Fussy eaters can be a real challenge for parents and having a child with autism who is highly selective about food means tensions can run high at mealtimes.
Key points:
- A range of techniques can help people with autism at meal times
- Experts say the right approach will depend on the individual
- They say it is important not to force strategies on the person
Sharee-Anne Earle's 13-year-old son Darcy Podsiadlo has a restrictive diet.
But with the help of specialists from Therapy Focus in Perth, Ms Earle said she has used a range of techniques to expand this.
"I've employed the slow progressive method of exposing [him to] new foods and having those on the table," she said.
"Darcy is not required to eat these foods; rather it's for him to get used to the sight and smells."
Ms Earle said she has also tried the FODMAP diet, which eliminates food that constipates and causes bloating.
"Darcy suffered bad bloating until we discovered the apples were high on the FODMAP. As he's getting older, he's recently increased his diet by three items."
Ms Earle said she is currently implementing the Satter division of responsibility in feeding, which is based on the teachings of US expert Ellyn Satter.
The idea behind this method is that parents decide what, when and where a child is provided food.
The child decides whether to eat and how much to eat.
"I've never forced Darcy to finish meals," Ms Earle said.
"We have always tried to keep eating as a positive experience and not a negative one."
Experts say there are things you can do to make it easier on everyone.
Dietician Natasha Lane works with many clients with autism and advocates for Ms Satter's system, but she warns it is not always easy to implement.
"After a long, demanding day, some autistic people just want to be alone," she said.
"It can also be difficult to manage sensory sensitivities at the table, even if you are not expected to eat the food."
Ms Lane said strategies to get a person with autism to eat foods they do not want to eat would depend on the individual, and it was important to approach the situation sensitively.
"Using strategies that are not compatible with the autistic person and their situation can be damaging, it can result in food-related trauma, making it even more difficult for everyone in the long run," she said.
"The best strategies to introduce new foods are the ones that are agreed to by the autistic person, overseen by an experienced, appropriately trained neuro-affirming clinician."
Provide a variety of foods
Senior clinical psychologist Suzanne Midford also recommended the Satter approach.
"Providing structure around the presentation of different foods is good," Ms Midford said.
"Forcing a child to eat and how much only adds complexity.
"Most children like to graze so [the] presentation of both liked, and less liked foods is good practice and keeps the other less liked foods in focus."
Jessica Della Pollina, a senior occupational therapist at Allegro Therapy, said people with autism spectrum disorder (ASD) can often display repetitive behaviours and restricted interests, which can also extend into eating habits and food choices.
"They may also be sensitive to taste, smell, colour, and texture of foods," she said.
"Fussy eaters or picky eaters could also be because of gastrointestinal problems."
Other causes may be sensory sensitivities, a preference to have the same foods at the same time every day, a focus on how the food looks over how it tastes and the desire for that food to be presented in the same way.
Don't force things
Ms Pollina said in her experience, she found graded exposure therapy to be a useful strategy in supporting the person with ASD to be gradually comfortable with food and introducing it slowly into mealtimes.
"Letting the person try the foods so that they feel in control, not forcing food or associating negative consequences with not trying the foods is not ideal," she said.
"I have also found supporting adults to explore menus before going to social events, or where possible, asking what foods will be available at events can support with reducing anxiety around attending social events."
Therapy Focus senior dietician Claire Breen said there were many different strategies that can be used if it is an important goal for that person to expand their dietary intake.
"Firstly, it is important to have a thorough assessment of your eating and drinking skills," she said.
"An assessment could include chewing [and] swallowing skills as well as self-feeding skills.
"All of these things can have a significant effect on a person's diet and mealtimes."
A tailored approach
Accredited practising dietitian Kate Upton said when it comes to why a person with autism may reject certain foods, there are no set strategies, and it really does need to be an individualised approach.
"The best strategy is to work with a health professional to help guide that person," she said.
Some adults may have no desire to expand their limited diet, she said.
They may be happy to supplement whatever's missing by taking a vitamin or mineral supplement.
"For others, those who would like help with expanding their diet, then we can help them to introduce new foods at a pace that they are happy with."
Darcy said his favourite foods are toast, grapes, and apples.
Forget about banana, most lollies, and mashed potatoes though — they're his least favourite.
Ms Earle said dinner time used to be a frustrating experience with Darcy, but things are now improving, albeit slowly.
Source: ABC