Feeding problems are seen in the vast majority of children with autism. Contributing factors include medical problems, psychological barriers, nutritional deficits, sensory disorder, oral-motor dysfunction, and environmental causes. These factors - alone or together - lead to food selectivity in up to 87% of children on the spectrum.
Parents come to me seeking to expand the diet of their picky eater with Autism Spectrum Disorder (ASD) not realizing that the eating behaviors they see are often more severe than typical picky eating. Children who eat under 20 foods, can’t tolerate introductions to new foods, drop once preferred foods without ever reintroducing them, and neglect entire food groups or food types are actually categorized as problem feeders. Many children with autism fall into the problem feeder category and actually won’t respond to many popular picky eating hacks.
You’ve probably been told “He won’t starve himself,” “He’ll eat when he’s hungry enough,” “She’ll outgrow this picky stage.” This isn’t true for many ASD children who have feeding problems.
So what can you do with a problem feeder on the spectrum?
First, download my FREE guide for exposing your child to new foods. Then,
Try these three scientifically proven strategies to expand the diet of your problem feeder with ASD
Positive reinforcement is exactly what it sounds like. It is simply providing your child with verbal praise or tangible items for eating. It sounds a lot like bribing, but the practice is more intentional and is actually backed by science. Reinforcement of appropriate behaviors has been shown to be highly effective in motivating children with autism. Verbal praise is the most commonly used to reinforce, but alternatives such as ‘token systems’ where the child can earn tangible rewards (like a favorite activity, extra screen time, or stickers) can also be effective. Positive reinforcement with eating can be immediate (provided during feeding, after each bite or goal behavior) or delayed. Delayed rewards, such as charting progress on sticker chart, may be more effective for children who have already made progress. When using verbal praise, be very specific: “Great job trying a bite of carrots” “Thank you for being comfortable with the fish on your plate.”
Food chaining, a method that incorporates sensory integration and behavioral modification, is an effective approach that expands food repertoire by emphasizing similar features between accepted and targeted food items. A food chain originates with an accepted food (one that child eats willingly and reliably) and ends with a goal food. New for previously rejected foods are introduced between the accepted and targeted foods. Chains can be long or short, simple or complicated. A common example of food chaining begins with a child’s favorite chicken nuggets and ends with acceptance of a mild white fish. In between might be other brands of chicken nuggets, different nugget shapes, different breadings, breaded fish nuggets, and eventually a plain mild white fish (maybe with a favorite dip). Another example of a food chain beginning with potato chips and ending in acceptance of a banana might look like this:
Food chaining can be a slow process, but it is effective. Of 10 children enrolled in a feeding program and treated with food chaining, all were able to increase their food repertoire over three months. After three months, the median number of accepted foods increased from five to 20.5.
With all feeding strategies, it is best to incorporate structure and basic policies around eating. Children with ASD benefit from routines and clear expectations. Try these basic strategies that can support your efforts to expand the diet of your problem feeder on the spectrum:
Schedule 3 meals and 1-3 snacks daily
Limit grazing outside of meal and snack times
Limit beverages between meals, especially caloric beverages like milk, juice, or soda
Limit mealtimes to no more than 30 minutes
Expose child to a non-preferred food daily
Be a positive social model by practicing the behavior you’d like to see
Do not beg, bribe, or force eating
I recommend Ellen Satter’s book Child of Mine: Feeding with Love and Good Sense for more ideas on creating productive mealtimes and fostering a positive feeding relationship with your child.
To recap, problem feeding is common in ASD and typical picky eating tips might not work for your child. To expand the diet of your child with autism, consider a few basic strategies to create structure around mealtimes while you explore other strategies like food chaining and positive reinforcement.