While it’s widely documented that autism spectrum disorder (ASD) affects social interaction, communication, and behavior, there is a less spotlighted, yet pivotal, piece to these neurodivergent children: feeding difficulties. It’s estimated that up to 80% of autistic children have some form of feeding challenges. To ensure holistic success, these feeding issues must be acknowledged by the industry and caregivers and promptly and appropriately addressed.
Feeding Hurdles in Autism: Common Challenges
Autistic children frequently encounter a range of feeding issues, including sensory sensitivities, selective eating, and aversions to certain textures or tastes, which can significantly impact their progress in other therapies and overall well-being. For example, gastrointestinal disorders (GID) are common in children with ASD due to nutritional deficiencies and can include constipation, vomiting, diarrhea, and abdominal pain. Feeling physical pain, whether chronically or intermittently, can prevent progress in all other areas of the child’s life.
Moreover, these feeding difficulties often manifest in problematic behaviors during mealtimes. Children may employ strategies to avoid specific foods or entire food groups, exhibiting actions such as screaming, crying, irritability, aggression, attempts to move away from the chair, expressing distress, turning their head away, chewing without swallowing, spitting out, and even vomiting.
Prevalence of Pickiness in Autistic Kids
It’s been found that children with ASD consume less fruit, dairy products, vegetables, proteins, and starch than children without a diagnosis. Results of a study conducted on children aged three to five showed that those with ASD, with respect to typically developing children (TDC), preferred foods of a certain consistency (68% vs. 5%), are choosier about food (79% vs. 16%), more hesitant to try new foods (95% vs. 47%) and assumed a restricted variety of food (58% vs. 16%).
This restive eating isn’t something they will simply grow out of. In a recent longitudinal study, 52 parents of autistic children were surveyed 20 months after completing an initial questionnaire. The results found no change in food selectivity level and a stable, significant relationship between food selectivity and sensory over-responsivity. This underscores the need for early interventions to increase the variety and promote healthy eating among children with ASD.
Is it Medical or Behavioral?
If you recognize that your child or the child under your care is experiencing notable challenges with feeding, it’s natural to feel a strong desire to support and assist them. Before determining the best approach to addressing the feeding problem – it’s important to identify if it’s a medical or a behavioral issue. This may require consulting with the child’s medical doctor and/or sending them for a referral to be cleared medically. Some symptoms, like vomiting or chewing/swallowing challenges, might be because of medical reasons, and establishing the solution to that problem will be essential to success in feeding therapy. In other situations, the restrictiveness and selectivity to food, as well as inappropriate mealtime behavior, is a manifestation of autism and environment/interaction with caregivers. The children can quickly create associations between what behaviors elicit access to what they want and gain the escape from what they don’t want. Both medical and behavioral reasons can happen at the same time during a kid’s development.
Feeding Challenges Impact More than Mealtime
By ensuring that autistic children are well-nourished and comfortable during mealtimes, we create a foundation that amplifies the benefits of occupational, speech, and other therapies. Therapists across fields often run into children who exhibit behaviors that make it difficult to conduct a productive therapy session. One of the biggest underlying factors of that difficult behavior is being hungry. As adults, it is easier to recognize when we become irritable to grab a snack and we feel better. Most autistic children with feeding difficulties cannot identify the correlation, and therefore, the irritability intensifies. Once those children establish a routine during feeding therapy and allow nutritious food to consistently enter their mouth, their whole body feels better, which in turn improves their overall demeanor, ability to focus, and energy level. This highlights that feeding therapy is not an isolated intervention but a catalyst that, when integrated into a holistic treatment plan, optimizes the overall effectiveness of therapeutic efforts.
Feeding difficulties extend beyond physical and sensory realms; they create social implications that can lead to isolation and stigmatization. The reluctance to try new foods or eat in public becomes a barrier to developing friendships, perpetuating societal misconceptions about autism. Feeding therapy becomes a powerful tool to break down these barriers. By incorporating social skills training within the context of feeding therapy, we empower autistic children to navigate social interactions, fostering a more inclusive environment that transcends mealtime.
Why a Behaviorally-Based Approach to Feeding is Best
A good behaviorally based approach to feeding will focus on the consumption of the food rather than interaction with the food. There is no proven benefit to encouraging children with significant feeding difficulties to play with food other than, for some, it might be a fun activity. Most families will often choose a non-behaviorally based approach at first, as it appears like the easier, gentler approach, but then typically hit a brick wall and struggle to move forward to make the progress they were hoping for, such as a sustained increase in variety and volume of food the child consumes. Applied Behavior Analysis (ABA) is the only empirically validated treatment for feeding disorders. When children display significant food refusal and it begins to impact their weight, nutritional intake, social interactions, and more, finding a quick and effective solution is essential. Treatment of feeding disorders utilizing ABA consistently appears in the research and continues to be proven effective when implemented correctly.
Empowering Clinics and Caregivers
Feeding therapy, positioned as a fundamental catalyst for comprehensive care, demands attention from clinics, healthcare executives, and caregivers. This often-overlooked therapy should be integrated into existing programs to enhance the overall impact of interventions. Clinics are urged to collaborate with feeding therapists, recognizing the far-reaching benefits of incorporating feeding therapy into their offerings. The call to action is clear: by embracing feeding therapy, clinics can not only meet the unique needs of autistic children but also elevate the effectiveness of their comprehensive care.
Dena Kelly, LPC, BCBA, BSL, is Founder and CEO of Focused Approach. For more information, visit focusedapproach.com or email firstname.lastname@example.org. Follow Focused Approach on LinkedIn and Twitter/X.