Autism & nutrition

My work in Autism was a happy  accident. In 2008 I attended a lecture by Elizabeth Strickland - a dietitian specializing in Autism. I was fascinated by the complexity of the condition and the powerful impact that nutrition had on physical complications for children and adults. After graduate school, I had the honor of coordinating research for the Autism Treatment Network (ATN) and the Autism Intervention Research Network on Physical Health (AIR-P). My time spent among these experts enriched my practice in so many ways, it only seems fair to share a few tidbits.

What is autism? 

Autism is a developmental disorder that affects communication and behavior. The Diagnostic and Statistical Manual (DSM) describes it as...

• Difficulty with communication and interaction with other people
• Restricted interests and repetitive behaviors
• Symptoms that hurt the person’s ability to function properly in school, work, and other areas of life

But as they say in the field, "if you've met one child with autism, you've met one child with autism." The condition has EXTREME variation person to person which is why it is difficult to diagnose and treat much less recognize in someone. Hollywood portrayals such as "Rain Man" and "What's Eating Gilbert Grape" are cute but not necessarily accurate.

Autism can affect someone head to toe, which makes treatment pretty intense. It often takes a village of providers including neurologists to sort through seizures and sleep, psychopharmacologists to assist with behavior management, gastroenterologists to resolve stomach issues, physical therapists / speech therapy / occupational therapists to improve movement and coordination, and behavior therapists to help children navigate and cope with every day life. It's not unheard of for families to have 40 hours of therapy a week. With so many areas of focus, it's common that nutrition falls to the wayside - after working full time, who wants to make meals another event? But the chemistry of food can have tremendous impact  on the effectiveness of the therapy. 

Nutrition and ASD

There are a number of associated health conditions with autism ranging from neurological to gastrointestinal conditions. The goal of nutrition in autism is to 1.) improve symptoms and 2.) improve quality of life. It's important to understand the root cause of the feeding behavior before trying to intervene. Behavioral vs medical motivators are very different treatments. 

Here are a few main areas nutrition impacts: ​

Tender tummies

​It's common for children to have "tender tummies" (examples include reflux, food intolerances, irritable bowel syndrome, constipation, etc). However many cannot express this discomfort nor do they understand where it's coming from. The pain becomes a distraction - who can concentrate on learning when they have stabbing pain?  It's important to sort out any physical discomfort before pushing food. Otherwise the behavior of eating is nothing but an unpleasant experience and a battle to be avoided . 

Sensory challenges

​Sorting through the senses around food is one of the primary obstacles for all children - autistic or not.

Some children have heightened senses in one area and dulled in another. This can make them sensory seeking or sensory avoiding, or both. 

For example, some children have heighten auditory senses - they hear EVERYTHING and find it challenging to filter out certain noises. Imagine sitting at a table trying to hear but you hear the fan whirring overhead, the fridge next to you, the tv in the background, the traffic outside, the chewing of the person next to you, and the chewing of yourself. It's overload and would make anyone want to escape. 

Senses impact a child's interaction with and preference for food. If they are sensory seeking with their mouth, they may prefer foods that give them strong feedback (more crunch, cold temperatures, intense flavors). Whereas if they are sensory avoiding with their mouth, they may prefer smooth, creamy, and consistent textures. The same principles apply for sense of touch, smell, and sight. To make things more complicated, some children are sensory seeking with their mouth but NOT their nose.

It's about learning what each child prefers, working with it, and expanding the options. ​

Developmental delays

​Sometimes children with autism have delays in motor abilities and lower muscle tone overall.  Less muscle = more challenge coordinating movements. Eating is actually a pretty complicated task we take for granted -

1. You have to pick up the food (eg, be able to grasp it or coordinate it with a utensil)
2. Chew (eg, your jaw has to move in the right direction - sometimes up and down and other times tearing)
3. Control / swallow (eg, your tongue has to keep the food controlled and in the right place, and the tongue controls how quickly / how much food goes down the esophagus)

The texture and consistency of food makes any of these steps easier or harder than another. For example, drinking water takes a lot of control whereas a thicker liquid is easier. 

Choking / gagging during this process is terrifying. If you've ever choked, how eager are you to try to eat that food again?? How excited would you be to "try it again" if you didn't understand what happened in the first place? Moving a child through food exposures and challenges too quickly makes the child feel unsafe. 

Sorting through food preferences

I cannot say this enough: Children with autism are still children. Not everything is a "behavior." All too often I hear families explain, "he's picky because he's autistic." Not necessarily. Most children have food preferences. If they learn a way to get their food preferences honored, they are going to stick to it! Children don't eat what they "should", they eat what they enjoy. It may take a little longer and a few extra steps for a child with autism to overcome the sensory barriers and navigate any health challenges, but the process and end result is often the same. The goal is to make eating and exploring food enjoyable for children. ​

Check out my blog post about picky eating to learn more about making eating enjoyable.

Want to learn more about feeding and autism?

Food Chaining by Cheri Fraker is perhaps one of my favorite resources for clinicians working with picky eaters. It starts by exploring common health conditions that may impact eating then dives into changing eating behaviors using a step-by-step program called food chaining.

Just two more bites by Linda Piette is another great read for parents trying to navigate their child's eating behaviors

Stay nourished friends!