Autistic people can experience increased anxiety in situations that other people seem to coast through, and all too often this includes eating and drinking. We call this resistive eating (or more recently, ARFID - Avoidant/Restrictive Food Intake Disorder), and in order to effectively support autistic children in this area we need to understand the drivers (reasons) behind the way they eat and drink.
For the purposes of this document, we’ve divided the drivers into three, sensory, behavioural and imagination/generalisation. Although it would be easier if resistive eating in autism were only driven by one of these in each case, usually it’s more complicated than that and you get an ‘overlap’.
In many cases (particularly where the child in non or pre-verbal) we cannot simply ask the child why they can’t or won’t eat certain foods, so we have to look at how they function in other areas in their lives and build up a picture.
| Think of the child and their rules around eating. | |||
| * | Packaging | ** | Person Specific |
| * | Taste and/or texture | * | Hyper-alert or easily distractible |
| * | Junk food | * | Sensory seeker or avoider |
| * | Presentation | *** | Location |
We’ll start with sensory reasons behind resistive eating. In order
to keep this simple I’m assuming you’ve already got some background
knowledge in this area. If not, please read my single page summary
here.
Common sensory reasons behind resistive eating and other things your
child may do:
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Hypersensitivity of taste - will usually prefer bland foods.
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Hypersensitivity of the tactile sense - may show a preference for foods that require very little chewing, in and down!
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Hypersensitivity of smell - may struggle with cooking smells, proximity of other people’s plates etc.
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Inability to screen input - may not cope with multiple tastes (e.g. sweet & sour) or textures (mince, stews, lumpy stuff in sauce), may also struggle to eat in busy environments (or with other people at all).
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History of hyper sensory needs being ignored - can lead to the child being ‘hyper-alert’ and anxious, suppressing the appetite and creating negative associations around trying new foods.
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The child may be overloaded by a stimulating environment (location), leading to difficulties concentrating on co-ordinating eating (hold spoon, scoop food, spoon to mouth, close lips, withdraw spoon, chew, swallow).
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Hypo vestibular and proprioception - may need to engage in activities that stimulate these senses, such as rocking, bouncing, climbing and twisting, not good when you’re supposed to be sitting at the table!
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Retching and gagging when presented with foods they don’t like.
We use our imagination to generalise, generalising is when we apply learning taken from one situation and apply it to another, such as learning to use the toilet at home and then applying that to other toilets.
We also do this with food. Take chips (fries if you’re from the USA) for example. They come in all shapes and sizes, from MacDonald’s thin fries to great big thick-cut steak chips, they can be straight, crinkly, curly, plain or coated in pepper or other spicy stuff. But they’re all chips to you or me, because we can use our magical powers of imagination to generalise between them.
If we couldn’t do that, how would we know a chip when we saw it? Many autistic kids go by packaging, with chips you may find they will eat a particular brand of chips but may be terrified of any other brand, or scared if they haven’t seen what packet the chips came from.
For you or me the equivalent is the Bushtucker Trial on I’m a Celebrity. How would you feel if you were given an unidentifiable pile of orange gloop and told to eat it all up without any fuss? Chances are you’d be very anxious and even maybe upset, you may even choose to leave the table and not eat anything! Look up ‘I’m a Celebrity Bushtucker Trial’ on YouTube and see if the extreme emotions the contestants display in any way mirror the emotions your child may be experiencing, and also look to see what works and doesn’t work for the poor celebrities in terms of whether they eat the foods or not.
Things we see with autistic children who have difficulty generalising foods:
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Only eating certain brands of foods.
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Only eating certain foods in certain locations - may eat Shepherd’s Pie at Granny’s but not at home.
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Only eating a food if the same individual cooks it each time.
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Retching and gagging when presented with foods they don’t like.
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Only eating foods if presented on the same plate, maybe with the same cutlery and at the same place on the table.
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Only eating certain foods at specific times of the day or following certain events.
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Resistive eating kicks in big time after a traumatic event such as a tummy bug that leads to vomiting.
And finally we come to behaviour. Some kids just have a ‘junk food palate’. This is true for all children, not just the autistic ones! They would choose chips and burger over fruit and veg any day. And, if they are used to using their behaviour in other areas of their lives and it works for them, they’ll apply it to food as well.
Things you may see in autistic children who use their behaviour to influence diet:
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The use of challenging behaviour (controlled meltdowns) in other areas of their lives, especially bed time!
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Insisting on junk food (especially MacDonald’s) but will eat a range of junk foods from a variety of sources at a variety of times.
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May choose to spend time in places or with people they associate with easier access to junk food.
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May struggle (meltdown) if you drive past a big golden M without stopping - many parents end up planning routes that avoid passing known triggers, harder and harder these days as junk food restaurants and their advertising are everywhere!
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Anxiety - autstic people experience it a lot as do most parents of children who won’t eat a balanced diet. It’s a natural instinct in parents, however try not to let it show as your child may translate it as anxiety about eating or the foods you are encouraging them to eat.
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Junk food is OK once in a while as a treat, it’s when it is eaten too often that it becomes a problem.
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If your child does eat too much junk food, try and counter calories with exercise, even if it’s just on the Wii or Kinect!
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Vitamin supplements are good! They’re also great at enabling children with autism to take medication when they need it.