'FUSSY EATERS' AND AUTISM

Many children go through a fussy eating stage, and most of us have at least a few foods that we still don't like as adults. However, a child on the autism spectrum can have many contributing factors that can lead to an extreme food selectivity where nutrition and health issues arise. Extreme food selectivity is well beyond the scope of what parents would call fussy eating - it implies the eating of very small quantities of food and/or only eating from a very limited range of foods.

possible causes of extreme food selectivity in autism and Asperger's

Children with an Autism Spectrum Disorder often have sensory problems. The brain's filtering mechanism can work differently in assimilating the senses such as touch, smell, hearing, taste and sight. They may be extremely sensitive to certain bland tastes, or possibly oblivious to strong tastes such as chili.

A child can find the very feel of a fabric against their skin very unpleasant, in the same way that the texture of a particular food could be almost painful. Conversely, foods with say a crunchy texture may be loved, while any other texture is rejected. This kind of sensitivity can also extend to temperature, where food may only be acceptable at a precise temperature.

The taste buds on our tongues are divided into four groups: sweet, sour, bitter or salty. Sometimes an autistic child may only eat foods from one of these categories. In other cases, most foods may be tolerable but only with liberal doses of a particular sauce or condiment covering everything. This may be accepted by parents if it is the only way to ensure a breadth of diet.

Another effect of sensory problems is that a child may be relatively immune to sensations that normally cause discomfort or pain in others. When children on the autism spectrum eat very little, there is the possibility that they don't experience hunger pangs to the degree we do, and simply don't feel hungry much of the time.

Smell makes up a large part of our sense of taste. A child with autism or Asperger's syndrome can also have an extremely fine sense of smell, and the odor of other nearby food they don't like can be enough to make them lose their appetite.

This tendency toward selectivity and routine can cross over into other areas. Some children will only eat foods of a certain color, or food can only be eaten if it is from a favorite container or plate. When there are so many possible 'invisible' causes, a child's refusal to eat can easily be interpreted as wilful misbehavior. Parents need to play the role of 'behavior detective' to find the precise causes of negative reactions to new food.

Strategies to deal with extreme food selectivity

Withholding food until the child is hungry enough to eat is a dubious strategy at best - for child on the autism spectrum, such a strategy could even be dangerous. The good news is that there are many positive strategies that can often help with extreme food selectivity. The first step is to clearly document what, when, where and how your child will and won't eat certain foods. Be aware of sensory issues such as textures, heat, cold, smell and color. Often a pattern can emerge with time that helps to determine the issues involved.

When texture is a known issue, try to introduce new foods in a similar way at first. For example, a new vegetable can be turned into a puree if chunky textures aren't liked, or traditionally hot food can be served at room temperature.

Desensitization is a behavioral technique that can work well with introducing new foods. Its gradual introduction can help the child to become desensitized to the smell, look and texture of an unfamiliar food. First, try a food that has the best chance of suiting your child's preferences. It may just sit on a plate near theirs for several nights. The next few dinners, it may be placed on their plate but with no expectation made of the child to eat it. Next, the family may try the new food and show their enjoyment. With gradual introduction with no negative effects may allow the child to eventually try the new food.

Another useful strategy is using social stories. The parent writes a story about this wonderful new food, how everyone loves it and the child will get to try it one day soon. Social stories use a verbal and visual approach to help children prepare for a new activity and form positive impressions before being introduced to it. Describing a favorite character like Barney or Spiderman eating this particular food gets them interested enough to taste it.

A positive attitude is important for parents who are introducing new foods. The focus should be on patience and to let the child feel in control of what will and won't be eaten. Undue pressure and arguments usually only make the child more resistant to new foods than ever.

Another strategy can be to alternate mouthfuls of a child's favorite food with mouthfuls of the new food. This activity would need to be introduced to the child, possibly through a social story or by placing two bits of each food on the plate and explaining that the child can have the a bite of the favorite food after each bite of the new food. As with all strategies, this should not be forced but done as a fun game.

When all else has failed, parents may try to get some nutritious food into their child's diet through hiding certain foodstuffs in favorite foods - for example, pureed vegetables may be hidden under the ketchup. This should be used with caution as the child may discover this ruse and become very suspicious of all meals, and even more resistant to any new foods.

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