When children won’t eat: Children with Autism Spectrum Disorders or sensory processing difficulties.
Sensory Processing refers to the way the nervous system receives messages from our senses (touch, taste, smell, sight, hearing, balance, motion) and turns them into appropriate motor and behavioral responses (SPD Foundation, 2010). Simply defined, it is a neurological disorder that is like a virtual traffic jam in the brain. The information from all seven senses are misinterpreted which causes a child to often act inappropriately (Hartley Steiner, 2011). Some examples include a dislike towards touch brushing or avoiding “messy play” with playdoh, sand or glue.
Is my child at risk of having a feeding problem?
A child who is not eating well will compromise on health and nutritional growth. Thus, even when failure to thrive is not evident and health is not immediately at risk, assessment and treatment of aberrant feeding behaviors in the ASD population should be a priority (Schwarz, 2003).
Below are the basic types of feeding problems among children with autism. If you have observed one or more behaviors persisting for 6 months or more, your child may be at risk of a feeding disorder:
1. Refusing to eat, or eating very selected types of foods.
2. Difficulties with chewing or swallowing.
3. Holding food in his or her mouth for prolonged periods.
4. Choking, gagging or regurgitating food.
5. Eating things that are not food (pica)
6. Sensory-based feeding problems (aversions or strong dislikes to specific kinds of foods, e.g. avoids particular smells, soft/hard textures, bland flavoured snacks, or biscuits with a specific shape).
7. Becomes agitated or aggressive at mealtimes.
What are some reasons for feeding problems in children with ASD?
Some issues may interfere with feeding, these include:
- Sensory Issues
- Concentration on detail
- Behavioural Issues:
- Parental Anxiety
- Reinforcement of Negative Feeding Patterns
- Fear of Novelty
- Communication Difficulties (e.g. problems understanding or expressing his/her wants)
- Biological food intolerance (Cumine, Leach, & Stevenson, 2000).
What to bring along for a feeding assessment?
- Typical meal or favourite snacks (including utensils e.g. spoon, bowl)
- Drink (including his or her usual bottle, cup, straw that your child drinks out of)
Additionally, it would be useful to bring along a list of food preferences that your child likes/dislikes.
What to Expect?
A feeding assessment lasts for approximately 60 minutes. This consists of:
- An oral motor assessment
- Feeding and drinking observation of your child.
- Intervention strategies and goals discussed with the parent and caregiver training.
Follow up sessions: Depending on the nature and severity of the feeding problem, follow up sessions may be recommended. Feeding management is also viewed as a holistic approach, with active involvement from a family member or caregiver to implement strategies taught in the clinic to the child’s home environment. This ensures that feeding intervention strategies are carried out effectively and appropriately in the child’s home or school environment
Note: If your child has severe attention or behavioral concerns (e.g. unable to sit to eat for at least 3 minutes), it will likely affect compliance in a feeding session and this concern will have to be addressed first. In such instances, a referral to an occupational therapist may be recommended. Alternatively, your feeding therapist may recommend joint feeding sessions with an occupational therapist. An occupational therapist will be able to help in providing strategies to improve your child’s attention such as engaging in sensory desensitization activities to calm your child down and move your child into optimal functioning for feeding.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. 4th, text.
Cumine, V, Leach, J. & Stevenson, G.(2000) Autism in the Early Years: A Practical Guide. David Fulton Publisher.
Sensory Processing Disorder Foundation (2010). About sensory processing disorder. Retrieved April 3, 2012, from http://www.spdfoundation.net/about-sensory-processing-disorder.html
Steiner, H. (2011).What is sensory processing disorder. Retrieved April 3, 2012, from http://www.earlychildhoodnews.net/special-needs/333-sensory-processing-disorder