Pediatric Feeding Disorders and Autism: It’s About More Than Compliance

Abstract This workshop will focus on the feeding skills that significantly influence feeding difficulties in children with Autism Spectrum Disorder (ASD), and will specifically highlight research in the areas of medical, nutritional, skill deficit and psychosocial domains. Practical strategies to address skill deficits and improve mealtime experiences are provided.

• In the medical domain, Autism is a neurodevelopmental disorder that is associated with PFD. In addition to their diagnosis of Autism, many children also have comorbid medical diagnoses that further impact their feeding. For example, research suggests children with ASD frequently present with GI tract symptoms including chronic abdominal pain, constipation, chronic diarrhea, and Gasteroesophageal Reflux Disease.
• In the nutrition domain, research indicates children with ASD frequently have food selectivity and restricted dietary diversity which influence the quality, quantity, and/or variety of beverages and foods which places them at risk of malnutrition, overnutrition, micronutrient deficiency or toxicity, and dehydration.
• Feeding skill deficits are another domain influencing the mealtimes for children with ASD. These impairments extend past oral sensory function. All eight of the sensory systems as well as postural and motor (gross, fine, and oral motor) capacities may be factors as well. Current research indicates that dysfunction can include difficulties from a sensory modulation perspective (over-responsivity and under-responsivity), dysfunction in discrimination (particularly visual processing, proprioceptive/vestibular, tactile, olfactory, and gustatory), and sensory based motor disorders (posture and praxis [gross, fine, and oral]). Deficits in these foundational skill areas lead to extensive challenges with the task of feeding.
• In the Psychosocial domain, individuals with ASD frequently demonstrate both active and passive avoidance behaviors during mealtimes due in part to a mismatch between feeding abilities and skills of the child and the feeding expectations of adult caregivers or the feeding situation. Children often develop learned feeding aversions because they are placed in situations where they are expected to complete tasks that are beyond their skill capacities which result in physical or emotional pain or discomfort during feedings. As a result of these experiences, children develop disruptive behaviors as a means to communicate their skill deficits and in an act of self-preservation against a perceived attack on their body and nervous system due to their sensory processing and/or motor skill deficits.

We will break down the relationship between skill-based deficits in these areas and a child’s food type and texture preferences as well as their behaviors during a mealtime. Mealtime behaviors will be described as a communication of foundational skill deficits that need to be assess and addressed in order for the child to develop a lifelong healthy relationship with food and mealtimes. Through the use of case studies, practical strategies to help a child have successful mealtime experiences and build the skills required to eat a wide variety of nutritionally dense foods will be offered.

Speakers Credentials Bethany CF Kortsha, MA, OTR/L received her Masters of Arts degree in Occupational Therapy from The College of Saint Catherine in St. Paul, Minnesota. She completed her Master’s thesis on Autism and feeding challenges using the SOS Approach to Feeding. Bethany has worked as a Pediatric Feeding Specialist and the Assistant Director of SOS Feeding Solutions at the STAR Institute for Sensory Processing Disorder with Dr. Lucy Jane Miller and as a member on a Multidisciplinary team in a day treatment clinic for children with Autism Spectrum Disorders, SPD, emotional/behavioral disorders, and feeding problems. Bethany is currently the Director of Clinical Development for Toomey & Associates, Inc. In addition to her specialty in Feeding, Bethany has completed the STAR Institute’s Intensive Mentorship Program and is a certified DIR Floortime Provider.