One trait of the autistic spectrum is the persistence of restricted, repetitive and limited interests, anomalous in intensity and depth (DSM-V, 2013)
Children diagnosed with autism often show more selective food preferences than typically developing peers (Kronfli, Vollmer, Fernand & Bolìvar, 2019).
To help these kids maintain a high motivation and make them understand clearly what the appropriate behaviors are, edible reinforcers are often used: highly favourite food (e.g.: chocolate, candies, potato chips, etc).
Important considerations on the use of food as a motivator
Many individuals with autism:
- Consume fewer fruits and vegetables than typically developing peers and often exhibit strict food preferences (Peterson, Piazza, & Volkert, 2016; Schreck, Williams, & Smith, 2004).
- Are more sedentary (Jones et al., 2017; McCoy, Jakicic, & Gibbs, 2016) and spend more time using screen-based stimuli (e.g. television, tablet) than typically developing peers (Must, Philips, et al., 2014) increasing the odds of weight gain.
- They produce more problematic behaviors (e.g., aggression, self-injuring behaviors, etc.) so that antipsychotic drugs are more likely to be prescribed to reduce such behaviors (Cascade, Kalali, & Feifel, 2008; Must, Curtin, et al., 2014). Side effects of these drugs often increase the likelihood of weight gain (Jobski, Höfer, Hoffmann, & Bachmann, 2017) resulting in an increased risk of metabolic syndromes that result in long-term health problems such as type 2 diabetes and vascular disorders (Chen et al., 2016).
Is it necessary to utilize food as a motivator?
In many cases, especially the most severe ones, food is one of the few really effective motivators.
It is therefore important to expand the variety of food allowed.
It becomes relevant to evaluate IF and UNDER WHICH CIRCUMSTANCES healthier foods, such as fruit and vegetables, can be used as motivators.
Can fruits and vegetables be valid motivators?
Kronfli et al., (2020) evaluated the food preferences of 13 children, between 2 and 12 years; 2 typically developing children and 11 with autism spectrum disorder.
These authors realized a ranking for each participant, under 3 different conditions:
- Choice of only unhealthy sweet (e.g., chocolate, Oreo™️, etc.) and salty (e.g., chips, popcorn, etc.) foods.
- Choice of only healthy foods between fruit (e.g., apple, banana, etc.) and vegetables (e.g., carrots, broccoli, etc.).
- Combined choice of the 4 most favorite healthy foods and the 4 most favorite unhealthy foods.
For instance, let us see Vincent’s case:
- If he can choose among only UNHEALTHY foods, the most favourite four are: plain chips, chocolate, cookies and tortilla chips (See the column on the left, Figure 1).
- If he can choose among only HEALTHY foods, the most favourite four are: apple, grapes, strawberry and peas (See the column on the right, Figure 1).
- If he can choose among both HEALTHY and UNHEALTHY foods, the most favourite four are (in order from the most to the least chosen): plain chips, chocolate, strawberry and apple (See the column in the center, Figure 1).
In summary, the authors noted that:
- 31% (4 out of 13) of the participants do not consume any type of fruit or vegetables.
- When placed together, some children may prefer fruit and / or vegetables to unhealthy foods.
- In at least 31% of cases there is fruit and / or vegetables among the 4 most favorite foods.
- Most participants prefer fruit to vegetables, probably because of their sweeter taste.
Enhancing preferences and reducing selectivity
In the course of our lives, our food preferences change, more or less randomly.
By applying procedures and methods proven valid and effective by scientific research, it is possible to reduce food selectivity (Silbaugh et al., 2016) and increase the variety of foods consumed, in favor of healthier foods (Church, Juanico & Dozier, 2021).
The only empirically supported treatment for food selectivity (Sharp et al., 2010) for children with ASD is behavioral intervention based on the principles of ABA.
- Church, J. A., Juanico, J. F., Dozier, (May, 2021). Evaluation of Preference Shifts Following Treatment for Picky Eaters. Paper presented at the Annual Convention of the Association for Behavior Analysis International; Online.
- Kronfli, F. R., Vollmer, T. R., Fernand, J. K., & Bolívar, H. A. (2020). Evaluating preference for and reinforcing efficacy of fruits and vegetables compared with salty and sweet foods. Journal of applied behavior analysis, 53(1), 385-401.
- Sharp, W. G., Jaquess, D. L., Morton, J. F., & Herzinger, C. V. (2010). Pediatric feeding disorders: a quantitative synthesis of treatment outcomes. Clinical and Child Family Psychology Review, 13, 348–365. doi:10.1007/s10567-010-0079-7.
- Silbaugh, B. C., Penrod, B., Whelan, C. M., Hernandez, D. A., Wingate, H. V., Falcomata, T. S., & Lang, R. (2016). A systematic synthesis of behavioral interventions for food selectivity of children with autism spectrum disorders. Review Journal of Autism and Developmental Disorders, 3(4), 345-357.