Autism Spectrum Disorder (ASD) is a neurodevelopment disorder characterized by deficits in motor development, linguistic skills, and social interaction. The disorder can be identified in the early developmental period. Children with autism are often described as not being cuddly, not seeking out warmth, not smiling, and ignorant of the comings and goings of people around them.

Repetition of speech termed echolalia is also a sign of disorder, and children are found to be using speech in a limited fashion. Self-stimulating behaviors, obsession with unusual objects, and resistance to change are some of the other signs of this developmental disorder. The disorder is of complex nature and several causal factors such as the family history of ASD, head injury, hypoxia, and environmental factors have been proposed to be leading to it. The disorder has been identified to be contributing to significant impairments in the social, cognitive, and occupational functioning of the individual.

Raising a child with autism can be challenging for parents. Caregivers have been found to be impacted both physically and psychologically. Studies have reported the presence of anxiety, impaired social relationships, and burnout among caregivers. Thus, in recent years, psychosocial interventions and parent management training have gained popularity. The aim of these programs is to alleviate the stress level of caregivers and to equip them with the necessary knowledge and skills required to manage problematic behaviors such as self-injurious behavior, and aggressive behavior in children. Family therapies have become an integral component of treatment enhancing the well-being of members. Family members are psycho-educated and trained to look after their child effectively and counteract maladaptive behavior patterns.

One of the major difficulties reported by parents of children with autism is dealing with feeding issues for their children. Many children are very selective and picky about their food. Their sensory issues also make them oversensitive to certain food textures leading to a strong aversion toward that food item. They can have intense likes and dislikes based on properties such as color, texture, smell, and taste of the food item. However, having a balanced diet is crucial for the healthy growth and development of the child. Therefore, this can be very concerning for parents. Several strategies have been identified which might help in such cases.

Some of the popular strategies are listed below-

• It is imperative to carry out a thorough assessment before initiating a feeding program. Apart from sensory issues, underlying medical problems such as food allergies, and gastrointestinal problems can also lead to food selectivity. Medical problems should be managed first before starting with behavior therapy.
• Applied Behavior Analysis (ABA) Therapy using principles has been found to be effective in ameliorating feeding issues in children. One of the prominent principles is known as the Premack principle. In this, a hierarchy of child’s preferred items is designed. The child gets to indulge in a desirable activity/have a desirable food item only after eating a non-preferred food item. For example, a child’s desirable food item can be chocolate. If the program is aimed at increasing a child’s consumption of an apple, then the child would be given a piece of chocolate after consuming a slice of an apple. Providing the child with their preferred food item acts as a reinforcer, enhancing eating of the non-desirable food items.
• Shaping: This technique involves reinforcing each small attempt that takes the person closer to the end goal. For example, when shaping is employed in feeding programs, initially the child will receive a reinforcer on picking up the food item. When that step has been accomplished, the next reinforcer will be provided when the child touches the food item on the lips. In a similar manner, each small step will be reinforced until the child starts consuming that food item.
• Reinforcement:  The employment of reinforcements is very popular in feeding programs. The schedule of providing reinforcements is gradually varied as the child starts consuming the food item. Initially, the reinforcements may be provided after every two bites. Fading procedures are then employed and the frequency of reinforcements is gradually declined. Differential reinforcements can also be employed wherein children get reinforcements on behaving in desirable ways and reinforcements are withheld when the child behaves in an undesirable manner. For example, when a child refuses food to get attention, parents ignore the child and give him/her attention when the child does not throw a tantrum.
• Underlying chewing and swallowing issues can be addressed by trained speech therapists and occupational therapists. For example, fine motor skills and gross motor skills which are required for chewing can be enhanced with the assistance of a trained specialist. A speech therapist can help children make the muscles required for chewing, biting, and swallowing stronger. Speech therapy can also strengthen a child’s jaw muscles. An occupational therapist can work with child’s posture, teaching them to utilize supports required for eating (example-using a spoon) effectively.
• Parents and caregivers can also make changes in the undesirable food item so that the item appears attractive and the child starts consuming it. For example, they can modify the texture by chopping the food item into smaller pieces. They can also add certain ingredients such as ketchup that the child likes to have.

With appropriate techniques, it is possible to alleviate feeding issues in children. It is important to parents and caregivers should stay consistent while employing reinforcements at an early stage. Delay and inconsistency while delivering rewards can hinder the effectiveness of the feeding program.

Gradually, the frequency of these rewards can be decreased until eating the food item itself becomes rewarding. It is also recommended to consult a trained Dr. R K Suri professional chartered Clinical Psychologist the earliest who can help you navigate your child’s problems and design an effective feeding program. There can be different underlying reasons contributing to food selectivity among children. It is important to identify the contributing factors that are leading to picky behavior in your child. After identification, suitable feeding programs can be employed working upon identified causes.