtime a stressful and challenging time.
In my 15-plus years working and living with children with autism, I have seen food selectivity in action a number of times. One time, I was consulted about a young girl whose diet consisted entirely of McDonald’s chicken nuggets and fries. That was all she would willingly eat. To keep her child fed, her mother would buy four servings of each from McDonald’s at lunch time. She would reheat one serving at dinner and pack one for school in the morning. She did this seven days a week. Any attempt to try to get her child to eat anything else resulted in severe tantrums and aggression. To put food that wasn’t chicken nuggets or fries in her mouth practically required holding the child down and force-feeding her. The team I was on helped craft a behavior support plan geared toward decreasing tantrums around mealtimes and increasing acceptance of novel foods. It took a couple of years and a lot of hard work to change her palate and get her to eat a more balanced diet.
Another child I worked with was my foster child. He came to us at 6 years of age. We were told his diet consisted of the following: round cereal, chicken nuggets, fries, and grilled cheese sandwiches (we quickly learned he didn’t like grilled cheese). I remember putting a sugar snap pea on his plate with some chicken; he started screaming and threw the plate of food across the room. Basically, if we tried to feed him anything grown from the earth that wasn’t fried first, he would reject it. His diet was high fat, high starch—what I lovingly call the autism diet. Not only was his diet restricted, he had severe gastrointestinal issues due to high levels of lead in his blood (which can lead to constipation) combined with a family history of constipation issues. For him, a balanced diet rich in high-fiber vegetables was not merely a good idea but a necessity. I crafted a behavior-shaping protocol geared toward getting him to accept new foods and we worked on it for years. It was slow and frustrating, but we made progress. He is still with us today and now eats a fairly balanced diet. He has even learned to enjoy fresh fruits such as apples and oranges.
It’s Not the Result of Lazy Parenting
Some readers may be wondering if these issues are just a result of lazy parenting. The answer is a resounding no. Think about the aforementioned examples, and imagine each meal being a literal, physical fight to get food into your child. Imagine having to spend hours to get your child to eat a meal while he or she screams and yells and hits and bites you. Imagine doing this every day, several times a day. It might be a relief to find a couple of foods your child will eat. Having a quiet meal might be an incredible gift.
I know a lot of parents of special needs kids, and very few are lazy. They are simply dealing with problems that go far beyond what many parents have to face with neurotypical children.
Treating Eating Issues Is Autism Treatment
After my success with my son in getting him to eat better, I attended a conference about eating issues in autism. The presenter was a national expert whose practice revolved around this issue. I was pleasantly surprised to find that the methods I used with my son closely mirrored what he did. One thing he said that resonated with me was that treating eating issues was autism treatment. The act of expanding your child’s palate addresses many core autism issues such as rigidity, tolerance of change, sensory needs, and improved health and wellness.
Why They Won’t Simply Eat When They Get Hungry Enough
I can’t say why, for sure, children with autism and food selectivity don’t simply eat nonpreferred foods out of hunger. What I know from treating my son and working with many other children is that these children will make themselves ill rather than willingly eat nonpreferred foods. One child refused meals for days just because the cafeteria switched butter brands and he didn’t like the new spread. Since he primarily ate half a loaf of bread with butter as the main part of his meals, we had to get ahold of surplus packets of the old butter spread and gradually get him to adjust slowly to the new spread just to get him to eat.
My son, despite painful GI issues, would not alter his diet from foods that made him sicker. He was never able to connect his stomach pains with his diet. It took extraordinary measures (and a great deal of time) to turn things around for him. The bottom line is that while a neurotypical child will probably eat differently when there is no other choice, children on the spectrum typically will not. This leaves their parents in a quandary—do they starve and harm their child to force compliance with a healthy diet or do they simply defer to the pressures of autism and give in to their child’s desires to get him or her fed? Luckily, there is a possible solution.
Expanding the Palate Teaches Flexibility and Tolerance
One of the hallmark issues of autism is a need for structure and sameness. Children on the spectrum simply do not do well with change. By treating food selectivity and teaching a child to accept new foods, we combat this need for sameness and introduce tolerance. Learning to like new foods expands the child’s sensory world in a positive direction.
Improved Health and Well-Being Decreases Challenging Behaviors
Food selectivity often results in a poor diet. Poor diet impacts one’s overall health and well-being. When one’s health and well-being are poor, it leads to feeling lousy. When a child with autism feels lousy, he or she tends to act out. By improving the child’s diet, you improve his or her health, which leads to feeling better, which reduces challenging behaviors.
The Basic System in Five Steps
Here is the system I developed to treat my son’s food selectivity issue. I was able over the course of about a year and a half to take him from eating four foods (round cereal, red juice, chicken nuggets, and grilled cheese sandwiches) to eating a wide variety of fruits and vegetables and being willing to at least try bites of new foods. This system is based on sound principles regarding behavioral shaping.
- Introduce one food at a time: You don’t want to overwhelm the child with too much change at once. Pick a new food and work it until your child accepts it. Then introduce the next food. Usually after three new foods are successfully introduced, things accelerate quickly. In my son’s case, he suddenly started eating apples (a food we hadn’t introduced) and it became his new favorite snack.
- Small bites/alternate with preferred food: When you do feeding sessions with your child, introduce the food in small bites (microbites … no larger than a small pea). Alternate the new food with preferred foods. I find it helps to put the foods on separate plates so you can swap them out more easily.
- Ease into actually eating the food: Don’t insist on your child eating the new food at first. Start with having the child just be willing to pick up the food (let him or her look at it, sniff it, get used to it) before rewarding him or her with a bite of preferred food. Once that is accomplished, reward the child for putting the food to his or her lips, then for putting it on his/her tongue, then for putting it in his/her mouth (but not swallowing), then for taking a tiny bite, and so on until the child is able to eat a small portion of the new food. Always alternate between the new food and preferred foods. If the child starts to tantrum, use your judgement; if the tantrum is minor, wait it out. If the tantrum is major, end the eating session. Try again later when your child is calm.
- Frequent practice throughout the day—not just at meal times: Don’t practice this just at meal times. Add frequent small-snack practice sessions throughout the day where you do most of your work. In fact, it may be beneficial to do the bulk of your work during these practice sessions and present new food only during meal times with a little less pressure to eat it (so as to make sure your child is getting some nutrition at first). Just remember that the more your child is exposed to the new food, the sooner he or she will learn to accept it. Also, make note of foods your child is simply not accepting. If after a week or two your child is not showing improvement, move on to a different food. In my son’s case, he simply did not like corn. No matter how often we tried to introduce it, he would not accept it. We finally figured he was not going to like corn and focused on other foods.
- Collect data on progress: Make note of which foods are being introduced and when. Chart how many and what kinds of prompts are needed with each trial. By collecting this data, you can more easily track small progress. You can also catch things such as plateaus and reversals sooner and make crucial adjustments.
Think about how often we eat. If every meal is a fight, imagine how draining and demoralizing that might be for a parent. By utilizing this system, meal times can become less stressful and more pleasant. The act of treating food selectivity is an important part of autism treatment. It doesn’t take any fancy therapy (although working with a skilled behavior therapist can make the process go quicker and smoother) and is well within the realm of possibility for most dedicated parents. I welcome your thoughts and experiences with food selectivity and its treatment.
Remember, parents: You’ve got this!
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