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| CASE REPORT |
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| Year : 2022 | Volume
: 19
| Issue : 1 | Page : 89-91 |
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Mealtime behavior in autism spectrum disorder: A case report
Tarubhi Agarwal1, Neelima Asthana2
1 Department of Home Science, Lady Irwin College, Delhi University, New Delhi, India
2 Department of Education, Lady Irwin College, Delhi University, New Delhi, India
| Date of Submission | 14-Jul-2021 |
| Date of Decision | 29-Aug-2021 |
| Date of Acceptance | 05-Oct-2021 |
| Date of Web Publication | 05-Jul-2022 |
Correspondence Address:
Dr. Tarubhi Agarwal
Department of Home Science, Lady Irwin College, Delhi University, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/iopn.iopn_68_21
Autism spectrum disorder is a neurodevelopmental disorder characterized by impaired social and communication skills and repetitive and restricted behaviors or interests. No exact cause has been determined that may be responsible for its occurrence. However, genetic and environmental factors could be responsible for this disorder. Autism spectrum disorder is one area where little research has been done regarding mealtime behavior and increasing prevalence of this disorder indicated a dire need to study this area. The study aimed to observe the mealtime behavior of 15-year-old adolescent boy during his mealtime and understanding the factors that might be responsible for the idiosyncratic mealtime behavior. Nonparticipatory observation method was used for about 1 month, and data were collected till the point of saturation, where the data collection process no longer offered any new or relevant data. Speech impairment, restricted interest, vestibular difficulties, interference, sensory issues, lack of social interest, and self-absorbed behavior were some of the factors that might be responsible for his idiosyncratic behavior during mealtimes. The study recommended that nutrition-based intervention programs must be initiated by the professionals as early as possible to minimize the effect of such factors during mealtime of people with autism spectrum disorder.
Keywords: Adolescence, idiosyncratic behavior, mealtime, sensory difficulties, and autism spectrum disorder
How to cite this article:
Agarwal T, Asthana N. Mealtime behavior in autism spectrum disorder: A case report. Indian J Psy Nsg 2022;19:89-91 |
| Introduction | |  |
Autism spectrum disorder is a group of neurodevelopmental disorder characterized by deficits in mainly three areas, i.e., communication, social interaction, and repetitive and restricted behaviors (Centre for Disease and Control (CDC) Prevention, 2016). Diagnosis of autism spectrum disorder has been made at the age of 2 years by the experienced professionals. No single cause has been determined that is responsible for its occurrence. There may be several reasons that make a child more sensitive to have autism spectrum disorder including environmental, genetic, and biological reported by CDC. About one in 54 children has been identified with autism spectrum disorder according to the estimates from CDC's Autism and Developmental Disabilities Monitoring Network, 2016. Boys are four times more prone to have autism spectrum disorder than girls. Research highlights that children who are on the autism spectrum can present with unique mealtime challenges that make them more prone to nutritional deficiencies. Nutrition is an important aspect in every age group, especially in childhood because it is related to growth and development and also interferes in health and illness. Way of eating, the preferred types of food represent their mealtime behavior.[1] Autism spectrum disorder is a neurodevelopmental disability that may affect nutritional management of children with this disorder as they are especially, at higher risk of malnutrition, since poor nutrition can often lead them to be either overweight or underweight due to limited nutrient intake.[2] Evidence indicated that eating problems at five times more among children with autism spectrum disorder including food selectivity is the most prominent unusual behavior problem among children with this disorder.[3] In addition, strong refusal behaviors such as refuse to sit at the family dinner table, eating at restaurants, attending birthday parties, or religious observances that include food are more likely to occur in children with autism spectrum disorder. This mealtime-related behavioral problem can result in serious health risks including nutritional deficiencies and medical complications. Extreme cases of food selectivity have been linked with severe malnutrition and overwhelmed by obesity, because their narrow food preferences most often deficits in variety, not volume.[4] There is an emerging consensus that children with autism spectrum disorder have idiosyncratic eating behavior, which makes this population nutritionally vulnerable.
Thus, looking toward the significance of the situation and increasing prevalence of this disorder, the present case study has been conducted that aimed to observe the mealtime behavior of a 15-year-old adolescent boy with autism spectrum disorder and understanding the factors that might be responsible for his idiosyncratic mealtime behavior.
| Methodology | | |
The current study was a qualitative investigation of the typical mealtimes of a 15-year-old adolescent boy with autism spectrum disorder. The case was observed for about 1 month, and data were collected till point of saturation, where the data collection process no longer offered any new or relevant data. The nonparticipatory observation method was used to observe the mealtime behavior intensively and to understand the factors that might be responsible for his idiosyncratic behavior. The researcher had gone for one-to-one interaction with the caregivers to understand the factors or reasons behind such behavior during mealtime. The study was undertaken in November (1/11/2019–30/11/2019). The written informed consent has been obtained from the parents before the enrolment of the adolescent with autism spectrum disorder in the study. The Institutional Ethical clearance of Lady Irwin College, Delhi University, has been obtained before conducting the study. Permission from the head of the special school of Delhi city was also taken before initiating the study.
