Diet and Individuality in Autism Spectrum Disorder

1
Diet and Individuality in Autism Spectrum Disorder

• Catherine Gavin, RD, LDN, MPH
• Pfeiffer Treatment Center

2
Variations in ASD

• Autism Spectrum Disorder is a group of
  developmental disorders with a wide range of
  presentations
• Autistic Disorder
• Retts Disorder
• Childhood Disintegrative Disorder loss of
  acquired skills after 2 years of age
• Aspergers Disorder - High-functioning Autism
  Intelligent, verbal, social deficits
• PDD Pervastive Developmental Disorder
  Developmental Delay, some Autistic Sx
• PDD NOS
• Atypical Autism
• Biomedical treatment must be individualized based
  on the physical symptoms and laboratory findings
• Dietary treatment must be coordinated with
  biomedical therapy
• Diet must be individualized based on the needs
  of the child and family

3
Goal of Nutrition Therapy in ASD

• Support the biochemical needs of the body and
  brain to optimize functioning of the child
• Maximize response to other therapies
• Occupational Therapy
• Speech Therapy
• Behavioral Therapy
• Educational Therapy

4
Dietary Assessment of the Individual Child

• Assess current growth and Body Mass Index to
  screen for malnutrition and overweight.
• Assess for drug/nutrient interactions of current
  medications, supplements herbal therapies
• Assess sufficiency, quality, and appropriateness
  of the current diet

5
Role of the Dietitian in ASD

• Clarify details and purpose of the special diets
• Guide parents to adapt diet to the childs needs
• Reduce anxiety about implementing special diets
• Suggest acceptable replacement foods
• Suggest cost-effective ways to adapt to the diet
• Help families make dietary changes that also
  benefit the entire family
• Provide resources for locating special foods
• Problem solve lack of response to uncover hidden
  exposures
• Keep current on new food products and sources
• Knowledgeable about availability, taste, cooking
  with special foods.
• Offer ongoing support and encouragement

6
Types of Dietary Treatment of ASD

• Improving nutrient-density of the diet
• Feingold Diet
• Additive, artificial color, preservative-free
  diets
• Low Salicylate, low phenol diets
• Yeast-free Diet
• Food Elimination/ Allergy Rotation Diets
• Casein and Gluten-Free Diet
• Specific Carbohydrate Diet
• Addressing feeding problems

7
Improving Nutrient Density

• A nutrient-dense food contains a high quantity of
  macro and micronutrients compared to the number
  of calories.
• High omega-3 egg
• vs deep fried breaded pressed chicken tenders

• Macronutrients
• Carbohydrates
• Simple Sugars
• Complex sugars (starches)
• Fiber
• Fats, Essential Fatty Acids
• Protein, Amino Acids
• Water

• Micronutrients
• Vitamins
• Minerals
• Trace Minerals
• Phytonutrients (Plants)
• Anti-Oxidants

8
Improving Nutrient Density

• Macronutrients and Micronutrients are needed in
  sufficient quantities for proper biochemical
  functioning of the body and brain.
• .
• Brain Neurotransmitters are produced from Amino
  Acids (Protein), Vitamins,
• and Minerals from the diet.
• Choose whole, unprocessed foods for maximum
  nutrient density.
• Choose Organic foods, whenever possible for
  greater nutrient-density
• Replenishment of soil
• Rotation of crops
• A whole food, organic diet provides nutrients
  that are needed simultaneously to facilitate
  biochemical pathways.

9
Improving Quality of the Diet

• Antioxidants - substances that protect cells
  from damage by free radicals.
• Free radicals - highly unstable molecules that
  damage cells.
• - Created from hydrogenated fats,
  trans fats, heavy
  metals, pesticides, organic pollutants,
  artificial colors flavors,
• nutrient deficiencies, zinc
  deficiency,
• Brain and GI tract are susceptible to damage from
  oxidative stress.
• Autistics
• Have a lower anti-oxidant defense system and
  suffer from Oxidative Stress
• Higher free radical production
• Behavioral improvements occur following use of
  antioxidants

