April is Autism Awareness Month and, to celebrate, we are discussing the unique feeding concerns parents have with children with autism. Research shows that children diagnosed with autism spectrum disorder (ASD) are more likely to have feeding challenges than their typical peers. When working with these kiddos and their families in feeding therapy, I often discover that a child’s severe feeding problems started with just a few picky-eating habits. These picky-eating tendencies unfortunately snowballed into severe selective eating or a diagnosis of a feeding/swallowing disorder. In my work with children with ASD the following feeding concerns (I call them the 5 R's) can be present:
Ritualistic Behaviors – Some children need specific utensils or food presented in a particular way. Others have a routine of only eating one type of texture or are still bottle-dependent (well past the age of typical bottle feeding). These rituals are difficult for parents to resolve and usually require feeding therapy.
Restrictive Eating Habits – Several children limit what they eat, causing frustration and disconnection at mealtime for the entire family. Others limit their intake so much that they only have a few foods that they are willing to eat! This usually leads to weight loss and growth issues, as well as malnutrition and hydration concerns. These restrictive eating habits generally require a feeding team of a Speech Language Pathologist (SLP), Occupational Therapist (OT), Registered Dietician and Pediatrician.
Rage & Tantrums – A select number of children can become violent during mealtime (both to themselves and others). For example, tantrum-inducing behavior can occur if the foods placed on their plate are not one of their routine favorites, or if their beloved cartoon-character dish is not included. Some children will throw a tantrum or have a complete meltdown at the dinner table because of sensory challenges in the environment.
Regress – Some kids with ASD achieve certain feeding milestones, like drinking from an open cup or eating multiple textures, and then they get sick or have a stressful life event and regress in their skills. To their parent’s dismay, they may regress back to Sippy cups and puree foods.
Refusal – Some kiddos completely reject any new foods offered, and others refuse entire food textures or food categories such as protein and/or vegetables. Children with ASD really do want to eat all the wonderful foods their families eat, but it is beyond their current motor or sensory abilities.
Kids who struggle with sensory-based feeding issues tend to have ritualistic behaviors, restrictive eating habits, rage and tantrums and regressions around eating. Feeding issues can continue because parents instinctively want their kids to eat – even if they eat the same foods over and over again or have daily meltdowns. It can be critical to find a Speech Language Pathologist (SLP) or Occupational Therapist (OT) who specializes in this type of therapy. For more information on autism and feeding, check out my article in the Autism File Magazine (Issue 32-2009) with renowned Autism diet expert, Julie Matthews, here.
This month, help us spread awareness and understanding of feeding challenges with children diagnosed with ASD and the parents and therapists that help them. Use the hashtags #ezpzfun #SLP #OT #autism #AutismAwarenessMonth.
Dawn Winkelmann, M.S, CCC-SLP
Speech Language Pathologist & Feeding Specialist for ezpz