Feeding and Swallowing Issues in Autism Spectrum Disorders

Abstract

Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children’s adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children’s restrictive diets supplant more healthy food options. When this is combined with the children’s noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices – aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.

Keywords:

• autism
• Covid-19
• feeding management
• fussy eating

Abbreviations

AAC, augmentative and alternative communication; AN, anorexia nervosa; ARFID, avoidant/restrictive food intake disorder; ASD, autism spectrum disorder; BAMBI, Brief Assessment of Mealtime Behavior Inventory; Covid-19/SARS-CoV-2; DSM-5, Diagnostic and Statistical Manual of Mental Disorders-5; ICF, International Classification of Functioning, Disability and Health; MDT, multidisciplinary team; OT, occupational therapist; PT, physiotherapist; SLP, speech-language pathologist.

Submission Declaration and Verification

This work described has not been published previously, that it is not under consideration for publication elsewhere, that its publication is approved by the author who is responsible for the work that was carried out, and if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.

Disclosure

The author declares no conflict of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

SA is supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No. G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Center, Norwegian Agency for Development Cooperation (Norad), and by the Wellcome Trust [reference no. 107768/Z/15/Z] and the UK Foreign, Commonwealth & Development Office, with support from the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme. The statements made and views expressed are solely the responsibility of the Fellow.