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 autism: -Autistic disorder -Childhood disintegrative disorder -Aspergers syndrome -Pervasive developmental disorder Objectives 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 communication -lack/have trouble with social awareness & interactions -Imaginative behaviors Child Disintegrative Disorder -Child develops normally til 2 or 3 years old -Severe regression of social and communication skills Aspergers Syndrome -Mildest form of ASD -Highly functioning -Undiagnosed until child/adulthood -Lack normal back & forth conversation -Narrow interests Pervasive Development Disorder -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 Children Food Refusal / Food Selectivity (picky eating) Disruptive Mealtime Behavior 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 FTT 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 Macronutrients: 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 groups ASD vs. TDC - Micronutrient Few consistent differences in the nutrient adequacy of childrens diets between both groups 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 calcium 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 children. 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 calculated
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 th percentile of CDC sex=specific BMI growth chart RESULTS 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.. Texture Appearance Temperature Presentation Brand Packaging Color Taste Smell 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 -Results 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 Taste/Smell Disruptive Mealtime Behavior -Tantrums -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 foods
Examination of Mealtime Experience: Method Examination of Mealtime Experience: Data Collection/Results: -DATA -Phone interview 20-50 minutes -interviews audio-recorded -Results -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 Family -limited variety of foods -failure to sit still, grab a bite then run around -certain temperature 3. Strategies to Make Mealtime a Success.or Not -keeping the peace at meal time attending to the environment -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 ways.
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. verses If you do not yell or throw things and dont say no then. http://www.youtube.com/watch?v=uRhPVEvTa3s Visuals / Structure & Routine -Visuals help the child form a picture in their head as to what they are to do. -Visual schedule provides structure -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 st time: 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 desensitization) -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 sweets? -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? -Shane -Q: How would you describe Shanes diet now? Is he more willing to try new foods, if so why? -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 bring? -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 dude?-Shane -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 VS Theyre both Sprite dude Id pick Sprite but I guess I could try that Amanda. VS VS I like all pizza, round or square. I like cheese so Id take the pepperoni off. VS I like cut down the middle better. Ive only had a few. At prom in my salad. I like salad I had it at prom 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 References B. Fink, personal communication. August 20 th , 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- 5. Define Autism. http://www.cdc.gov/ncbddd/autism/facts.html . Updated March 20th, 2014. Accessed August 8 th , 2014. Eating Among Autistic Children. http://www.youtube.com/watch?v=uRhPVEvTa3s. Published February 12, 2014. Accessed August 10 th , 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- 2672(14)00460-2/abstract 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 th , 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: 102-107. 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 th , 2014.