Understanding Safe Foods for Individuals with ASD

Understanding safe foods for individuals with ASD is extremely important to help establish a balanced diet and keep them nourished and healthy.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects various aspects of daily living. One aspect often overlooked is how diet is impacted by ASD and understanding the role of diet in supporting the health and well-being of individuals with ASD. For many individuals on the spectrum, food choices can significantly impact not only nutritional status but also daily comfort and behaviour. Understanding "safe foods" — meaning foods that are well-tolerated and the individual is able to eat consistently as it is acceptable to their sensory preferences and sensitivities — is essential for caregivers and families.

Individuals with ASD may struggle with sensory processing more than neurotypical individuals, and this extends to food selection. Importantly, texture, smell, colour and temperature can all influence whether a food is perceived as tolerable or even edible. Zobel-Lachiusa et al. (2015) found that children with more severe sensory sensitivities had a more limited food repertoire, often preferring bland, soft, and predictable foods. Understanding and respecting these preferences is key to ensuring mealtime is both safe and less stressful. One example of food that can be unpredictable are fruits – sometimes strawberries are sweet and sometimes they are sour – as such, children who are sensitive to taste may avoid such foods and prefer other foods such as biscuits or crackers from specific brands, which always taste the same. Furthermore, Bandini et al. (2010) found that children with ASD demonstrated greater food refusal and limited food repertoire. 

It is also possible that individuals with ASD might experience physical reactions such as gastrointestinal distress and skin reactions after consuming specific food due to heightened sensitivities, as evidenced by a study conducted by Coppola et al. (2024) that found that, 71.4% of ASD children with food allergies exhibited gastrointestinal symptoms. It may not just be a sensory issue, but it could be a physiological reason why the individual is more inclined to specific foods and is aversive to other foods. A study by Jyonouchi et al. (2018) found that many children with ASD exhibited abnormal innate immune responses to food proteins, especially gluten and casein, leading to inflammation. They suggested a possible link between GI and behavioral symptoms (e.g., aggression, irritability, anxiety, and sleep disturbances) mediated by innate immune differences.

While honouring safe foods is essential, it is good to expand food repertoire to ensure balanced nutrition and reduce mealtime stress. For individuals with ASD, gradual exposure and a structured, low-pressure approach can be especially effective. A study by Fishbein et al. (2006) highlighted the effectiveness of food chaining as a gradual desensitization strategy for selective eaters, including children with ASD. The children in this study demonstrated improvements in food variety and mealtime tolerance over time. Food chaining is a method where new foods are introduced by making small, predictable changes to textures, flavours, or appearances of already accepted safe foods. It is typically done in a home environment with minimal stress. For example, if a child enjoys plain crackers, a soft spread could be introduced in tiny amounts before gradually transitioning to new textures or flavours. Pairing new foods with familiar routines or foods (eg. serving a new vegetable alongside a safe food and introducing a new fruit during a regular snack time) , visual support (pictures of the food) can also reduce anxiety around trying unfamiliar foods. Safe foods are safe to the individual for a reason, and it is important to remember that while expanding food repertoire is important, it should always be done in a safe and comfortable manner for the individual, and although improvements might seem small, any expansion of food repertoire is positive! 

Written by: Tan Yock Kim

References

Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R., Maslin, M., & Must, A. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. The Journal of Pediatrics, 157(2), 259–264. https://doi.org/10.1016/j.jpeds.2010.02.013

Coppola, S., Nocerino, R., Oglio, F., Golia, P., Falco, M. C., Riccio, M. P., Carucci, L., Rea, T., Simeone, S., Garotti, R., Marani, N., Bravaccio, C., & Canani, R. B. (2024). Adverse food reactions and alterations in nutritional status in children with autism spectrum disorders: results of the NAFRA project. the Italian Journal of Pediatrics/Italian Journal of Pediatrics, 50(1). https://doi.org/10.1186/s13052-024-01794-8

Fishbein, M., Cox, S., Swenny, C., Mogren, C., Walbert, L., & Fraker, C. (2006). Food Chaining: A systematic approach for the treatment of children with feeding aversion. Nutrition in Clinical Practice, 21(2), 182–184. https://doi.org/10.1177/0115426506021002182

Jyonouchi, H., Geng, L., Ruby, A., & Zimmerman-Bier, B. (2005). Dysregulated innate immune responses in young children with autism spectrum disorders: their relationship to gastrointestinal symptoms and dietary intervention. Neuropsychobiology, 51(2), 77–85. https://doi.org/10.1159/000084164

Science Photo Library. (n.d.). Child eating yogurt [Photograph]. https://www.sciencephoto.com/media/840770/view/child-eating-yogurt

Zobel-Lachiusa, J., Andrianopoulos, M. V., Mailloux, Z., & Cermak, S. A. (2015). Sensory differences and mealtime behavior in children with autism. American Journal of Occupational Therapy, 69(5), 6905185050p1-6905185050p8. https://doi.org/10.5014/ajot.2015.016790