Autism is a developmental disorder characterized by a severe impairment of language, cognitive skills, and social development.10 Ritualistic and obsessive/compulsive behavior is frequently seen.1 Approximately 70r/r of children with autism have some level of mental retardation.11 The etiology of autism is unclear but the disorder is believ ed to have a neurobiology- basis with multiple possible causes, including structural abnormalities of the brain, viruses, genetic disorders. chromosomal abnormalities (fragile X syndrome), metabolic disorders (PKU). and specific seizure disorder (infantile spasms)."1 The incidence of autism has been reported as 1 in every 50()-l,(XX) people.12
Table 22-10. Common Feeding Concerns for Children with Pervasive Developmental Disorder/Autism
Difficulty with texture transition Heightened sensory responses
Restricted intake due to color/texture/temperature of foods Decreased selection ot foods over time Difficulty accepting new foods
Difficulty with administration of multivitamin/mineral supplement Difficulty with changes in mealtime environment
Adapted from Puelzl Quinn H, Levine K. Nutrition concerns for children with pervasive developmental disorder/autism. Nutrition Focus for Children with Special Health Needs 1995;10(5):3.
The primary nutrition and feeding concern in children with autism is selective intake, often due to altered sensory responses that affect how food tastes, smells, and feels inside their mouth (Tables 22-10 and 22-11). For some children, intake may be limited to as few as two or three foods or beverages. Foods may be refused due to color, temperature, texture, smell, or slight variations in taste; the accepted foods are frequently hrand-specilic. Supplementation with a multivitamin with minerals in a form the child will accept
Table 22-11. Helpful Mealtime Strategies for Children with Pervasive Developmental Disorder/Autism
Consistent mealtime environment Calm, comfortable environment
Some children focus better on eating with accompaniment of music or video
Some children do better eating with others at the table, some do better eating alone
Adapted from Puelzl Quinn H, Levine K. Nutrition concerns for children with pervasive developmental disorder/autism. Nutrition Focus for Children with Special Health Needs 1995:10(5):3.
may be difficult, possibly requiring multiple trials with various forms (liquid, powder, tablet). It is important to note that an accepted food or beverage may subsequently be refused if alterations in the taste, smell, or texture are detected when the supplement is added. Despite selective intake, adequate grow th is generally seen, with the exception of late infancy/early toddlerhood when there is sometimes poor growth as a result of the transition from baby foods to table foods. Specific energy requirements for children with autism have not been established but the RDA for age is generally used, with modifications as needed based on activity level. Some children with autism are quite sedentary while others are constantly active, often with self-stimulatory behavior (eg, spinning, hand flapping, rocking).
Due to the special feeding challenges presented by the child with autism, the nutrition and feeding assessment should be addressed by a team that includes a nutritionist, an occupational therapist or speech therapist with training in oral-motor sensory therapy and/or sensory integration, and a psychologist/psychiatrist.
Perhaps because there is no cure for autism, parents are often drawn to investigate alternative therapies. Current alternate therapies include high-dose vitamin Bf, and magnesium supplementation, dimethylglycine (DMG), a gluten-free/casein-free diet, and a yeast-free diet." Further research regarding the efficacy of these therapies is required.
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Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.