Many families of children with Autism Spectrum Disorders (ASD) encounter feeding challenges. Though the estimated prevalence rates of feeding challenges among those with ASD vary greatly in the literature, there is general consensus that they are more prevalent than in the general population. These challenges are associated with the core symptoms of ASD. Here's how:
1. Social Interaction Difficulties
Feeding is a social experience from infancy. From the start, typically developing babies learn behaviors such as leaning in towards the caregiver and opening their mouths. When this social component doesn't develop or is delayed, feeding can be impacted. Further, it may be challenging or aversive for a child with ASD to participate in the social aspects of feeding. For example, there are many social components to sitting down at snack time or the school cafeteria. If those components are challenging, mealtimes may be negatively impacted.
What can we do?
Look at the entire picture. The social skills required to participate in a mealtime can be thought of as a prerequisite. If a child doesn't even want to sit down with peers at snack time or with the family at dinner time, the actual eating part is bound to be affected. Work on one step of the equation at a time.
2. Language and Communication Difficulties
ASD is also associated with difficulties in communication, which can have a big impact on mealtime behaviors. Effective communication is so important for a successful mealtime. Children communicate their needs and desires throughout a mealtime: "I want more of that," "I don't like the taste of this," "I'm hungry," "I'm full," and so on. So, you can imagine how not being able to effectively communicate these things can lead to challenging behaviors during meals. The child that can't communicate that he's all done and keeps being offered food is bound to cry, scream, throw food, etc.
What can we do?
Give children a way to communicate their needs effectively. For a child that is nonverbal, it may be providing a photo to show that he is all done, or a sign to request "more." I'll devote a post to this in the future.
3. Behavior Challenges
The final core symptom associated with ASD is behavioral challenges. In regards to feeding, here are some common ones that can have a big impact:
Ritualistic behaviors/need for routine: the child needs to eat the same food in the same environment (same spot at the table, food presented on the same plate, with the same silverware, etc.).
Attention to detail: children may refuse food based on what seem like minute details to us. For example, I've worked with multiple children that wouldn't eat food that was broken or that was presented outside of a wrapper.
Sensory difficulties: This is where texture difficulties come into play. Many children with ASD will refuse entire groups of textures. For example, a child might only eat foods that are crunchy but avoid anything that feels "mushy" in the mouth.
What can we do?
Introduce change in gradual steps. Show the child that change can be associated with positive outcomes. For example, you might just change spots at the table and really praise flexibility with trying something new. Make simple changes before you do anything about the food. I'll talk more about how to do this in future posts, as well.
The literature tells us that feeding challenges in children with ASD tend to be more prevalent, more restrictive, and longer lasting than what we might see in a "typical picky eater." The most important implication is to act early! As soon as you notice challenges, intervene. Waiting for a child to "grow out of it" will only cause stress and bigger problems down the road. Stay tuned for coming posts with more information about simple interventions you can implement!