autism Archives

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NUR HANA HAMZAID

FEATURED EXPERTS

AINUL SYAFIQAH MOHD AZAHARI
Nutritionist and Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

DR NUR HANA HAMZAID
Senior Lecturer
Center for Rehabilitation & Special Needs Studies (iCaRehab)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Autism spectrum disorder (ASD), also known as autism, is a developmental disability caused by neurodevelopmental disorders that affect how the brain functions and alter the development of the nervous system.

As a result, someone with autism typically experiences difficulties in their social, cognitive, and emotional functioning.

Among the main characteristics of people with autism are significant social communication and behavioural challenges that can be seen as early as when they are 18 months old.

Additionally, people with autism would also exhibit a high degree of repetitive behavioural patterns.

AUTISM CAN GIVE RISE OF PROBLEMS AFFECTING THE CHILD’S GASTROINTESTINAL SYSTEM

These problems, called gastrointestinal issues (GI), are common among with children with autism.

A 2019 review of 13 studies found out that 80% of children with autism experience gastrointestinal issues.

These children typically experience:

Constipation
Diarrhoea
Abdominal bloating
Abdominal pain

The same review also found out that there is an association between poor gut health and the children’s behavioural response, due to the impaired function of the gut and disruptions to the population of bacteria in the gut (the gut microbiome).

ISSUES IN THE GUT CAN CAUSE THE CHILD WITH AUTISM TO ACCEPT ONLY A SMALL SELECTION OF FOODS

The affected gut-brain axis results in neurological imbalance that gives rise to the child’s tendency toward repetitive behaviour and sensitivity.

This repetitive behaviour can restrict the variety of foods accepted by the child, or food selectivity, based on their taste and sensory requirements. A hypersensitive child with autism, for instance, usually prefer foods with less texture and milder tastes, while a hyposensitive child with autism—one with lower-than-normal sensitivity to sensory input—may prefer instead foods with more textures and stronger tastes.

THESE ISSUES CAN PUT A CHILD WITH AUTISM AT RISK OF NUTRITIONAL DEFICIENCY

Food selectivity as well as gut issues in children with autism can put their nutritional status at stake. Here are some common issues related to this.

Reduced absorption efficiency of nutrients in the gut during digestion

This is due to abnormalities in gut functions.

Reduced digestion of carbohydrates

Some studies mentioned that children with autism lack the enzymes needed for a better carbohydrate digestion.

Preference for carbohydrate-rich and often sweet foods

One 2004 study found out that children with autism prefer foods high in carbohydrates, which are generally sweet, while commonly rejecting foods that are bitter and sour. High consumption of carbohydrate-rich foods can impact the child’s glucose tolerance and sensitivity, which over time would lead to overweight and obesity, diabetes, and dental caries.

Food selectivity keeps children with autism from obtaining the types and amounts of nutrients to meet their daily nutritional intake

Rejection of certain tastes and food textures may restrict the child from obtaining essential micronutrients such as vitamin D, vitamin B12, vitamin C, calcium, and zinc.

The child may also have a lower consumption of dairy products.

Furthermore, parents of some children with autism put these children under dietary restrictions protocols, such as casein- and/or gluten-free diets. However, to date there is no evidence that these dietary restrictions can improve the child’s behavioural and gastrointestinal issues. On the other hand, it is likely that such dietary restrictions only further narrow the window of opportunity for proper nutrient intake.

HOW TO PROVIDE OPTIMAL NUTRITION & CARE TO A CHILD WITH AUTISM

Providing optimal care to a child with autism involves a multidisciplinary team, which comprises of paediatricians, psychiatrists, occupational therapists, speech-language therapists, dietitians, and social workers.

The paediatrician and psychiatrists work to recognize the early symptoms of and conduct assessments for autism.
Occupational therapists evaluate the current developmental levels of emotional self- regulation and participation in social interactions.
Speech-language therapists provide interventions to help the child improve their communication skills.
Dietitians consult with carer or the child themselves to understand the child’s dietary and eating behaviours, in order to identify the child’s food aversion and/or nutritional deficiencies and to advise the child’s carers on how to best manage these issues.
Social workers link parents and families with agencies and autism-related community programmes.

HOW PARENTS CAN MANAGE THE FOOD SELECTIVITY OF A CHILD WITH AUTISM

Explore various food textures and tastes

A hyposensitive child requires more triggers in order to stimulate their senses, so offer crunchy and chewy foods with strong aromas. Use herbs and spices, instead of salt and sugar, to enhance the flavours of these foods.
For hypersensitive children, introduce softer, mushier foods with less intense flavours such as porridge, yoghurt, and mashed foods. Parents and caregivers should also incorporate desensitization techniques into playtime and other activities with these children outside of eating time.

Roleplay with the child during mealtimes

For example, pretend to be a cook or feed the child’s favourite toy. You can also use the foods that your child likes and accepts to spin a story about other foods that your child may also enjoy.

Such imaginative games can help switch on the child’s imaginative skills, make mealtimes for enjoyable, and reduce the child’s reluctance to eat.

Food challenge

For example, if your child accepts a certain sauces, dips, or gravy, try dipping new foods into them to get your child to try these foods.

Food chaining

Food chaining helps to encourage a child with food selectivity to try new foods.

If your child like apple sauce, for example, you can try introducing the apple fruit into their meals.

Food chaining involves trial and error, and parents/caregivers may experience some degree of frustration when the child rejects the new foods that are introduced into their meals.

However, be patient and don’t give up! Perseverance and consistency are essential when it comes to success in helping a child with autism to adopt healthier eating habits.

