From Picky to Adventurous Eater
Food selectivity, or picky eating, can be the source of significant difficulties for autistic** individuals and their families. As a child develops a selective food palate, it may first be developmentally appropriate in early childhood and only pose mild challenges to family eating habits and mealtime. However, over time, food selectivity can impede a child’s development and may lead to nutritional deficiencies, weight concerns, and eventual health problems. Food selectivity can take a severe toll on a family’s stress level over time, and can negatively impact important family routines such as daily mealtimes, social opportunities, and holiday gatherings. Parents of children with autism spectrum disorder (ASD) and food selectivity report a greater frequency of mealtime behavior problems and negative impacts on family members. (Curtin, et.al., 2016).
Addressing picky eating and helping a child with autism broaden their palate often requires the child and their parents to develop new habits and learn to cope with the anxiety they experience when trying new foods. For autistic individuals, food selectivity likely stems from a wide variety of factors, including sensory sensitivities related to food taste, smell, or texture, gastrointestinal difficulties, and oral muscular or fine motor impairments. Additionally, mealtimes may challenge their social and behavioral skill sets. For example, meals often require a high level of social interaction and the ability to adjust to different types of foods each night. Individuals with ASD frequently find comfort in routine and sameness, making the variation of meals, and being flexible with trying new foods, particularly challenging.
15-year-old Eric “Bean” McKay recently captured national attention when his quest to win a lifetime supply of peanut butter went viral. His mom, Tracy, explained Bean’s food preferences to the Washington Post:
“Eric’s preference for a particular food isn’t uncommon for people with autism, who can be sensitive to tastes, textures and sounds. She said they often choose to narrow their diets to foods with which they’re comfortable. For Eric, that’s peanut butter and English muffins”
Although high in calories, peanut butter provides more nutrition than the often desired salty snacks, such as fried chicken nuggets or potato chips. A diet based on salty, high calorie, snack foods can easily contribute to weight gain in children. On the other hand, an autistic child who eats a highly selective diet also may not consume very many calories at all, leading lead to weight loss and delayed development.
Recognizing that the key to addressing food selectivity may lie in addressing the anxiety and inflexibility faced when trying new foods, CAR researcher and clinical psychologist, Emily Kuschner, PhD, developed the intervention BUFFET: the Building Up Food Flexibility and Exposure Treatment program. BUFFET is based in cognitive behavioral therapy and teaches autistic children and their parents how to build the skills needed to cope with anxiety and rigidity related to trying new foods. Once children have built their coping skills, the program gives them an opportunity to practice introducing new foods in a safe supported environment.
“BUFFET is about teaching the whole family how to develop skills for trying new foods. Families develop a vocabulary for how to approach these situations and negotiate the child’s food repertoire,” explains Dr. Kuschner of the intervention.
While an initial pilot of the BUFFET program showed it was acceptable to parents and children, it is an intensive, on-site program, limiting its ability to reach large numbers of children and families struggling with food selectivity. In an effort to develop interventions which are accessible to more families, Dr. Kuschner has partnered with scientists at the UPenn School of Nursing, CHOP, and Brown University to conduct a new study, the Healthy Eating Study. The study promotes healthier eating habits using both a mobile phone app and traditional education. Parents and children will learn about the importance of eating a healthy and varied diet and receive guidance on how to set nutrition goals, like eating a new fruit or vegetable each week. The study will monitor their progress over the course of three months. The study is currently enrolling children with ASD between the ages of 6 and 10 years old along with their parents. Families interested can contact Lauren O'Malley via email at firstname.lastname@example.org or by phone at (215) 746-2427.
In addition to expanding available treatments, Dr. Kuschner hopes to gain a better understanding of food selectivity, willingness to try new foods, and other behaviors contribute to food selectivity. “Many research studies focus on nutrition and weight status in ASD, but often a child is doing okay, health-wise. However, food selectivity is still huge problem in their daily life and having a major impact on their family. We want to figure what drives these challenges and how to make eating habits and mealtimes more manageable,” Dr. Kuschner explains. To try and answer these questions, Dr. Kuschner will use an online questionnaire to examine a child’s willingness to try new foods and other behaviors that contribute to food selectivity. The “What Do You Eat” study will launch soon, and interested families with children between the ages of 7 and 16 years who have a diagnosis of ASD may contact Dr. Kuschner at WhatDoYouEatStudy@email.chop.edu.
** Please note, CAR uses both person-first and identity- first language. Recent research has demonstrated that “autistic” is the preferred term in the autism community, with many others preferring “on the autism spectrum” or “person with autism”(Kenny et al., 2016, "Which terms should be used to describe autism? Perspectives from the UK autism community" Autism).