Feeding disorders are often present in children with ASD, and food selectivity is one special characteristic. The scientific literature is reporting food selectivity in 46-90% of children with ASD, in a study in Slovak ASD children almost 70% of children were picky eaters. Its manifestations are more serious than the usual pickiness, which to some extent is also manifested in children with typical development. It is not an exception that a child with ASD is sticking to the same small group of foods. Children with ASD often prefer crunchy, dry foods, often with very low nutritional value. On the contrary, they reject nutritious foods such as fruits, vegetables, dairy products or meat dishes.
Food selectivity is related to differences in sensory perception (sensory sensitivity), as a result of which the child only accepts foods with a certain consistency, shape, color, temperature, etc. The limited diet is also a consequence of neophobia – fear of unknown food, which is the source of the child’s reluctance to taste new foods. However, it can also be caused by chewing or swallowing problems, or insufficient self-service skills in regards to eating. Elements of stereotypical behavior can also manifest themselves while dining in that the child always requires serving food in the same way (on the same plate, always arranged the same on a plate, etc.).
As a result of selectivity, the variety and nutritional value of the diet is reduced. Although children who are picky eaters are consuming enough calories, fats, or carbohydrates, protein intake is reduced, as is the fiber content in the diet. This adds to bowel problems as well as intestinal microbiota disorders. The intake of vitamins and minerals is also reduced, which, if it lasts longer, is dangerous due to increased risk of metabolic and functional consequences. Especially in older children with ASD, a higher incidence of underweight was observed, on the other hand, also an increased risk of obesity, to which, in addition to a nutritionally unbalanced diet, a lack of physical activity also contributes.
Eating in child with ASD may also be a social problem for the family; the child shows his/her lack of interest in food by running away from the table, turning his/her head away from food, or spitting out. It also happens that children show extreme undesirable behavior in an effort to avoid food. Parents stop offering the food to the child or offer something else (preferred food) in an effort to avoid conflict situations. This will reinforce the child’s adverse reaction and increase the child’s likelihood of using this behavior in the future. This creates a vicious circle in which parents, in an effort to help the child, actually reinforce problematic behavior.
Problems with food intake represent a significant emotional stress for both the child and the parents, who may perceive the situation as a failure in the basic parental role – to provide the child with adequate nutrition.
Proper nutrition is a basic prerequisite for a child’s healthy development. Even children with ASD are advised to eat a varied, rational diet. Within the family, the child should be guided to proper eating habits. Achieving improved eating habits is not easy, it is usually a long-term gradual process. It may take longer for a child with ASD to eat a varied diet. One of the most effective ways is to apply the Applied Behavioral Analysis (ABA) approach.