Introduction
Autism Spectrum Disorder (ASD) is a complex group of neurodevelopmental disorders that affect how people communicate and interact with others. One of the common challenges that many autistic children face is food selectivity (FS), which means having a limited range of foods that they are willing to eat. FS can lead to poor nutrition, health problems, and social difficulties. Therefore, it is important to find effective ways to help autistic children expand their food preferences and enjoy a balanced diet.
In this blog post, I will summarize a recent review paper that examined the existing nutritional interventions for FS in autistic children. The paper was published in the journal Nutrition Research Reviews. The authors reviewed 28 studies that evaluated different types of interventions, such as nutrition education, taste exposure, cooking sessions, and behavioral strategies. They also discussed the advantages and limitations of each approach and provided some recommendations for future research and practice.
Nutrition Education
Nutrition education is an intervention that aims to teach autistic children and their caregivers about the benefits of healthy eating and the consequences of poor nutrition. The idea is that by increasing their knowledge and awareness, they will be more motivated to try new foods and improve their dietary habits. However, the authors found that most of the studies that used nutrition education as the main or sole intervention did not show significant effects on FS or nutritional outcomes. They suggested that this might be because nutrition education alone is not enough to change the complex and ingrained behaviors of autistic children, who may have sensory, cognitive, or emotional barriers to food acceptance. Therefore, they recommended that nutrition education should be combined with other interventions that target the specific factors that contribute to FS in each child.
Taste Exposure and Cooking Sessions
Taste exposure and cooking sessions are interventions that involve exposing autistic children to new or disliked foods in a gradual and positive way. The goal is to increase their familiarity and liking of these foods and reduce their fear or aversion. Taste exposure can be done by presenting small samples of new foods, either alone or mixed with preferred foods, and encouraging the child to taste, smell, touch, or look at them. Cooking sessions can be done by involving the child in the preparation of new foods, such as washing, cutting, mixing, or decorating them. The authors found that many studies that used taste exposure or cooking sessions reported positive results, such as increased food acceptance, variety, and intake, as well as improved nutritional status and quality of life. They also noted that these interventions can be fun and engaging for autistic children and their families, and can promote social skills and self-confidence. However, they also pointed out some challenges, such as the need for individualized and flexible protocols, the difficulty of generalizing the effects to different settings and foods, and the lack of long-term follow-up data.
Behavioral Strategies
Behavioral strategies are interventions that use principles of learning and motivation to change the behavior of autistic children. They include techniques such as reinforcement, shaping, fading, modeling, prompting, and feedback. Reinforcement involves providing rewards or praise for eating new or disliked foods, or removing unpleasant consequences for not eating them. Shaping involves breaking down the eating behavior into small steps and reinforcing each step until the desired behavior is achieved. Fading involves gradually reducing the amount or frequency of reinforcement or preferred foods until the child eats the new or disliked foods independently. Modeling involves demonstrating the eating behavior by a parent, sibling, peer, or therapist, and encouraging the child to imitate it. Prompting involves giving verbal, visual, or physical cues to guide the child to eat the new or disliked foods. Feedback involves giving information or comments on the child’s eating performance and progress. The authors found that behavioral strategies were the most widely used and effective interventions for FS in autistic children. They reported that many studies that used behavioral strategies showed significant and lasting improvements in food acceptance, variety, intake, and nutrition. They also highlighted that behavioral strategies can be tailored to the individual needs and preferences of each child and can be implemented by parents or caregivers at home or in natural settings. However, they also acknowledged some limitations, such as the need for intensive training and supervision, the potential for negative side effects, such as increased stress or resistance, and the ethical issues of using aversive or coercive methods.