10
Oxidative Stress in ASD

• Oxidative Stress caused by free radicals is
  associated with
• ? Damaged lipids (fats) in cell membranes
• ? Lower antioxidant enzyme activity
• ? Gastrointestinal inflammation
• ? Increased Intestinal permeability
• ? Leaky Blood Brain Barrier
• ? Esophageal reflux
• ? Constipation
• ? Inhibited bile from gallbladder
• ? Changes in EEG brain waves
• ? Sleep disturbances
• ? Impaired energy production from cellular
  mitochondria
• ? Excitotoxicity due to increased brain
  Glutamate
• decreased GABA (inhibitory neurotransmitter)

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Improving the Quality of the Diet to Reduce
Oxidative Stress

• Antioxidants found in plant foods combat damage
  from free radicals.
• Fruits, vegetables, beans, whole grains, seeds,
  nuts
• Vitamins - A, C, E, B6, B complex
• Vit A - CLO, carrot, sweet potato, butternut
  squash, mango, cantaloupe, greens, apricots
• Vit C - Orange juice, grapefruit juice,
  strawberry, kiwi, red pepper, broccoli, Br.
  Sprouts, peapods
• Vit E - Raw sunflower seeds, almonds, hazelnuts,
  pine nuts, peanuts, Brazil nuts.
• B6 - Banana, salmon, herring, chicken, turkey,
  potato w/ skin, beans, prune juice, filberts,
  halibut
• Plant Bioflavenoids, Carotenoids Ubiquinones
  (Coenzyme Q10)
• Minerals Zinc, selenium, magnesium
• Zinc - Beef, turkey, pumpkin seeds, soybeans,
  lamb, almonds, pecans, brazil nuts, chicken,
  pork, sunflower seeds.
• Selenium Brazil nuts, oysters, pork, pasta,
  chicken, turkey, sunflower seeds, beef, oatmeal,
  tofu
• Magnesium Nuts seeds, peanuts, soybeans, dark
  green veg, dried beans, yogurt, bn rice, fish
• Cysteine produced from Methionine from dietary
  protein
• Organic Fruits/ Vegetables whenever possible
• Pesticide residues inactivate key enzymes
• Serve a rainbow of colors each day for
  phytonutrient antioxidant protection for entire
  family
• Avoid microwaving foods since it destroys 90 of
  antioxidants.
• Hormone and antibiotic-free meats, poultry
• Wild caught fish salmon, sardines, mackerel,
  herring, halibut, Light canned tuna, brook
  trout. to
  minimize Mercury exposure. www.cfsan.fda.govdm
  s/admehg3.html

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Supporting Metallothionein (MT) Proteins

• MT Proteins are present in all body tissues and
  are critical for trace metal metabolism and
  protection from oxidative stress.
• MT I II in all tissues regulate zinc copper
  prevent toxic metals from crossing the blood
  brain barrier and intestinal tract.
• MT III in the brain controls neuronal growth and
  development.
• MT IV in the GI tract regulates stomach acid pH,
  and taste texture discrimination by the tongue.
  
• Increasing dietary zinc and decreasing copper
  supports the Metallothionein Protein System.
• Increase Zinc foods - Beef, turkey, pumpkin
  seeds, soybeans, lamb, almonds, pecans, brazil
  nuts, chicken, pork, sunflower seeds.
• Decrease copper veal beef liver, oysters,
  cashews, Brazil nuts, Alaska King crab,
  chocolate.
• Avoid Copper in drinking water from copper
  plumbing, synthetic foods dyes.
• Copper sulfate algaecide in pools hot tubs may
  be absorbed through the skin.

13
Improving Quality of the Diet

• Eliminate or decrease
• Deep fried foods,
• Hydrogenated fats, trans fats
• Artificial colors artificial flavors
• Preservatives,
• Monosodium glutamate
• Eliminate synthetic sweeteners
• Aspartame (Nutrasweet, Equal) Sucralose,
  Saccharine
• Bleached, bromated white flours
• White rice
• Excess refined sugars, corn sweeteners,
• Limit fruit juice (add ½ water)
• 1-6 years - limit juice to 4-6 oz./day
• 7-18 years limit juice to 8-12 oz/day (Amer
  Acad. Pediatrics)

