Dr Randy Martin, OMD, LAc, CCH, QME, PhD - Canyon Country

Yes, picky and selective eating is actually a quite common concern for children with autism. If you rolled your eyes looking at the steps above because your child with autism has never had a full day's serving of vegetables in their life, you are definitely not alone. As if getting kids to eat their veggies isn’t challenging enough, research shows children with autism have significantly more eating challenges than their peers who are not autistic.

In addition to sensory difficulties that can lead to a lot of anxiety with food, autistic children are 4x more likely to have gastrointestinal issues such as stomach pain and discomfort. This creates the perfect storm for extra extra picky eaters - and a lot of added obstacles and concerns for parents. 

The difficulties associated with autistic children and food can cause a wide range of concerns from children being underweight to overweight (overweight children can still be at risk for nutritional deficiencies!).  This can lead to slower than normal growth and nutritional deficiencies like low vitamin D and calcium levels. Even when given multivitamins, many children with autism are still found to have some of these nutritional deficiencies.

Here are some tips:

1. Keep to a schedule - setting schedules for meal and snack  time can help picky eaters build up their appetite throughout the day
2. Minimize distractions - removing distractions like screens and toys can help your child be more engaged at mealtime 
3. Approach new foods together - Make new foods less scary by trying them together. Touching and smelling the food together before tasting it 
4. Support choice & control - Allowing your child to pick which foods they eat will help them feel more in control 

For more tips, check out our guide for getting a complete diet.

It may not seem obvious, but eating is a complex behavior that involves perceptual, emotional, and cognitive processes. And we know that children with autism process things differently. While many of us look forward to things like our afternoon snack, it may be an activity that causes a lot of anxiety for your child.

Parents describe food selectivity being determined by a few of the following factors: texture (69%), appearance (58%), taste (45%), smell (36%), and temperature (22%). Uniform texture, bland and neutral color foods are reported to be overwhelmingly preferred by more than 90% of children with ASD.

More research is needed to understand the link between sleep disturbance and autism, but there are a few possible reasons why autistic children have difficulty sleeping.2

• Co-occurring conditions. Coexisting medical conditions like ADHD, anxiety, or sleep apnea (when you stop breathing multiple times throughout the night), environmental allergies, and gastrointestinal upset (like constipation), can negatively impact sleep.
• Sensory sensitivities. Sensitivity to lights, sounds, and touch (think textures of blankets and clothing) can disrupt sleep.
• Medications. Often autistic children are prescribed medications to address various concerns like hyperactivity, anxiety, or aggression. Many of these medications may contribute to sleep problems. Adderall, Focalin, and Vyvanse are examples of stimulants prescribed to children on the spectrum to treat hyperactivity, impulsivity, and inattention, that can cause insomnia. Abilify and Risperdal (medications commonly prescribed for autistic children who have severe irritability, aggression, and/or self-injurious behaviors) may cause some children to become very sleepy.  However, each person responds differently to medications. (Pro tip: Keep channels of communication open with your doctor so that you can find the best medication to help your child that least affects sleep.)
• Neurobiological differences. Some research suggests autistic people may not produce the same levels of neurotransmitters (such as serotonin) or hormones (melatonin) important for sleep regulation, and may also experience disruption in circadian rhythms.3 In addition, low muscle tone can contribute to sleep-breathing disorders, such as sleep apnea, which also affects the quality of sleep and can lead to increased inattentive and hyperactive symptoms during the day. These behaviors, in turn, make it more challenging for the child to participate in therapies and activities. 

For more information, read our comprehensive sleep guide.

Like anyone else, when children on the spectrum don’t get adequate sleep, they may find it difficult to self-regulate during the day. But there’s another consequence – autistic kids who don’t get enough sleep can experience an increase in stimming, irritability, inattention, difficulty socializing, and keeping up in school.3 They may also face challenges with increased hyperactivity and lack of impulse control. In short, lack of sleep can intensify your child’s existing challenges.

The same goes for parents, too. It’s hard for you to keep your cool and be fully present when you aren’t well-rested.5 As you’ve already found out, good sleep is crucial for everyone in the home.

Speak with your doctor if you have concerns – especially if you notice your child snores or gasps in their sleep, grinds their teeth (bruxism), sleeps with their mouth open/drools, or is very sweaty during sleep, as these are potential signs of sleep apnea. It can be helpful to keep a log of concerns, including when the child falls asleep, how many times they wake up, when they wake for the day, and any unusual behaviors (e.g., an unusual number of sleep terrors, recurrent nightmares, sleepwalking, sleep talking, unusual hand movements, lip-smacking).

Research shows that pediatricians are sometimes unaware of the severity of sleep issues in autistic children, so please continue to advocate for your child if you have concerns.