The treatment of food selectivity and other feeding problems in children with autism spectrum disorders

doi:10.1016/j.rasd.2008.09.005

Research in Autism Spectrum Disorders

Volume 3, Issue 2, April–June 2009, Pages 455-461

https://doi.org/10.1016/j.rasd.2008.09.005 Get rights and content

Abstract

Food selectivity and other feeding problems are endemic in children with autism spectrum disorders (ASD). Additionally, many of the challenging behaviors which fall into this category are idiosyncratic to ASD. A technology is beginning to emerge regarding methods to lessen and effectively treat these issues which, if unchecked, can result in poor nutrition and difficulties in feeding. Specificity in foods consumed, choking, and aggression associated with food refusal can put the child and caregiver at risk. This paper provides a critical review of the current status of evidence-based clinical practices for this highly important set of challenging behaviors of ASD children.

Section snippets

Nosology

An important setting event for the discussion of feeding problems in children with ASD is to define the problem adequately. Twachtman-Reilly, Amaral, and Zebrowski (2008) stress the unique qualities of feeding problems in these children and the modification to assessment and treatment that are required to tailor these methods to the child, thus resulting in the most effective intervention. With this point in mind, it should be noted that feeding problems are much more frequent than what is

Etiology

The causes of eating problems and food selectivity are complex and often interrelated. Because of this, a considerable amount of research will be required to tease out these variables. At present, such efforts have only just begun. Having noted this, we would point out that three broad domains have been identified: comorbid psychopathology, biological variables, and environmental factors. Some tentative conclusions based on the available data are possible and will be reviewed next.

Assessment

One reason so little has been done with respect to the etiology of feeding problems in ASD is related to the lack of adequate methods to assess these problems. One of the best studies to date on the topic was by Ahearn et al. (2001). They evaluated 30 children between 3 and 14 years of age who were diagnosed with autism or PDD-NOS. Children were exposed to 12 food items across six assessment sessions. Food acceptance, food expulsion, and challenging behaviors were recorded for each trial. About

Treatment

A variety of food-related problems have been treated in ASD children such as eating compliance, rapid eating, inadequate food consumption, and food packing. However, food selectivity has been the most frequently studied feeding problem. Furthermore, applied behavior analysis has been the treatment model of choice in most instances.

Patel et al. (2007) used a behavioral momentum procedure to increase eating compliance of a young boy. Treatment consisted of three trials of a high probability

Conclusions

Feeding problems of children with ASD are frequent and can have serious consequences. As a result, better understanding the nature of the problem and establishing sound assessment and intervention strategies are warranted. Initial attempts, particularly with respect to behaviorally based interventions have been promising. However, little is known at this time about the complex biological and environmental factors which are likely to cause the condition.

