What is Food Selectivity and Aversion and How Prevalent is it in Children with Autism?
Has anyone described your child as a picky eater? Naturally, every one of us has preferences around food, but for someone with autism, they tend to be intensified due to sensory integration or overload issues. They may be extremely sensitive to the flavor of a food and every aspect of it, like the texture, smell, and even the color or shape. The meals they enjoy may be so limited that they end up eating the same foods, using the same dishware, and eating in the exact location for every meal. Additionally, because many people with autism face communication difficulties, they may not be able to express their preferences or dislikes regarding specific meals, upping the chances for a meltdown.
It is estimated that 50% of children with autism have just texture aversion issues, and potentially up to 80% have feeding issues. For children with autism and other developmental problems, Applied Behavior Analysis (ABA) has a long history of efficiency in promoting appropriate behavior and reducing or removing undesirable behavior. An eating problem affects children in many ways than just their ability to eat certain foods. Food selectivity can lead to inadequate nutrition, weight gain, and even a lack of social opportunities where people celebrate with food, like birthday parties.
How To Work With Food Aversion and Autism
The purpose and strategies behind ABA are to encourage and reward good behavior and to extinguish undesired behavior. Some things we can see in a child who has food aversion:
Behavior: What it can look like:
Escape/Avoidance
Running away (elopement), covering eyes, ears, or mouth, throwing food or dishware, spitting out food
Refusal
Refusing to eat any or very little food, refusing to eat food that is presented or prepared in a certain way, overly selective, and sometimes reluctant to eat whole food groups
Inflexibility
Inability to be flexible with mealtimes and their associated routine, food has “rules” (for example, not allowing foods to touch), must use the same food/same dishware
Uptick in Self-soothing Behavior
This looks different in all children; however, these behaviors sometimes have the ability to hinder the eating process
A functional evaluation is needed to determine the root cause of the child’s problematic mealtime behavior patterns. To figure out what’s influencing the child’s behavior, we need to look at both positive and negative reinforcement. Removing an unwanted food from a child’s plate after a mealtime tantrum may negatively encourage the child’s behavior. It can also be positively reinforced if it is exchanged for a preferred food. When a youngster learns that yelling and screaming to get what they want is an effective strategy, they will continue to use it as long as it gets the results they are looking for. That is to say, a child’s disorderly habits during mealtime might be reinforced by the choices and reactions of their caregiver.
Biological conditions such as allergies, reflux, oral motor difficulties, and constipation/diarrhea might potentially explain a person’s intentional refusal of foods and drinks. Be sure to rule out any medical problems by speaking with your child’s doctor before using behavior-based strategies. A behavior intervention plan will be devised based on the “ABC approach” (the antecedent, behavior, and consequence).
ABA Therapy Strategies That Can Deal With Food Aversion
ABA Strategy: What it means: What it can look like:
Positive Reinforcement
Using something (praise, stickers, toys, fun activities) to encourage desired behavior
Giving a sticker to a child who tolerates a non-preferred food on their plate or tries something new
Differential Reinforcement Alternative Behavior (DRA)
Reinforcing a desired behavior while inhibiting an undesirable one
Giving your child a goldfish cracker (or one of their favorite foods) when they eat something non-preferred
Noncontingent Reinforcement (NCR)
The child has access to their favorite activity or tangible item the whole time they are eating
The child is able to watch their favorite tv show or hold their favorite fidget toy while they eat
Stimulus Fading
Stimulus fading, in this case, involves introducing the non-preferred food in gradually higher concentrations over time so that they adjust to it
If a child likes ice cream but does not like fruit smoothies, adding a tablespoon of a smoothie to a bowl of ice cream gradually until they are consuming 90-100% of the smoothie
Simultaneous Presentation
Simultaneous presentation entails providing a less preferred dish at the same time as a highly preferred food
Non-liked foods might be placed within or covered by preferred food, or they can be served on the spoon combined with favored foods
Escape Extinction (EE)
Reinforcement for negative behaviors is no longer provided. Avoiding and escaping from mealtimes can perpetuate the food aversion cycle. A functional analysis must be conducted to investigate the motivating factor. Suppose caretakers must physically restrain a child from escaping or avoiding eating while also managing the side effects of extinction. In that case, meals may become stressful, especially if the child does not progress quickly.
