Nutrition and Autism

Why are dietitians recommended for people with Autism Spectrum Disorder?

Many individuals with autism have food sensitivities. Many also have behavioural issues that make mealtime particularly challenging. Parents and carers often worry about providing their children with healthy diets. Many people on the autism spectrum can have difficulty with eating, or can be selective eaters and our AYS dietitian has been working with children and adults on the autism spectrum.

Researchers at Marcus Autism Center at Emory University School of Medicine reviewed and analysed all published, peer-reviewed research relating to eating problems and autism spectrum disorder (ASD). They found that children with ASD are five times more likely to have mealtime challenges such as tantrums, extreme food selectivity and ritualistic eating behaviours so it is no surprise parents and carers are seeking as much advice and support as possible.

published meta-analysis of scientific studies confirms these parental concerns and provides insights into the most common nutritional deficiencies associated with autism. It appears online this week in the Journal of Autism and Developmental Disorders.

Behavioural challenges as well as sensitivities to certain foods can make it difficult for parents and carers to ensure they are providing them with a nutritious diet.

People with autism may refuse to eat unless they sit in the same place at the table, eat on the same dishes, use the same tablecloth, and eat the same foods every single day. Just a small change in routine can cause an enormous amount of anxiety or fear in a child or person with autism, and can often result in the refusal to eat.

Researchers at Marcus Autism Center at Emory University School of Medicine found that children on the autism spectrum are five times more likely to have mealtime outbursts, be more selective about their food, or have ritualistic eating behaviours.

Chronic eating problems also increase a child’s risk for social difficulties and poor academic achievement, the researchers note. This may also increase risk for diet-related diseases such as obesity and cardiovascular disease in adolescence and adulthood.

The researchers expressed additional concern about alternative diets. Many parents report that their children’s autism symptoms and related medical issues improve when they remove casein (milk protein) and gluten (wheat protein) from their diets. However, casein/gluten-free diets can increase the challenge of ensuring adequate nutrition.

“This highlights the importance of assessing diet as part of routine healthcare for all individuals with ASD,” comments Daniel Coury, M.D., medical director of Autism Speaks Autism Treatment Network. Dr. Coury is also a developmental-behavioral pediatrician with Nationwide Children’s Hospital, in Columbus, Ohio. “We know that the use of alternative diets is common among parents of children with ASD,” he says. “And so we encourage families to consult with their provider when considering these diets. While many of these diets are safe, they have potential for nutritional deficiencies.” 

There is general agreement, that as many as 50% of children on the autism spectrum have digestive problems , but the reasons for this are not established.

Just like the nature of the autism spectrum, there is no one size fits all approach to autism and diet, so if you have any concerns around your child’s nutrition, it’s best to contact a dietitian and seek professional advice.

How can a dietitian help?

Generally, a dietitian will initially undertake a consultation with you, or your child or dependant, to understand diet and eating behaviours.

The consultation will identify food aversions that may be promoted by texture, appearance, smell or temperature.

They will also want to learn more about health and lifestyle problems such as constipation and diarrhoea, sleep issues, body weight, and skin conditions such as eczema.

They may then recommend biomedical testing to identify food allergies and sensitivities, gastro-intestinal parasites and viruses or micro-nutrient deficiencies.

After a comprehensive review of a person’s current diet they will often then recommend an individualised diet that provides the right nutritional balance for that person. They can also clarify current research relating to diets such as the Gluten-free casein-free (GFCF) diet, and will provide an objective opinion about the benefits and potential problems that may arise as a result of such diets.

A dietitian will sometimes collaborate with an Occupational Therapist or Speech Pathologist to develop a program which can support a healthy diet and assist with mealtimes. This might include developing a specific mealtime environment that is practical for your family and routines, such as optimal seating positions, table height, or the removal or adjustment of distracting noises, lighting and smells.

Depending on age, children may like to get involved in their own menu planning in conjunction with their dietitian.

  • Limited food selection or strong food dislikes. Someone with autism may be sensitive to the taste, smell, color and texture of foods. They may limit or totally avoid some foods and even whole food groups. Dislikes may include strong flavored foods, fruits and vegetables or certain textures such as slippery or soft foods.
  • Not eating enough food. Kids with autism may have difficulty focusing on one task for an extended period of time. It may be hard for a child to sit down and eat a meal from start to finish.
  • Constipation. This problem may be caused by a child’s limited food choices, low physical activity levels or medications. It typically can be remedied by gradually increasing sources of dietary fiber, such as bran cereals and fruits and vegetables, along with plenty of fluids and regular physical activity.
  • Medication interactions. Some stimulant medications used with autism can lower appetite. This can reduce the amount of food a child eats, which may affect growth. Other medications may increase appetite or affect the absorption of certain vitamins and minerals. If your child takes medication, ask your healthcare provider about possible side effects.

Caring for a child with ASD can be challenging on many levels, and healthful eating is no exception. For children with ASD, a nutritious, balanced eating plan can make a world of difference in their ability to learn, how they manage their emotions and how they process information. Because children with ASD often avoid certain foods or have restrictions on what they eat, as well as difficulty sitting through meal times, they may not be getting all the nutrients they need.

Preparing for Pickiness

Many parents find their child’s sensitivity to tastes, colors, smells and textures the biggest barriers to a balanced eating plan. Getting your child to try new foods — especially those that are soft and slippery — may seem nearly impossible. You may find that your child avoids certain foods or even entire food groups. One of the easiest ways to approach sensory issues is to tackle them outside of the kitchen. Have your child visit the supermarket with you to choose a new food. When you get home, research it together on the internet to learn about where it grows. Then, decide together how to prepare it. When you are done, don’t worry if your child doesn’t want to eat it. Simply becoming familiar with new foods in a low-pressure, positive way eventually can help your child become a more flexible eater.

Make Mealtimes Routine

A child with ASD will have to work harder at mealtimes because a busy kitchen, bright lights and even the way the furniture is arranged all are potential stressors. Making meals as predictable and routine as possible can help. Serving meals at the same time every day is one of the simplest ways to reduce stress. In addition, think about what concessions you can make for easier mealtimes. If your child is sensitive to lights, try dimming them or consider candlelight with adult supervision. Let your child pick a favorite food to include at every meal. Or, let your child choose a favorite seat at the table.

Seek Guidance for Special Diets

You may have heard that a gluten- or casein-free diet can improve symptoms of ASD. Gluten is a type of protein found in wheat, rye and barley. Casein is a protein found in milk. Proponents of the diet believe people with autism have a “leaky gut,” or intestine, which allows parts of gluten and casein to seep into the bloodstream and affect the brain and central nervous system. The belief is that this may lead to autism or magnify its symptoms. However, controlled scientific studies have not proven this to be true, so the research at this time does not support their use. Keep in mind that restrictive diets require careful planning to make sure your child’s nutrition needs are being met. Consult with a registered dietitian nutritionist before making any drastic changes to your child’s meal plan as there can be side effects and potential nutrient shortfalls when a gluten- or casein-free diet is self-prescribed.

Working With a Registered Dietitian Nutritionist

Most children, with or without autism, can be choosy and particular about the foods they eat. A registered dietitian nutritionist can identify any nutritional risks based on how your child eats, answer your questions about the effectiveness and safety of nutrition therapies and supplements advertised for autism and help guide your child on how to eat well and live healthfully.

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