Autism, Diet & the NDIS
Advice from an Accredited Dietician
It is estimated that approximately 1% of the Australian population is on the autism spectrum, characterised by fundamental differences in communication, social interaction, sensory receptivity, repetitive behaviours and highly focused interests. Whilst autism has been linked to several commonly presenting physical health challenges, it is said that “if you’ve met with one person with autism, then you’ve met with one person with autism”. This saying is also applicable when it comes to the diversity of nutrition-related concerns associated with autism and diet.
When to See an Accredited Practising Dietitian About Autism / Diet
Food selectivity tends to be the area that gets the most focus when it comes to autism and diet. However, there are many reasons why you or your child might benefit from seeing a dietitian, even if food selectivity isn’t occurring. If you are wanting to speak to someone about an autism diet, referral to an Accredited Practising Dietitian (APD) may be indicated for the following reasons:
Ritualistic mealtime behaviours which affect food & fluid intake
(requiring nutrition supplements)
Food allergies and intolerances
Autism Diet: Picky Eaters vs. Problem Feeders
Historically individuals with autism have been described as “picky eaters” which ultimately results in those living with autism being isolated and stigmatised. Often, individuals with autism are “problem feeders” which differ from “picky eaters” in the following ways (i):
- Picky Eaters generally eat at least 30 different foods whereas Problem Feeders have a restricted range of foods and generally eat less than 20 foods.
- “Food jag” is a term used to describe the behaviour of eating a food over and over, and then suddenly stopping eating the food. A Picker Eater will often accept and eat the food after taking a 2-week break, whereas a Problem Feeder will rarely ever accept that food again even after taking a break (results in a decreasing number of foods in a child’s food range).
- Picky Eaters are generally able to tolerate new foods on their plate, and can usually touch or taste a new food, even if they do so reluctantly. Problem Feeders can cry and protest when presented with new foods.
- Problem Feeders can have difficulty accepting entire categories of food textures or nutrition groups and can be particularly averse to particularly colours, textures, smells, etc.
- Picky Eaters often eat different foods at a meal than the rest of the family but will eat with the family. Problem Feeders will often prefer to eat separately in their own space.
A Dietitian’s Role in Supporting Problem Feeders
Dietitians work with Problem Feeders and their families to ensure a well-rounded autism diet including adequate food intake and variety for normal growth and development. This is accomplished via:
- Thorough nutrition assessment (height, weight, oral intake and diet history, blood test results (if available)).
- Forming part of the multi-disciplinary team approach to tackling Problem Feeding. Our dietitians work with our participants’ occupational therapists, speech pathologists and psychologists to ensure best outcomes. Dietitians guide the trialing of foods of most interest to ensuring nutritional adequacy, based on thorough assessment.
- Upskilling and training families in arranging a safe mealtime environment for the child.
- Providing education to the family and the child on the importance of nutrition. This involves finding the motivator for the child e.g. I want to be big and strong like my Dad.
- Upskilling and training families in supporting their child to trial new foods in their own time. Trialing foods doesn’t necessarily mean tasting or consuming them. Oftentimes, the trialing phase begins by supporting the participant to become familiar with the food first. An example of how this might occur is:
- Gradual exposure, i.e. the food is present at the table for sessions,
- Progressing to touching and playing with the food e.g. making pictures out of the food
- Progressing to describing the different sensory properties of the food,
- Progressing to tasting the food when the child is more familiar.
AUTISM DIET Case Study:
Our dietitian Amanda has recently been working with a 16-year-old NDIS participant with autism and an intellectual disability. Her goal is to increase her acceptance of a broader variety of foods to rely less on carbohydrate-type foods and discretionary food choices. Her restrictive eating patterns have resulted in physical health concerns including obesity, insulin resistance (precursor to diabetes) and fatty liver disease. She has a very supportive team that consists of her family (informal supports), occupational therapist and her dietitian, Amanda.
The participant’s occupational therapist has set up a cooking program with a support worker which increases the NDIS participant’s exposure to new foods whilst not having the expectation that the participant needs to eat these foods. The participant enjoys meal preparation sessions but struggles with some sensory aspects of the task, for example, washing the fresh produce. The foods introduced in these cooking sessions have been identified as appropriate foods to add to the participant’s everyday diet, based on dietary assessment. In this case, the participant was hoping to increase her intake of protein foods so the occupational therapist supported the participant to find a protein food that may match the sensory profile of other accepted foods i.e. not hard or crunchy, not too colourful, etc. In this case, hummus was one of the foods that was prepared.
After increased exposure during cooking sessions, these foods are then introduced in dietary counseling sessions via a tasting plate whereby the participant was asked to describe the food, identify whether she could try it and proceed to trying it with a lot of support and verbal encouragement. She then practiced trialing the food on weekdays between fortnightly dietetic sessions with the understanding that she needs to increase her food variety for her health and wellbeing, and that it takes time and practice to start liking new foods.
This process continued with new foods and the participant is involved in each stage. For example, the dietitian noted that the participant needed to increase her intake of vegetables so together, they looked at different pictures of vegetables and the participant identified the ones she thought she might try.
A Note on Autism Diets
It is essential, when deciding on an autism diet, to maintain an awareness of the popular nutritional management strategies on offer that lack an evidence base (such as gluten and casein free diets). Please be sure to consult with an accredited practising dietitian (APD) should you be concerned about any potential food intolerances or allergies.
While there have been some other positive findings from more recent studies which explore the link between autism and the gut, these have been conducted using mice so more research in humans is required before these results can be extrapolated.
Take home message:
There is a lot of misinformation out there regarding the role of diet in improving symptomology of autism with claims that some diets can even cure autism! A disability dietitian will be up to date on all the research and can guide you towards the best, evidence-based information to supporting someone with autism reach their full potential regarding their health and wellbeing.
NDIS and Autism / Diet
Like more information before arranging your service agreement with Active Ability?
If you’re keen to get started with an NDIS registered dietitian to help with an autism diet and ready for a service agreement, please fill out our NDIS referral form.
Written by Rebecca Lancaster and Amanda Eldridge, Accredited Practising Dietitians
Rebecca provides Active Ability’s dietetic services in Ryde, the Inner West. St George, the Sydney CBD and the Sutherland Shire. Some of her suburbs include Gladesville, Hunters Hill, Eastwood, Hurstville, Arncliffe, Mascot, Bangor, Cronulla, Gymea, Five Dock, Glebe, Ashfield, Concord, Redfern, Waterloo, Darlinghurst and Chippendale.
Amanda provides Active Ability’s dietetic services in the Hills District, the North West of Sydney, the North Shore, Ryde, the Northern Beaches and Parramatta. Some of her suburbs include Castle Hill, Dural, Kenthurst, Cherrybrook, Kellyville, Stanhope Gardens, Pennant Hills, Blacktown, St Marys, Rooty Hill, Thornleigh, Lane Cove, Waitara, Hornsby, Dee Why, Mona Vale, Frenchs Forest, Westmead and Auburn.
(i) Adapted from the SOS Approach to Feeding available via: https://sosapproachtofeeding.com/wp-content/uploads/2019/01/Picky-Eaters-vs-Problem-Feeders-Color-white.pdf (accessed on march 30th 2021)