EATING AND FEEDING ISSUES
Parents of children with neurotypical development
will often encounter mild feeding problems at some point in their
development. But parents of children with autism or Asperger's syndrome
may need a lot more support as these problems can be more severe.
Strategies will usually need to be different too. For example, withholding
food until a fussy eater is hungry enough to eat is a dubious strategy
at best - for a child on the autism spectrum, such a strategy
could be dangerous. 'Fussy eating' in greatly complicated by the
autism spectrum due to sensory
problems. Click here
to read about how this affects the strategies used.
This fact sheet covers a wide range of eating
feeding issues:
• Learning to sit at the table for meals
• Assessment of eating and feeding issues
• Gastrointestinal tract problems
• Diets for biomedical intervention
• Pica - the eating of non-nutritious substances
• Regurgitation and re-eating of food
• Anorexia nervosa
Learning to sit at the table
Sitting together to eat is a social custom across
virtually all cultures. As autism and Asperger's syndrome affect
social interaction skills, it is not surprising that a child may
be less inclined to stay at the table during a meal. Determining
the reason your child is not able to sit at the table will help
in deciding what to do to address your child’s needs.
Some children need to organize their bodies with
a little physical activity before they are asked to sit at a table.
Sometimes a timer needs to be set to show more concretely that sitting
is expected at mealtime, at least for a few minutes until the timer
rings. The length of time a child is expected to sit may be gradually
lengthened so success is built up slowly. It helps if the expectation
to sit and eat at the table can be structured in small steps and
paced so the child is successful.
Some children can sit and eat quickly at the table
but will not be able to sit and wait for others before being served
and/or after they have finished their food. This inability to wait
can sometimes be addressed with special waiting toys or activities.
Sometimes items to focus on while waiting are helpful. Even some
older children and adults on the autism spectrum have a need to
develop waiting strategies to use at mealtime while eating with
others. In this situation, bringing something to read or a pocket
sized game to focus on while waiting, is a positive coping strategy
for older children and adults, too.
Importance of assessment
Medical, behavioral, and environmental factors,
including sensory problems, must be considered when feeding and
eating problems occur in young children. Medical assessments can
include evaluation of oral motor function including swallowing studies,
assessments of food sensitivities and allergies, medications and
their effect on eating, and a profile of the child’s diet and resulting
nutritional issues. A multi-disciplinary approach is common, with
occupational therapists, speech and language pathologists, and nutritionists
or dieticians along with doctors and nurses taking part in a feeding
assessment.
abnormal gastrointestinal functioning
It has been claimed that up to fifty percent of
children with autism experience persistent gastrointestinal tract
problems, ranging from mild to moderate degrees of inflammation
in both the upper and lower intestinal tract. This has been described
as a syndrome, autistic enterocolitis, by Dr. Andrew Wakefield;
this diagnostic terminology, however, has been questioned by medical
experts. Constipation, often with overflow, or encopresis, is often
associated with developmental disorders in children, and is often
difficult to resolve, especially among those with behavioral and
communication problems. Click here
strategies to deal with constipation.
Treatments of abnormal gastrointestinal functioning
have led to varying degrees of improvements in the symptoms of Autism
Spectrum Disorders, including behavior, communication and social
skills. A range of biomedical
interventions have been suggested, including the gluten-free
casein-free diet, probiotic
diet, Feingold
diet and vitamin
supplements. It should be stressed that anecdotal evidence suggests
there is no magic cure for everyone, as parents report a great range
of effects from dramatic improvement to none at all for various
biomedical
interventions.
diets for biomedical intervention
Different diets seem to help some people with
Autism Spectrum Disorders. A gluten-free, casein-free diet seems
to be where many families start when exploring a gastrointestinal
connection between their child’s behavior and their diet. Families
often anecdotally suggest they find their child’s self- imposed
restricted food choices do expand significantly when they start
a gluten-free, casein-free diet. The Specific Carbohydrate Diet
(Gottschall, 2002) is also gaining a lot of interest among families
of children with Autism Spectrum Disorders. It is best to read the
latest research and information, and find a knowledgeable medical
professional to work with if you are considering a particular diet,
gut healing treatment and/or supplements for your child. This approach
certainly does not work for everyone, is very individualized and
is a substantial commitment to most families if or when they begin.
behavioral issues
Eating disorders are complex and continue to be
studied among various populations. Eating disorders such as failure
to thrive, rumination, pica, obesity and anorexia nervosa can affect
children with Autism Spectrum Disorders. Children experiencing these
problems are at risk for serious health and growth problems that
can lead to life threatening consequences.
Pica
Pica is an appetite for non-nutritive substances
(e.g., coal, soil, chalk, paper etc.) or an abnormal appetite for
some things that may be considered foods, such as food ingredients
(e.g., flour, raw potato, starch). In order for these actions to
be considered pica, they must persist for more than one month, at
an age where eating such objects is considered developmentally inappropriate.
The condition's name comes from the Latin word for the magpie, a
bird which is reputed to eat almost anything. Pica is seen in all
ages, particularly in pregnant women and small children, especially
among children who are developmentally disabled, where it is the
most common eating disorder.
Pica in children, while common, can be dangerous.
Children eating painted plaster containing lead may suffer brain
damage from lead poisoning. There is a similar risk from eating
dirt near roads that existed prior to the phase out of tetra-ethyl
lead in gasoline or prior to the cessation of the use of contaminated
oil (either used, or containing toxic PCBs) to settle dust. In addition
to poisoning, there is also a much greater risk of gastro-intestinal
obstruction or tearing in the stomach. This is also true in animals.
Another risk of dirt eating is the possible ingestion of animal
feces and the accompanying parasites.