14
Obtaining Quality Foods

• Shop a variety of large smaller grocery chains
  for organic produce, high omega-3 eggs, some
• organic foods..
• Local Health Food or Specialty Stores (Will
  special order)
• Food Cooperatives Buying Clubs
• http//www.unitedbuyingclubs.com/RESOURCES/FABC/FA
  BC_Home.htm
• Local Harvest www.localharvest.org/about.jsp
• Directory of nationwide small farmers markets,
  local foods
• Local Services that deliver organic produce to
  your home
• Timber Creek Farms www.tcforganics.com
• Produce, grassfed meat, eggs, dairy, fundraisers
• Biologique Foods IL, WI, IA, MN, NE SD, ND
  www.biologiquefoods.com
• Organic foods, non-toxic personal, household
  products
• Natural Health Foods of Naperville
• CFGF, Allergen-free foods
• Ship internationally www.ShopByDiet.com

15
Pure Drinking Water is Critical

• Drinking Water
• Water is the largest single component of human
  body
• Vital for digestion, transport of nutrients to
  cells, excretion of waste products
• Drinking water can contain lead, arsenic,
  cadmium, copper, mercury, chlorine, fluoride,
  VOCs, PCBs etc.
• Selecting a Home water filter
• Choose a filter tested certified by NSF
  International
• Two-Stage Reverse-Osmosis Carbon Filtration Water
  Treatment System
• 300 and up
• Get listing of filters that remove specific
  contaminanats
• Specify contaminants type of filter to search
  for brand names of filters.
• http//www.nsf.org/consumer/drinking_water/dw_cont
  aminant_guide.asp?programWaterTre
• Well Water Testing potential source of heavy
  metals, pesticides, contamination
• http//www.nsf.org/consumer/drinking_water/dw_well
  .asp?programWaterTre

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Essential Fatty Acids in ASD

• Omega-6 and Omega-3 fats
• Required, but cannot be synthesized by the body
• Essential for proper brain and Nervous System
  Function, and for all body cells.
• Building blocks for prostaglandins with the help
  of vitamins
• B-3, B-6, C, zinc, magnesium and selenium
• The FA composition of cell membranes is
  influenced by fatty acids ingested over time.
• Current ratio of Omega-6 Omega-3 is 10 to 201
  in Western diet
• Suggested ratio is between 2 and 4 1
• Decreasing ratio of Omega-6 Omega-3 fats
  enhances mental function and protects from
  allergies, illness, inflammation and chronic
  disease.

17
Essential Fatty Acids in ADHD

• Omega-6 fatty acids
• Corn, soybean safflower oil, beef, pork,
  chicken, whole milk
• High in the Western diet.
• Promote inflammatory prostaglandins
• Higher Omega-6 fats linked with depression,
• poor mental function
• Decrease dietary intake to limit inflammation.

• Omega-3 fatty acids
• Cold water fatty fish, flax seed oil, canola
  oil, walnuts, walnut oil, green leafy vegetables,
  high Omega-3 eggs
• Low in the Western diet.
• Promote anti-inflammatory prostaglandins
• Increase omega-3 dietary fats to promote mental
  fx and general health

18
Blockers of Healthy Prostaglandins

• Avoid the following which block
• Delta-6-desaturase enzyme conversion of
  essential fats to favorable prostaglandins
• Trans fats
• Excess saturated fat and cholesterol
• Chronic stress (elevates cortisol levels)
• Excess sugar
• Yeast overgrowth
• Insufficient protein
• Prolonged fasting
• Copper toxicity

19
What are Salicylates?

• Salicylates are a subgroup of Phenols
• Phenols are natural synthetic compounds that
  contain a benzene ring and hydoxyl group (-OH).
• Found in Tomatoes, apples, peanuts, red grapes
  bananas, oranges, cocoa,
• blue, blue-red and violet plant pigments, milk
• Found in disinfectants (Lysol), antiseptics, food
  dyes
• Highly acidic
• Exert toxic effects on the brain
• Phenol sulfo-transferase Enzyme (PST) needed for
  Sulfation Rx for detoxification
• PST Deficient in 90 of Autistics - Dr. Rosemary
  Waring
• A factor in success of Feingold Diet
• (McFadden, SA, Toxiciology July 1996
  (111) 1-3, 45-65)
• Sulfation detoxifies toxins, phenols,
  salicylates in foods, spices, drugs
• Sulfation required for NTs Dopamine, Adrenalin,
  Serotonin
• Sulfation of glycoproteins in GI Tract to produce
  mucous membrane
• Sulfation of tyrosine-cont. peptides - CCK, bile
  acids, thyroxine

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Low Salicylate Foods thatSupport Liver
Detoxification

• Thiols sulfur-containing phytonutrients found
  in broccoli, cauliflower, Brussels sprouts, kale
  cabbage
• Upregulate detoxification enzymes
• Allium Family - Garlic, onion, shallots, leeks
• Contain organosulfurs
• Allyl Sulfides - Garlic
• ? production of glutathione S transferase Phase
  II Liver Detoxification
• Enzyme supplements can metabolize phenols in
  fruit, veg. and grain to
• support sulfation.
• Enzymes may also cause yeast die off symptoms
  as they break down
• Candida cell walls.

