Does your child with autism spectrum disorder (ASD) only eat French fries from McDonald’s or chocolates? Does he eat only foods that are crunchy? When offered food he doesn’t like, does he throw a tantrum? You’re not alone. These are just some common features of picky eating, or food selectivity, in children with ASD.
These children tend to eat a limited variety of food and refuse foods based on characteristics such as texture, taste or smell, and brand (Hubbard, Anderson, Curtis, Must, & Bandini, 2014). More worryingly, they often replace healthier foods like fruits and vegetables with high-calorie, nutrition-deficient foods like sweets and chips (Peterson, Piazza, & Volkert, 2016). Such foods high in sodium, sugar and fat put these children at higher risks for chronic and severe health problems like heart disease and diabetes. Moreover, during the period critical for children’s brain development, poor nutrition can have the most adverse effects on children aged below 5. Poor nutrition can lead to more learning and behavioural issues in children with ASD (Rosales et al., 2009).
Their insistence on eating the same foods can make it difficult for parents to expand their dietary repertoire. Problems with social communication may also further inhibit this process as children with ASD struggle to imitate other family members who are modelling eating a wider variety of foods. Fortunately, after ruling out any medical abnormalities for causing picky eating and nothing has seemed to work, receiving applied behaviour analysis (ABA) therapy might be helpful for your child.
Research is growing in proving that ABA is effective for enhancing diet variety in children with ASD. A study published this year demonstrated the effectiveness of ABA interventions for picky eating in children with ASD (Peterson, Piazza, Ibañez, & Fisher, 2019). Young children with ASD who displayed food selectivity were randomly assigned to either the ABA intervention or waitlist control group.
Before the study, each child only consumed a total of less than 15 foods consisting of carbohydrates, cookies, candy, some fruits and protein. Novel healthy and non-preferred foods were chosen by each caregiver as goals for this study, such as broccoli, brown rice, chicken and pear. These key outcomes were assessed: independent acceptance and mouth clear of these foods. ABA techniques included hand-over-hand guidance and non-removal of spoon (positioning the spoon in front of the child’s mouth until the bite is accepted). If the bite was expelled, it was immediately deposited into their mouths. Therapists also continuously interacted with the child. With weekly therapy for 12 to 32 sessions, the ABA group demonstrated superior results to the waitlist control group.
In other recent studies, using physical guidance as a consequence for food refusal was shown to be effective in increasing compliance to eating target foods (Kadey, Roane, Diaz, & Murrow, 2013). Another study addressed the tendency for children with ASD to hold foods in their mouth without swallowing with some ABA techniques such as non-removal of spoon and positive reinforcement (Levin, Volkert, & Piazza, 2014).
While food selectivity is pervasive among children with ASD and can be challenging to address, through targeted and individualised intervention plans, developments in ABA therapy provide immense hope.
Hubbard, K. L., Anderson, S. E., Curtin, C., Must, A., & Bandini, L. G. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. Journal of the Academy of Nutrition and Dietetics, 114(12), 1981-1987.
Kadey, H. J., Roane, H. S., Diaz, J. C., & Merrow, J. M. (2013). An evaluation of chewing and swallowing for a child diagnosed with autism. Journal of Developmental and Physical Disabilities, 25(3), 343-354.
Levin, D. S., Volkert, V. M., & Piazza, C. C. (2014). A multi-component treatment to reduce packing in children with feeding and autism spectrum disorders. Behavior Modification, 38(6), 940-963.
Peterson, K. M., Piazza, C. C., Ibañez, V. F., & Fisher, W. W. (2019). Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder. Journal of applied behavior analysis, 52(4), 895-917.
Peterson, K. M., Piazza, C. C., & Volkert, V. M. (2016). A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 49(3), 485-511.
Rosales, F. J., Reznick, J. S., & Zeisel, S. H. (2009). Understanding the role of nutrition in the brain and behavioral development of toddlers and preschool children: identifying and addressing methodological barriers. Nutritional neuroscience, 12(5), 190-202.