The scant research that has been done on the root
causes of Pica suggest that the majority of those afflicted tend
to suffer some biochemical deficiency and more often iron deficiency.
Often the substance eaten by those with the disorder does not even
contain the mineral they are deficient in. In cases where a biochemical
deficiency is the problem, Pica is generally not discovered until
the deficiency is addressed. Once the deficiency has been identified
and treated with vitamins or minerals, the Pica is usually resolved.
If a mineral deficiency is not identified as the cause of Pica,
it often leads to a misdiagnosis as a mental disorder. If the deficiency
continues to go unnoticed it can become severe if the root of the
deficiency is a disease or internal problem.
Treatment emphasizes psychosocial, environmental, and family guidance
approaches. Treatment options include: discrimination training between
edible and nonedible items, self-protection devices that prohibit
placement of objects in the mouth, sensory reinforcement involving
screening (covering eyes briefly), contingent aversive oral taste
(lemon), contingent aversive smell sensation (ammonia), contingent
aversive physical sensation (water mist), brief physical restraint,
and overcorrection (correct the environment, or practice appropriate
alternative responses).
This involves associating negative consequences
with eating non-food items and good consequences with normal behavior.
Medications may be helpful in reducing the abnormal eating behavior,
if pica occurs in the course of a developmental disorder, such as
intellectual
disability, or pervasive developmental disorder. These conditions
may be associated with severe behavioral disturbances, including
pica. These medications enhance dopaminergic functioning, which
is believed to be associated with the occurrence of Pica.
Rumination
Rumination is the persistent regurgitation, re-chewing,
re-swallowing, or occasionally vomiting of previously eaten foods
and is a second behavioral problem of eating that can have serious
health consequences. In some animals, known as ruminants, this is
a natural and healthy part of digestion and is not considered an
eating disorder. However, in other species (including humans), such
behavior is atypical and potentially dangerous as the esophagus
can be damaged by frequent exposure to stomach acids.
The causes of rumination are not clear but are
thought to begin due to gastro-intestinal disorders and continue
due to the self-stimulatory rewards the individual experiences.
Rumination is a relatively rare disorder; the best course of action
is an appropriate medical assessment and treatment. Behavioral interventions
may be appropriately designed and implemented once medical issues
have been thoroughly addressed. Behavioral issues, when severe,
will also need to be assessed and treated medically.
Rumination is also associated with eating disorders
such as anorexia nervosa, and can be the result of one's apprehension
and nervousness after eating a normal meal. For those with purging
behaviors, rumination can take place when the option of getting
rid of a meal via throwing up is not available (thus, one might
feel worried and visibly upset).
Anorexia nervosa
Anorexia nervosa is a psychiatric diagnosis that
describes an eating disorder characterized by low body weight and
body image distortion. Individuals with anorexia often control body
weight by voluntary starvation, purging, vomiting, excessive exercise,
or other weight control measures, such as diet pills or diuretic
drugs. It primarily affects young adolescent girls in the Western
world and has one of the highest mortality rates of any psychiatric
condition, with approximately 10% of people diagnosed with the condition
eventually dying due to related factors. Anorexia nervosa is a complex
condition, involving psychological, neurobiological, and sociological
components.
Anorexia is a life threatening condition that
can put a serious strain on many of the body's organs and physiological
resources. The first line treatment for anorexia is usually focused
on immediate weight gain, especially with those who have particularly
serious conditions that require hospitalization. In particularly
serious cases, this may be done under as an involuntary hospital
treatment under mental health law, where such legislation exists.
In the majority of cases, however, people with anorexia are treated
as outpatients, with input from physicians, psychiatrists, clinical
psychologists and other mental health professionals. It is important
to note that many recovering underweight persons (who are more or
less forced against their will into recovery by parents or other
relatives) often harbor a hateful dislike for those who they feel
to be robbing them of their treasured emaciation. Often when well-meaning
friends or relatives compliment the recoveree on how much healthier
they look, the recoveree's mind replaces "healthy" with
"fat."
Drug treatments, such as SSRI or other antidepressant
medication, have not found to be generally effective for either
treating anorexia, or preventing relapse although it has also been
noted that there is a lack of adequate research in this area. It
is common, however, for antidepressants
to be prescribed, often with the intent of trying to treat the associated
anxiety
and depression.
Bulimia nervosa
Bulimia nervosa involves at least two binges per
week for an extended period of time. Episodes of binge eating are
followed by purging, periods of fasting, or performance of strenuous
exercise - indeed, "exercise bulimia," in which a person
eats normally but then engages in strenuous exercise, is an inverse
form of bulimia. People with binge eating disorder, by contrast,
do not purge, fast or engage in strenuous exercise after binge eating.
Additionally, people with bulimia are typically of normal weight
or may be slightly overweight (the purging, etc., have little to
no effect on the subject's body fat), whereas people with binge
eating disorder are typically overweight or obese.
Treatment is most effective when it is implemented
early on in the development of the disorder, and is usually very
similar to that of anorexia nervosa. Unfortunately, since this disorder
is often easier to hide and less physically noticeable, diagnosis
and treatment often come when the disorder has already become a
static part of the patient’s life. Historically, those with bulimia
were often hospitalized to end the pattern and then released as
soon as the symptoms had been relieved. However, this is now infrequently
used, as this only addresses the surface of the problem, and soon
after discharge the symptoms would often reappear as severe, if
not worse, than when they had originally been.
Click here for the full
range of Asperger's and autism fact sheets at www.autism-help.org
Click here to read the Fussy
eaters fact sheet
This autism fact sheet is licensed under the GNU
Free Documentation. It is derivative of an autism-related articles at http://en.wikipedia.org |
