Food Selectivity in Children with ASD - Blog - Achieve Beyond

Food Selectivity in Children with ASD

By: Gina Ballone, MS, BCBA, LBA

It is estimated that 75% of children with ASD have limited food preferences (Maye & Calhoun, 1999). Insistence to sameness, restricted routines, and difficulty coping might be some symptoms of ASD that are directly correlated with restrictive food intake. The good news is that various disciplines (Speech Therapists, Occupational Therapists and ABA therapists working alongside Board Certified Behavior Analysts) can offer successful interventions towards increasing food acceptance. When looking at the social validity as to why increase the variety of food in a child’s food repertoire, there are many things to consider.

For example, one might say “leave the child alone; if they want to only eat pizza and French fries, then so be eat”. It’s the parents’ final decision if increasing food variety is significant to their family, but here are some other things that are connected to eating a limited variety of food: vitamin consumption might be lower, GI dysfunction, not enough nutrients, not enough fiber, and/or not enough protein.

For this article, I will be addressing how a BCBA (Board Certified Behavior Analyst) conducts their assessment and analysis. The first thing a BCBA does is determine if they are the appropriate clinician. BCBA’s can ethically intervene when the need is only related to food selectivity, or what people commonly refer to is “picky eaters”. If the eating behavior is related to Physiological issues related to the mouth and tongue (e.g., swallowing disorders (Dysphasia), chewing problems, etc.), then they will refer out to the appropriate clinician (e.g., SLP).

Also, we must rule out any medical issues such as hyperactive gag reflux, eating disorders (different from “Feeding Disorders”), gastrointestinal issues and food allergies. Once the BCBA has ruled out all of this, and has determined that the need is only for increasing acceptance of food, then our assessment can appropriately begin.

The first part of the analysis is to observe what the “selectivity” actually looks like (we call this defining the “topography” of the food refusal). This will look different in many children, but here are just a few examples of what might occur when food is presented: Turns head abruptly, verbal refusal (cries/whines), pushes spoon away, covers mouth, throws food, runs away from table and/or expels food.

These behaviors not only impede with trying new food, but also disrupt family meal time. The other part of the analysis is observing the common response (or consequence) that occurs. Some common responses that parents might do are: removes the food, removes the food and offers something that their child likes, reprimands, does time-out, and/or tries to bribe into eating.

The other component to the assessment is finding out everything that the child does enjoy eating. Upon providing the parents a very detailed list of foods (food questionnaire), the BCBA is able to see if there is any correlation if the food preference is: salty, sweet, crunchy, soft, sour, bitter, temperature preference, and/or texture. Further assessment data includes finding out: preferences for certain smells, preferences for a certain brand or container, preferences for the way food “looks” (e.g., color), the way the food is presented (e.g., can the child eat with their fingers or utensils), resistance to chewing (how much pressure is needed to initially take a bite, or the “response effort”), the ability for food to dissolve quickly, moisture level (wet foods vs dry foods) and/or variation in textures.

Antecedent Manipulations for Food Selectivity in Children with ASD

Once the targeted foods are selected, it’s important that all food programs have as many proactive strategies as possible (we call these “antecedent manipulations”) in order to increase the chances of success. The following are only examples, and all information provided in this article are for the sake of “general concepts” and not intended for the treatment of any individual child.

  • Only run the food protocol during times of the day in which you know that your child will be hungry.
  • Have the table in which he/she eats paired with many preferred items (bring favorite toys and food items to the table and in sight)
  • Start off with having the learner eat foods that he/she likes (this will “ease” your child into the concept of eating at the table)

Studies indicate that typical children need a new food to be presented 7-10 times before trying it (Ernsperger & Stegen-Hanson, 2004). If this is the consensus for typically developing children, then I think we need to be very cognizant that this takes time with children of various sensory needs. I want to end my article with a personal story related to food selectivity that resonated with me during my career. This story has to do with making our targeted food “attainable”.

For example, if the desire is to have your child eat vegetables and they are only eating creamy, soft textured food, then trying to target raw broccoli would be out of the question. We need to really meet our learners half way. For example, if your child loves soft, creamy textures and you are very determined to get your child to eat vegetables, then maybe starting with creamed corn is your only option. It’s not the ideal option, but we need to start someone and gradually progress from there. My take home point is that we need to focus on the current food repertoire and slowly expand and build from there. Here is a fun example that I’ve used in the past that was very successful.

I had a client once that loved french fries (as most children do). However, we were able to shape french fries into eating zucchini fries, and then into green bean fries (all in an air fryer to make things healthier), and then one day my friend realized that regular steamed zucchini, and long green beans were yummy and there was no more need for the air fryer! However, if this was started with just a boiled green bean, then we probably would not get to the same level of success because “shaping” needs to be conducted (slowly and gradually reinforcing successive approximations to the desired food item).

In closing, don’t ever give up and remember it takes time, an awareness of what your child currently likes and positive reinforcement to motivate your child!

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