Gavin Cathy

Diet and Individuality in Autism Spectrum Disorder: 

Diet and Individuality in Autism Spectrum Disorder Catherine Gavin, RD, LDN, MPH Pfeiffer Treatment Center

Variations in ASD: 

Variations in ASD Autism Spectrum Disorder is a group of developmental disorders with a wide range of presentations Autistic Disorder Rett’s Disorder Childhood Disintegrative Disorder – loss of acquired skills after 2 years of age Asperger’s 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

Goal of Nutrition Therapy in ASD: 

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

Dietary Assessment of the Individual Child: 

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

Role of the Dietitian in ASD: 

Role of the Dietitian in ASD Clarify details and purpose of the special diets Guide parents to adapt diet to the child’s 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

Types of Dietary Treatment of ASD: 

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

Improving Nutrient Density: 

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

Improving Nutrient Density: 

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.

Improving Quality of the Diet : 

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

Oxidative Stress in ASD: 

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)

Improving the Quality of the Diet to Reduce Oxidative Stress: 

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.gov~dms/admehg3.html AVOID: Shark, Swordfish, King Mackerel, Tilefish (Golden Bass or Golden Snapper). Use cold-pressed Omega-3 and Omega-6 Oils (organic, if possible)

Supporting Metallothionein (MT) Proteins: 

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.

Improving Quality of the Diet: 

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)

Obtaining Quality Foods: 

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/FABC_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 Grow your own organic vegetables, herbs Plant a salsa garden – tomatoes, onions, green onions, garlic, peppers, CILANTRO, parsley, Child’s garden – Cherry tomatoes, leaf lettuce, carrots, chives, sunflowers,

Pure Drinking Water is Critical: 

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_contaminant_guide.asp?program=WaterTre Well Water Testing – potential source of heavy metals, pesticides, contamination http://www.nsf.org/consumer/drinking_water/dw_well.asp?program=WaterTre

Essential Fatty Acids in ASD: 

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 20:1 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.

Essential Fatty Acids in ADHD: 

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

Blockers of Healthy Prostaglandins: 

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

What are Salicylates?: 

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 Sulfation required to form myelin protective sheath around neurons Overload of inhaled phenols (Lysol), environmental chemicals, foods can overload PST System

Low Salicylate Foods thatSupport Liver Detoxification: 

Low Salicylate Foods that Support 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.

Feingold Dietwww.feingold.com: 

Feingold Diet www.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

Feingold DietStage One: 

Feingold Diet Stage 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

Feingold DietStage Two: 

Feingold Diet Stage 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

Additional Sensitivities: 

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 (p<0.001).(Masters & Coplan 1999). Food List includes 150 pages of acceptable food products

Yeast-free Diet: 

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 >24 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.

Characteristics Associated with Intestinal Yeast Overgrowth of Candida albicans : 

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

Yeast-free Diet: 

Yeast-free Diet Improvements can occur after 10-14 days After 2 weeks symptom-free begin individual food challenges: Yeast challenge with small amt. Brewer’s 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

Leaky Gut Syndrome : 

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.

Candida albicans and Leaky Gut: 

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.

Food Allergy : 

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 – Other members of food family are separated by 1 day IgG Foods slowly reintroduced individually in 4-day rotation (or greater)

Casein and Gluten-Free Diet in ASD: 

Casein and Gluten-Free Diet in ASD Recommended Trial Period Child < 5 years – 3 months Child > 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

Casein and Gluten-Free Diet in ASD: 

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.

Specific Carbohydrate DietBreaking the Vicious Cycle – Elaine Gottschall: 

Specific Carbohydrate Diet Breaking 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 goat’s 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

Specific Carbohydrate Diet: 

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

Common Feeding Problems in ASD: 

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

Feeding Problems in ASD: 

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

Feeding Problems in ASD: 

Feeding Problems in ASD Sensory Issues that contribute: Oral hypersensitivity Oral aversions Overactive gag reflex Texture hypersensitivity Detects slight changes in textures or tastes

Feeding Problems in ASD: 

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

What parents can do: 

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

What parents can do: 

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.

Servings Sizes for Children: 

Servings Sizes for Children

 Calorie Dense Foods for Children: 

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. (Avoid sulfites, added sugars, caution with yeast-free) Fish oil - Use mild flavored (lemon or orange) on organic popcorn, with Real Salt

Feeding Problems in ASD: 

Feeding Problems in ASD Myth – Children will not “starve” themselves. Child’s logic tells them: If eating hurts - don’t eat If eating doesn’t 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.

Determining When a Feeding Problem Requires a Referral: 

Determining When a Feeding Problem Requires a Referral Picky Eaters Eats > 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 < 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 > 25 steps. Kay Toomey, PhD.

Food for Thought on Food Acceptance: 

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

Determining When a Feeding Problem Requires a Referral: 

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

Dietary Role of Parents in ASD: 

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!

Thank you for your attention.: 

Thank you for your attention. Catherine Gavin, RD, LDN, MPH Pfeiffer Treatment Center 4575 Weaver Parkway Warrenville, IL 60555 630-505-0300