Autism and ketchup

This answer is from behavioral psychologist and board-certified behavior analyst Jennifer Bass. Dr. Bass, who specializes in feeding issues, works in the Autism Speaks Autism Treatment Network at Cincinnati Children’s Hospital Medical Center.

What is it about autism and food condiments? Our adult son covers pretty much everything he eats in ketchup. Now we’re hearing that this sort of thing is fairly common with individuals on the spectrum. Is it okay to indulge it?

Thank you very much for your question. I would love to say that your son probably likes to dip all of his foods in ketchup because it simply tastes good. I personally believe that everything tastes better fried and dipped in ranch dressing.

However as a parent of a child with autism, you know that the answer is probably not that simple. Every individual with autism is unique. So there could be many reasons why your son loves to cover everything in ketchup.

Many individuals with autism have a need for “sameness.” If you think about it, condiments such as ketchup can be used to add a familiar taste to pretty much any food. Or to put it another way, that sweet ketchup flavor can help mask food flavors that your child finds “too different.”

In addition, plain-old picky eating is so common among individuals with autism. Many are averse to not just certain flavors but also certain textures. Along these lines, covering everything in ketchup might be your son’s way of tolerating foods that he simply doesn’t like for whatever reason.

It might also be that your son tried new foods for the first time by dipping them in ketchup. If so, awesome! That can become a great way to introduce new foods.

You may have even reinforced this habit. Let’s say your son finally took that first bite of grilled chicken after he was allowed to dip it in ketchup. You probably beamed and made sure that the Heinz bottle was always on the table after that.

I may be off-base here, but I would imagine that your son shows a strong preference for ketchup and does not like to dip his foods in other condiments. This goes back to how individuals with autism often get into certain routines that are comfortable and predictable to them. It could be that your son has gotten into the habit of putting ketchup on everything because that’s something that helps him feel in control. This would be similar to another child insisting that he eats only off of his favorite Buzz Lightyear plate while using his Nemo spoon.

Putting ketchup on everything

You also asked whether it’s okay to indulge in your son’s love of ketchup. The short answer is: It depends.

If you have concerns about your son’s overall health and nutrition, I would highly recommend addressing this behavior as soon as possible. I’m referring here to concerns related to obesity, diabetes or malnutrition. Along these lines, an obsession with salt or a very salty condiment such as soy sauce might raise concerns around blood pressure or kidney health.

The first step is to discuss your concerns with a trusted medical professional like your son’s doctor. If needed, your doctor can provide referrals to a specialist experienced with autism-related feeding issues. With many feeding issues, it can also help to enlist a behavioral psychologist or a board-certified behavior analyst. Behavioral strategies are extremely effective in addressing behavior-related eating issues.

If you’re not concerned about your son’s health, then this issue becomes a matter of “picking your battles.” Is this behavior significantly interfering with an area of your son’s life? For example, does he absolutely refuse to eat any food unless dipped in ketchup? Does a meal without ketchup trigger a tantrum? Then definitely seek professional help, as I describe above.

Working on food flexibility

If it’s not a major problem but you’d like to introduce more flexibility in your son’s diet, I suggest setting some limits and practicing portion control in a low-key way at home. Here are some things you can try:

• Your son may respond well to a visual cue that shows him how much ketchup he is allowed at each meal. For example, you might color a red circle on a piece of paper or plastic plate to show him how much.
• He may also like being provided with, say, two choices of how much ketchup he can use. Again you could do this with a picture or other visual cue of two portion sizes that are both acceptable to you.
  • Or, you could try telling him how many bites he is allowed to dip in ketchup during a given meal. I think this works better than telling him how many bites he needs to eat that are not dipped in ketchup. (Keep it positive.)
• Finally, consider offering ketchup as a reward for trying new foods. You might say something like, “First try a bite of corn and then you can have your French fries with ketchup.”

I hope this information helps not only you and your son but the many other families dealing with this and similar food issues.