21
Feingold Dietwww.feingold.com

• Uses foods and products free of
• Synthetic colors
• Artificial color, certified color, synthetic
  color, Color added. FD C No., or by name, such
  as tartrazine.
• Synthetic flavors
• Only flavor listed by name is Vanillin
• Preservatives - BHA, BHT TBHQ
• BHA Buylated Hydroxyanisole
• BHT - Butylated Hydroxytoluene Vit A Palmitate
  lowfat, skim milk, shortening, lard, bee
  chicken fat, oil, gum base
• TBHQ -Tertiary Butylhydroquinone
• Aspartame
• Temporarily removes salicylate foods that are
  most likely to cause problems

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Feingold DietStage One

• Also temporarily remove Natural Salicylates
• Almonds Coffee Peaches
• Apples Currants Peppers bell, chili
• Apricots Cucumbers Plums/Prunes
• Berries (all) Grapes/Raisins Tangerines
• Cherries Nectarines Tea
• Cloves Oranges Tomato
• Aspirin Oil of Wintergreen

23
Feingold DietStage Two

• Add back salicylate-containing foods one at a
  time
• Test for sensitivity
• Test for amount tolerated
• Start with most missed fruit or food
• Tolerance may improve with time
• If sulfation problems stay on Stage One
• to take the stress off PST Sulfation system

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Additional Sensitivities

• Feingold diet can also be individualized for
  additional sensitivities
• Gluten and/or Casein-free Diet
• MSG sensitivity
• (Food sources are noted on Feingold Foodlist)
• Food allergy
• Benzoates
• Sodium benzoate, benzoic acid preservative, or
  naturally-occurring in foods.
• Sulfites, sulfur dioxide,
• Residue in corn syrup, cornstarch, and dried
  fruit, wine, raw apple, raw potatoes to prevent
  browning.
• Fluorides
• (Mullinix 1998, Masters, 1999) Researchers feel
  fluoride may trigger learning/ behavior problems
  in some individuals
• Found in fluoride supplements, drinking water and
  dental products.
• Silicofluorides used in 90 of US water supplies
  increase absorption of lead/
• Commercial silicofluorides may contain traces of
  arsenic, and other heavy metals.
• Blood of 280,000 MA children from
  Silicofluoride-treated communities was
  significantly higher in lead (plt0.001).(Masters
  Coplan 1999).

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Yeast-free Diet

• Yeast-free diet eliminates yeasts toxins from
  tissues strengthens the immune system.
• Eliminates all foods that contain or support
  yeast growth
• All sugars, sugar-containing foods, artificial
  sweeteners, yeast breads baked goods
• Milk products (lactose sugar)
• Fruit juices for 2-4 weeks.
• Yeasty, moldy, fermented aged foods, smoked
  meats, alcohols, vinegars
• Mushrooms, malt, miso, tempeh, peanuts,
  pistachios, caffeine
• No leftovers gt24 hours old
• Allowed
• Fresh fish, poultry, meats, eggs, legumes
• Non-starchy vegetables, legumes, raw nuts, seeds,
  
• Unrefined, cold-pressed olive coconut oils
• Limited whole grains, starchy vegetables, lima
  flat beans, soybeans tofu.