Additionally, it is surprising and a bit

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Autism spectrum disorders (ASDs) are associated with specific dietary habits, including limited food selection and gastrointestinal problems, resulting in an altered gut microbiota. Autistic patients have an elevated abundance of certain gut bacteria associated with increased oxidative stress in the gastrointestinal tract. Probiotic supplementation has been shown to decrease oxidative stress in a simulated gut model, but the antioxidant effects of probiotics on the oxidative stress of the gut in autistic patients have not been directly studied. However, it is speculated that probiotic supplementation may help decrease oxidative stress in the gastrointestinal tract of autistic patients due to their specific dietary habits altering the microbiota. PubMed, Scopus and Web of Science databases and Google Scholar were searched up to May 2023. This systematic-narrative review aims to present the latest evidence regarding the changes in eating habits of autistic children which may further increase the gut microbiota induced oxidative stress. Additionally, this review will assess the available literature on the effects of probiotic supplementation on oxidative stress parameters.
Accessibility of nutritional services for children with autism spectrum disorder in the United Arab Emirates: Insights from special education teachers and parents
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Goal 2 of United Nation’s Sustainable Development Goals exhorts countries to provide guidelines on better nutrition for all children. In response, the United Arab Emirates (UAE) government designed a national nutrition framework to encourage better eating habits. However, large body of literature has reported that children with ASD are at high risks of malnutrition and poor eating habits. Yet, in the UAE and other contexts, there is limited research on accessibility of nutritional services to adults in the lives of children with ASD.
As parents and teachers spend the most time with children with ASD, this study sought to understand their perceptions of the availability of nutritional services for such children in the UAE.
Penchansky and Thomas’ (1981) health access theory served as the theoretical framework; its five tenets (geography, finance, accommodation, resources and acceptability) informed the design of a semi-structured interview guide. Data were collected from 21 participants, comprising 6 parents and 15 teachers of children with ASD.
Thematic analysis revealed that participants perceived accommodation, acceptability, and human resource availability as barriers to accessibility. However, geographical and financial accessibility were not identified as challenges.
The study calls for health policymakers to formalise nutritional services as an integrated part of the UAE health system, while also extending services to children with ASD.
This study makes a substantial contribution to the literature. First, it addresses the needs for nutritional services for children with ASD. There is a limited body of knowledge on whether children with ASD have access to the requisite nutrition for development This study sheds light on an area that has received limited scholarly insight. Second, it adds to the usage of health access theory in studies on nutritional services for children with ASD.
Randomized trial of a self-administered parenting intervention for selective eating in young children
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Selective eating is a common childhood feeding problem associated with family stress and micronutrient deficiencies. While there are empirically-supported behavioral strategies for addressing selective eating, there are significant systems-level barriers to implementing them. The aim of this study was to develop and test a self-administered intervention for parents of children with selective eating. Participants were 156 parents of children with selective eating ages 18 months-6 years who were randomly assigned to either the handout + video condition (8-module video intervention and detailed handout) or handout condition (detailed handout only). Outcome measures were administered pre-intervention and 4 weeks post-intervention. Only 23 % of participants in the handouts plus video condition played more than one video module. Both groups had significant decreases in maladaptive mealtime parenting practices, undesired child mealtime behaviors, and number of foods offered. No significant effect of study condition was found on the outcome measures. Further research is needed to determine how to encourage engagement of parents with self-administered intervention materials.
Nutrient intake profile, growth patterns and hemoglobin levels in children with ASD – A case control study in Mysuru, India
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Research evidence suggests that the prevalence rate of Autism Spectrum Disorder (ASD) is increasing in India. In addition to socio-behavioral problems, diet-related issues are common and recurrent problems experienced by children with ASD. As there is only minimal research work done on these aspects, the present study is carried out as a case control snapshot to investigate the nutrient intakes of ASD children (n = 104) residing in the Mysore region, India. This data is compared with the nutrient intakes of Typically Developing (TD) controls (n = 121).
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Significantly (p< = 0.05) lower Z_HA, Z_WA, Z_BMIA values among ASD children were observed. Limited food variety and inadequacy of micronutrient intakes were observed and the ORs of ASD children were at 3.57-fold higher risk for failing to meet the recommendations for calcium. Their risk was 2.17-fold higher for iron, 3.06-fold for zinc, 2.92–fold for folate and 1.87-fold higher for vitamin C compared with the TD children. Overall, mealtime behavior issues and eating problems were higher (28.66%) among ASD than TD (10.51 %).Hemoglobin levels of ASD were significantly (p< = 0.05) lower than TD children. There was a negative partial correlation between Hb levels (8.97 ± 0.91 g/dL) and micronutrients viz., Iron (5.14 ± 2.83 mg), Calcium (2.52 ± 1.41 mg), Zn (2.81 ± 1.90 mg),Folate (83.48 ± 52.57 mg) and Vitamin B6 (0.47 ± 0.29 mg). We found that while controlling the ISSA scores (1.94 ± 0.62), there was no significant difference. Thus signifying ISSA score has strong influence on controlling the relationship between Hb levels and selected micronutrients.
Observations strongly indicate that well-timed nutritional screening and personalized dietary interventions can prevent/manage the nutritional deficiencies prevalent among ASD children of this region.
A comparison of food avoidant behaviours and sensory sensitivity in adults with and without Tourette syndrome
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Food selectivity has been shown to be more persistent and severe in children with Tourette syndrome (TS) compared to their typically developing peers. The current study aimed to examine differences in food selectivity, food neophobia and Avoidant Restrictive Food Intake Disorder (ARFID)-associated behaviours, between adults with and without TS. Fifty-three adults diagnosed with TS were compared to 53 neurotypical adults and completed the following measures online: Adult Eating Behaviour Questionnaire (AEBQ), Nine-Item Avoidant/Restrictive Food Intake disorder screen (NIAS), Food Neophobia Scale (FNS) and the Sensory Perception Quotient (SPQ). Higher levels of food avoidant behaviours, in terms of food fussiness, food neophobia and ARFID-associated behaviours, were identified in adults with TS compared to adults without TS. While heightened sensory sensitivity failed to predict food fussiness, greater sensitivity to taste was found to be predictive of food neophobia in TS. These are the first findings to suggest that food avoidant behaviours are more prevalent for adults with TS and signal a need to address health implications.
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The treatment of food selectivity and other feeding problems in children with autism spectrum disorders

Abstract

Section snippets

Nosology

Etiology

Assessment

Treatment

Conclusions

Research in Developmental Disabilties

The Journal of Pediatrics

Research in Developmental Disabilities

Research in Autism Spectrum Disorders

Research in Autism Spectrum Disorders

Research in Developmental Disabilities

Educational Psychology

Research in Developmental Disabilities

Research in Developmental Disabilities

Research in Developmental Disabilities

Research in Autism Spectrum Disorders

Research in Autism Spectrum Disorders

Research in Autism Spectrum Disorders

Journal of the American Dietetic Association

Research in Developmental Disabilities

Appetite

Journal of the American Academy of Child and Adolescent Psychiatry

Research in Developmental Disabilities

Journal of the American Academy of Child and Adolescent Psychiatry

Research in Developmental Disabilities

Research in Developmental Disabilities

Psychiatry

Using simultaneous presentation to increase vegetable consumption in a mildly selective child with autism

Journal of Applied Behavior Analysis

An assessment of food acceptance in children with autism or pervasive developmental disorder-not otherwise specified

Journal of Autism and Developmental Disorders

Reducing rapid eating in teenagers with autism: Use of a pager prompt

Journal of Applied Behavior Analysis

An evaluation of functional variables affecting severe problem behaviors in adults with mental retardation by using the Questions About Behavioral Function Scale (QABF)

Research in Developmental Disabilities

Outcomes of eating disorders: A systematic review of the literature

International Journal of Eating Disorders

An evaluation of simultaneous presentation and differential reinforcement with response cost to reduce packing

Journal of Applied Behavior Analysis