Feeding Difficulties in Children with Autism

It seems as though a large percentage of children with autism are extremely picky eaters to the point that they may have less than 10-15 total foods in their diet.  Most of these tolerated foods are carbohydrates that tend to be dry and crunchy such as cookies, crackers, and cereal.  Although some of these children branch out to other “kid-friendly” food items such as chicken fingers and macaroni and cheese, most of them do not have a wide range of meats, fruits, or vegetables that they eat readily.  This can be extremely concerning for their parents as many of them are not receiving the necessary vitamins and minerals that such food has to offer.  Some of our clients are even to the point that they are labeled as “underweight”  or “failure to thrive” by their health care provider.  Although the phrase “they will eat if they are hungry enough” may pertain to a typical child, it does not apply to a child with autism. These children may need a behaviorally-based intensive feeding program in order to continue to thrive. 

Having a child with autism is a challenging task for any parent but having a child with autism who is difficult to feed can create a daily struggle that occurs during each scheduled meal.  From my experience, feeding difficulties in children with autism stem from one of 2 sources: sensory issues or non-compliant behavior.  Regardless of the root of the problem, the intervention is the same- a behavioral approach to feeding.  This involves using a technique called “negative reinforcement” which involves placing a demand and allowing the child to escape from the demand upon compliance. 

In my practice, prior to the first feeding session, an interview is conducted with the parents to get an idea of currently tolerated foods and foods that were tolerated previously.  Then, a plan is developed to target food items very similar to the current food preferences and to branch-out to other food items as the child displays success with the feeding program.  So, if the child tolerates multi grain cheerios, banana nut cheerios may be the first food targeted.  Then, a very small bite of food (1 cheerio in this case) is placed in front of the child and the demand is placed to eat the bite.  The demand is repeated every 30 seconds until the child consumes the bite.  During this time, all problem behavior is ignored since it serves the function of escaping from the feeding demand.  Once the child consumes the bite, which may take up to 2-3 hours on the first session, they are allowed to escape from the feeding session for a 5 minute period of time.  Once this time has passed, they are brought to the feeding session again and the procedure is repeated. 

Overtime, the child begins to comply with the demand to take a bite of food quickly.  They also learn that novel food items do not provide a negative experience and they are more apt to try new foods.  Once the child readily consumes new food with a variety of caregivers when the demand is placed, they are no longer in need of an intensive feeding program.  I feel that this is one of the most rewarding programs to implement as the improvements occur within a few weeks and it positively impacts the lives of the family on a daily basis.  For more information about our intensive feeding program, please feel free to contact us at info@bcotb.com. 

Kelley Prince, M.A., BCBA

President of Behavioral Consulting of Tampa Bay