Picky Eating and Autism

Eating is a complex behaviour that relies on skills and functions that are often challenging for children with ASD. Development of food preferences and diet variety requires repeated exposure to novel foods; along with processing the similarities and differences of items within a food group or category (e.g. cheese varies widely in flavour, colour and form). Mealtime is also inherently variable, with most people regularly changing menus, utensils and dishes, and eating environments. Difficulties with managing novelty, prototype formation and generalisation and behavioural inflexibility and a need for sameness prime children with ASD to experience feeding challenges. Moreover, sensory processing differences, oral motor impairments, fine motor impairments and gastrointestinal problems common in individuals with ASD may also contribute to feeding challenges.

Picky eating is a common problem in children with Autism Spectrum Disorder (ASD), apparent across age groups and intellectual ability levels. Historically, atypical eating was so common in children with ASD that it was originally considered a criterion for diagnosis. While picky eating is common in neurotypical development between 2 and 6 years of age, food selectivity in ASD does not necessarily resolve in these early years. Severity of food selectivity appears to decrease across childhood in ASD; nonetheless, several studies suggest that symptoms may persist into adulthood. The majority of research on food selectivity in ASD has focused on early childhood and primary school age children. Some studies documenting increased food selectivity in ASD have included adolescent participants, however mean ages across groups are primary school age or younger.

In a recent study (2015), published in the journal, Research in Autism Spectrums, researchers identified that adolescents and young adults with ASD reported preferences for familiar foods and dislikes for foods with particular textures and strong tastes. Globally lower sensory seeking behaviours may partially explain preference for milder foods, but do not account for the dislike of textured foods. There appears to be something uniquely unpleasant about food textures for young people with ASD. At present researchers can only speculate about the cause of this phenomena, but it is worth noting that specific cranial nerves (facial and glossopharyngeal) carry taste and food texture information, via dedicated brainstem and thalamus pathways to the insula, a region that has been implicated in the neural pathophysiology of ASD. Moreover, there appears to be a link between neophobia and practical/daily living skills among adolescents and young adults with ASD.

The evidence suggests that picky eating does not resolve in childhood for individuals with ASD as would be expected in neurotypical development. Although, it is unclear whether food selectivity is associated with micro/macronutrient insufficiency in childhood, the findings from the foregoing study indicate that possible nutritional insufficiency may remain a concern beyond early development in ASD as limited diets persist into adolescence and young adulthood. Results highlight the need for effective intervention strategies for treating food selectivity in adolescence and adulthood. To date, food selectivity issues have been addressed by taking a behaviourist perspective; however, given that this difficulty of food selectivity also remains in older, high functioning individuals with ASD, cognitive behavioural approaches to intervention may be warranted and prove more effective (e.g. BUFFETT program).

As is well documented, there is already a high risk for weight gain and unhealthy eating in typical teenagers transitioning into young adulthood. This risk is likely even higher for individuals with ASD during this life stage. In fact, a recent CDC study of nearly 10,000 adolescents suggests that obesity rates in ASD are higher relative to those found among not only their same age typically developing peers, but also same age peers with other forms of developmental concern. With the notable increase in the prevalence of ASD and the transition of generations of children with ASD into adulthood, there is a prominent need for independent and healthy daily living skills.
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