Eating, diet, and GI problems

About strong preferences:

Many people have strong food preferences, and children with autism may have extreme preferences which involve not only taste and smell but also texture, “noisy foods” and how the food is organized and presented on the plate.  This, coupled with what is sometimes a strong preference for sameness, can make mealtimes difficult and can lead to diets which lack adequate nutrition.  For a scholarly article on this problem, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601920/ .

There is no one-size-fits-all solution to this problem.  For some children, a diet high in uncooked or less processed food may help, or cold food rather than warm food.  Children generally have a much better sense of smell than adults, so cold food may increase acceptance.  For instance, many children will reject well-cooked warm spinach but will eat spinach cooked 2 minutes, squeezed to eliminate extra water, and refrigerated before dinner.  They may prefer fruit to cooked vegetables.  The range of likes and dislikes is great and can vary over time, so don’t be afraid to experiment.  Pizza might work for one and noodle-based dishes for another.  One rule always applies – don’t get angry around food issues or try to force a child to eat – that only makes the problem worse.  Vitamin supplements for your child may make you less anxious.  Your pediatrician can follow height and weight gains and lab tests to provide additional guidance or assurance.

About pica and swallowing non-food items

Some children will eat paint chips or dirt.  This sometimes is caused by dietary insufficiencies so talk it over with your doctor.  Emergency rooms often see children who have swallowed coins, small batteries, ball bearings and other small objects.  Obviously you should try to stop these behaviors.  Among the more dangerous are tablets containing medicine, small magnets and button batteries. Home safety strategies depend on the age and abilities of your child.  To prevent accidental poisoning, medication containers should not contain a lethal dose.  This means that large bottles of pain pills and of many prescription medications should be stored out of reach or locked away, with only smaller quantities closer to hand.  Remember that over the counter medications like acetaminophen (Tylenol) and aspirin can be lethal in overdose.  Small magnets pose a risk of intestinal perforation, so it’s best to avoid having them around.  Loose change shouldn’t be easily accessible, and children who swallow coins will often need to have an x-ray to make sure it isn’t in the esophagus (once coins reach the stomach, they generally go the rest of the way without incident).  Since all of these situations can be dangerous, consult your health professional.

About gastrointestinal problems and Autism Spectrum problems:

It appears that half or more of people with Autism Spectrum problems have some gastrointestinal problem.  This may be because autism is a whole body disease.  In any case, it’s always important to treat the whole person, not just one symptom at a time.  Among these problems, frequent diarrhea, constipation, and acid reflux are fairly common.  Since these conditions require long-term strategies for control, it’s useful to discuss any concerns with your pediatrician.

There is some research evidence that the gut flora – the different bacteria which live in our digestive tract and help to digest food — may be different in kind and number in people who have Autism Spectrum Disorder.  We all have different kinds, but this difference may account for some part of the reason for gastrointestinal problems.  At the present time, there isn’t enough known about this to recommend any treatments beyond a healthy diet with adequate fiber.

Will changing diet help with changing behavior?

This is a common question.  A physician may be able to help pinpoint problems such as food allergies, gastroesophageal reflux (GER), problems with swallowing, or metabolic problems.  Treatment of these will improve your child’s health, and that’s very important.  Full blown celiac disease doesn’t appear to be associated with autism, but those with autism are more likely to have gluten sensitivities.  At present, there is no evidence that the lack of social engagement in autism can be helped by diet, however.  Some allergists believe that the hyperactivity which often accompanies autism may be helped by avoiding food additives or dietary allergens.

-Emily Diamond, Psy.D. & Jim Diamond, M.D.