Feeding, Eating & Nutrition in 
                                     Autism Spectrum Disorders
                                                  Kimberly A Brown, PhD
                                               Licensed Pediatric Psychologist
                                                   Brianne L Schmidt, RD
                                                      Pediatric Dietitian
                                                     Neurodevelopmental 
                                                  and Behavioral Pediatrics
                                            Golisano Children’s Hospital at Strong 
                                                     Objectives
                            •  Understand common feeding problems in children with ASD
                            • Review the literature on nutritional status of children with ASD
                            • Discuss dietary interventions frequently used by families of 
                               children with ASD and the evidence behind their use 
                            • Discuss recommendations for improving nutritional status of 
                               children with ASD
                            • Learn about behavioral interventions frequently used to treat 
                               feeding issues in children with ASD
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                             Common Feeding Problems in ASD
                            •  Food selectivity by type and/or texture
                            •  Food selectivity by brand and/or container
                            •  Perseverative interests, obsessions, presentation and 
                               routines
                            •  Food neophobia, anxiety
                            •  Food refusal
                            •  Oral motor delay/deficit
                            •  Parent‐child interactions
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                                    Food Selectivity
                                    • Type
                                    • Texture
                                    • Brand
                                    • Container
                                    • Visual presentation
                        Perseverative Behaviors at Meals
                     • Bottles, cups
                     • Utensils, plates, bowls
                     • How food is presented on plate
                     • Food can’t touch, only eat 1 food at a time
                     • Significant disruptive behaviors if food items 
                       are exactly the same
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                                       Food Refusal
                     • Head turning
                     • Batting at the spoon
                     • Throwing food
                     • Spitting food out
                     • Holding food in the mouth (packing)
                     • Screaming
                     • Leaving the table –refusing to sit**
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                                   Oral Motor Delays
                     • Poor tongue lateralization
                     • Delayed chewing skills
                     • Hypersensitive gag reflex
                     • Poor endurance/weak muscles
                     • Difficulty biting/tearing food
                     • Tactile and oral defensiveness
                              Parent‐Child Interactions
                     • Attention
                     • Follow‐through
                     • Distractions
                     • Siblings
                               Current DSM Definition
                     • Persistent failure to eat adequately or gain 
                       weight, or significant weight loss over at least 
                       one month
                     • Not due to existing medical condition
                     • Not better accounted for by another mental 
                       health disorder or lack of food
                     • Onset before age 6
                     • Failure To Thrive
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                About 30 Years Ago…
           • FTT kids were admitted and fed by nursing
           • If they gained weight, they went into foster care
           • Faulted the parent for poor weight gain
           • Research conducted on parent variables related 
            to feeding demonstrated they were not the 
            cause of the feeding problem.
              Origins of Feeding Disorders
           • Not one that accounts for all problems
           • Assume that an aversive event was paired with 
            eating, usually a physical illness, disrupted 
            eating
           • Illness is treated, but the aversion of food 
            remains
           • Classical Conditioning Model
           Origins of Feeding Disorders –Con’t
           • Treatment sought well after problem arises.
           • Many parents report feeding concerns at the 
            time they tried to introduce solids/table foods
           • Disruptions in the developmental food 
            continuum
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