With April 2nd designated as World Autism Awareness Day, it's a timely moment to explore the realities of living on the autism spectrum. In the UK alone, more than one in 100 people are autistic, meaning around 700,000 autistic adults and children live here. A significant challenge is the backlog in autism assessments, with over 150,000 people currently waiting.

At Uniquely Created U (UCU), we understand that even basic daily activities can present hurdles for autistic individuals. One particular challenge is mealtime, as children with autistic traits are far more likely to develop selective eating habits than their neurotypical peers. This article delves into the connection between autism and selective eating, offering insights and strategies to navigate mealtimes for autistic children.

Autism Spectrum Disorder (ASD), often simply called autism, is a developmental disability characterised by differences in brain function. It affects how a person perceives and interacts with the world around them.

Here's a very basic breakdown of how autism can manifest in various ways:

• Social communication and interaction: People with autism may struggle with interpreting social cues like body language and facial expressions. This can make social interactions confusing and lead to difficulties in forming friendships or understanding social situations.
• Restricted, repetitive behaviours and interests: Many autistic individuals are fixated on specific topics or activities. They may engage in repetitive behaviours like lining up toys or repeating phrases, which can provide comfort and predictability.
• Sensory Sensitivities: The world can be a more intense place for people with autism. They may be overly sensitive to sounds, textures, tastes, smells, or bright lights. This can lead to sensory overload in overwhelming situations.

It's important to remember that autism is a spectrum. This means the way it affects people can vary greatly. Some individuals may have significant challenges with communication and social interaction, while others may function quite well in these areas but struggle with sensory sensitivities.

Our understanding of autism is constantly developing, and the way we define it may change in the future.  ASD encompasses a wide range of experiences, and some people argue that the spectrum is too broad. They point out that it includes individuals with very different needs, from those requiring constant 24/7 support to those who might simply find bright lights overwhelming.

Regardless of how autism presents itself in an individual, challenges with selective eating are a frequent occurrence. In fact, a significant portion, around 89%, of autistic children struggle with aspects of eating. This can be due to sensory sensitivities, a desire for routine, or even digestive issues. These factors can limit dietary choices and make mealtimes stressful for both the autistic person and their caregivers.

Selective eating, in the context of autism, goes beyond just being a "picky eater." It's a pattern of restricted food choices that can be caused by various factors related to autism. Here's a breakdown:

• Limited variety: Children with selective eating tend to stick to a very small range of familiar foods. They may refuse to try new things or even reject foods they previously enjoyed.
• Sensory aversions: Taste, texture, smell, and appearance of food can play a big role. Certain textures might feel unpleasant in the mouth, strong flavours might be overwhelming, or the visual presentation of food might be off-putting.
• Desire for predictability: Routine and familiarity comfort autistic individuals. Selective eating can be a way of maintaining control over mealtimes and avoiding the anxiety of new or unpredictable foods.

It's important to distinguish selective eating from eating disorders. While both may involve limited food choices, the motivations differ. Selective eating in autism is driven by sensory sensitivities and a desire for routine, not weight control or body image concerns. Let’s look at the issues in a little more detail.

Sensory Overload

The world can be an overwhelming place for someone with autism. Everyday sights, sounds, smells, tastes, and textures can be amplified and become intensely unpleasant. This can be particularly true at mealtimes, where multiple senses are bombarded all at once:

• Taste: Strong flavours, bitterness, or spiciness can be intolerable. Unusual textures like mushy vegetables or grainy bread might feel unpleasant in the mouth.
• Smell: Certain food odours can be overpowering or even nauseating. This can make trying new foods particularly difficult.
• Touch: The texture of food on the skin or utensils can be a source of discomfort. For example, someone might dislike the feeling of wet lettuce or the coldness of metal cutlery.
• Sight: The visual presentation of food can be off-putting. Brightly coloured foods, messy plates, or unfamiliar arrangements might cause anxiety or even meltdowns. Some individuals may prefer to see their foods laid out separately and not touching each other on their plate to ensure different textures and flavours can be eaten separately.
• Sound: The clatter of dishes, chewing noises, or even background music can be distracting and contribute to sensory overload.

For example, trying different cultural foods with strong smells and tastes could stimulate sensory challenges which if not enjoyed could also impact future social situations. The ability to visit a noisy restaurant, for example, for a social gathering where similar strong smells and flavours may be present may immediately trigger hypersensitivity and sensory overload.

The need for predictability

Many autistic individuals find comfort in routine and familiarity. This extends to mealtimes, where a predictable menu and consistent environment can create a sense of control and reduce anxiety. Here's how the need for predictability can impact eating:

• Limited Food Choices: Sticking to a small set of familiar foods provides a sense of security and avoids the potential for overwhelming sensory experiences with new dishes.
• Mealtime Routines: Having a consistent schedule for meals and snacks, along with established routines like setting the table or washing hands beforehand, can create a sense of calm and predictability.
• Resistance to Change: Introducing new foods or changing the mealtime routine can be highly disruptive. This can lead to meltdowns or tantrums as the individual struggles to cope with the unexpected.

Gastrointestinal Issues

Some autistic people experience digestive problems that can make certain foods uncomfortable or painful to eat. This can lead to an association of specific foods with negative feelings and further restrict their diet.

Mealtime challenges

The combination of sensory sensitivities and the need for predictability can create significant challenges during mealtimes for autistic individuals and their caregivers. Children may flatly refuse anything but their preferred foods, adhering strictly to familiar options. This, coupled with a sensitivity to sensory overload or disruptions in routine, can easily trigger meltdowns, making mealtimes stressful for everyone involved.

Furthermore, a limited diet can lead to deficiencies in essential vitamins and minerals, impacting a person’s overall health. Perhaps most significantly, selective eating can create social isolation as participating in shared meals with friends or family becomes difficult.

It's important to remember that these challenges are not due to a lack of cooperation or bad behaviour. They are a result of the underlying neurological differences associated with autism.

At Uniquely Created U we appreciate how stressful and impactful selective eating can be, not only for the individual but for the whole family. We also appreciate the very real concerns about nutritional deficiencies and consequently, the impact this can have on the ability to be able to lead a healthy and fulfilled life.

The great news is that this is a manageable condition.

At Uniquely Created U, we draw on our own personal insights coupled with our years of professional expertise, to approach Selective Eating and ARFID with a unique blend of empathy and science.

Read our blog on Strategies to expand food choices and reduce stress and find out how our multidisciplinary team of GPs, registered nutritionists, dieticians, and behavioural change and stress management specialists, are here to help guide you to a better understanding of the condition and help address the underlying and deeper sensory issues at heart through our personalised support.

You don't have to navigate this alone.