11 Feb Nutrition in children with Autism Spectrum Disorder
If you have a child who has been diagnosed with autism, you may already know that mealtimes can be full of challenges. As a parent, you might also feel confused about if there’s any food you need to avoid or if there are meals that can improve your child’s condition.
What is autism?
Autism Spectrum Disorder (ASD) is the term used to describe a group of neurodevelopmental disorders, which affect how a person communicates with and relates to other people. (1) ASD includes not only autistic disorder, but also Asperger’s and Rett’s disorder, among others. (2)
Usually, children with ASD are considered nutritionally vulnerable because they exhibit a wide range of feeding challenges and particular feeding behaviors, which predisposes them to restricted intakes and nutritional deficits. Many authors also conclude that children with autism are more likely to be obese, therefore increasing the risk of chronic diseases later in life.
Parents and caregivers of children with autism, face unique difficulties with their children’s daily eating routines, meal choices and food intake patterns. (3) Some of these difficulties are around gastrointestinal issues, for example, symptoms like abdominal pain, constipation, diarrhoea, and gastrointestinal reflux are common in children with ASD.
Other problems are related to eating patterns. Some studies and case reports suggest that these children are generally picky eaters, for example, when parents are asked about their child’s feeding habits, they say that they prefer just some food textures like crunchy crackers, others might prefer puree like textures. Caregivers also say that their children are less likely to eat a variety of foods and are opposed to trying new foods. Children with autism may be more sensitive to some tastes, textures or smell of foods, which can be a cause for their food selectivity. (3) This means that they can reject a meal or food not only for its texture, but also because how it smells, its colours, the temperature it is served, or even the brand. Depending on the foods or food groups avoided, it can adversely affect diet quality and also put a lot of strain on parents.
Other feeding challenges in ASD are linked to ritualistic feeding behaviours. Often, children with autism require specific utensils or food presentation in order to eat a meal. Rituals or obsessive like behaviours can also be in relation to person, place, or meal preference.
All these behaviours put children with ASD at an increased risk for poor diet quality, which in turn can have a detrimental impact on their neurodevelopment and growth.
Is there any special diet for autism?
For a long time, a number of diets have been suggested in order to improve behavioral aspects of ASD. Some of them, or at least, the ones most acknowledged by people, are gluten-free and casein-free diets. This means that the child avoids wheat and cereals in the first case, and milk and other dairy foods in the last one. However, most studies are seriously flawed and currently, it is considered that there’s insufficient evidence to recommend them as a standard treatment. Therefore, experts recommend these nutritional treatments only if an allergy or intolerance to gluten or casein is diagnosed. (4) (5)
Food and nutrients you should keep in mind
Until more research is done and general recommendations can be made regarding a therapeutic diet for ASD, parents should put a restriction on sugar and sweeteners. It is also recommended to avoid refined foods, additives, colorants, and preservatives and replace with a diet that is organic, and additive-free foods. (5) (6)
Many studies have also tried to find supplements which might help with the symptoms of autism, but, most of them have failed to show many improvements. However, a couple of years ago, a randomized clinical trial published in the Journal of Child Psychology and Psychiatry (7) evaluated the effect of Vitamin D supplementation on the core symptoms of ASD in children. According to their results, Vitamin D supplementation showed significant improvements in irritability, hyperactivity, social withdrawal, stereotypic behavior, and inappropriate speech. Supplementation of omega-3 fatty acids may also be recommended to ADHD patients to improve behavioral and attention performance. (5) Some other practitioners recommend omega-3 fatty which might help with anxiety and aggression. (6)
It might be challenging, but children with autism should be encouraged to keep healthy nutritional habits and ensure a good quality and balanced diet. Before taking any chances or implementing a diet by yourself, it’s best to seek the advice of your healthcare team, particularly an Accredited Practicing Paediatric Dietitian. They will make sure that your child gets all the nutrients they need, but also help you to treat some other problems related to eating behavior.
What else can you do?
If you’ve read to this point, you are probably beginning to understand why nutrition in children with ASD is so challenging. Some children take even more time than others to overcome eating difficulties and caregivers might feel frustrated and consider it a time-consuming endeavour. However, a multi-disciplinary team might help you to overcome these eating difficulties. This team should include a paediatric specialist, behavioural psychologist, occupational therapist or speech language therapist and an Accredited Practicing Paediatric Dietitian, who will assess the adequacy of your child’s diet and nutrient intake. (7)
For now, you can focus on small changes, for example, give your child repeated exposures (it takes about 10–15 exposures) over time, of small amounts of novel foods while providing them also with their preferred foods at the same time. This can help your child to develop a liking for foods they disliked before in a non stressful way. You can also offer meals and foods in textures or shapes that your child prefers, to make it fun and creative. And with the help of a paediatric dietitian, look for fortified foods or supplements to help them meet their nutrient needs. (8)
And finally, always remember that a parent’s diet influences your child’s food choices, so focus on more variety in your own diet and demonstrate how it should be incorporated into the family meal in a fun, non-stressful way.