Conclusion
The authors concluded that there is no one-size-fits-all solution for FS in autistic children, and that the best intervention should be based on a comprehensive assessment of the child’s characteristics, needs, and goals. They also emphasized the importance of involving the child and the family in the intervention process and evaluating the outcomes in terms of both quantity and quality of food intake, as well as nutritional status, health, and well-being. They suggested that future research should focus on developing and testing more multidisciplinary and multimodal interventions that combine different types of strategies, such as nutrition education, taste exposure, cooking sessions, and behavioral strategies, and that address the sensory, cognitive, emotional, and social aspects of eating. They also recommended that future research should use more rigorous and standardized methods, such as randomized controlled trials, objective and reliable measures, and long-term follow-up assessments. They hoped that their review would provide useful information and guidance for researchers, practitioners, and families who are interested in helping autistic children eat better and live healthier.
Faq
What is food selectivity and how common is it among individuals with autism spectrum disorder (ASD)?
Food selectivity is a term that describes having a limited range of foods that one is willing to eat, or rejecting certain foods based on their sensory properties, such as taste, texture, color, or temperature. Food selectivity is very common among individuals with ASD, affecting up to 89% of them, according to some studies. Food selectivity can lead to nutritional deficiencies, health problems, and social difficulties for individuals with ASD and their families.
What are the differences between food selectivity, picky eating, and food neophobia?
Food selectivity, picky eating, and food neophobia are terms that are often used interchangeably, but they have some differences in their definitions, characteristics, and implications. According to the review paper by Breda et al. (2024), the differences are:
- Food selectivity is a term that describes having a limited range of foods that one is willing to eat, or rejecting certain foods based on their sensory properties, such as taste, texture, color, or temperature. Food selectivity is very common among individuals with ASD, affecting up to 89% of them, according to some studies. Food selectivity can lead to nutritional deficiencies, health problems, and social difficulties for individuals with ASD and their families.
- Picky eating is a term that describes having a low appetite, a slow eating pace, or a preference for familiar foods, and avoiding foods that are new, different, or disliked. Picky eating is a normal developmental stage that occurs in many children, especially between the ages of 2 and 6, and usually resolves by adolescence. Picky eating can cause some minor nutritional or growth issues, but it is usually not a serious concern, unless it is persistent, severe, or associated with other problems.
- Food neophobia is a term that describes having a fear or reluctance to try new or unfamiliar foods, and preferring foods that are known, safe, or liked. Food neophobia is a trait that varies among individuals, and is influenced by genetic, biological, psychological, and environmental factors. Food neophobia can limit the food variety and intake of individuals, and may affect their nutritional status, health, and well-being.
What are the types or categories of food selectivity in individuals with ASD?
Food selectivity in individuals with ASD can be classified into different types or categories, based on the criteria or dimensions that are used to define or measure it. Some of the types or categories of food selectivity in individuals with ASD are:
- Food refusal, that involves rejecting or avoiding certain foods or food groups, based on their sensory properties, such as taste, texture, color, or temperature, or their presentation, such as shape, size, or arrangement
- Food neophobia, that involves fearing or resisting new or unfamiliar foods, based on their novelty, difference, or uncertainty, or their association with negative or unpleasant experiences or outcomes
- Food variety, that involves having a limited or narrow range of foods that one is willing to eat, based on their familiarity, preference, or habit, or their availability, accessibility, or suitability
- Food intake, that involves having a low or high amount or frequency of food consumption, based on their appetite, hunger, or satiety, or their energy, nutrient, or health needs or goals
What are the possible causes of food selectivity in individuals with ASD?
The exact causes of food selectivity in individuals with ASD are not fully understood, but some possible factors include:
- Sensory sensitivities or aversions to certain food stimuli, such as smell, taste, texture, or appearance
- Cognitive rigidity or preference for sameness and routines, which may make it hard to accept new or different foods
- Emotional or behavioral issues, such as anxiety, fear, or tantrums, which may interfere with eating or trying new foods
- Communication difficulties, which may limit the ability to express food preferences or needs
- Environmental influences, such as family, peers, or cultural norms, which may affect food exposure and acceptance
What are the consequences of food selectivity in individuals with ASD?
