Thursday, 24 March 2011

Food, feeding and autism

It's Bacon Conoisseurs’ Week this week here in the UK. Er.. happy Bacon Conoisseurs’ Week. Enjoy your er... bacon.

I know that this is a bit of a flaky way to start a post on food but please bear with me. The main reason that I am taking a look at food and feeding in autism spectrum conditions now is because of one of my previous posts on Kanner's original descriptions of autism and the fact that 6 of his 11 patients presented with early feeding problems. This really got me thinking about food (not just early feeding problems) as an issue.

Also, last night I chanced upon a programme called Supersize vs Superskinny Kids on Channel 4 and quite frankly I was pretty shocked by what I saw - not Mary Whitehouse shocked - but taken aback by the scale of food and feeding problems amongst quite a lot of kids nowadays in general. It got me thinking and questioning (hence the blog name): what are the main feeding issues present in childhood in autism, and are they so different from what seems to be happening with many kids in general, in these modern times?

Many years ago my colleagues and I published the results of a small scale trial looking at food and feeding behaviour in autism. It was not the best study ever done (i.e. no control group) but certainly also, not the worst. We asked parents about their child's food intake and feeding patterns, noted them in qualitative fashion and came up with a few, quite interesting things.

We found out for example that the children with autism in our group tended to have quite a restrictive diet in terms of the range of foods eaten. Nothing really earth-shattering there, given that various patterns of 'restricted' behaviour are core to diagnosis so why should feeding also not be affected?

When asked about the types of food which were included in the 'core' diet, there was some variability in the response. Some kids only liked 'dry' foods (crispy, crunchy); others only like soft foods (mushy, wet). For some kids it would be very 'bland' foods; for others it would be very 'strong' foods (I remember one child who enjoyed drinking neat cordial fruit juice without the water). Food refusal was pretty common. In some extreme cases there were reports of new foods being met with retching and/or vomiting even just by sight or smell, before taste. Food packaging also seemed to be quite important to some children. What brand, box, tin or bottle the food came from dictated whether it would be eaten or not. Some parents told us that they had taken to 'hiding' new foods in 'desired' food packages with varying degrees of success.

Looking at the other literature on food and feeding issues in autism, it looks like our study seemed to have captured the main issues: problems with food selectivity, food sensitivity (with regards to the perception of food eaten, not allergy or related mechanism) and an effect from food packaging.

Aside from the functional issues highlighted, we turn also to the more pathological aspects of food problems - when a feeding issue turns into a clinical issue - an eating disorder. There is still some controversy about whether eating disorders can/are present in autism spectrum conditions to any greater degree than in the general population.  Allowing for the fact that there may be some similarity in the cognitive profiles in autism and anorexia for example, there is only limited research on the prevalence of eating disorder in autism. One potential factor is gender: autism is male-dominated; anorexia is female-dominated; another is the varying impact of social factors which are thought to influence eating disorders. At this point I should mention that I am not going to discuss issues such as weight, BMI and diet in this post - perhaps in another post, but not this one.

We turn then to the question of whether such feeding issues are exclusive to childhood autism. Answer: probably not. Feeding problems are present in lots of different conditions including learning disability. Studies of LD seems to indicate similar issues to those noted in autism - food refusal, food selectivity, etc. Where a physical 'disability' is present, such as a cleft palette, food difficulties are exacerbated.
In the general population also, feeding problems seem to be quite prevalent. I found some difficulty in ascertaining exactly how prevalent given that lots of different factors can affect feeding habits. But many authors seem to say yes, they are prevalent to varying degrees; moderated by many things including age.

What then can we surmise from all this?

Autism is associated with food and feeding issues - yes. Other conditions are also associated with food and feeding issues - yes. Lots of children in the general population are affected by food and feeding issues - yes. Whilst not trying to downplay the effects of feeding problems in childhood autism spectrum conditions, the take-home message is that parents of children with autism are not alone on this issue.