A defining feature for people with autism is feeding-related problems, as identified by Dr. Leo Kanner in the in 1940s.

It is estimated that 70% of children with autism have feeding and / or eating problems, 36% of these problems were classified “severe” from the point of review of diagnostic records. (Romero 2016)

Caregivers and researchers have long reported that feeding children with autism is often challenging. (Kanner 1943)

Feeding disorder is a term that describes problems with eating enough or eating the right type of food.  Children with autism often eat only a few types of foods—choosing certain textures or colors of food for instance, and / or indulging in disruptive meal-time behaviour.  The causes of the issues are many, including sensory aversions, anxiety (e.g. after an incidence of choking, gagging or vomiting) and rigidity (aversion to change).  Difficulty in chewing and swallowing the food may also be related to motor issues in children with autism.  Digestion problems such as slow stomach emptying may also be a cause.

Eating disorders could also refer to anorexia or bulimia, caused fear of weight gain.  Researchers suggest an overlap between anorexia and autism in some young women. (Wentz 2005)

Chronic overeating is another common problem among both children and adults on the autism spectrum. This could also be a result of poor sensitivity to internal cues such as feeling full.  The aversion to strong flavours, textures and smell can lead to excess consumption of high calorie, low nutrient foods.

In addition, increased appetite is a common and serious side effect of the only FDA-approved medicines for autism-associated challenging behavior (agitation) – risperidone (Risperdal) and aripiprazole (Abilify).  (Maayan 2011, Scahill 2016) The result is a high incidence of obesity – often combined with nutritional deficiencies – in both children and adults on the autism spectrum. (Shmaya 2015, Croen 2015, Hill 2015)

Another feeding disorder associated with autism is eating non-food items such as sharp objects like nails, broken glass and pins as well as poisonous substances such as paint chips, swimming pool chlorine tablets.  This disorder, called PICA, appears among those whose autism is complicated by intellectual disability, and can cause tremendous stress on caregivers as they demand constant vigilance.

Restricted / picky eating

Studies find that 75% of children with autism are highly selective “picky” eaters. (Emond 2010, Beighley 2013, Castro 2016) Studies also suggest that these children are more likely to be underweight and have one or more nutrient deficiencies. (Zimmer 2012, Mari- Bauset 2015)  Care givers /parents need to approach health care professionals who can assess the child’s diet and nutrition and help them with a customized therapy plan.

Overeating and obesity

Unhealthy weight gain starts surprisingly early in life for children affected by autism. (Oregon Health & science university, 2015)  Investigators found that chances of being overweight or obese increased with the number of psychoactive behavioural medicines a child or teen was taking.  (Hill 2015) Weight gain related to behavioural medication is a major concern for specialists in autism health care. (Coury 2014) Dietary approaches such as healthier food choices, monitoring portion size and increasing daily exercise is the first line solution.  High calorie foods can be removed from refrigerators and pantries.  Encouraging family activities such as walking or riding bicycles can help in weight management and has the added advantage of reducing a child’s behavioural problems.

Autism-friendly communication tools and daily schedules while increasing nutrition and exercise help curb overeating, says behavioural therapists. (Ward 2015) People with autism (children, teens or adults) engage less in physical activity when compared with typically developing children. (Rimmer 2007, Rimmer 2008) Social difficulties result in reduced involvement in team and competitive sports.  They prefer more solitary physical activity such as running, bicycling and swimming. (Potvin 2013) It is found that physical activity has the strongest influence among children with special needs. (Yazdani 2013)

Some people with autism may also find difficulties because of food restrictions and increased activity levels.  When behavioural strategies fail, parents find it difficult to choose a child’s physical health and a behavioural medicine that helps them in improving their child’s ability to function on a daily basis.  Long term health consequences like obesity need to be addressed with more research.

Recognizing and treating PICA

PICA can prove deadly as it may result in choking, poisoning, infection or gastrointestinal perforation.  (Decker 1993, Williams 2012) Pica-related problems include broken teeth or other dental problems, constipation, bowel obstruction and chronic lead poisoning.  Researchers suggest that PICA can be decreased with behavioural therapy, if they can identify possible medical causes which need to be ruled out by a physician. (Call 2015).  Medical causes can include nutritional deficiencies in iron or zinc and/or infection with intestinal parasites. Generally, people with pica also need evaluation for possible lead poisoning.

 

Sri Lakshmi H A  (Senior Nutritionist)