Diet

Some people on the autism spectrum can have difficulties relating to feeding and diet. See below for possible reasons for a restricted diet and strategies you can use to try and overcome this problem. 

This information is aimed at parents and caregivers – the section refers to ‘your child’ throughout – but is also relevant adults on the autism spectrum.

Please note that all of the following points are general and we would always advise you to speak to your GP, or another medical professional, if your child has any dietary issues.

First steps: create a food diary

If you are concerned about your child’s restricted diet, we suggest you create a food diary. By regularly recording your child’s eating habits you will get some useful information about their eating patterns – and also about what’s going on while your child is eating. You may also start to see some possible reasons for the restricted or rigid diet.

Here are some questions that could be used in a food diary:

  • What time of the day did my child eat?
  • What did they eat?
  • Where did they eat?
  • How much did they eat?
  • Who was there?
  • Were there any environmental factors? (eg. Radio on in the background)

There are a number of reasons for restricted (or rigid) diet, and several ways you might address any difficulties. We summarise these below.

Physical/health
Loss or change in appetite is quite a common indicator of feeling unwell.

  • Is your child unwell?

Some people on the spectrum also have gastrointestinal problems, so they may experience discomfort during or after eating, such as wind or constipation.

  • Does your child associate eating with a pain?

Does your child have any problems with the actual function of eating?

  • Do they have any difficulties with chewing, swallowing or jaw function?
  • Is your child taking any medication?

Communication

Expression
We can have a huge variety and range of foods presented to us every day, and we all like and dislike different foods. However, all children – and particularly those on the autism spectrum – may not be able to express these likes and dislikes.

  • Could your child’s refusal to eat a particular food simply mean that they don’t like it, but can’t tell you this?

Understanding
People on the autism spectrum can have difficulties understanding and processing language. Consider how you ask your child about food and what they want to eat. Do you get a better reaction if you phrase things in a certain way? For example:

  • You normally say ‘Would you like fish fingers, chips and beans?’ Today you said ‘Would you like beans, chips and fish fingers?’ and your child seemed to find it easier to answer the question.

Dislike of change

Routine
Many people on the spectrum rely upon routine and sameness. This may well affect their eating patterns, so your child may want to have meals at the same time every day, be seated in the same position at the table, or always use the same plate or cutlery. This need for routine may also extend to the food that they eat.

Appearance
Attention to detail is also a characteristic of autism. This can result in issues with eating. For your child, the way the food is presented or positioned on the plate may dictate whether it is eaten or not. If individual items of food are different in any way, your child may not eat them.

  • Has the positioning of the food on the plate been altered?
  • Is the food over- or undercooked?
  • Are there ‘bits’ on the food?

Familiar packaging
Following on from the above, some people who have an acute eye for detail or are uncomfortable with change may not like it if food packaging is different in some way. Ask yourself:

  • Has the packaging changed? Is the logo a different colour? Is the box damaged? Have I bought a different brand?

Sensory difficulties
Many people with ASD have sensory sensitivity and may be over- or under-sensitive to tastes, textures and smells. This is likely to have a direct influence on whether they enjoy certain foods or not.

People who are very sensitive to smells and taste may prefer to eat quite bland food. On the other hand, those who are under-sensitive and find it more difficult to taste or smell things may crave stronger, spicy food.

  • Is the food uncomfortable to eat or is the taste overpowering?

Texture
Does your child prefer a particular type of food, for example crunchy or sloppy?

Taste
Is your child over- or under-sensitive to particular flavours (such as dry/bland or hot/spicy)? The former is the most common.

Smell
Is the smell of the food too intense?

The physical environment
Where does your child eat and does this have any affect on them? For example, are they trying to eat in a noisy canteen which, because of sensory issues, is very distracting? Are they sitting on a hard chair and feeling uncomfortable?

The social element
Mealtimes are, generally, social occasions and require a degree of social interaction. Many people on the autism spectrum find social interaction difficult to some extent, so it is understandable that they may feel anxious about mealtimes (and by association, eating) and possibly try to avoid them. What level of social interaction is required at mealtimes? if your child finds social interaction difficult, can you take this into account?

