Summarize 3 articles

Summarize at least 3 articles that explore the GI and feeding challenges of children with autism.

Childhood autism, feeding problems and failure to thrive in early infancy

This article did a case study on seven children with autism and looked at their early eating/feeding habits and failure to thrive diagnosis. These children had very low BMI. Eating disorders are common in 25-30% general population but 80% of developmental delays. The article discusses “the physical process of feeding can be disrupted through structural abnormalities or neurodevelopmental disabilities. Disruption of the process of learning to eat and accept new tastes during the critical ‘‘window’’ of opportunity can result in both oral-sensory and oral-motor dysfunction. Infants experiencing early adverse feeding experience such as recurrent vomiting (especially gastrooesophageal reflux) are particularly at risk for failure to thrive.”  The study showed that all children had problems early on, some had difficulty breast-feeding or bottle-feeding, all had difficulties weaning to solids. All had either selective eating or refusal to eat between 2-5 years of age.  The outcomes ranged 5-13 years showed better BMI and better growth but many still had ritualistic eating, selective eating, texture issues, and one child continues to be fed via gastrostomy.  This research article wants clinicians to be alert to feeding problems and FTT in young children as a potential child with ASD.

Correlates of Specific Childhood Feeding Problems

This article looks at five defined feeding problems: food refusal, food selectivity by type, food selectivity by texture, oral motor delays and dysphagia. They compared this to predisposing factors including developmental disabilities, GI problems, cardiopulmonary problems, neurological problems, renal disease and anatomical anomalies (like cleft palate).  It was discovered that gastro-esophageal reflux was the most prevalent condition associated with food refusal.  The three categories of developmental disabilities in this study were autism, Down syndrome, and cerebral palsy.  Autism had the highest rating for food selectivity and the lowest of the three developmental disabilities for food refusal, oral motor delays and dysphagia.  They also noted that constipation was very common in children with autism.  They reported that if constipation is resolved, children will have increased appetite and improved feeding. They report that behavioral therapy has proven to be effective in treating food refusal and food selectivity.

Feeding Problems in Children with Autism Spectrum Disorders: A Review, Focus on Autism and other Developmental Disabilities

This article looks at research regarding feeding issues/behaviors (selective eating, refusal to eat with no medical condition) and intervention with children with autism. It discusses “a number of reasons have been suggested for the prevalence of feeding problems in children with ASD, including a concentration on detail, perseveration, impulsivity, fear of novelty, sensory impairments, deficits in social compliance, and biological food intolerance. Parental anxiety, reinforcement of negative feeding patterns, and communication difficulties have been suggested as additional social reinforcers that contribute to the maintenance of maladaptive feeding behaviors in this population.”

Mealtime behavior and eating problems aren’t necessarily assessed until a child is diagnosed with failure to thrive and at that point growth rates are well below average.

These studies in other populations have investigated numerous interventions, including differential reinforcement, escape extinction, the Premack principle (eat non-preferred food then can eat preferred food), behavioral momentum, and textural manipulation.  All the interventions had a positive outcome. 

I feel this article did a nice job summarizing feeding issues and some of the research.  After reading this article and a few others, it appears that once the GI issues are resolved, a behavioral program will need to be implemented to change the eating habits/fears/etc. for the best outcome.

Field, D., Garland, M., Williams, K. (2003) Correlates of Specific childhood feeding problems Journal of Paediatric Child Health 39:299-304

Keen, D., (2008) Childhood autism, feeding problems and failure to thrive in early infancy.  European Child Adolescence Psychiatry 17:209-216.

Ledford, J., Gast, D. (2006) Feeding Problems in Children with Autism Spectrum Disorders: A Review, Focus on Autism and other Developmental Disabilities 21:3 153-166