Aida Miles, EdD, MMSc, RDN, LD, FAND 7/24/2019

Aida Miles, EdD, Define and describe autism spectrum MMSc, RDN disorder

University of Minnesota Leadership, Education and Review common feeding and nutrition Training in Maternal and Child Potential Nutrition Health Nutrition problems in children with autism (until August 2019) spectrum disorder University of Tennessee, Implications of Knoxville Today (starting September 2019) Discuss signs that a child may need a Autism feeding evaluation and intervention Clinic4Kidz, Sausalito, CA Munroe-Meyer Feeding Disorders Program, Omaha, NE List types of interventions for feeding problems

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What is autism spectrum disorder? 1. Define and describe • A developmental disability that can cause autism spectrum significant social, communication and behavioral challenges. disorder • Prevalence: 1 in 59 children • Occurs in all racial, ethnic, socio economic groups • Four times more common in boys than girls

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1 Aida Miles, EdD, MMSc, RDN, LD, FAND 7/24/2019

Autism Spectrum Disorder Social Communication Difficulties

• Characteristics vary with age and development • Symptoms are present in the first 2 years of life • Defined solely on • No neurobiological marker • Likely a result of many causes, strong genetic component DEFICIT IN SOCIAL-EMOTIONAL DEFICIT IN NON-VERBAL DEFICIT IN DEVELOPING, RECIPROCITY COMMUNICATION USED FOR MAINTAINING, AND • It is lifelong SOCIAL INTERACTION UNDERSTANDING RELATIONSHIPS

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Restricted interests, repetitive 2. Review common Insistence on sameness, Stereotypical or repetitive inflexible adherence to motor movements, use of feeding and nutrition routines, or ritualized patterns objects, speech of verbal or nonverbal behavior problems in children with autism spectrum Hyper- or hypo-reactivity to Highly restricted, fixated sensory input or unusual interests that are abnormal in interests in sensory aspects of disorder intensity or focus environment

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What is a Pediatric Feeding Disorder? Pyramidal representation of young “A pediatric feeding disorder is defined as children’s impaired oral intake that is not age- feeding appropriate, and is associated with medical, behaviors. nutritional, feeding skill, and/or psychosocial dysfunction.” (Godav, et al., JPGN 2019; 68:124- 129)

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• 89% of children with ASD are said to have food selectivity • Feeding Fewer foods from all food groups Feeding Problems in problems in children with Children Autism with ASD

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Possible Possible Feeding Feeding Problems problems Preschool Infancy Age

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Nutrient Intake

• Children with ASDs tend to have a narrow number of foods they will eat. Intake • Macronutrient intake seems adequate. • Calorie intake seems adequate. What do we know? • Micronutrient intake may or may not be adequate. • Fruits and vegetables seem to be lacking. • Growth seems adequate.

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Inadequate Inadequate nutrient intake nutrient intake

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3. Discuss signs that a Inadequate child may need a feeding nutrient intake evaluation and intervention

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Severe cognitive delay

Communicate through gestures and manual signs Child’s Ambulates independently 7 year old boy Development Has anxiety & Behavior Lacks social skills, bothers others with autism Engages in hand flapping

Throws things, has temper tantrums

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Does not eat enough healthy foods

Has inappropriate mealtime behaviors Feeding Eats too much Concerns

Eats mostly junk food

Cries and tantrums at meals

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4. List types of interventions for feeding problems

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Types of Treatment

Medical • Medications Clearance • Habilitative therapies (Occupational / Speech) • Applied Behavior Analysis • Diets

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Occupational and Medications Speech Therapy

• Broad sensory integration therapy (OT) • Anti-reflux / Acid Reducers: Tagamet, Prilosec, Prevacid, Nexium, Maalox • Motility: Reglan, Erythromycin • Sequential Oral Sensory Therapy • stimulants: Periactin • Food Chaining

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Behavioral Dietary Restrictions Treatments to Address Symptoms

• Applied Behavior Analysis • More focus on data • Gluten • Slow systematic changes • Casein • Specific • Considerable overlap with other therapies

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9 Aida Miles, EdD, MMSc, RDN, LD, FAND 7/24/2019

The Gluten Free Consensus Report Casein Free Diet

• Gastrointestinal issues are common in • Eliminates gluten: children with and without autism. • Barley • Some people with autism may benefit from • Rye diet interventions. • Oats • There are potential nutrition problems in • Wheat children with autism. • Professional guidance is needed if a child is placed on a special diet. • Eliminates Casein (all products derived from milk and ).

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Autism is a common neurodevelopmental disorders with symptoms evident in early childhood

Many children with autism have feeding difficulties

Summary Feeding challenges can have serious health consequences

Children with feeding disorders need multidisciplinary GFCF Diet – What does evaluation and treatment the research say? The Registered Dietitian/Nutritionist is an integral part of the team working with children with autism with feeding disorders

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Bibliography

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