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Characteristics Associated with Intestinal Yeast
Overgrowth of Candida albicans

• Cravings for foods that feed yeast
• Sugars, honey, desserts, cookies, sodas, fruit
  juice, yeast breads, pizza, cheese, dried fruit,
  peanut butter (mold), foods made with refined
  carbohydrates (white flours sugars).
• Loss of taste for foods that do not promote yeast
• Animal protein, vegetables
• Appetite for a greater variety of food returns
  after yeast die-off period

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Yeast-free Diet

• Improvements can occur after 10-14 days
• After 2 weeks symptom-free begin individual food
  challenges
• Yeast challenge with small amt. Brewers yeast or
  vinegar.
• Observe for 48 hr. and record reactions
• If no reactions, try other yeast foods, ketchup,
  vinegar,
• Test fruits, one a time, small amount, peeled,
  then unpeeled.
• Observe for 48 hr. record reactions
• Try small amount alternative Sweeteners agave
  nectar, brown rice syrup, raw honey, pure maple
  syrup (organic) to determine tolerance
• Observe for food allergies
• Candida inflames and damages the gut lining
  leading to Leaky Gut Syndrome

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Leaky Gut Syndrome

• Increased intestinal permeability
• Most common cause is indiscriminant use of broad
  spectrum antibiotics
• Antibiotics kill beneficial gut bacteria
• Allows overgrowth of bacteria, parasites,
  viruses, yeasts fungi that causes intestinal
  inflammation.
• Irritation causes tight junctions between
  intestinal cells to loosen allow large
  particles to enter blood stream.

29
Candida albicans and Leaky Gut

• Candida albicans yeast is most common to
  overpopulate after antibiotic
• Candidia produces acid protease cleaves
  protective Secretory IgA from the mucus membrane
  allows Candida to anchor colonize.
• Toxins given off affect immune system, hormones,
  thought processes.
• Leaky gut allows large food particles to enter
  the bloodstream,
• causing food allergies against foreign
  proteins.
• Food allergies cause further irritation and gut
  inflammation.
• Treat the Leaky Gut prior to food allergy
  testing.

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Food Allergy

• Types of Food Hypersensitivities
• IgE - Immunoglobulin E Antibody RAST -Indicates
  immediate true, fixed, or classic allergy
• Usually involves one or few foods
• Reactions occur minutes to hours after exposure/
  ingestion
• Cross reactions with IgE Inhalant allergies
• Small amounts of food protein trigger rx -
  Asthma, hay fever, rhinitis, atopic dermatitis,
  hives
• Sx Wheezing, coughing, tightening throat,
  tingling, nausea, cramping, diarrhea, or in
  severe cases, anaphylaxis
• Usually requires permanent elimination of food
• IgG Immunoglobulin G Antibody ELISA -
  Indicates delayed food hypersensitivity
• Reactions can occur 1 to 3 days after exposure
• Usually excess amounts of trigger food cause
  reaction
• More generalized symptoms headache, muscle
  aches, tension-fatigue syndrome
• Can involve skin, gut, respiratory system
• Assoc. with inflammatory GI disorders, irritable
  bowel, dermatitis exacerbation of IgE asthma
  rhinitis
• Can stress immune system
• Strict elimination of reactive foods for 12 weeks
• Allergy Rotation Diet

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Casein and Gluten-Free Diet in ASD

• Recommended Trial Period
• Child lt 5 years 3 months
• Child gt 5 years 6 months
• Elimination of casein, followed by
  gluten-containing foods
• Individualize
• Can introduce milk substitutes before eliminating
  dairy, slowly remove dairy products OR remove all
  casein simultaneously
• Introduce gluten-free cereals, breads, cookies
  before eliminating gluten
• Gluten remains in system longer more difficult
  to eliminate
• Disadvantages to cold turkey approach
  withdrawal symptoms, strong cravings
• Casein, gluten soy proteins similar Observe
  for soy sensitivity

33
Casein and Gluten-Free Diet in ASD

• When a child self-limits foods to wheat
  dairy-containing foods, good indication of need
  for CFGF trial
• Macaroni cheese, grilled cheese, pizza, chicken
  tenders, pasta, bread, milk.
• CFGF Children who continue to self-limit may
  still be getting a source of hidden gluten or
  casein.
• School aged children may be getting casein or
  gluten from other children.
• Make an effort to find acceptable CFGF breads,
  baked goods and cereals that the rest of the
  family can enjoy. Often siblings or parents
  improve.
• Cook casein and gluten-free for the family for
  the sake of the affected child.
• Toasters, butter, jams, nut butters, etc. are
  contaminated with gluten by knives used on gluten
  products.

