Autism and the Picky Eater

Helen Attar, M.A., BCBA, Assistant Clinical Director at Gateway Pediatric Therapy's Livonia clinic, shares advice for parents of extremely selective eaters.

Children with Autism Spectrum Disorder (ASD) are five times more likely to experience mealtime challenges. Top among those is extremely narrow food selectivity. Helen Attar, M.A., BCBA, is the Assistant Clinical Director for Gateway Pediatric Therapy‘s Livonia location. She says that the majority of kids she sees would be considered selective picky eaters. “This can, of course, be true of typically developing kids too,” she notes. “But it’s especially common among kids on the spectrum.”

Attar says that the tendency for children with ASD to restrict their variety of foods can have behavioral roots or medical ones. With this in mind, she says a first step for parents is to rule out the possibility that underlying medical factors may be influencing their child’s food preferences. “We want to make sure the child isn’t refusing a particular food because it causes him or her pain or discomfort as this could be the case if there is a food allergy or intolerance,” Attar explains. “To that end, the clinician typically refers the child to his or her pediatrician to rule out any gastrointestinal or digestive issues.”

According to Attar, kids on the spectrum commonly refuse food for sensory reasons. Specifically, the child may not like the texture, color or appearance of the food. He or she may be sensitive to it being too crunchy or too soft. “Based on the degree of selectivity, the child may benefit from seeing a specialist who can help address the behavioral roots of the issue,” Attar notes. “We often collaborate with our occupational or speech therapy team members when this is the case.” Speech and occupational therapists may work with the child on oral motor skills. As an example, if a child is averse to crunchy foods, therapists may work with the child on strengthening tongue movement.

When it comes to introducing new foods, the Gateway team will first gather information from families on foods they typically eat. “We’re not going to introduce 50 foods all at once,” Attar says. “We’ll start with one or two foods the family often eats during mealtime and celebrate any success – big or small – that the child achieves.”

Success, at first, may mean helping a child build a tolerance to simply looking at or playing with the food he or she typically avoids. Later, it may be having the child hold the food up to his or her mouth or teeth. “We’re not going to get them to eat the food on the first day,” she explains. “It’s about desensitization and reinforcement.”

Attar notes that one tactic the Gateway team may employ is one with which many families are familiar – that of “grandma’s rule.” “This entails using ‘first, then’ statements,” she explains. “For example, we may say something like, ‘First touch or taste this raspberry, then you can have dessert.’ We then reinforce any little bit of success we get.”

An important component of feeding intervention is establishing trust.

“This means not sneaking foods into what your child is eating when conducting a feeding program,” Attar explains. “Children are pretty brilliant and will know. Take the time and do it the correct way, so you’re not taking 10 steps backwards when they realize you’ve snuck them something they don’t want.” Attar stresses that feeding interventions take time and that patience is a crucial component of success.

“If you have the ability to consult with someone, whether in Applied Behavior Analysis or otherwise, who can help you through outpatient therapy, you may want to consider that option,” she says. “It can be easy to give in and give your child what he or she wants when you’re at home and the child puts up a fight.”

Ultimately, Attar urges parents to set aside the time to make feeding intervention a priority. “The longer the child goes without having these foods, the harder it will be to expand his or her food range,” she says. Change may not happen overnight, but with the help of patience and positive reinforcement, families can be successful in helping their children try new foods and increase their overall diet.

For more information on the services provided by Gateway Pediatric Therapy, call 248-221-2573, send an email to or visit its website at


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