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What Is Autism?

Autism Spectrum Disorder (ASD): A developmental disorder of the brain

affecting a childs ability to socialize, converse with another individual, and
display inappropriate / repetitive behaviors
As of 2013 the term Autism Spectrum Disorder groups all different types of
-Autistic disorder
-Childhood disintegrative disorder
-Aspergers syndrome
-Pervasive developmental disorder
To define the different behavioral disorders
that fall underneath the umbrella Autism
Spectrum Disorder
To identify the multiple challenges autistic
children and family members experience
during mealtime
To identify the different strategies used to
help overcome or improve these
behavioral conditions at mealtime
Autistic Disorder
-Children are less able to interact.
-Difficult with verbal/nonverbal
-lack/have trouble with social
awareness & interactions
-Imaginative behaviors
-Child develops normally til 2
or 3 years old
-Severe regression of social and
communication skills
-Mildest form of ASD
-Highly functioning
-Undiagnosed until child/adulthood
-Lack normal back & forth
-Narrow interests
-subthreshold of Autism child has
some but not all charteristics
-Recognized during infancy-unusual
behavior when playing with toys
Autism Diagnosis
Early brain development: Between the ages 2
and 3 years old
CDC statistics:
1 in 68 American children
4-5 times more common in boys rather than girls
1 in 42 boys
1 in 189 girls
3 million(+) Americans

Behavior Cues
Failure to make eye contact
Failure to respond to their own name
Unusual/repetitive behaviors: i.e)flapping
arms, jumping up and down,
arranging/rearranging objects, repeating
phrases, etc.
Communication difficulties
Eating Behaviors
Among Autistic
Food Refusal /
Food Selectivity
(picky eating)
Food Neophobia (fear
of trying new foods)
Feeding Issues Can Lead To
Restrictions in necessary food groups (fruits,
vegetables, whole grains, etc) which can lead
to nutrient deficiencies
Risk of obesity
Failure to partake in social events
Tantrums/Inappropriate behavior

Review of 47 published papers
Review posted in the Journal of Pediatric
Nursing compares both macro/micro-nutrient
intake and deficiencies among Autistic
children and normally developing children
Looked at:
Eating behaviors
Diet quality
Gastrointestinal symptoms

ASD vs. TDC - Macronutrient
Carbohydrates: Several studies indicated no
significant difference in absolute intake
Protein: Several studies indicated no significant
difference in absolute intake while one study
(Zimmer) showed poor protein intake among 8
year old ASD children vs TDC. Others indicate
ASD significant greater number of protein
servings a day vs TDC.
No information on fat intake between the two
ASD vs. TDC - Micronutrient
Few consistent differences in the nutrient
adequacy of childrens diets between both
Study looking at 2-8 year old children, both
TDC and ASD children, showed micronutrient
deficiencies between both groups:
Fiber, iron, vitamin E, calcium, and vitamin D
When compared to TDC, ASD children had
lower levels of vitamin K, vitamin D, and
Risk of Obesity
Research article concerning the prevalence of
obesity in children with Autism
National Survey of Childrens Health 2003,
sponsored by CDC:
Purpose to obtain state and national prevalence
estimates of the physical and emotional health of
children ages 0-17 including both TDC and ASD
Data Collection Period: Jan 2003-July 2004
Method: Computer-assisted telephone
interviewing (CATI) system.

Randomized sampling, one child per household-
parent or guardian responded
Final sample:102,353 children 0-17 years old,
approximately half, 55.3% responded
3-17 years old (Autism shows around 3 years of age)
Trained Interviewers asked questions related to
childs: physical, emotional, and behavioral health
Has a doctor or health professional ever told you
that your child has Autism?
Children with Autism: ~483
Weight status: How tall is your child now? How
much does your child weigh now? BMI was then

1 in 189 children over 3 were diagnosed with
Autism (0.5346%)
Obesity prevalence: 30.4% in Autistic children
vs. 23.6% in children without Autism
***obesity is defined as BMI-for-age greater than
or equal to the 95
percentile of CDC sex=specific
BMI growth chart
It Is Common for Children With Autism
To Favor Eating
High sugar/high carbohydrate foods
-Some autistic children will
only eat if it is in the same
location, in the same spot,
using the same exact
utensils, plates, and cups.

