Diet Strategies

© Source Autism.au

Many children with an Autism Spectrum Disorder will only tolerate a very restricted diet. Often when parents speak of their child’s eating habits to friends and members of the extended family, they receive the response, “yes, all children at a young age are difficult eaters”. However, as parents of children with Autism know, the restricted diet of their children is frequently off the scale of anything seen in normally developing children. Many children with Autism will eat only from foods of a particular texture or colour. Some will only eat cold food. Many will smell food and eat only foods of a particular odour. Others may have only two or three foods (exclusively) which they will eat. It might be bread and ice cream, chocolate and 5-minute noodles.

We do not understand why food restriction is so common in Autism. Some writers in the field have postulated that diet restriction is simply a variant of other restricted activities seen in Autism whilst others have connected the child’s aversion to certain foods with sensory sensitivity in areas such as food smell and texture.

The type of restricted diet seen in children with Autism can lead to enormous difficulties fir parents visiting the extended family, or going on outings. It often necessitates elaborate pre-planning for simple commonplace family activities. It is important, therefore, not simply for the child’s nutrition, but also for the wellbeing of the family, that we look at ways of improving the child’s diet.

Any approach used to improve the child’s diet should be positive. Attempts should never be made to force-feed or to punish the child for not eating what we place before them. We should also remember that if we are going to embark on an intervention plan, the problem should be real i.e. the child’s diet is significantly unbalanced (talk to your doctor), or is so bizarre as to make family life difficult.

There are a variety of different strategies which can be used to expand a child’s diet. The following is one strategic approach which is useful with many children.

1.Make a list

Foods my child eats now. List all of the foods your child eats now. List them in order of your child’s preferences, from their most favourite through to their least favourite food.

2.List Two – Foods I want my child to eat

List the foods you would like to introduce to your child. List these in order from the food that your child hates the least, to the foods they hate the most!! It can be difficult to rank these foods given that your child does not eat any of them. Consequently, when you are attempting this ranking exercise, think about:

The texture: is it similar to something else the child likes?

Has the child made any attempt to eat this food in the past?

Does your child have a preference for savoury or sweet foods?

3.Select the first food item that you want to introduce

Identify your goal e.g. my son/daughter to eat a quarter piece of apple.

Teach your child to understand the contract system

Place before the child a tiny piece of the food they do not like e.g. a piece of apple. Make sure the piece is a very small crumb size. Also place in view their favourite food e.g. potato chips. Depending upon the level of your child’s comprehension, either tell or indicate that when they eat the crumb they can have the chips. If the child continues to have difficulty, make the crumb even smaller, the size of a pinhead. Most children will agree the contract at this stage in order to get their favourite food. The point of this exercise is to teach the child the steps involved in the contract: first you do this and then you get that.

5.Be faithful to your contract

Once the child has eaten one tiny piece, they should immediately have their chips and be allowed to go. Do not be tempted to repeat the exercise immediately at this early stage.

6.Increase the size of the food portion

Later on in the day, or the following day, take a slightly larger crumb of apple and repeat Step Three (3).

This exercise can be repeated at intervals, increasing the size of the portion over time. Remember, however, you do not have to increase the size of the portion on each occasion you carry out the exercise. If the child shows signs of balking at a larger piece, stay at the smaller size portion over a period of time before moving on to the larger piece. In this way, the child is given the longer period they need to get used to the new food.

7.Increase the child’s motivation

You may need to vary the reward foods if you think your child will lose interest in the reward you have chosen. If possible, while implementing this programme, try to ensure that the only time the child has access to the designated reward food (in this case, chips) is when you are involved in the contract. In this way he/she will be more motivated to engage in the exercise to get the chips. However, if the reward food is also a staple food, the child’s access to it should not be restricted to this exercise.

8.Congratulations

Congratulate yourself because it probably hasn’t been easy.

9.Start again

Begin to target another food (the second item on List Two)

• Select one goal at a time. If your top goal is to increase the variety of foods in your child’s diet, do not target this at the same time as getting the child to sit at the table for meals.
• Make your goal realistic, e.g. a small amount of a new food. Work systematically through your list. Do not set yourself or the child up for failure by targeting too big a goal in too short a time.
• Don’t let the child fill up on favourite foods during the day as this will make them less motivated when you introduce the contract.
• Plan your contract sessions when you know your child will be hungry.
• Use other family members as models.
• Record their progress. This will keep you motivated. It will also remind you that although they are not eating a roast dinner yet, they have increased their range of foods from six foods to ren or instead of throwing a tantrum at a request to eat a piece of apple, the child is now eating a quarter piece of apple. Without a record, you are likely to forget how far you have come.
• Remember that any change is going to be a little stressful. If possible, get the assistance of others but make sure there is consistency of approach.