This section explains some of the most common reasons for a child with an ASD over-eating and provides some basic strategies to help you try and overcome the problem.

Some individuals with autism spectrum disorders (ASDs) can have problems relating to feeding and difficulties surrounding their diet. These dietary problems can relate to both over- and under-eating. Unfortunately, there is limited literature which focuses on this issue. For further information relating to a restricted diet please see the 'Dietary management for children and adolescents with ASDs: restricted diet' information sheet.

Please note that all of the following points are general and therefore we would always advise individuals or their carers to consult with a GP or a medical professional if they have any dietary issues.

The first step if you are concerned about an individual's diet should be to create a food diary. A food diary will hopefully be able to show possible reasons for the over-eating or weight gain.  By regularly recording an individual's eating habits you will be provided with useful information about their eating pattern. Possible sample questions for the food diary could be:

  • What time of the day did they eat? - 11: 05
  • What did they eat? - Walkers salt and vinegar crisps
  • Where did they eat? - In the living room
  • How much did they eat? - 2 x bags
  • Who was there? - Mum, brother
  • Were there any environmental factors? - Radio was on in the background

 

Possible reasons for over-eating and weight gain

Initially, it is important to identify, if possible, from the food diary whether it is the volume or type of food being eaten which is the core dietary issue.  In addition, the following reasons may be affecting the individual's eating pattern.

Physical

Sometimes an individual may over-eat as a result of lack of control and the ability to know when they are full. It has been suggested that the hypothalamus, the part of the brain that tells us when we are full and regulates food intake, does not function correctly for individuals on the spectrum.

Obsession

One feature of ASDs can be obsessive behaviours; this is where an activity or interest is extreme in one or all of the following factors: its intensity, frequency and/or duration. For some individuals on the spectrum, food and the consumption of it may have turned into their obsession or area of special interest, possibly leading to over-eating and weight gain. Please see the helpline's information sheet on Obsessions, repetitive behaviours and routines for further information.

Coping strategy

Naturally we all have in built ways of dealing with stress and difficult periods of our lives.  Having to deal with the difficulties and differences ASD presents them with could have an effect on an individual's confidence. Some individuals may over-eat as a result of low self-esteem and see food as a source of comfort.

Sensory

Individuals on the spectrum can experience sensory integration dysfunction, which could have an effect on the volume of food intake.  An individual may have a particular craving for a specific food, because it may be providing them with sensory satisfaction.

Strategies for controlling over-eating and weight gain

It is important to stress that all of the following ideas are just suggestions and what works for one individual may not work for another. With any approach used it is important that instructions to the individual are clear, consistent and are delivered in a calm manner.

Adapt the environment

  • Limit accessibility to food by keeping it in secure, out of reach places
  • Put locks on fridges and cupboards

Our Janice is very large for her age (10 years) and likes to eat a tremendous amount of food. Her main occupation at home, when not distracted by something else, is raiding the refrigerator.  This results in constant spills and messes, not to mention over-eating. We tried teaching her to stay away from the refrigerator, but this didn't work if we were out of sight. Luckily ours has two doors (freezer and fridge, side by side), so we brought a plastic lock and locked the doors together. She has not figured out how to unlock the padlock and so leaves the food alone.
Schopler (1995). p.143

  • Use visuals to remind individuals of out of bounds areas - No entry signs on cupboards and fridges.

 

Communication

Presenting information visually can assist in an individual's understanding and processing of information relating to diet and healthy eating. This can assist in setting clear rules surrounding food intake.

For example:

  • Produce clear daily and/or weekly menus of foods - display the time of next meal in a prominent position.
  • Show them the empty saucepan to assist with understanding. Confirm verbally that the food has all gone.
  • Set rules relating to restaurants and food shops If you have a starter you cannot have a pudding.
  • Use visuals to reinforce and assist with the understanding about a healthy diet.
  • Have a food chart which lists both healthy and unhealthy foods. The rule is they must have one food from the healthy list once a day.
  • Use visual emotional tools - this will provide the individual with the opportunity to express their needs. 

 

Social stories

Social stories have been found to be an effective approach in providing individuals on the spectrum with factual information.  A social story could help the individual to understand why we eat and the function of food. They can also be used to indicate the need to eat a variety of foods, both healthy and unhealthy. Educate the individual about healthy eating by giving clear information. An individual may have difficulty relating good nutrition to what they actually eat.

For example:

  • Food provides us with fuel/power, which enables us to do things we enjoy. Healthy food gives us energy and unhealthy foods can make us tired.

 

Managing the obsession

Depending upon the level and degree of the obsession, it is important that you focus on trying to manage it without causing the individual any additional distress and/or anxiety. Through the food diary you will hopefully gain a valuable insight into the level of the obsession and hopefully the best possible way of managing it. Below are basic factors, which you may consider.

  • Clear and consistent guidelines may need to be set around the times food is eaten (7.00pm), the amount of food eaten (one plate full) and the location (the kitchen table) of where food is eaten.
  • It may be appropriate to channel the obsession into something positive such as cooking and producing recipes.