Mealtime behavior of a case
A 15-year-old adolescent boy diagnosed with mild autism spectrum disorder who was attending junior section of special school in Delhi. This case was diagnosed at the age of 3 years, when the boy had avoided eye contact, not responded to his name or the word “bye,” had not liked to play simple games with his parents or the other children of the same age then his parents took him to a pediatrician, he referred to psychologist where it was diagnosed that child had mild autism spectrum disorder reported by his parents. Since then, different intervention therapies were started particularly occupational therapy and speech therapy. The result of therapies was not very extreme; however, it improved gross motor movement of the child. The child was not on any medical support or dietary recommendations, and there was no reported a genetic history of autism spectrum disorder in the family. He was 5 feet height and was overweight (body mass index = 22.2 kg/m2). He had sedentary lifestyle. He was the only child of his parents who had a cozy relationship with his mom and enjoys bowling and messing around.
The school timing of the boy was from 9:00 A.M. to 2.00 P.M. The morning session was from 9:00 A.M. to 12:30 P.M. During this time, the boy was engaged in various learning activities by playing. After the learning session, the mealtime duration was 30 min (12:30 P.M. to 1 P.M.). He was very much attentive for ringing up the bell for lunch break, and once it ringed, he held his seat immediately and eagerly waited for lunch that indicated his interest toward food. He has completed his meal fast, i.e., within 5 min which was unusual to normal time. Literature supported this as children with autism spectrum disorder have finished their lunch very fast, i.e., <10 min.[5] The bites of food were small. With every bite of food, he liked to lick his fingers. Eating the food fast revealed that food was swallowed, i.e., without chewing or moving the tongue. He felt difficulty in sitting erectly that made difficult for him to eat properly. Sometimes, it was observed that, when he wanted to take more food but unable to express it verbally or nonverbally to others, it indicated his receptive language inability.
He demonstrated a lack of social interaction toward the peer group, especially did not like to share food with others. Even did not like to respond when someone asked – “Do you want to have more food?” Although he was weak in social skills, he showed some peculiar behavior during mealtime like placing the food on others plate without asking them which used to create noisy environment in mess area.
He preferred to have only liquid part of the curry (gravy) part of the food. He ate only rice and dal during his mealtime and never ate solid parts such as roti and subji. Eating the same food daily indicated his restricted interest toward eating or might be associated with having food of the same texture or due to poor proprioception. When someone asked “try to taste this subji,” he started to show his aggression including spitting of food on others which indicated his disruptive behavior.
He was continuously rotated his head while eating. Sometimes, it was also noticed that he liked to dance before and after meal that time it was felt by the observer that he was self-absorbed in dancing with fluttering lips.
After completion of his meal, he daily kept his plate in the washing area and moved back to his class. In the afternoon session (1:00 P.M. to 2:00 P. M.), the boy was engaged in music therapy. It was the daily routine observed by the researcher for the duration of a month.
Factors that might be responsible for idiosyncratic behavior of adolescents with autism spectrum disorder
- Sensory issues: He felt difficulty in chewing the food or moving the tongue properly due to poor proprioception.
- Language impairment: He wanted to take more food but unable to express it verbally or nonverbally to others; it might be associated with potential delay in his language.
- Lack of social interest: He did not show any interest with his peer group; it indicated his lack of social interest.
- Interference: He did not like interference of other person/child during mealtime. When interfered, he showed his peculiar behavior such as spitting of food on others.
- Restricted behavior: He was very much restricted for his meal timings, eating pattern, and food items also that made difficult for him to eat different types of food and that's why called him as a choosy/picky/selective eater.
- Self-absorption: He was interested to remain himself alone by dancing before and after the meal which indicated self-absorbed behavior, it might be one of the reasons that dragged him to stay away from social interaction.
- Vestibular issues: He was unable to sit properly while eating; it might be due to vestibular difficulties.
| Conclusion | | |
Autism spectrum disorder is a developmental disability that can cause significant social, communication, and behavioral challenges. There is often no hint about how people with autism spectrum disorder look that sets them apart from other people, but people with autism spectrum disorder may communicate, interact, behave, and learn in ways that are different from most other people. The same characteristics were found in the present case study while observing the mealtime behavior of adolescent boy with autism spectrum disorder including speech impairment, no communication, stereotyped behavior, and social deficits. Further, research is needed to understand about the cognition impairment, behavior profile to know about the mechanisms beyond such difficulties and for planning nutrition-based intervention programs for the parents/caregivers to minimize the effect of such factors on the mealtime of children with autism spectrum disorder.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Noori M, Weisi F, Rashedi F, Sani AT, Rezaei M, Mahboubi M. Nutrition related behaviour problems in autism spectrum disorder. J Biol Today's World 2014;3:117-9.  |
| 2. | Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, et al. Food selectivity in children with autism spectrum disorders and typically developing children. J Pediatr 2010;157:259-64. |
| 3. | Palta A, Saxena R. Mealtime behaviour of children with autism. Int J Sci Res 2015;4:197-9. |
| 4. | Gray HL, Chiang HM. Brief report: Mealtime behaviors of Chinese American children with autism spectrum disorder. J Autism Dev Disord 2017;47:892-7. |
| 5. | Williams KE, Seiverling L. Eating problems in children with autism spectrum disorders. Top Clin Nutr 2010;25:27-37. |
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