Food selectivity can have negative impacts on the physical, mental, and social well-being of individuals with ASD and their families. Some of the possible consequences include:
- Poor nutrition, which may affect growth, development, immunity, and overall health
- Increased risk of obesity, diabetes, cardiovascular disease, and other chronic conditions, due to overconsumption of high-calorie, low-nutrient foods
- Reduced quality of life, due to stress, frustration, or dissatisfaction with eating or food choices
- Social isolation or exclusion, due to difficulties participating in family or community meals, celebrations, or outings that involve food
What are the dietary patterns or preferences of individuals with ASD?
The dietary patterns or preferences of individuals with ASD may vary depending on their personal, medical, or environmental factors, but some of the common characteristics are:
- They tend to eat fewer fruits, vegetables, and whole grains, and more processed, packaged, or fast foods, than their typically developing peers
- They tend to prefer foods that are bland, sweet, or salty, and avoid foods that are bitter, sour, or spicy, or that have strong or unfamiliar smells, tastes, textures, or appearances
- They tend to have rigid or repetitive eating habits, such as eating the same foods every day, at the same time, in the same order, or in the same way, or refusing to eat foods that are mixed, touched, or cut differently
- They tend to have more food allergies, intolerances, or sensitivities, such as to gluten, casein, or soy, than their typically developing peers
What are some of the myths or misconceptions about nutrition and food selectivity in individuals with ASD?
There are many myths or misconceptions about nutrition and food selectivity in individuals with ASD, but some of the common ones are:
- Myth: Individuals with ASD are naturally picky eaters and there is nothing that can be done to change their food preferences
- Fact: Individuals with ASD may have food selectivity due to various factors, such as sensory, cognitive, or emotional issues, but they can learn to expand their food preferences and enjoy a balanced diet with appropriate interventions and support
- Myth: Individuals with ASD need special diets, such as gluten-free or casein-free diets, to treat their symptoms or improve their behavior
- Fact: Individuals with ASD may have food allergies, intolerances, or sensitivities, such as to gluten, casein, or soy, but there is no conclusive evidence that special diets can cure or improve ASD, and they may pose nutritional risks or challenges if not followed properly
- Myth: Individuals with ASD do not care about or enjoy food or eating
- Fact: Individuals with ASD may have different or reduced sensory or emotional responses to food or eating, but they can still have food preferences, needs, or pleasures, and they can benefit from positive and rewarding eating experiences
How can individuals with ASD and their caregivers use cooking sessions or food preparation activities to manage food selectivity?
Cooking sessions or food preparation activities are fun and engaging ways to manage food selectivity, by involving individuals with ASD and their caregivers in the process of selecting, preparing, and presenting foods, and increasing their exposure, familiarity, and acceptance of new or disliked foods. Some of the ways that individuals with ASD and their caregivers can use cooking sessions or food preparation activities to manage food selectivity are:
- Using recipes, that provide step-by-step instructions, pictures, or videos, on how to make various dishes, snacks, or drinks, that include new or disliked foods, and that are suitable, easy, or enjoyable for individuals with ASD and their caregivers
- Using utensils, tools, or gadgets, that help individuals with ASD and their caregivers cut, chop, peel, grate, or blend foods, and that are safe, accessible, or fun to use
- Using decorations, shapes, or colors, that make the foods look more appealing, attractive, or interesting, and that stimulate the visual, tactile, or creative senses of individuals with ASD and their caregivers
- Using themes, characters, or stories, that relate the foods to the interests, preferences, or hobbies of individuals with ASD and their caregivers, and that increase their relevance, connection, or identification with the foods
How can individuals with ASD and their caregivers use dietary supplements or fortified foods to manage food selectivity?
