Autism Spectrum Disorders include autism, Asperger’s syndrome, and other disorders not specified. Recent estimates put the prevalence of ASDs to 1 in every 110! It is highly likely then that health care professionals, including dietitians, will come across a patient with an ASD.
According to the Nutrition Care Manual:
“Autism spectrum disorders (ASDs) are characterized by three key manifestations:
- Impaired sociability, empathy, and ability to read other people’s moods and intentions, with resulting inadequate or inappropriate social interactions
- Rigidity and perseveration, including stereotypies (purposeless repetitive movements and activities), the need for sameness, and resistance to change
- Impaired language, communication, and imaginative play”
Children with ASDs will benefit from using a variety of approaches– behavioral health, developmental, and social.
Having an autism spectrum disorder can affect a person’s food pattern and eating behavior in several ways:
- A need for a structured routine can affect food pattern- a patient may not be accepting of eating in a different place, at different times, with different dishes/utensils, or trying different foods.
- Increased sensitivity with taste, texture, smell, and temperature – a patient may have a restricted intake of foods due to texture issues (too soft, too crunchy), smell issues (aversions to strong smells like fish, broccoli, garlic), taste issues (sweet, bitter, salty, sour, umami), temperature (too cold, too hot), and color (aversion to red foods, for example). A patient can have difficulty adjusting to new temperatures and tastes, and may have gagging/vomiting issues as a result. In addition, patients can have problems with noise levels (in a noisy school cafeteria), lighting, and can even have issues with metal utensils (metallic taste, sound of fork scraping teeth) all of which affect the patient’s nutritional status.
- Short attention span – a patient may lose interest in eating quickly, or forget to eat altogether.
- Impaired social interaction – a patient does not recognize appropriate eating behaviors from others, does not mimic or learn these behaviors from others.
Children with ASDs may have a list of just a dozen different foods that they will willingly eat. They also may eat the same food over and over again for months, then all of a sudden have an aversion to it. Combined with a short attention span, it can be difficult to get a child with an ASD to eat the appropriate amount of calories needed to maintain a healthy body weight. It is also important to make sure the child is getting enough fiber and fluid in their diet. Often when a child isn’t getting enough calories because they’re not eating enough, they’re also not getting enough fluids and fiber in their diet, which can lead to gastrointestinal problems such as chronic constipation.
Suggestions to increase bodyweight, improved gastrointestinal health, and improving protein status include encouraging the child to try new foods, keeping mealtime distractions low, modeling appropriate mealtime behaviors, introducing new foods along with favorite foods, and in age-appropriate portions. Make small, gradual changes and avoid overwhelming a child. Introduce new foods that are similar to already accepted foods (ie: child likes mashed potatoes, try mashed sweet potatoes or mashed cauliflower). It may also benefit the child to use some “stealth health” — sneak new foods or high-calorie/high-protein foods into accepted foods such as casseroles, soups, shakes, and sandwiches.
Of course in order to encourage the child to gain weight and get enough macronutrients, vitamins, and minerals each day, nutrition supplementation can be very helpful. Pediasure Sidekicks come in chocolate, vanilla, and strawberry shakes as well as juice drinks in wild berry and tropical fruit flavors. There’s also Carnation Instant Breakfast, which can be purchased in a powder form and mixed into smoothies and shakes, or a bottled drink form. ScandiShake can also be used- when mixed with 1 cup of whole milk, it totals 600 calories.
The nutrition diagnosis that dietitians would use when charting the nutrition care process could include diagnoses from intake, clinical, or behavioral. Possibilities are included below, from the Academy of Nutrition and Dietetics International Dietetics and Nutrition Terminology, 4th edition.
- Increased energy expenditure (NI-1.1)
- Inadequate energy intake (NI-1.2)
- Inadequate oral intake (NI-2.1)
- Excessive oral intake (NI-2.2)
- Limited food acceptance (NI-2.9)
- Inadequate fluid intake (NI-3.1)
- Excessive fluid intake (NI-3.2)
- Increased nutrient needs (NI-5.1)
- Malnutrition (NI-5.2)
- Inadequate fiber intake (NI-5.8.5)
- Inadequate protein intake (NI-5.7.1)
- Inadequate mineral intake (NI-5.10.1)
- Inadequate vitamin intake (NI-5.9.1)
- Swallowing difficulty (NC-1.1)
- Biting/chewing (masticatory) difficulty (NC-1.2)
- Altered gastrointestinal function (NC-1.4)
- Impaired nutrient utilization (NC-2.1)
- Food–medication interaction (specify) (NC-2.3)
- Unintended weight loss (NC-3.2)
- Self-monitoring deficit (NB-1.4)
- Disordered eating pattern (NB-1.5)
- Limited adherence to nutrition-related recommendations (NB-1.6)
- Undesirable food choices (NB-1.7)
- Physical inactivity (NB-2.1)
- Inability to manage self-care (NB-2.3)
- Impaired ability to prepare foods/meals (NB-2.4)
- Self-feeding difficulty (NB-2.6)
- Visual disturbances that cause interrupted mealtimes
PES statements could include:
- Inadequate energy intake related to diagnosis of Asperger’s syndrome as evidenced by patient at 68% ideal body weight.
- Limited food acceptance related to Autism disorder as evidenced by patient’s reports of limited food/beverage intake inconsistent with nutrition reference standards.
- Malnutrition related to current medical diagnosis as evidenced by BMI < 5th percentile.
- Inadequate mineral intake (iron) related to food selectivity and hypersensitivities, as evidenced by food record analysis (iron intake < 3 mg/day) and low hematocrit.