Using self-suctioning dishware (if the negative behavior is throwing items) or closing the door to the playroom (if they run). Depending on the function (reason behind) the behavior, consequences will look different from case to case
SOS Approach
This clinical approach was developed by a team of doctors, Speech Pathologists, Registered Dieticians, and Occupational Therapists. During a twelve-week period, the SOS protocol is utilized as an intervention for eating issues, using a reduction sequence that gradually comprises non-preferred and preferred meals
These graduated steps can progress from tolerance being around the food (smell), then moving to the food on their plate, then touching the food, licking the food, and so on
Treating children’s feeding issues using behavioral interventions has been proven to be successful in the past. Positive reinforcement and escape extinction (EE) are the most broadly utilized interventions combined in a therapy regimen for these issues. Using EE by itself can pose new problem, like aggression, emotional outbursts and quick increases in undesirable behavior. However, research shows that in the lack of EE, some of the solutions listed above can likewise be unsuccessful.
The characteristics of the positive reinforcement activities (like reinforcer amount, and how motivated your child is by their reinforcer depending on their opportunities to access it) may impact whether positive reinforcement competes with an active escape contingency for food refusal. Because these characteristics might negatively impact the success of the reinforcement strategies (like restricting access to food), it is critical to evaluate their impact on the child’s nutritional condition.
According to Bachmeyer (2009), research shows that positive reinforcement alone can increase the child’s willingness to eat non-preferred foods without the need for EE. Because of this, it may be feasible to increase the amount or variety of foods that your child consumes without using EE if highly favored foods or beverages can be used.
The autism and “picky eating” correlation is still a mystery to researchers. As a result, Autism Speaks is presently sponsoring an investigation into how anxiety, inflexibility, and sensory difficulties might be alleviated to broaden eating options. Dietitians, occupational therapists, psychologists, and Board Certified Behavior Analysts (BCBAs) can facilitate a successful nutritional intervention to ensure that the child receives sufficient nutritional intake and reduces family stress during mealtimes. They can help identify appropriate foods, modify the sensory qualities (like texture) or the environment (external stimuli), suggest assistive eating utensils, and implement supportive behavioral interventions.
How ABA Therapy Through Apollo Behavior Can Help
As mentioned above, ABA strategies are an integral piece to aiding a child in overcoming food aversion. Not only is our team versed in tried and tested strategies, we’re constantly learning new techniques that become available to assist your child’s growth and development. Apollo Behavior strives to provide the skills necessary to succeed. We also work with your insurance provider and have a list of resources available for parents. Schedule an appointment today at any of our locations in Johns Creek, East Cobb and Lawrenceville today for services.
Autism and Food Aversion: How ABA Therapy can Help
What is Food Selectivity and Aversion and How Prevalent is it in Children with Autism?
Has anyone described your child as a picky eater? Naturally, every one of us has preferences around food, but for someone with autism, they tend to be intensified due to sensory integration or overload issues. They may be extremely sensitive to the flavor of a food and every aspect of it, like the texture, smell, and even the color or shape. The meals they enjoy may be so limited that they end up eating the same foods, using the same dishware, and eating in the exact location for every meal. Additionally, because many people with autism face communication difficulties, they may not be able to express their preferences or dislikes regarding specific meals, upping the chances for a meltdown.
It is estimated that 50% of children with autism have just texture aversion issues, and potentially up to 80% have feeding issues. For children with autism and other developmental problems, Applied Behavior Analysis (ABA) has a long history of efficiency in promoting appropriate behavior and reducing or removing undesirable behavior. An eating problem affects children in many ways than just their ability to eat certain foods. Food selectivity can lead to inadequate nutrition, weight gain, and even a lack of social opportunities where people celebrate with food, like birthday parties.
How To Work With Food Aversion and Autism
The purpose and strategies behind ABA are to encourage and reward good behavior and to extinguish undesired behavior. Some things we can see in a child who has food aversion:
Behavior: What it can look like:
Escape/Avoidance
Running away (elopement), covering eyes, ears, or mouth, throwing food or dishware, spitting out food
Refusal
Refusing to eat any or very little food, refusing to eat food that is presented or prepared in a certain way, overly selective, and sometimes reluctant to eat whole food groups
Inflexibility
Inability to be flexible with mealtimes and their associated routine, food has “rules” (for example, not allowing foods to touch), must use the same food/same dishware
Uptick in Self-soothing Behavior
This looks different in all children; however, these behaviors sometimes have the ability to hinder the eating process
A functional evaluation is needed to determine the root cause of the child’s problematic mealtime behavior patterns. To figure out what’s influencing the child’s behavior, we need to look at both positive and negative reinforcement. Removing an unwanted food from a child’s plate after a mealtime tantrum may negatively encourage the child’s behavior. It can also be positively reinforced if it is exchanged for a preferred food. When a youngster learns that yelling and screaming to get what they want is an effective strategy, they will continue to use it as long as it gets the results they are looking for. That is to say, a child’s disorderly habits during mealtime might be reinforced by the choices and reactions of their caregiver.
