Background: Autism is a broadly defined and complex neurodevelopmental condition with a high prevalence of eating disorders. Issues reported are diverse but can be divided into broad categories: Sensory issues predominate in this population but pharmacological and biologically-based eating disorders are also noted, as are pica and rumination. Lastly, rapid eating is widely prevalent amongst adults with autism and new health related concerns are being raised about this behavior. The effect of eating disorders on health status is assessed, as are treatment options. The presentation closes with a discussion of how DSM-5 criteria typically preclude formal diagnoses.
Objectives: Following this presentation, participants will be able to identify some of the many eating disorders that have been identified on the autism spectrum. Following this presentation, participants will be able to explain how sensory abnormalities, which predominate in autism, are manifested in eating behaviors. Following this presentation, participants will be able to broadly outline treatment strategies for eating disorders on the autism spectrum.
A Broad View: Understanding Eating Disorders Across the Autism Spectrum
Janice Goldschmidt, MS, RD, LDN
1. Introduction to Autism Spectrum Disorder
a. Brief introduction to trends and prevalence
2. Eating Disorder Rates
a. Children and Adolescents
b. Adults
3. Eating Disorders Documented on the Autism Spectrum
a. Sensory Based Eating Disorders
Specificity in Taste
Specificity in Temperature
Specificity in Color
Specificity in Texture
Specificity in Presentation
Food Refusal
Limited Variety
b. Pharmacologically Based Eating Disorders
Polypharmacy on the Autism Spectrum
c. Biologically Based Eating Disorders
Dysphagia
Chewing Abnormalities
d. Pica
e. Rumination
f. Rapid Eating
4. Manifestation of Eating Disorders
a. Nutritional Status
b. Health Concerns
5. Overview of Treatment Options
6. Formal Diagnoses of Eating Disorders on the Autism Spectrum
a. DSM-5 Criteria
Janice Goldschmidt, MS, RD, LDN
Eating disorders are highly prevalent across the autism spectrum; they are estimated at 90% in children, though less is known about rates for adults. Issues reported are very diverse but can be divided into broad categories. Sensory issues are manifested in eating pathologies related to specificity in color, presentation, texture and temperature. Food refusal and limited variety, widely noted for those with autism, are also included in this category. Due to widespread polypharmacy, some eating pathologies documented are related to drug-drug and drug-food interactions. Biologically-based eating disorders on the spectrum are often a manifestation of dysphagia and chewing abnormalities. Presentation of pica is tremendously diverse for those with autism and far more common than in the general population; rumination is also noted. Lastly, rapid eating is widely noted for adults with autism and new health related concerns are being raised about this behavior. What is understood regarding the effect of these diverse eating pathologies on nutrition and overall health status is discussed as well as a general overview of treatment options. Despite the wide prevalence of disordered eating, diagnoses for eating disorders are rarely seen on the autism spectrum due to the nature of DSM-5 criteria.
Janice Goldschmidt has spent the last decade teaching cooking skills to adults with autism as a form of nutrition intervention. She is currently completing a book on this topic for the American Association on Intellectual and Developmental Disabilities (AAIDD). Other Publications include: "Nutritional status and autism spectrum disorders." Adv Nutr 6(6): 865 "What Happened to Paul? Manifestation of Abnormal Pain Response for Individuals With Autism Spectrum Disorder." Qual Health Res. With H. J. Song (2015). "At-Risk and Underserved: A Proposed Role for Nutrition in the Adult Trajectory of Autism." J Acad Nutr Diet 115(7): 1041-1047. With H.J. Song (In Press). "Development of Cooking Skills as Nutrition Intervention for Adults with Autism and Other Developmental Disabilities." J Acad Nutr Diet. 2016;117(5):671-679.
