Children with autism spectrum disorders are five times more likely to have eating problems than children without autism, and are at increased risk for nutritional deficits, according to a new analysis.
Parents of children with autism often note that their children are especially picky eaters, and the first description of autism in 1943 by child psychologist Leo Kanner included irregular eating habits among the hallmarks of the condition, but surprisingly little research has been done on the link between autism and eating problems. The analysis, published online this month in the Journal of Autism and Developmental Disorders, rigorously examined 17 studies on autism and feeding disorders, and is the first attempt to synthesize the available research using advanced statistical methods. The authors of the report hope that their work will increase attention to nutrition and diet in treating children with autism.
Researchers from Emory University and the Marcus Autism Center in Atlanta, Ga. found that all of the studies in their analysis reported significantly higher levels of feeding problems in children with autism compared to children from the general population and children with other developmental and learning disabilities. Problem behaviors included tantrums during mealtime, peculiar or ritualistic behaviors concerning food, and extreme selectivity. Six studies reported that children with autism ate fewer fruits and vegetables, and the authors of the analysis concluded that the children frequently had calcium and protein deficiencies.
Feeding problems can also add to the challenges of raising a child with autism, and are often stressful for parents. Melanie Donus, a mother of three boys with autism, tries to make sure her children eat a balanced diet and gives them daily multivitamins, but struggles with their many idiosyncrasies concerning food. Her youngest will only eat a handful of things, including pizza, cheese quesadillas, and raisin bread. Her son Michael demands a specific meal for each corresponding day of the week, and must be served certain items in threes, or he will throw a tantrum.
The boys are overweight, but between raising three children with autism and running her own resume-writing business, Melanie doesn’t have the time or energy to face a battle at every meal. “If I had more help I could create healthy meals,” she says. But as it is, she spends most of her day in her van, driving her boys to school and dropping off their lunches.
For two years, Melanie’s children were on the Gluten Free Casein Free (GFCF) diet, a popular alternative treatment for autism that discourages the consumption of dairy products. Some parents believe that the GFCF diet can treat the symptoms of autism, but there is limited empirical support for the intervention. The authors of the recent analysis suggest that by restricting the intake of calcium, dietary interventions for autism may exacerbate the nutritional deficits related to feeding problems. They therefore encourage families to be cautious when considering such treatments, and recommend that doctors regularly screen for nutritional deficits in children with autism.
There is evidence that behavioral interventions can be successful in treating feeding problems in children with autism, but most programs are limited to inpatient and day-treatment settings. Considering the prevalence of feeding problems in children with autism, the researchers conclude that it is imperative that we expand access to behavioral interventions, and support parents like Melanie by adopting less restrictive modes of treatment, such as outpatient services, group therapy, and caregiver training.