Dietary supplements or fortified foods are products that contain added vitamins, minerals, or other nutrients, that can help individuals with ASD and their caregivers manage food selectivity, by providing them with adequate or extra amounts of nutrients, that they may lack or need due to their limited or restricted food intake. Some of the ways that individuals with ASD and their caregivers can use dietary supplements or fortified foods to manage food selectivity are:
- Using dietary supplements, that are available in various forms, such as tablets, capsules, liquids, or gummies, and that contain specific or multiple nutrients, such as iron, calcium, vitamin D, or omega-3 fatty acids, that are essential or beneficial for the health and development of individuals with ASD and their caregivers
- Using fortified foods, that are foods that have nutrients added to them, such as cereals, breads, milks, or juices, and that contain nutrients that are commonly deficient or insufficient in individuals with ASD and their caregivers, such as folate, iodine, vitamin B12, or zinc
- Using dietary supplements or fortified foods, that are recommended, prescribed, or approved by a nutritionist, dietitian, or doctor, and that are based on the nutritional assessment, status, or needs of individuals with ASD and their caregivers
- Using dietary supplements or fortified foods, that are used as a complement, not a substitute, for a balanced and varied diet, and that are consumed in moderation, not in excess, by individuals with ASD and their caregivers
How can individuals with ASD and their caregivers use mealtime management strategies to manage food selectivity?
Mealtime management strategies are techniques that can help individuals with ASD and their caregivers manage food selectivity, by creating a comfortable and supportive eating environment, that minimizes distractions, stress, or pressure, and that maximizes enjoyment, relaxation, or socialization. Some of the ways that individuals with ASD and their caregivers can use mealtime management strategies to manage food selectivity are:
- Using mealtime routines, that involve following the same or similar schedules, rules, or expectations for eating and food choices, and that provide consistency, predictability, or stability for individuals with ASD and their caregivers
- Using mealtime prompts, that involve using verbal or non-verbal cues, such as words, gestures, or pictures, to remind, instruct, or guide individuals with ASD and their caregivers on their eating and food choices, and that provide clarity, direction, or assistance for them
- Using mealtime praise, that involve using positive or encouraging words, such as “good job”, “well done”, or “I’m proud of you”, to reinforce, reward, or motivate individuals with ASD and their caregivers for their eating and food choices, and that provide feedback, recognition, or appreciation for them
- Using mealtime modeling, that involve using the eating and food choices of others, such as parents, siblings, or peers, to demonstrate, influence, or inspire individuals with ASD and their caregivers, and that provide examples, comparisons, or challenges for them
How can individuals with ASD and their caregivers use play-based or fun-based interventions to manage food selectivity?
Play-based or fun-based interventions are techniques that can help individuals with ASD and their caregivers manage food selectivity, by using games, toys, or activities, that involve or incorporate foods, and that increase their interest, curiosity, or enjoyment of new or disliked foods. Some of the ways that individuals with ASD and their caregivers can use play-based or fun-based interventions to manage food selectivity are:
- Using food games, that involve using foods as props, tokens, or rewards, for playing various games, such as bingo, memory, or tic-tac-toe, and that increase the exposure, familiarity, or acceptance of new or disliked foods
- Using food toys, that involve using foods as materials, parts, or accessories, for making various toys, such as puzzles, blocks, or dolls, and that increase the exploration, manipulation, or interaction with new or disliked foods
- Using food activities, that involve using foods as ingredients, tools, or products, for doing various activities, such as arts, crafts, or experiments, and that increase the creativity, learning, or discovery of new or disliked foods
- Using play-based or fun-based interventions, that are appropriate, enjoyable, or motivating for individuals with ASD and their caregivers, and that are performed in a safe, comfortable, or supportive environment, according to their age, ability, or preference
How can individuals with ASD and their caregivers use sensory-based feeding strategies to manage food selectivity?