Food Refusal / Selectivity
Based off of..
Foods touching each other
The Childrens Activity and Meal
Patterns Study
Type of study: Cross-sectional (2007-2008)
Participants: ASD (53) and TD (58). Aged 3-11
years old
Methods: Information obtained via parents
who were interviewed about childs dietary
habits, use of special diet, and whether or not
refused food for specific reasons.
The Childrens Activity and Meal
Patterns Study
Hubbard KL, Anderson SE, Curtin C, Must A, Bandini LG. A comparison of
food refusal related to characteristics of food in children with autism spectrum
disorder and typically developing children. Journal of The Academy of Nutrition
and Dietetics. August 2014; 2014: 1-7.
The Childrens Activity and Meal
Patterns Study
-Results Cont
Greater Prevalence Among
ASD Children
Similar Prevalence
Texture of Food Temperature
Foods Mixed Together Food Touching Other Foods
Brand of Food Color
Disruptive Mealtime Behavior
-Throwing food during meal time
-Leaving the table to run around
-Refusing to sit in chair / eat
-Pica-eating nonfood substances
-Qualitative Study: Purpose=learn about
the experience of mealtime from the
perspectives of parents of children with
autism and food selectivity.
-Large behavior survey study conducted
-Only 4 mothers qualified to interview
-child diagnosed with autism
between ages 4-12
-child accepted fewer than 10

Examination of Mealtime Experience: Method
Examination of Mealtime Experience: Data
-Phone interview 20-50 minutes
-interviews audio-recorded
-all children were male
-no treatment
-Top 3 themes found throughout all 4 phone interviews:
1. Unfulfilled hopes for mealtime as quality time
2. Reasons for mealtime not working for the families
3. Strategies that are working to make mealtime a
success or not

1. Unfulfilled Hopes for Mealtime as Quality Family Time
-dissatisfied stressful chaotic
-missing out on normal family activity
2. Reasons for Mealtime Not Working for the
-limited variety of foods
-failure to sit still, grab a bite then run
-certain temperature
3. Strategies to Make Mealtime a Success.or Not
-keeping the peace at meal time attending to the
-Cook several meals to make sure all members of the
family were happy
Food Neophobia
Overcoming The Obstacles
-Helping Autistic Children overcome their fear of new
foods or fear of foods with different textures and
consistency can be achieved through several different

Positive Reinforcement
Visuals / Structure & Routine
Systematic Desensitization

Positive Reinforcement
Telling a child that if he or she does something
we ask them to do, in return, he or she will do
something they really want to do.
Chose positive words verses negative
Ex: If you sit at the table during the entire meal
and select one food to touch, then.
If you do not yell or throw things and dont
say no then.
Visuals / Structure & Routine
-Visuals help the child form a
picture in their head as to
what they are to do.
-Visual schedule provides
-Try to offer both meals and
snacks around the same time; get
child into a routine
-Small servings
-Timed meals
-Introduce new food item with
two preferred food items
Systematic Desensitization
A type of behavioral therapy that aims to
remove the fear response of a phobia, and
substitute a relaxation response to the
conditional stimulus gradually using counter
conditioning Simplyphsychology.org
Systematic Desensitization
Scenario: Presenting celery to an Autistic child for
the 1
1. Child allows celery to be on plate
2. Child will pick up celery, smell celery , yet not
put into mouth
3. Child will bring celery to their lips and kiss
celery, but not put into mouth
4. Child will lick celery
5. Child will take a bite of celery
Questions & Answers With Mr. Fink
Q: Growing up, was feeding Shane or getting
him to try new foods difficult?.
A: Yes very; when he was younger, ~3 he was
very flexible, would try almost anything. Then
as he got older he got very strict with what he
would eat. It was not until ~10 years old when
he became more flexible again.
-Q: What techniques/strategies did you use to
break his eating habits?
-A: He became very trusting of us; if we said
that we thought he would like it he eventually
was willing to try it. We would place a new
item on his plate, hed freak out. Wed try it
again the next day hed touch it but wouldnt
eat it or he would bring it to his mouth, lick it
and say see I tried it Dad. (systematic
-Q: If food was presented differently or not the
exact brand he liked would Shane refuse to
eat it?
-A: Oh yeah. There was a time where wed
make him mac & cheese yet hid the box and
he would refuse to eat it because he could tell
it was not Kraft Mac & Cheese. If food was cut
differently/appeared differently hed look at it
for a while before he would eat it or wouldnt
eat it at all.
-Q: Did Shane every act out or behave
inappropriately at meal time (run around the
table, throw food, yell, etc.)?
-A: There were times when he was younger
that we would have to completely walk out of
a restaurant because of the way he was
behaving. Now he brings his video game with
him, his drawing pad/game book to occupy
him. When it is time to eat he will focus on his
food and engage in conversations with us.
-Q: How is Shane now with
-A: Surprisingly Shaney is
not crazy about sweets.
His go to dessert is
chocolate chip cookies.
Skittles are his favorite
candy, he never goes for
chocolate bars. Believe it
or not he used to not like
ice cream a few years
back. Now he loves it,
chocolate is his favorite.
Amanda I was acting
strange back then;
wasnt I Dad?
-Q: How would you describe Shanes diet now?
Is he more willing to try new foods, if so
-A: Overall, I would say he has a fairly balanced
diet. When he was younger he definitely stuck
to carbs. Today he does not eat any red meat
(Mothers choice) and has not had milk since
he has grown out of his bottle years ago. He
eats his select fruits and vegetables, protein
including turkey, chicken, turkey meatballs,
and even fish. Every now and then hell snack
and when he does it is cheese and crackers.
Questions & Answers With Shane Fink
-Q: Alright dude if you were stuck on a desert
island, what are the top 5 foods you would
-A: 1. Spaghetti w/ sauce. 2. Pizza. 3. Mac &
Cheese. 4. Apples. 5. Oranges. Dude
-Q: What kind of fruits do you like?
-A: Red apples, oranges, bananas, strawberries,
grapes. Dude.

