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Some children have difficulties with swallowing or eating foods with particular texture, smells, colors, etc. Refusing to eat certain food, throwing tantrums or showing other behaviors during meals, or gagging and vomiting around certain foods can be very difficult. These children may have a feeding disorder.
Picky Eating and Food Selectivity
Food selectivity, or picky eating, is present in up to 70% of children on the autism spectrum, but it is often overlooked as clinicians focus on treating core symptoms of ASD. Picky eating often causes family conflict and parent stress, restricts family activities, and puts children at risk for health problems. Effective treatments have been developed for children on the autism spectrum who are younger and/or cognitively lower functioning, however food selectivity appears to also be prevalent in older children, adolescents, and adults on the spectrum who are cognitively higher-functioning.
Treatment and techniques are implemented through and under the guidance of a qualified professional. Many children respond well to treatments implemented in the home setting; however, it is important to monitor treatment effects to be sensitive to those who may respond better in a more highly controlled setting, for example a "feeding clinic."
When considering a treatment approach for food selectivity, it is important to rule out any medical explanations or food allergies that could be causing a dislike of particular flavors or food groups. Children may avoid particular foods because they upset their stomachs, but this connection and bodily experience can be difficult to describe. It is always important to consult your pediatrician to investigate these possibilities before starting any new eating or treatment plan.
Once you confirm that medical issues aren't behind a child's picky eating, you should keep one basic rule in mind: Avoid making food a source of conflict within your family. It is very common for picky eating to lead to dinner table arguments and battles of will between parents and children. Arguing or trying to force a child to eat something he or she doesn't want usually makes the situation worse. Instead, aim to explore the possible causes behind your child's dislike of new or particular foods while also encouraging flexibility around food choices and diet variety.
Consider Anxiety and Food
Many children on the autism spectrum dislike trying new things. This is sometimes called neophobia. If a child seems to have food neophobia, it is important to manage this anxiety in order to increase food intake. Take a slow and gradual approach to encountering new foods. Simply looking at a new food or having it on the table may be anxiety provoking for someone with food neophobia. A stepwise approach might start with looking at the food or talking about the food, and then moving to touching or smelling the food. With school-age children, this might include using the food in a game or art project, while adolescents or adults might use the food in a science experiment. When moving onto the step of eating the food, taking a lick or tiny bite might be the first step before building up to regular bites or average-sized portions. You may consider introducing new foods during non-meal times. It may also help to mix the new food with a familiar and preferred food for these first tastes. This stepwise approach to encountering new foods helps to ease an individual on the autism spectrum into exposure to the food, which in turn increases familiarity and decreases anxiety.
Choices, Control, and Flexibility
Picky eating often causes family conflict because it is one of the few ways that children can gain control over adults. A key strategy to managing this risk of conflict is for adults to provide children with choices around eating and mealtime that still allow the adults to guide food variety and diet. For example, rather than insisting that a child eat a particular vegetable, indicate that the rule of the house is that one vegetable must be on the child's plate, but the child gets to choose the vegetable. Similarly, present an array of food options at mealtime (within reason), and then invite the individual to choose three foods to put on his or her plate. This approach helps to encourage flexibility with food choices while allowing children to voice preferences around food. Everyone (whether on the autism spectrum or not) has foods they like and don't like. The key is to help the individual on the spectrum to create some variety within their selectivity, and to discuss their preferences in socially acceptable and expected ways (for example, "I'm not a fan of broccoli, but I like peas and green beans if you have those available").
This food flexibility can also be created by expanding on a familiar and preferred food. Work with your child to explore what new or different food he or she might be willing to add into his or her favorite dish (for example, turkey into macaroni and cheese, or dipping a grape into yogurt). This can even be a game you create within the family — can the rest of the family guess or find the new ingredient?
Many individuals on the autism spectrum have sensory difficulties with food that go beyond flavor. For example, a child may dislike the way a cherry tomato turns from solid to squishy in his or her mouth, though he or she likes the flavor. It can be difficult for children to separate out that good taste from the disturbing texture. In these cases, the key is to explore creative solutions for managing the sensory concern. For example, maybe the child can smash the tomato with his fork before eating it so it doesn't explode in his or her mouth. In addition, modeling language for describing these different features of food helps the individual articulate the experience with the food more clearly (for example, "I like the taste and flavor of tomatoes but I don't like the squishy texture").
Reward systems around food can be very tricky. The age-old "if you eat your broccoli, you can have ice cream" approach can work as a quick fix, but it will not always actually increase the preference or willingness to eat broccoli. Children and adults generally do more of whatever receives attention. That means negative attention too! Aim to reward and reinforce flexibility with food as well as the individual's gradual steps around anxiety-provoking foods.
Exposure Opportunities and Fun with Food
Having fun with food serves as a strategy to increase exposure to a food, decrease anxiety around the food, and provide opportunities for flexibility with the food. Here are some ideas:
- Bowl with watermelons
- Make faces on pizzas with vegetables or pepperoni
- Paint with pasta sauce
- Experiment with how ingredients change color or consistency when mixed together