Sensory-based feeding strategies are techniques that can help individuals with ASD and their caregivers manage food selectivity, by modifying the sensory properties of foods, such as temperature, texture, or flavor, and presenting them in a gradual and positive way, to increase their sensory acceptance and tolerance. Some of the ways that individuals with ASD and their caregivers can use sensory-based feeding strategies to manage food selectivity are:
- Using temperature modification, that involves changing the temperature of the foods, such as heating, cooling, or freezing them, and helping individuals with ASD adjust to different levels of heat or cold, that may affect their taste, smell, or texture perception
- Using texture modification, that involves changing the texture of the foods, such as pureeing, mashing, or chopping them, and helping individuals with ASD progress from smooth to lumpy to crunchy textures, that may affect their oral motor, chewing, or swallowing skills
- Using flavor modification, that involves changing the flavor of the foods, such as adding, reducing, or masking spices, herbs, or sauces, and helping individuals with ASD tolerate different levels of sweetness, sourness, saltiness, or bitterness, that may affect their taste preferences or aversions
How can individuals with ASD and their caregivers use oral motor-based feeding strategies to manage food selectivity?
Oral motor-based feeding strategies are techniques that can help individuals with ASD and their caregivers manage food selectivity, by modifying the oral motor demands of foods, such as size, shape, or consistency, and presenting them in a gradual and positive way, to increase their oral motor skills and abilities. Some of the ways that individuals with ASD and their caregivers can use oral motor-based feeding strategies to manage food selectivity are:
- Using size modification, that involves changing the size of the foods, such as cutting, slicing, or grating them, and helping individuals with ASD handle different amounts or volumes of foods, that may affect their biting, chewing, or swallowing skills
- Using shape modification, that involves changing the shape of the foods, such as molding, rolling, or flattening them, and helping individuals with ASD manipulate different forms or contours of foods, that may affect their oral motor, tongue, or jaw movements
- Using consistency modification, that involves changing the consistency of the foods, such as thickening, thinning, or blending them, and helping individuals with ASD adjust to different levels of firmness, softness, or liquidity of foods, that may affect their oral motor, chewing, or swallowing skills
How can individuals with ASD and their caregivers use food chaining to manage food selectivity?
Food chaining is a technique that can help individuals with ASD and their caregivers manage food selectivity, by expanding their food repertoire, based on their existing food preferences, and using small or gradual changes in the sensory properties of foods, such as taste, texture, color, or shape. Some of the ways that individuals with ASD and their caregivers can use food chaining to manage food selectivity are:
- Using food chaining assessment, that involves identifying the core foods, or the foods that individuals with ASD eat most frequently and consistently, and analyzing their sensory characteristics, such as flavor, texture, temperature, or appearance
- Using food chaining plan, that involves creating a food chain, or a sequence of foods that are similar or related to the core foods, but have slight or gradual variations in their sensory characteristics, such as adding a new ingredient, changing the cooking method, or altering the presentation
- Using food chaining implementation, that involves introducing the new foods in the food chain, one at a time, along with the core foods, and providing positive reinforcement, feedback, or support for individuals with ASD who try, taste, or eat the new foods
How can individuals with ASD and their caregivers use food choice or food control to manage food selectivity?
Food choice or food control are methods that can help individuals with ASD and their caregivers manage food selectivity, by providing individuals with ASD with options, alternatives, or preferences for their eating and food choices, and by increasing their autonomy, involvement, or satisfaction with eating and food choices. Some of the ways that individuals with ASD and their caregivers can use food choice or food control to manage food selectivity are:
- Using food choice, that involve offering or presenting individuals with ASD with two or more foods, and allowing them to choose or select the food that they want to eat, and respecting or honoring their choice, without any pressure or coercion
- Using food control, that involve involving or engaging individuals with ASD in the planning, preparation, or presentation of the foods, and allowing them to decide or determine the type, amount, or combination of the foods that they want to eat, and respecting or honoring their decision, without any pressure or coercion
- Using food choice or food control, that are done in a supportive, collaborative, or empowering way, and that are done with preferred, familiar, or new foods, and that are done with reasonable, appropriate, or healthy limits or boundaries
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