Mealtime with a Child Who Has Autism

Q: I have a 14-year-old son who has autism. Due to sensory issues, he will eat fries but not a baked potato. He eats meat and fruits, but will not eat vegetable unless I grind them up and sneak them into a sauce. During one stretch of time, I tried to serve him new foods and he went on strike for 9 days without eating anything for dinner. Do you have any tips to help him eat better?

A: As with all children, it's important to pick your battles. Since you've been successful in getting your son to eat fruits, vegetables in sauce, and various meats, you're off to a great start. However, I understand your concern. His 14-year-old body is going through a growth spurt and needs a proper balance of vitamins, minerals, healthy fats, proteins and complex carbohydrates. First, let's talk about autism and how this disorder can impact a child's senses. Then, we'll take a look at some ideas to help expand your son's dietary choices.

The spectrum of autism       

Autism is the most common of a group of developmental disorders known as autism spectrum disorders. Although symptoms often begin before the age of three, the effects on behaviors are life-long and range from very mild to severe. Areas that may be impacted include the ability to communicate, socialize and learn (physical and social skills), as well the flexibility to adapt to change. Some children may even develop repetitive behaviors, unusual movements (flapping of the hands) and an obsessive attachment to certain objects. Others, like your son, may experience difficulty in their ability to process and/or respond to sensory stimulation. (And some children who do not have autism may experience sensory issues, as well.)

Sensory responses to food

Your son's sensory processing disorder may affect his response to food, and in turn lead to one of the following behaviors:

• Under-response—may lead to overstuffing of his mouth as he may be unaware of the food in or around his mouth
• Over-response—may lead to gagging because of increased sensitivity to some of the food properties (hot, salty, rough texture)
• Mixed response—may be very sensitive to some properties (sweet sensation, sour, others) and under–responsive to others (pureed foods, soft textures)

Additionally, the properties of the foods may further determine what he will or will not eat. Characteristics to consider include the following:

• Taste (bitter, salty, sour, sweet and spicy)
• Temperature (hot, warm, cold or room temperature)
• Texture (rough, smooth, mushy)
• Touch to his fingers as he handles the food (sticky, hard, flexible)
• Smell (citrus, spicy)
• Color (bright, dull, dark, multi-colored, others)
• Shape (round, square, pointed)
• Consistency (liquid, soft and chewy, hard and chewy, solid)

Even sounds like crunching or squishing when your son chews his food may influence whether or not he will eat a particular food.

Expand the menu one bite at a time

To evaluate whether nutritional supplementation or dietary intervention is needed, I'd suggest that you schedule a visit with a registered dietitian. Before this visit, you should prepare a food-preference and nutritional inventory. This includes a list of every food and liquid item he takes in over a period of five days. You would record the following:

• The time of his meals
• What and how much he ate
• Whether or not the same foods were eaten by other members of the family
• How the foods were prepared (fried, baked, broiled, steamed, grilled)
• How the food was served (hot, cold, by itself or touching another food item)
• Whether he stopped because he was full or because he was upset or irritated by another type of food or liquid that he tried
• Whether he only ate foods that were covered with gravy, mustard or other “masking” ingredient

Next, review the information to see if there are any similarities to what he likes to eat. For example, does he only eat foods that are served at room temperature or topped with catsup? If so, he may be open to trying other foods topped with catsup and served at room temperature. Try these other approaches:

• Gradually introduce new foods, one item at a time. It's preferable that the food have a similar feel, smell, texture and temperature as the others he likes to eat. In other words, try a new food with the best "sensory" fit.
• Offer the new food on a daily basis using a different plate. At first he may only look at it, but over time he will become "desensitized" to its appearance. After several days or weeks, move it onto his plate and let it stay there. At the same time, include this same food on another family member’s plate. Then, have that family member eat the item and "model" enjoyment and pleasure. This may encourage your son to “try” the new food.
• If your son is very sensitive to foods with a certain smell, do not serve these foods while your son is at the dinner table, as it may affect his ability to eat.
• Offer large bites of his favorite food, and alternate with a very small bite of a new food. For example, if he likes rice, try giving him a tablespoon of that while alternating with a new item such as corn. Sometimes this is successful, but should not require a lot of work. Instead, it should be a pleasurable exchange, offered with a smile. If your son is not open to it, avoid the battle and move on.
• Know the environment. For example, if your son has difficulty sitting in a loud or busy room, a restaurant or dining area with a lot of activity and noise may impair his ability to eat.
• Make an appointment with an occupational therapist who has added training in sensory integration.    

In addition, try to get your son involved in meal planning. If he enjoys going to the store, ask him to choose one or two items from the fruit, vegetable, salad or food buffet counter. If he makes these selections himself, he may be more receptive to seeing them on his plate.

Discovering how to expand your son's dietary menu can be difficult and frustrating. However, the rewards of success will pay nutritional and emotional dividends.

For further information, please speak with your son’s family physician, as well as visit the American Academy of Pediatrics and the Autism Society of America.

More on autism:

• Court Says Vaccine Not the Cause of Autism
• Autism: Can Special Diets Help?
• Find all articles by Dr. Rob