34
Specific Carbohydrate DietBreaking the Vicious
Cycle Elaine Gottschall

• SCD used for 50 years for inflammatory bowel
  disease.
• Goal is to restore digestive system - correct
  bacterial yeast overgrowth, decrease
  inflammation, heal the GI tract.
• Adopted by ASD parents to treat gastrointestinal
  problems
• No gluten, no grains, no flours
• (except nut flours)
• Children currently on CFGF Diet begin w/
  Introductory Diet for 2-5 days
• Allows only carbohydrates that do not feed
  intestinal microbes
• Allows only fresh or frozen meats, poultry, fish,
  eggs, nuts
• Fruits and vegetables are introduced slowly after
  diarrhea subsidses
• Uses probiotics, home-made goats milk yogurt
• Must use approved supplements and medications

• SCD Diet Protocol
• Allows CHO in fruits, honey, limited veg, nuts,
  home-made yogurt
• Allows monosaccharides single sugar molecules
• Glucose, fructose, galactose
• Honey, ripe fruits, some vegetables
• NO disaccharides two sugar molecules that
  require splitting by enzymes
• Sucrose, lactose, maltose, isomaltose
• Table sugar, milk products, molasses, brown
  sugar, maple syrup,
• NO polysaccharides sugar chains (starches)
• Amylose, amylopectin
• Grains, corn, rice, potatoes

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Specific Carbohydrate Diet

• Child should be assessed for gastrointestinal
  problems
• Before beginning diet.
• Consider if severe GI problems after CFGF Trial
• Drawbacks of SCD
• Very restrictive and difficult to follow
• Need to read Breaking the Vicious Cycle book
  before implementing
• Book insists on fanatical adherence
• Intro diet relies heavily on chicken, eggs (food
  allergies/ hypersensitivities)
• Heavy use of nuts and nut flours may elevate
  copper
• Elevated copper is a distinctive feature of
  Autism

36
Common Feeding Problems in ASD

• Limited number of acceptable foods
• Food jags overeats one particular food,
  followed by burn-out for that food
• Food texture sensitivities (smooth, lumpy,
  chewy, crispy)
• Food temperature sensitivities
• Aversion to food smells or sights
• Over stimulation from mealtime noise chaos

37
Feeding Problems in ASD

• Physical Factors that can contribute
• Poor appetite
• Medications
• Constipation
• GI pain, discomfort
• Nausea, vomiting, hyperactive gag reflex
• Food allergy, sensitivity or intolerance,
  irritable bowel
• Addictiveness of Casein Gluten proteins
• Motor, oral-motor, swallowing problems
• Delayed self-feeding skills
• Refusal to self-feed
• Stuffing food into mouth, danger of choking
• Delayed chewing/swallowing coordination

38
Feeding Problems in ASD

• Sensory Issues that contribute
• Oral hypersensitivity
• Oral aversions
• Overactive gag reflex
• Texture hypersensitivity
• Detects slight changes in textures or tastes

39
Feeding Problems in ASD

• Behavioral factors that contribute
• Lack structured meal or snack time
• Lack of consistency by parents/caregivers
• Child grazes all day
• Overconsumption of fruit juices or other
  beverages
• Stressful, chaotic household

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What parents can do

• Have structured meal and snacks times
• Do not allow child to graze throughout the day.
• Limit fruit juices.
• Food jags
• Serve foods from neutral container to prevent
  brand recognition
• Limit quantities of favorite food type. (potato
  chips)
• Expand by introducing other foods similar in
  color, texture (nuts, rice chips, GF prezels)
• Serve quantity of favorite food and do not allow
  more unless other foods are eaten.
• Serve all foods together, rather than trying to
  offer substitutions as foods are declined.
• A replacement food may be better accepted if you
  wait a period of time after the favorite foods
  has been discontinued.
• Allow child to have sensory warmup before meal
• Physical play, climbing, crawling, physical play
• Have child help with food prep, putting away
  groceries, setting table with their favorite
  dishes, clear table.
• Use colorful, festive plates
• Place no more than 3 foods on plate. Try a
  divided plate

41
What parents can do

• Have consistent feeding rules for caretakers,
  family, therapists
• No YES/ NO questions about food make simple
  statements
• Use non-food rewards for therapies, if possible
• Destress mealtime
• Make mealtime playful positive
• Can talk about food
• Or minimize talk about food if child is easily
  overstimulated
• Child can cut colored paper into food shapes that
  will be offered (white brown foods).
• Child can smell a small amount of food in a cup.
• Take baby steps
• Keep food journal to track small successes over
  time.