Ideas to encourage your child to try new foods and vary their diet

All of the following ideas are just suggestions and what works for one person may not work for another. With all of these strategies, make sure that any instructions you give your child are clear, consistent and delivered in a calm manner. If your child refuses a food, try not to give too much attention to this.

Food charts
Using visual supports to give your child information about the food they are eating could help to reduce any anxiety. Your child can refer to a visual support, such as a food chart, so that they can see what they will be eating and when they might have a chance to try something new. For example:

  • list the menu for the day or week ahead and have a section at the bottom stating ‘This week or today I will try [name of food]’
  • have a list of good and bad foods and let your child pick one from each list.

Timetables
It may be important for your child to have regular, set mealtimes. If this is an issue then try to allow yourself a little flexibility while still giving your child the structure they need. For example:

  • say that lunch will be between 12:15-12:30
  • say that you’ll do another activity first (eg, some colouring) then have dinner.

Disguise food
If your child is over- or under-sensitive to certain food textures, smells, tastes or colours, think about how you can use this to introduce new foods. For example:

  • puree foods (including new foods) if your child is very sensitive to textures, and try to progress slowly from there
  • use food colouring if there is a certain colour your child likes, or is averse to.

Small steps – gradual exposure
By breaking down the introduction of foods into manageable steps it can reassure your child and make them feel in control. For example:

  • place a new item of food on the table
  • then place a small piece on your child’s plate
  • try to get them to touch it
  • try to get them to hold it to their mouth
  • try to get them to lick the new food
  • see if they can put the food into their mouth, but not swallow
  • then ask them to swallow.

Rewards
See if you can reward your child’s successful attempts at trying new foods. For example:

  • give your child a new food and a favourite food. With each small taste of a new food, your child gets some of their favourite food
  • create a behaviour chart. If your child eats a reasonable amount or, for example, three potatoes in a certain amount of time, they get a point on the chart. They could work towards a small reward.

Food books
Food books are sometimes used by professionals as diaries of achievement.

Pictures or drawings of foods that your child likes and dislikes are placed in the book - usually the food they like is at the front and the food they don’t like at the back.

As your child tries new foods and expands their diet, the ‘don’t like’ pictures are gradually moved forward in the book. This provides a nice record of progress that your child may like to look at and take encouragement from.

Encourage your child to handle and prepare food
Increasing your child’s contact with food could encourage positive associations with it. Try making simple things such as sandwiches, fruit kebabs, little cakes or pizzas.

Environment
Look at the environment(s) where your child eats and see if you can make any changes if your child is experiencing sensory discomfort. For example:

  • at school, they may prefer a quiet room to a noisy canteen
  • the chair on which they are sitting may be too hard – add a cushion
  • reduce background noise if it is distracting – turn off the radio or the washing machine.

Games
Sometimes mealtimes can be very stressful, pressurised occasions, but by introducing new foods during an enjoyable and hopefully relaxing activity your child may be more willing to try them. For example:

  • Games based around food – use written instructions and visual clues, eg if you land on a particular square you have to eat two segments of orange.

‘Modelling’
Some children eat better in the company of adults or peers – your child may be more willing to try new foods if they see other people trying the same food and enjoying it.

Social stories
Social stories are short stories, often with pictures, that explain different situations to people with ASD and give them an idea of what to expect. A social story might help your child to understand why we eat and the function of food. Here is a very short example.

We all need to eat food. This is because food is like fuel – it gives us energy.

If we have energy, we’ll be able to do the activities we enjoy.

Distraction
Some parents have found that by having a child’s favourite music or story tape playing in the background, the pressure of eating is removed. Their child is slightly distracted, feels more relaxed and may not find eating such a task.

Use special interest
If your child has a special interest, could you use this to encourage a more varied diet? For example, they might eat from a Thomas the Tank Engine plate, or having animal-shaped chicken pieces.

Motor development
Encourage activities that develop oral motor skills, including:

  • using straws
  • blowing a whistle
  • blowing bubbles
  • using a toothbrush.

Social interaction
If your child finds the social nature of mealtimes stressful, try giving them as much information as possible about the situation – especially if it’s not your regular family meal at home.

  • Who will be there?
  • Who will they be sitting with or next to?
  • What might people talk about?
  • What could they say to start a conversation? Give them a few ideas.

 

Reproduced by kind permission of The National Autistic Society – www.autism.org.uk.