Increasing awareness of the impact of diet and nutrition on physical health has prompted discussions about food and its relationship with a wide range of distressing physical and psychological problems, including Autism Spectrum Disorder (ASD).
For parents of children with ASD, daily management of the children’s routines can be distressing and create challenges for both parents and the rest of the family.
Physical, emotional, or behavioural deficits may impair a child with ASD’s ability to maintain a healthy diet. Consequently, there is a need to understand the health impacts on children with ASD, and how parents are managing food choices to accommodate the child’s symptoms.
How Eating Problems Affect Health
Children’s diets have been found to impact on their health, with concerns being raised over the quantity and lack of a variety of foods (Dovey, Staples, Gibson & Halford, 2008).
Generally, children may display behaviours around refusal of eating particular foods. Child feeding problems are a common concern for parents and health professionals (Coulthard & Harris, 2003), with behaviours such as food refusal; selective, picky or fussy eating; slow eating; loss of interest in food, and small or overly large appetites (Carruth, Ziegler, Gordon & Barr, 2004).
These difficult behaviours may implicate health concerns for both children and their parents (Hagekull & Dahl, 1987). Prolonged feeding problems have been shown to increase the risk of developmental and cognitive delays (Chatoor, Egan, Geston, Menville & O’Donnell, 1988), and cause stress for parents during mealtimes (Sanders, Patel, Le Grice & Shepherd, 1993).
Furthermore, feeding problems have been associated with increased risk of eating disorders (Kotler, Cohen, Davies, Pine & Walsh, 2001), and poor diet in adolescence and adulthood (McDermott, et al, 2010).
Children who are often selective in food types and only eat a small variety of food, may be described as “fussy eaters” (Birch, Johnson, Andresen, Peters & Shulte, 1991). Fussy eating may involve difficulties with textures of food and the rejection of unfamiliar food (Birch, Johnson, Andresen & Peters, 1991). Fussy eating has also been associated with difficulties in lower cognition and attentional issues (El-Chaar, Mardy, Wehlou & Rubin, 1996).
Additionally, parenting styles during meal times (Galloway, Fiorito, Lee, & Birch, 2005), cultural norms (Kannan, Carruth & Skinner, 1999), and parental eating behaviours (Fisher, Mitchell, Smiciklas-Wright & Birch, 2002) also impact children’s fussiness with food selection.
How Common are Feeding Problems in Children with ASD?
Studies show that feeding issues affect between 25 and 50 percent of children aged between 4 and 36 months old (Coolbear & Benoit, 1999).
These figures increase to 85 percent of children with developmental disabilities or chronic disease, including ASD (Manikam & Perman, 2000). This large risk in feeding issues with children diagnosed with ASD, reflects the need to identify factors affecting children’s diets (Manikam & Perman, 2000).
Due to difficulties in social, behavioural and sensory issues, children with ASD present special challenges for parents.
Specifically, these challenges may include difficult behaviour in all aspects of living, including dietary habits – for example, clinical features of ASD including erratic modulation in activity and insistence on familiar foods, possibly interfering with eating behaviours (Raiten & Massaro, 1986).
Links have been found between eating habits and challenging behaviours in children with ASD. Manikam and Perman (2000) found that children with ASD and feeding issues, show mild to very severe behaviour problems. Further research has shown that behaviour difficulties are likely implicated as the main reason for dietary issues among children with ASD (Riordan, Iwata, Finney, Wohl & Stanley, 1984).
In general, challenging behaviour – including in their food behaviours – by their child can make daily activities more difficult for parents.
An increasing amount of research exists detailing food selectivity as a challenging behaviour among children with ASD.
Specifically, Curtin et al. (2015) found that children with ASD were more likely to have high food selectivity compared with children without ASD. Additionally, this study found mealtime behaviour problems and higher stress among spouses whose children have ASD, compared with those children who do not have ASD; however, high food selectivity was associated with mealtime behaviour problems for both children with ASD and without ASD.
If you have concerns about your child’s eating habits, whether or not they have a diagnosis of ASD, it is worth seeking out the help of a psychologist.
Author: Cassandra Gist, BPsych (Hons), MPsych, MAPS.
Brisbane Psychologist Cassandra Gist works with clients aged from two years old right through to adulthood. She has a special interest in working with children and their families around the diagnosis and treatment of issues such as Autism Spectrum Disorder.
To make an appointment with Brisbane Psychologist Cassandra Gist, try online booking – Loganholme or call M1 Psychology (Loganholme) on (07) 3067 9129.