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Servings Sizes for Children

43
Calorie Dense Foods for Children

• Calorie-dense foods AS TOLERATED to increase
  energy intake
• Nut butters - Crackers, breads, shakes, apple
  slices, baked goods, hot cereal
• (Almond, cashew, sunflower, peanut butter
  (mold) as tolerated)
• Cheese - Bread, toast, vegetables, salads,
  meatloaf, potatoes, soups,
• Hummus or bean spread - Bread, crackers,
  tortillas, vegetable dip, potatoes
• Whole milk, or dairy substitutes - Soups, cooked
  cereals, beverages
• Granola, gluten-free or regular - Topping for
  fruit, yogurt, ice cream, applesauce, trail mix
• Vegetable nut oils - Soups,
  casseroles, vegetables, gravies, cooked cereals,
  spaghetti sauce.
• Butter, or soft spread - - Pancakes, waffles,
  French toast, potatoes, pasta, vegetables, baked
  goods, casseroles
• Tahini (Sesame butter) - Crackers, sandwiches,
  dips, stir fry, salad dressings
• Avocado - Sandwiches, wraps, crackers, salads,
  salsas, dips
• Ground Flax seeds - Baked goods, smoothies,
  cooked cereals,
• Chopped nuts - Puddings,
  salads, casseroles, baked goods, hot cereal,
  vegetables, fruit
• Mayonnaise - Sandwiches, pasta, deviled eggs,
  vegetable dips (Canola Mayonnaise, or
  homemade)
• Sour cream - (Dairy or Soy) - Vegetables,
  potatoes, casseroles, dips.
• Cream Cheese - (Dairy or Soy) Toast,
  sandwiches, bagels, baked goods, dips, eggs.
• Dried fruit - Plain, on hot/cold cereal, w/
  celery nut butter, baking, salads, in yogurt.

44
Feeding Problems in ASD

• Myth Children will not starve themselves.
• Childs logic tells them
• If eating hurts - dont eat
• If eating doesnt work cry or run away
• Children can suppress their appetite and fail to
  respond to appetite cues.
• Eating requires simultaneous coordination of all
  8 sensory systems.
• Kay Toomey, PhD.

45
Determining When a Feeding Problem Requires a
Referral

• Picky Eaters
• Eats gt 30 foods
• Foods lost to burn out are regained after 2
  weeks
• Tolerates new foods on plate and can touch or
  taste them
• Eats 1 or more foods from most foods textures.
• Adds new foods in 15-25 steps

• vs. Problem Feeders
• Eats lt 20 foods
• Foods lost to burn out are
• not re-acquired
• Cries or falls apart when presented with new
  foods
• Refuses entire categories of textures
• Adds new foods in gt 25 steps.
• Kay Toomey, PhD.

46
Food for Thought on Food Acceptance

• Typical 12-month old takes 10-20 tries before
  accepting a new food
• Typical preschoolers are more likely to accept a
  food
• When allowed to help with preparation or setting
  the table
• When allowed to take small portions of new
  foods
• When eating with parents and/or siblings
• When allowed sufficient time
• Ellen Satter, RD Child of Mine Feeding with
  Love and Good Sense

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Determining When a Feeding Problem Requires a
Referral

• SOS Sequential Oral Sensory Approach to Feeding
  Program
• Based on developmental stages of feeding in all
  children
• Dr. Kay Toomey, Pediatric Psychologist
• Trains therapists in SOS Approach
• 32 Steps to eating a new food include
• Tolerate
• Interact
• Smell
• Touch
• Taste
• Eat

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Dietary Role of Parents in ASD

• Work with Dietitian to properly implement
  recommended diets.
• Be a positive role model for children about
  eating for good health.
• Stress positive approach with spouses family
  team effort
• no negative talk about special diets
• Work consistently toward a nutrient-dense diet
  for the entire family.
• Involve your child in planning, shopping,
  preparing meals.
• Listen to their feedback.
• Reinforce with child that you are actively
  seeking good-tasting food.
• Keep food journals and reassess diet over time
• Share failures successes with dietitians,
  practitioners parents.
• Get enough sleep to keep your sense of humor!

49
Thank you for your attention.

• Catherine Gavin, RD, LDN, MPH
• Pfeiffer Treatment Center
• 4575 Weaver Parkway
• Warrenville, IL 60555
• 630-505-0300