Understanding causes of children’s food intolerances and idiosyncratic ‘eating behaviours’ is vital if we want to help them.
If we start with addressing ‘diagnostic features’ of the condition, neglecting their causes (that can be different in different children), any improvements are unlikely. Some sensory perceptual difficulties can be caused by correctable problems, which, if addressed, can affect the efficiency of functioning through improving the supply of nutrients and reduction of toxicity (e.g., treatment of the fungal infection, candida albicans; casein/gluten intolerances, vitamin-mineral/ amino acids problems, etc.). Other problems can include metabolic disorders, ‘gut leakages’, viral infections, etc. Reduced delivery of nutrients to the brain through the blood can mean limited ability to process information, delayed processing, sensory hypersensitivity, overload and shutdowns.
Such behavioural suggestions (based on positive and negative reinforcements) as to encourage autistic ‘picky eaters’ to try new food, rewarding them with stickers, etc. are useless at best and cruel at worst. If children are hypersensitive to certain foods/smells they cannot even stay in the proximity of anyone eating because of intolerable smell. Some children would vomit if they encounter the smell they cannot tolerate, which they can detect even from two rooms away. Behavioural methods ignore real difficulties some children experience (e.g., hypersensitivity) and often will not work with autistic individuals. The more pressure is applied, the stronger resistance emerges. The extreme form – force-feeding – will make the situation even worse. On the other hand, encouragement through shaping and fading while addressing the sensitivity problems and offering rewards with recognition (praise) of the child’s efforts to achieve it is a better option and worth trying. Starting with acceptance of a new food on the child’s plate, to letting the food to touch face, then lips, to very small amount of the food in the mouth, and finally swallowing it.
If the child is hypersensitive to touch, facial massage may be used, then gradual desensitisation to textures, sounds, tastes, smells, etc.
Keeping the pressure off and the least fuss about trying new foods bring better results – the child is more relaxed and may become more curious about new foods that others eat and would want to try. If the new food is regularly presented on the table or on the child’s plate (without any pressure – “If you don’t want it, don’t eat it, just leave it on your plate”), the child gets accustomed to the sight, smell and feel of it without any pressure from the parents. Asking (from time to time) if he wants to try it can result one day in ‘Yes, please.’ Gradual introduction is a slow process but with patience and consistency it works for some children.
Disguising new food: e.g. under ketchup (if the child likes ketchup).
Providing new foods that look similar to those they already like: some may try something if it looks similar to what they like.
Creating new routines (introducing new foods in new places, e.g.). Eating in a new environment can bring both problems and opportunities. For example, the chaos in school at lunchtime and pressure from lunchtime staff can put the child off not only from trying something new but also from eating his/her packed lunch. On the other hand, a thorough preparation and introduction of a new ‘eating routine’ (which will include new food in the menu) in a new setting can encourage the child to eat new food (which will be associated with this place and routine).
Using visual aids, written rules explaining what is expected in certain situations may be successful with some children.
Sometimes offering ‘character meals’ (food in shapes of the character, objects, etc. the child is interested in) can encourage the child to eat/to try new food. But the effect can be the opposite for other children – they can refuse to eat their ‘favourite characters’. Favourite characters can be used as role models, e.g., if the child likes rabbits, telling him that his favourite rabbit likes carrots may encourage him to eat it.
Because many autistic children monoprocess (use only one sensory channel at a time), distraction can be used with them. This type of processing is taken advantage of by some parents of autistic children with very restricted diets who will eat better if they are watching a video, listening to music or talking to someone.
Making choices: Some faddy eaters can be encouraged to choose the food (e.g., giving them two options) they would like to eat. This will give them some control of the eating process. Yet again, there may be difficulties with this as well: if both options are unacceptable, or if they experience difficulty to make a choice, etc.
Involvement: in some cases children become more adventurous if they are involved in the whole process – starting from buying necessary ingredients in the supermarket, opening packets, (if they can tolerate the smell) cooking, serving, and then eating the food.
Peer pressure and desire to please their family is relevant for children with Asperger syndrome who want to fit in and/or to make their parents happy, but it is unlikely to work with someone on the more severe end of the autistic spectrum. Some will agree to try a new food but insist on having a glass of water to wash it down in case they do not like it. Some will listen to explanations about different products and their benefits for the organism and will be eager to eat ‘healthy foods’.
Likes and dislikes change with time. With age many children will try new foods. Many high-functioning youngsters with autism and Asperger syndrome who become more aware of diet and nutrition will try to follow the advice to improve their eating preferences. However, some will continue to be on a restricted diet throughout their lives. (Children with very restricted diets can be given mineral and vitamin supplements.)
In some children and adults with ASD, various diets and supplements that address biochemical, immune system and metabolic problems, bring significant improvement in their processing of information, sensory hypersensitivities, communication and behaviour in general.
The special diets research has been criticised for being ‘anecdotal’, lacking ‘scientific evidence’. However, none of the approaches would benefit the average person with autism – the underlying causes (leading to the same clinical manifestation of the condition) are different in different individuals. There is no one-fit-all treatment.
Good news is, with time, quite a few autistic children start enhancing their menu, without much effort from their carers.
Keeping in mind that there are no two autistic individuals with the exactly same sensory-perceptual profile, specialists working with this population should approach each case individually and decide what is best for each particular child. Sometimes mistakes will be made, but by trial and error (with consistency and patience) we can change what they eat to make them healthier and happier. The process may be slow and complicated, but let us remember – whatever autism is, it is never boring.
Written on behalf of Integrated Treatment Services by Olga Bogdashina
See here for part 1 of this article