-Q: Do you eat any vegetables?
-A: I love carrots. I like green beans (raw) and corn
and mashed potatoes.
Is this all about food
-Q: What do you have for breakfast?
-A: Blueberry poptart, turkey sausage, apple
juice, yogurt.

-Q: How about lunch, what do you usually eat
for lunch?
-A: You know dude a hot dog in a bun
both Sprite
Id pick Sprite
but I guess I
could try that
I like all pizza, round or square. I like
cheese so Id take the pepperoni off.
I like cut
down the
Ive only had
a few. At prom
in my salad.
I like salad I
had it at
Oh thats broccoli.
Ive never had it but I
can try it if you want
Amanda, dude.
-It is not guaranteed that using the strategies
mentioned in the previous slides will reverse the
childs eating behavior
-The use of experts may be required
-Some parents may look for supplementation or
special diets
-Further research is needed to better understand
the long term affects of selective eating and nutrient
intake/developmental concern/long term health
among autistic children
Keep In Mind
B. Fink, personal communication. August 20
, 2014.
Curtin, C et al. The prevalence of obesity in children with autism: a secondary data analysis using
nationally representative data from the National Survey of Children's Health. BMC Pediatrics. 2010; 10: 1-
Define Autism. http://www.cdc.gov/ncbddd/autism/facts.html . Updated March 20th, 2014. Accessed
August 8
, 2014.
Eating Among Autistic Children. http://www.youtube.com/watch?v=uRhPVEvTa3s. Published February 12,
2014. Accessed August 10
, 2014.
Hubbard KL, Anderson SE, Curtin C, Must A, Bandini LG. A comparison of food refusal related to
characteristics of food in children with autism spectrum disorder and typically developing children. Journal
of The Academy of Nutrition and Dietetics. August 2014; 2014: 1-7. http://www.andjrnl.org/article/S2212-
Kral TVE, Eriksen WT, Souders MC, Pinto-Martin JA. Eating behaviors, diet quality, and gastrointestinal
symptoms in children with autism spectrum disorders: a brief review. Journal of Pediatric Nursing. 2013;
28: 548-556
Marshall J, Hill RJ, Ziviani J, Dodrill P, Features of feeding difficulty in children with autism spectrum
disorder. International Journal of Speech-Language Pathology. 2014; 16: 151-158.
Palmieri MJ, Powers KM. Feeding Your Child With Autism: A Family-Centered Guide to Meeting The
Challenges. Bethesda, MD: Woodbine House; 2013.
S.Fink, personal communication. August 20
, 2014.
Suarez MA, Atchison BJ, Lagerwey M. Phenomenological examination of the mealtime experience for
mothers of children with autism and food selectivity. American Journal of Occupational Therapy. 2014;68:
Tougas, L. Nutrition Challenges in Autism Spectrum Disorder. [PowerPoint]. Boston, MA. 2013.
What is Autism? http://www.autismspeaks.org/what-autism . Accessed August 8th, 2014.
What Is Systematic Desensitization? http://www.simplypsychology.org/Systematic-Desensitisation.html .
Published 2008. Accessed August 14
, 2014.