Sugar and autism

Today’s answer is by occupational therapist Desiree Gapultos, of the Autism Speaks Autism Treatment Center at Children's Hospital Los Angeles.

Our child, severely affected by autism, refuses to eat anything but sweets. How can I direct her diet in healthier directions?

Thanks so much for your question. As an occupational therapist at an autism center, I often work with sensory issues that can interfere with a child’s ability to try new foods or otherwise expand a narrow diet. In encouraging a wider and healthier range of food choices, it helps to understand why these aversions and obsessions develop.

Many individuals affected by autism either avoid or crave certain flavors, food textures or even colors. Similarly, many want to eat from only certain food groups, such as grains or dairy. Some gravitate strongly to certain food types, such as pasta or bread or sweets.

This may be related to the fact that many individuals with autism are over or under responsive to sensory input. We call this hypo- or hyper-responsiveness, and it can include a person’s response to flavors and food textures.

Naturally, a blast of sweetness provides a powerful sensory input that many of us crave. This craving can be particularly powerful for an individual affected by autism.

Helping reduce your child's sugar intake

To encourage your child to expand out of the sweet-food realm, I suggest exploring healthier ways to provide the sensory input she craves. It’s particularly important to be patient and creative when trying to figure out healthier choices.  Here are some of my own tried-and-true strategies:

1. If your child prefers, say, a particular sugary cereal, try crushing it to make a crumb powder. Sprinkle a bit on a healthier alternative such as an unsweetened cereal or home-cooked porridge. This will provide the flavor of the food she prefers while introducing a healthier option. 
2. Does your child crave sweetened sodas? Try flavoring plain carbonated water with fruit juice for a healthier, less sugary option. Another trick is to freeze some fruit juice in ice cube trays and put a few cubes in a cup of sparkling water. You may even find that the refreshing temperature of ice cubes helps satisfy your child’s oral sensory cravings.
3. Homemade smoothies and milkshakes are another option for providing nutrition with a healthy touch of sweetness. Try blending some fruit or a sweet vegetable such as carrots with low-sugar yogurt or ice cream.
4. Did you know that a straw can increase sensory input? With children, I find that crazy, twisty straws often prove a hit. Have your child try one with her next milkshake or juice-sweetened seltzer.
5. A surprising number of fresh and cooked vegetables come with a wonderful touch of natural sweetness. Try slicing sweet potatoes into strips and baking them for a sweet snack that’s also crunchy. When in season, you might try sweet peas in the shell or sliced zucchini.
6. Does your child beg for cake? Consider baking a low-sugar version of zucchini, banana or carrot bread. I add applesauce to the batter for added sweetness and softer texture.

For more tips, I highly recommend the Autism Speaks the ATN/AIR-P Guide to Exploring Feeding Behavior in Autism.

If you need further help, I suggest using the Autism Speaks Resource Guide to find and consult a feeding specialist experienced in working with individuals affected by autism. This can be an occupational therapist, a speech-language specialist or a psychologist. Such professionals can provide suggestions tailored for your child.