Children with autism spectrum disorder (ASD) often experience difficulty accepting a variety of tastes, textures and temperatures of foods. As noted in this review of recent studies on the topic, “the estimated prevalence of feeding problems in children with autism has been reported to be as high as 90 percent, with close to 70 percent of children described as selective eaters.”
Children with ASD likely face difficulty eating in the school cafeteria as well as restaurants, which often feature overstimulating and overwhelming sensory environments. These kids also probably only eat highly selective foods at home. They might want specific brands, colors or even shapes of food. SLPs address the many aspects of feeding treatments during individual sessions, but they can also offer strategies for parents to implement at home.
These strategies become the foundation for steady progress over time:
- Sit at the table. The first step to learning to tolerate just the presence of a new food involves learning to eat meals at a table. Often, because mealtimes equal stress, parents allow their kids to wander about the house and graze or sit in front of a tablet or TV while they eat. Sitting at the table for meals—and when possible, snacks—establishes a mealtime routine and creates a hunger pattern, so children feel hungry at mealtimes. Plus, proper seating provides the core stability for learning to use utensils and bite, chew and swallow more challenging foods. Read more about the importance of sitting at the table from a young age, which you can also apply to older clients. Footrests also add stability for kids whose feet don’t yet reach the floor when they sit. If children experience difficulty staying at the table for mealtimes, start by teaching them to stay at a table for other activities, keeping the time short and doing a preferred activity. Then introduce less-preferred activities while keeping the time at the table to a manageable amount.
- Build familiarity. One of the common difficulties parents encounter with children who are highly selective eaters is that the kids limit themselves to one brand of pizza or one shape of cereal, or even a specific color of their plate. Sometimes, before we build familiarity around new tastes, we need to help a child feel comfortable with new packaging or unfamiliar visual aspects of food (for example, a square chicken nugget rather than a dinosaur-shaped chicken nugget) before approaching other sensory properties of new foods. Begin by putting the containers, the plate, the utensil or whatever is unnerving to the child on the table where he’s eating. Put unfamiliar objects farther away at first but, if possible, it’s important to begin to engage the child in interacting with the new item, even if it’s to hand the item back to the adult. The point of building familiarity with anything new is to help the child become comfortable with the concept of “new,” whether it be a new type of milk carton or eventually, a different-tasting milk. Children with ASD like to “stick to sameness” because new and unfamiliar experiences raise anxiety. Being rigid about food is one way to feel in control and feel calmer in an already-challenging world.
- Expose, Explore, Expand: In this previous blog post, I discuss the importance of getting children to follow the 3 Es to eating to help them enjoy new foods. Children with ASD need exposure to new foods, even if it starts with just a new package, as described in #2 above. But once a child is becoming comfortable with new exposures to visual aspects of food, begin helping him explore those foods with all of his senses. Every child is unique in his willingness to participate in food play, cooking, gardening or other explorations, but gentle encouragement from parents encourages the child to participate in these opportunities and allows him to continue to build familiarity with a variety of nutritious foods.
Often, parents of children who have ASD get overwhelmed themselves, especially if their child participates in many different types of therapies. Dividing their home program into manageable, small segments of information sets them up for success and ultimately supports your treatment plan, too. So, whether the child and parent have to begin with learning to stay seated at a table or can begin to explore all the sensory properties of food early on in treatment, help the parents be a part of the process by breaking it down into the smallest steps, a few strategies at a time, and build from there.
Melanie Potock, MA, CCC-SLP, treats children, birth to teens, who have difficulty eating. She is the co-author of “Raising a Healthy, Happy Eater: A Parent’s Handbook—A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating,” the author of “Happy Mealtimes with Happy Kids,” and the producer of the award-winning kids’ CD: “Dancing in the Kitchen: Songs That Celebrate the Joy of Food!” Melanie@mymunchbug.com