By: Robert O’Hare, MS, BCBA, LABA-MA, LBA-NY

Stories abound about individuals with Autism Spectrum Disorder (ASD) struggling to accept new foods into their diets.  One does not have to look far to learn of a family who must be near a McDonald’s restaurant at all times because their child will only eat Chicken McNuggets.  Some individuals will only eat foods of a certain color, specific food group, e.g., fruits, carbohydrates, etc. or consisting of a certain texture,e.g., grainy, pureed, minced, etc.  As Tarbox and Bermudez (2017) describe, food selectivity issues can interfere with attempts to establish mealtimes with all family members at once.  Also, special accommodations need to be made ahead of time regarding what foods a child will eat in order for the whole family to enjoy a community outing. 

Highlighting the impact of a selective diet on an individual’s overall physical health and development, Hubbard, Anderson, Curtin, Must, and Bandini (2014) found that children with ASD typically refused more foods than typically developing children based on texture (77% vs. 36%), taste or smell (49% vs. 5%), and brand (15% vs. 1%).” (p. 895, as cited in Peterson, Piazza, Ibanez, and Fisher, 2019)  In addition, a common replacement for healthier options like fruits and vegetables is often a diet deficient in nutrients and high in fat, sodium and sugar.  In other words, children with ASD who have a selective diet are likely to gravitate towards what one might consider junk food such as chips and candy (Peterson, Piazza, and Volkert (2016) and Schreck, Williams, & Smith (2004) as cited in Peterson, Piazza, Ibanez and Fisher, 2019).  

Fortunately for these individuals and their caregivers, a variety of interventions based in ABA can be effective at addressing food selectivity problems.  Provided below are some strategies which have been shown to be effective at improving the number and type of foods individuals consume:

• Rewarding acceptance of non-preferred foods-  

Sometimes called “Grandma’s Law,, this procedure involves giving some type of reward for the individual’s acceptance of eating a new food.  For example, one part of the strategy used by Anderson and McMillan (2001) was to give children a bite of preferred food after they ate a bite of nonpreferred food.

• Non-removal of the spoon-  

Another approach to treat food selectivity is called “non-removal of the spoon” (Anderson & McMillan, 2001; Peterson et al., 2019).  Given that some individuals with food selectivity issues might display refusal behaviors, this method is sometimes added to the “Grandma’s Law” procedure in order to improve acceptance of new foods.  Although variations exist, the general method is to hold the food in front of the individual’s mouth, i.e., on a spoon and not allow the individual’s refusal behaviors to work for them.  This means that if the child bats the spoon away, turns their head away, or tries other ways to avoid or escape eating the food, the requirement for eating remains until the food is consumed (Tarbox & Bermudez, 2017).

• Simultaneous presentation-  

This means that foods are blended into other foods in order to increase acceptance.  These involve making salads or combining foods in food processors or blenders, with the aim of fading in the non-preferred food in increasingly greater proportions (Tarbox and Bermudez, 2017).

These interventions are the tip of the iceberg in terms of what can be done to address an individual’s unique needs.  Practitioners of ABA strive to determine the most effective intervention for each person who receives services, which may include a combination of strategies, i.e., an “intervention package.”  The effort put into treating an individual’s food selectivity issues will likely benefit their integration into other areas of life, such as socializing with peers, holiday gatherings, and community outings.

Sources:

Anderson, C.M., & McMillan, K. (2001).  Parental use of escape extinction and differential reinforcement to treat food selectivity.  Journal of Applied Behavior Analysis, 34, 511-515.

Hubbard, K. L., Anderson, S. E., Curtin, C., Must, A., & Bandini, L. G. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. Journal of Academy of Nutrition and Dietetics, 114, 1981–1987. https://doi.org/10. 1016/j.jand.2014.04.017

Peterson, K.M., Piazza, C.C., Inbanez, V.F., and Fisher, W.W. (2019).  Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder.  Journal of Applied Behavior Analysis, 52, 895-917.

Peterson, K. M., Piazza, C. C., & Volkert, V. M. (2016). A comparison of the modified-sequential oral sensory approach to an applied-behavior analytic approach in the treatment of food selectivity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 49, 485–511. https://doi.org/10.1002/jaba.332

Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism. Journal of Autism and Developmental Disorders, 34, 433–438. https://doi.org/10. 1023/b:jadd.0000037419.78531.86

 Tarbox, J. & Bermudez, T.L. (2017).  Treating feeding challenges in Autism: Turning the tables on mealtime.  Academic Press.

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