If your child has an Autistic Spectrum Disorder and has a fairly limited diet, the following tips may be helpful. Each of these ideas has been implemented successfully with more than one child in Highland. The ideas will not help every child because every child is different. Think of this as a menu of options from which if you are able to choose right three or four ideas. You might be able to make a significant breakthrough. Remember that it is quite typical for Autistic children to be highly selective in their eating habits. You should avoid blaming yourself for this, and recognise that you will need to develop a range of skills and techniques that other parents might not have or need. So, be patient, be persistent, and don’t give up!
Almost all children accept food more readily when given the opportunity to take it on their own terms. If the child eats with the rest of the family, the foods you would like them to try could be made available on serving dishes in the middle of the table. Each family member can help them selves. Typically, salad or vegetables can be served this way. If other family members are adding these foods to their plates, the child has an opportunity to do the same, without the pressure or threat of it being put on their plate. Also, fruit, carrot sticks, strips of red pepper and other foods can be left out on small plates or bowls around the house so that the child can choose to eat these if and when they are ready.
Some foods can become more valuable in a child’s mind by pretending to restrict access to them. For example, parents eating a meal or a particular food could give the child the impression that this meal or food is “too good” for them and is only for grown-ups. This can increase interest in the food from the child’s point of view. Ultimately, the child can then be given the “special privilege” of eating that food or meal.
Rewards are the opposite to the “Self service” and “Forbidden fruit” techniques. Children sometimes respond to the incentive of a reward for eating or trying a particular food. Autistic children often respond to this too. However, it is important to be very clear what the reward will be, and to explain exactly what needs to be done to get the reward. The best rewards are the ones that the child can see “on show” prior to eating or tasting a food. The reward should be immediate so that the child can make the connection.
New foods can be difficult for Autistic children for both psychological and sensory reasons. A new food might have a different colour, shape, smell, texture and taste. All of this can be very daunting to child that dislikes change, particularly if they are highly sensitive to smell, taste or texture. It is important to consider both the type of food and the degree of exposure to it:
If a particular food is favoured by a child, try to think of a new food that is very similar, but different in only one of its sensory characteristics. Small changes may be accepted more readily that wholesale changes. Foods can be hot, cold, bland, strong, light, dark, spicy, sour, sweet, salty, bitter, astringent, crunchy, soft, chewy etc.
Also, one can choose to expose a child to a new food in stages. The child could be shown the food so that they get used to what it looks like. You could ask the child to touch the food. The next step might be smelling or licking the food. The taste and feel of food in the mouth, and what it feels like to bite, chew and swallow a new food are further steps in the process. For those of us who enjoy trying new things, we think nothing of it. For many Autistic children, it may be better to take one step at a time.
Labels or photos of food can be put into a scrap book as a visual record of the food a child has eaten or foods the child likes. Every time a new food is tasted or liked, the label, drawing or photo can be added to the scrap book. Every so often the book can be opened so that the child can see how much progress they have made, and can be reminded of foods they may have not eaten for some time.
It is natural and entirely justified for parents to be concerned about their child if they do not appear to eat as well as other children. Children’s eating habits can be unacceptable in two ways – socially and nutritionally. It can help to separate these two problems in your mind:
Some children graze well, but will not sit down to a meal, other children eat slowly or messily, and some children like combinations or sequences of foods that are unconventional. These are examples are children breaking social conventions of “normal behaviour”. It is sometimes important to tackle this and to replace it with an eating style that is more acceptable to other people. However, there are some social conventions that really are not that important.
The range and quantity of food that a child eats will, for the most part, determine how well nourished they are. Sometimes, a child will eat a narrow range of foods that compliment one another nutritionally. This means that some children avoid nutritional deficiencies despite only eating limited number of foods. On other occasions, a child may appear to eat lots of different foods, but nutritionally these foods might all be very similar. This could mean that some important nutrients are missing.
It is important to decide on your priorities. If your immediate goal is to get a child to eat in a way which is socially more acceptable, then concentrate on that, using the foods the child likes to eat. If your main aim is to improve the range of foods the child eats, then concentrate on that rather than on social conventions.
Children will often refuse food if they have learnt that this refusal will result in something better being offered. Parents often give in before the child, feeling that it is better the child has something rather than nothing. No child should be force fed or bullied into eating something that they have decided they do not want to eat. At the same time, it is not helpful to effectively reward a child who has refused their dinner by giving them their favourite food. Sometimes, it is enough to remove the favourite foods from view. Often however, the child learns that there is a cupboard that contains this food and that if they hold out a bit longer, it will be offered to them. Sometimes, not buying the favourite foods is the only option.
Food, for most of us is a social activity. Many people are attached to a “Golden Age” when families always ate together around the table. For Autistic children, it can be difficult to concentrate on conversation and on eating. Watching a favourite television programme while eating however, requires little concentration but can act as a welcome distraction to child who may then be more accepting of food. Furthermore, the child may grow to develop a positive view of the food because it is linked to watching their favourite programme.
Some children find eating different foods with cutlery difficult. Asking a child to eat their dinner can be like asking someone to drive if they do not know how. Try to keep it simple and give clear instructions if that is what is required.
Many Autistic children have special interests. Try to make a connection between these special interests and the food you would like them to eat.
Allowing children to play with, grow, prepare and cook food helps them to experience food in a non-threatening way. It is often not necessary to encourage a child to eat the food immediately after one of these activities. The activity gets the child used to the sight, smell and feel of the food. Do not offer the food to the child after the activity. The experience should be as unthreatening as possible. On another day, continue to do more activities with the same food. After several episodes, the child may be ready to take the next step and taste it.
Some children depend heavily on visual communication. Also, Autistic children prefer things that are predictable. They like to know what is going to happen next. Spend some time drawing out and colouring in a picture of the meal the child will be offered for tea. When the meal then appears, it will be less unexpected.
Most of us are to attached to the taste and the social conventions of food for us to be influenced much by being told how healthy or unhealthy something is. However, many older children, particularly those with Asperger’s Syndrome, are more attracted to logical reasoning, facts and figures, and information about the precise effects on the body. In comparison, the social rituals that surround food can seem pointless. Spend some time finding out what nutrients are in certain foods and what effect these have on the body. Explaining this to your child, with the help of graphs, diagrams and tables, can be surprisingly effective in some cases.
Some researchers have suggested that a proportion of Autistic children are addicted certain foods and that when they eat them they get a kind of “high”. This claim has been made for gluten and casein containing foods, artificial sweeteners, flavour enhancers, some food colourings, bananas and chocolate. Some children react to some of these foods. When they do, they may favour such foods to the exclusion of all others. This can lead to an inadequate diet. Also, if some of the foods are eaten to excess, the child can become very overweight.
If you require any further information or advice about anything you have just read, ask your paediatrician.