Please note the ways of managing and dealing with obsessions are very varied, so please refer to the 'Obsessions, repetitive behaviours and routines' information sheet, available from the Autism Helpline, for more in-depth management strategies as well as seeking professional medical advice

Controlling the volume

Everyone has their own individual eating pattern. From the food diary, try and establish the times of the day the individual is eating and the volume of food being eaten at these times. For some it could be little and often others may have large portions at regular meal times or lots of snacks. So the focus needs to be on ways of managing the food intake.

For example:

  • Try to reduce food portions
  • Use a smaller plate
  • Try to do a food timetable. You can have snacks at 11.00am, 3.00pm and 6.00pm (two healthy snacks and one unhealthy snack) reducing the amount of food intake gradually.

 

Encourage exercise

If an individual is overweight it is important to try and encourage activities which involve movement and exercise in order to try and assist them with their weight loss.

For example:

  • Trampolining, swimming, walking, cycling.

 

Counselling

If an individual is turning to food as a source of comfort then it is important that they see a professional to help them to tackle the issues they may have which are leading them to be unhappy. Counselling may provide individuals with the opportunity to develop and understand their emotions. Hopefully, this will help them to improve their self-esteem and self-confidence.

* Please note there is a specific disorder, Prader Willi syndrome, which relates to individuals not being able to control their eating. Please see contact details if you require any further information on this condition.

Professionals who may be able to help

Over-eating and weight gain can lead to medical problems. It is therefore necessary if the problems persist to contact your GP about the situation. The GP may then refer them onto one or more of the following professionals.

  • Dietician/Nutritionist - they offer advice on healthy eating and produce programmes to assist in both weight gain and loss
  • Eating disorder clinic
  • Clinical psychologist or psychiatrist - if the problem is thought to be psychological they can help implement cognitive and behaviour strategies
  • Paediatricians - are experts in child health issues and can help provide solution to the dietary problems
  • Occupational therapist - may be able to offer advice on the family management of the situation
  • Dentist - an individual's eating difficulties may result in poor dental hygiene management or toothache
  • Counsellor - is an individual who is trained to talk through a variety of issues.

 

Useful contacts

Autism Helpline
Tel: 0808 800 4104 (open 10am-4pm, Monday-Friday)
Minicom service: 0845 070 4003
Email enquiry service: visit www.autism.org.uk/enquiry and complete the online form.

The Autism Helpline holds a database of specialists who have indicated that they have expertise or interest in the area of autistic spectrum disorders. This database is not comprehensive (it does not include the details of all specialists across the country) and the Helpline is unable to recommend any particular specialist. However we are able to provide the details of specialists listed in different parts of the country if requested.

Feeding Team
Great Ormond Street Hospital
London WC1N 3JH
Tel: 020 7405 9200
(Only take internal referrals)

PWSA (UK) - Prader Willi Syndrome Association
125a London Road
Derby DE1 2QQ
Tel: 01332 365 676
Fax: 01332 360 401
Email: Website@pwsa-uk.demon.co.uk

The British Dietetic Association
5th Floor Charles House
148/9 Great Charles Street
Queensway
Birmingham B3 3HT
Tel: 0121 200 8080

Dietitians Unlimited
FDG Administrator
Freelance Dietitians Group
22 Birkbeck Road
North Finchley
London
Email: fdg.administrator@virgin.net
Website: www.dietitiansunlimited.co.uk

National College of Occupational Therapists
Tel: 0207 357 6480
Website: www.cot.co.uk

Nutritionist resource
Further information on nutrition and to locate a nutritionist.
Website: www.nutritionist-resource.org.uk

Private Occupational Therapist
Tel: 0800 389 4873
Website: www.otip.co.uk

British Association for Behavioural and Cognitive Psychotherapies (BABCP)
They have a register of qualified counsellors with details of the types of problems that they help people with.
Tel: 0161 705 4304
Website: www.babcp.com - there is a list of counsellors on their website

British Psychological Society (BPS)
They have a register of Chartered Psychologist. Some psychologists do counselling too so you may be able to get some help by looking at their list.
Tel: 0116 254 9568
Website: www.bps.org.uk - there is a list of psychologists on their website
  
UK Council for Psychotherapy (UKCP)
They have a list of registered psychotherapists (can be requested by e-mail of post)
Tel:  020 7014 9955
Website: www.psychotherapy.org.uk

The British Association for Counselling and Psychotherapy
They have a list of accredited counsellors and psychotherapists
Tel: 0870 443 5252
Website: www.bacp.co.uk - there is a list of counsellors on their website

Fridge lock suppliers

Child Alert
Childalert have an online shop with locks for fridges.
Website: www.childalert.co.uk

Niche locks
A & E Squire Ltd
Bloxwich Road North
Willenhall
West Midlands WV12 5PX
Tel: 01922 476243
Email: info@nichelocks.com
Website: www.nichelocks.com

References and recommended reading

Gray, C. (2002) My social stories book. London, Jessica Kingsley

Legge, B. (2002) Can't eat won't eat: Dietary difficulties and autistic spectrum disorders London, Jessica Kingsley
                                                                                  
Schopler, E. (ed.) (1995) Parent survival manual. New York, Plenum Press