Feeding difficulties are a common source of concern for many parents of autistic children. Current evidence suggests that many autistic children also have sensory processing disorder and feeding disorders, with the most common feeding issues being food refusal and food selectivity (Elsayed et al., 2022).
Eating is not just about "eating something"; it is actually a highly sensory experience that involves receiving and integrating various sensory inputs, including auditory, visual, taste, smell, touch, vestibular balance perception, proprioception, and interoception.
Let's look at the following example together.
After school, Little Mei feels hungry when she returns home, which is a stimulus to her interoceptive system. Then she decides to find something to eat; she chooses sesame cookies and ice cream, and then sits down at the dining table, which requires the use of visual, proprioceptive, and vestibular balance sensations to sit in the chair.
Each type of food has different colors, appearances, smells, and tastes. They also have different textures, so the tactile sensations when we chew them are different, and the sounds they make are different too. Sesame cookies are flat, salty, and crunchy, while ice cream is sweet, frozen, and smooth, providing different sensory stimuli in terms of touch, sight, taste, smell, and hearing. Therefore, mealtime requires the integration of different sensory systems, making it a challenging experience for autistic children.
Each autistic child's sensory traits are unique. In terms of auditory sensitivity, they may dislike the sounds produced during food preparation, chewing sounds, or the clinking of utensils; in terms of visual sensitivity, they may have preferences or aversions to certain shapes and colors of food; in terms of tactile sensitivity, they may be tactile-sensitive, hating certain textures of food, or tactile-underresponsive, leading to putting too much food in their mouths at once.
In terms of taste sensitivity, current research has not fully determined which types of taste sensitivities lead to feeding difficulties. For example, one study suggests that children with oral hypersensitivity may prefer bland and room-temperature foods (Cermak et al., 2010), but on the other hand, some research suggests that children may prefer strong flavors because they have difficulty discerning or perceiving the sensation of food in their mouths, so they seek stronger sensory input (Kranowitz, 2006).
Finally, it's worth noting that we have discussed many sensory processing issues, but there are other factors related to feeding difficulties. For example, in terms of executive function, children need to plan and execute steps during mealtime. We may think that eating with a spoon is a simple task, but it actually involves many steps, such as the child understanding how to pick up the spoon, how to hold it (by the handle or the scoop? Scoop up or down? What hand gestures to use?), then picking up some rice (which also requires skill, or it can end up everywhere), and then carefully bringing it to their mouth while remembering to open their mouths.
Additionally, autistic traits, such as restrictive and repetitive behaviors, may also lead them to insist on using specific utensils, meal preparation methods, or foods with certain colors/shapes/textures.
Therefore, addressing feeding difficulties requires a careful assessment of the child's sensory abilities, executive function, and other skills to gain a deeper understanding of the potential causes of feeding difficulties and tailor interventions accordingly.
Speechie x Audiologie
Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246.
Elsayed, H. E., Thompson, K. L., Conklin, J. L., & Watson, L. R. (2022). Systematic Review of the Relation Between Feeding Problems and Sensory Processing in Children With Autism Spectrum Disorder. American Journal of Speech-Language Pathology, 1-25.
Kranowitz, C. (2006). The out-of-sync child: Recognizing and coping with sensory processing disorder (Rev. ed.). Perigee.