Biological conditions such as allergies, reflux, oral motor difficulties, and constipation/diarrhea might potentially explain a person’s intentional refusal of foods and drinks. Be sure to rule out any medical problems by speaking with your child’s doctor before using behavior-based strategies. A behavior intervention plan will be devised based on the “ABC approach” (the antecedent, behavior, and consequence).
ABA Therapy Strategies That Can Deal With Food Aversion
ABA Strategy: What it means: What it can look like:
Positive Reinforcement
Using something (praise, stickers, toys, fun activities) to encourage desired behavior
Giving a sticker to a child who tolerates a non-preferred food on their plate or tries something new
Differential Reinforcement Alternative Behavior (DRA)
Reinforcing a desired behavior while inhibiting an undesirable one
Giving your child a goldfish cracker (or one of their favorite foods) when they eat something non-preferred
Noncontingent Reinforcement (NCR)
The child has access to their favorite activity or tangible item the whole time they are eating
The child is able to watch their favorite tv show or hold their favorite fidget toy while they eat
Stimulus Fading
Stimulus fading, in this case, involves introducing the non-preferred food in gradually higher concentrations over time so that they adjust to it
If a child likes ice cream but does not like fruit smoothies, adding a tablespoon of a smoothie to a bowl of ice cream gradually until they are consuming 90-100% of the smoothie
Simultaneous Presentation
Simultaneous presentation entails providing a less preferred dish at the same time as a highly preferred food
Non-liked foods might be placed within or covered by preferred food, or they can be served on the spoon combined with favored foods
Escape Extinction (EE)
Reinforcement for negative behaviors is no longer provided. Avoiding and escaping from mealtimes can perpetuate the food aversion cycle. A functional analysis must be conducted to investigate the motivating factor. Suppose caretakers must physically restrain a child from escaping or avoiding eating while also managing the side effects of extinction. In that case, meals may become stressful, especially if the child does not progress quickly.
Using self-suctioning dishware (if the negative behavior is throwing items) or closing the door to the playroom (if they run). Depending on the function (reason behind) the behavior, consequences will look different from case to case
SOS Approach
This clinical approach was developed by a team of doctors, Speech Pathologists, Registered Dieticians, and Occupational Therapists. During a twelve-week period, the SOS protocol is utilized as an intervention for eating issues, using a reduction sequence that gradually comprises non-preferred and preferred meals
These graduated steps can progress from tolerance being around the food (smell), then moving to the food on their plate, then touching the food, licking the food, and so on
Treating children’s feeding issues using behavioral interventions has been proven to be successful in the past. Positive reinforcement and escape extinction (EE) are the most broadly utilized interventions combined in a therapy regimen for these issues. Using EE by itself can pose new problem, like aggression, emotional outbursts and quick increases in undesirable behavior. However, research shows that in the lack of EE, some of the solutions listed above can likewise be unsuccessful.
The characteristics of the positive reinforcement activities (like reinforcer amount, and how motivated your child is by their reinforcer depending on their opportunities to access it) may impact whether positive reinforcement competes with an active escape contingency for food refusal. Because these characteristics might negatively impact the success of the reinforcement strategies (like restricting access to food), it is critical to evaluate their impact on the child’s nutritional condition.
According to Bachmeyer (2009), research shows that positive reinforcement alone can increase the child’s willingness to eat non-preferred foods without the need for EE. Because of this, it may be feasible to increase the amount or variety of foods that your child consumes without using EE if highly favored foods or beverages can be used.
The autism and “picky eating” correlation is still a mystery to researchers. As a result, Autism Speaks is presently sponsoring an investigation into how anxiety, inflexibility, and sensory difficulties might be alleviated to broaden eating options. Dietitians, occupational therapists, psychologists, and Board Certified Behavior Analysts (BCBAs) can facilitate a successful nutritional intervention to ensure that the child receives sufficient nutritional intake and reduces family stress during mealtimes. They can help identify appropriate foods, modify the sensory qualities (like texture) or the environment (external stimuli), suggest assistive eating utensils, and implement supportive behavioral interventions.
How ABA Therapy Through Apollo Behavior Can Help
As mentioned above, ABA strategies are an integral piece to aiding a child in overcoming food aversion. Not only is our team versed in tried and tested strategies, we’re constantly learning new techniques that become available to assist your child’s growth and development. Apollo Behavior strives to provide the skills necessary to succeed. We also work with your insurance provider and have a list of resources available for parents. Schedule an appointment today at any of our locations in Johns Creek, East Cobb and Lawrenceville today for services.
Recent Posts
Categories