References:

Lefter, R., Ciobica, A., Timofte, D., Stanciu, C., & Trifan, A. (2019). A descriptive review on the prevalence of gastrointestinal disturbances and their multiple associations in autism spectrum disorder. Medicina (Kaunas, Lithuania), 56(1), 11. https://doi.org/10.3390/medicina56010011
Narzisi, A., Masi, G., & Grossi, E. (2021). Nutrition and autism spectrum disorder: Between false myths and real research-based opportunities. Nutrients, 13(6), 2068. https://doi.org/10.3390/nu13062068
Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism. Journal of autism and developmental disorders, 34(4), 433–438. https://doi.org/10.1023/b:jadd.0000037419.78531.86
Williams, B. L., Hornig, M., Buie, T., Bauman, M. L., Cho Paik, M., Wick, I., Bennett, A., Jabado, O., Hirschberg, D. L., & Lipkin, W. I. (2011). Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PloS one, 6(9), e24585. https://doi.org/10.1371/journal.pone.0024585
Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism research : official journal of the International Society for Autism Research, 15(5), 778–790. https://doi.org/10.1002/aur.2696

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

FEATURED EXPERTS

AINUL SYAFIQAH MOHD AZAHARI
Nutritionist and Student of Master Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

DR NURUL HUDA RAZALLI
Dietetic Programme
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS

Dysphagia comes from Greek word ‘dys’, which means difficulties, and ‘phagia’, which means swallowing.
Medically, dysphagia is a term for swallowing difficulties. Someone with dysphagia takes more time and effort to move food or liquid from their mouth down to their stomach.
Episodes of dysphagia can be intermittent or progressive.

IT IS A SYMPTOM FOR MANY MEDICAL CONDITIONS

In adults, dysphagia is very common in adult that has a history of stroke, dementia, Alzheimer’s disease, neck cancers, and gastroesophageal reflux disease (GERD).
It could also be present in children with attention deficit hyperactivity disorder (ADHD), autism, Down syndrome, and cerebral palsy.
Dysphagia can also be a sign that there are some issues with the many nerves and muscles that are involved in swallowing activities.

YOU MAY HAVE DYSPHAGIA IF YOU EXPERIENCE THE FOLLOWING

Persistent drooling of saliva
Coughing or choking when eating or drinking
Bringing food back up, sometimes through the nose
Feeling as though food is stuck in your throat or chest
Being unable to chew food properly

PEOPLE WITH DYSPHAGIA FACE ISSUES THAT CAN JEOPARDIZE THEIR HEALTH & WELL-BEING

Choking and lung infection

Individuals with dysphagia are susceptible to choking. Due to difficulties in swallowing normally, consumed foods or liquids can accidentally enter the airway into the lungs. This could result in aspiration pneumonia, often known as a lung infection and can be fatal.

Poor nutrition intake

The prevalence of malnutrition among people with dysphagia is reported to be anywhere between 3% and 29%, which is quite a high number.
Malnutrition leaves people with dysphagia more vulnerable to diseases, should they not receive enough essential nutrients for optimal body function.
Muscle wasting, underweight, and stunting could be other issues that arise. Hence, people with dysphagia needs to be aware of any weight loss, hair loss, feeling of coldness, and fatigue as these are the early symptoms of malnutrition.

Loss of appetite and fear of mealtimes

People with dysphagia often lose their appetite in conjunction with their reduced swallowing ability.
They might develop some degree of “laziness” when it comes to drinking more often, which may lead to dehydration.
Because their eating experiences can be difficult, uncomfortable, and unpleasant, they may develop anxiety during mealtimes.

Inability to talk fluently

Dysphagia can hinder one’s ability to talk fluently and, combined with difficulties in eating, may cause the affected person to experience low self-esteem and lead to self-isolation.
The decrease in social engagement will give a negative impact in the person’s quality of life.
Thus, social support from their carer, family members, and close friends are crucial. A little extra kindness and help will give a huge impact in their life and sometimes even touch their heart.

Proper nutrition management for people with dysphagia involves providing adequate nutrients through modification of food texture and fluid consistency.

We need to also keep an eye out for symptoms of dehydration such as dry mouth or tongue, thirst, headache, and lethargy.

Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.

IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA

Consult a speech language pathologist, a healthcare professional trained to diagnose dysphagia, for a proper diagnosis.

People with dysphagia can consult with dietitians for their nutritional concerns or if they want to assess their nutritional adequacy.

TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION

Understand the extent of one’s dysphagia

Discuss with the speech language pathologist and other relevant healthcare professionals on the degree of swallowing ability in the person with dysphagia.

Refer to the International Dysphagia Diet Standardization Initiative (IDDSI) Framework

This guideline has seven levels. Flow test, spoon tilt, and fork drips are used as measurement methods to determine each level.

Click to view a larger and clearer image.

Further information can be obtained from the IDDSI website (link opens in a new tab).

Modify foods into certain textures

For more detailed information on how to modify the textures of various foods, you can refer to this page on the IDDSI website (link opens in a new tab).

While modifying the textures of foods into appropriate textures, take into consideration the nutritional content (carbohydrates, protein, fat, as well as vitamin and minerals). Daily meals should provide all the nutrients to improve the person’s nutritional status.
Always choose softer food options if texture modification is not possible. For example, choose papaya instead of apple, and ‘soften’ a dish with gravy.
Add special thickening powder to watery liquids. This thickening allows for easier swallowing.

Useful tips for eating

Have the person with dysphagia sit upright to prevent choking.
Have them tilt their heads to prevent liquids from going into their air passage.
Encourage the person to take smaller bites, and give enough time to chew the food thoroughly.
If small pieces of food or liquid are stuck, have them cough a little.

Dysphagia is a journey of eating experience that may switch an individual’s life 360 degree. Hence support and motivation play an important role in the management of one’s dysphagia.