By Danielle MacDowell
Main Takeaways
- The terms picky or selective eaters are often used interchangeably and encompass individuals who will only eat certain foods (or food groups).
- Picky eating occurs across abilities and ages.
- Food selectivity, or the acceptance of only a few foods, is more prevalent in people with ASD and intellectual disabilities (ID).
- Medical issues, physical issues, and sensory challenges can all influence an individual’s eating behavior.
- Once an individual associates a negative experience with eating, whether it be eating in general or eating specific foods, a child will often use different behaviors to avoid the adverse experience.
- Three mealtime issues that have important medical and health implications include, 1.) not eating enough food to sustain weight, 2.) not eating enough food to match development and nutritional needs, 3.) and lack of variety of foods
- Applied behavior analysis (ABA) is the science behind learning and behavior and ABA can be a helpful tool in helping your child to overcome food selectivity and improve mealtime behaviors in general.
- 7 Common ABA strategies used to improve mealtime behaviors include reinforcement, response shaping, planned ignoring, differential reinforcement, the premack principle, modeling, and escape extinction.
Table of Contents
Mealtime can be challenging under the most normal circumstances. So, what happens when a parent has a child labeled as a “picky eater” or a “selective eater?” Traditional recommendations, such as caregiver modeling and presenting new foods with preferred foods, may not be as effective for picky and selective eaters. This is particularly true for individuals with autism spectrum disorder (ASD). Picky and selective eaters may require additional strategies and support systems to help increase both food tolerance and appropriate mealtime behaviors.
Picky and Selective Eaters Defined
The terms picky or selective eaters are often used interchangeably; these encompass individuals who will only eat certain foods (or food groups). While this blog is primarily focused on ASD and intellectual disabilities (ID), neurotypical individuals are not immune from becoming picky eaters. In fact, anywhere between 8-50% of individuals, across ages and developmental abilities, are deemed picky or selective eaters at some point.[1] As you can see, this estimated range is quite large and not nearly as precise as we would like it to be. This is due to different types of participant samples used across studies. While this estimated percentage is not nearly as clear as we would like it to be, what we can deduce is that picky eating occurs across abilities and ages.
The terms picky or selective eaters are often used interchangeably and encompass individuals who will only eat certain foods (or food groups). Picky eating occurs across abilities and ages.
Autism, Food Selectivity, & Mealtime Behaviors
- Food selectivity, or the acceptance of only a few foods, is more prevalent in people with ASD and intellectual disabilities (ID). However, food selectivity affects children of varying neurological and cognitive backgrounds.
- Individuals with ASD are five times more likely to have mealtime challenges as compared to their neurotypical peers.[2]
- Individuals with autism are more likely to have a different and sometimes unusual relationship with foods. This may be due to hypo-sensitivity or hypersensitivity, gastrointestinal distress, or their inclination to have restrictive and rigid routines and rituals.
- Food textures, tastes, and even food color can be an influential factor in the type of foods individuals choose to eat. Regardless of what is motivating food choices, anytime there is a lack of variety in one’s diet, macronutrient and micronutrient deficiencies and their associated health consequences can occur. For these reasons it is important to implement interventions as soon as possible.
- While we can be eager to increase food variety in children, it is important to remember that this process will take time. Neurotypical children may need up to 15 exposures of a new food before it can be added into the regular meal repertoire.[3] So, increasing food repertoire in children with developmental disabilities is likely going to take extra time, patience, and strategy.
Potential Causes of Food Selectivity
Rowell & McGlothlin [4] identify several areas to examine if a parent has a picky or selective eater to help determine appropriate interventions. These include:
Medical Issues: Determine if there is an underlying medical condition that could be impacting food choices and mealtime behaviors. A few common examples of medical conditions that influence eating patterns are allergies and gastroesophageal reflux disease (GERD).
Physical Issues: Physical issues, such as oral-motor and gross-motor deficits, can also interfere with eating behaviors. If a child has a hard time chewing, moving his/her tongue adequately, breathing, swallowing, or sitting up-right, mealtime is going to be much more complex and taxing on the child. If any of these challenges are observed, parents should notify their pediatrician as soon as possible. An evaluation from an occupational therapist or speech-language pathologist may be necessary.
Sensory Challenges: Individuals can be hypo or hypersensitive to foods. Meaning, they either experience food in a heightened way or cannot feel the food enough to be able to manipulate it in their mouths in the correct way. Either way, having an atypical sensory experience with food can greatly interfere with eating.
Sensory challenges can likely be ruled out if a child eats a variety of textures. It is important to note that if a child gravitates to one type of texture, it doesn’t necessarily mean that there is a sensory disorder. Rather, it could simply be the child’s food preference. It will take an expert, such as an occupational therapist to determine if a sensory disorder/sensitivity is present.
Addressing Underlying Issues: Once an individual associates a negative experience with eating, whether it be eating in general or eating specific foods, a child will often use different behaviors to avoid the adverse experience.[5] So, addressing food challenges will be important to tackle early on before behaviors become further established, and in turn, harder to correct.
If all of the above possibilities have been ruled out, behavioral options may be worth seeking to increase food variety and food quantity.
Medical issues, physical issues, and sensory challenges can all influence an individual’s eating behavior. Regardless of the reason behind the challenging mealtime behaviors, once an individual associates a negative experience with eating, whether it be eating in general or eating specific foods, a child will often use different behaviors to avoid the adverse experience.
Common Targets of Mealtime Interventions
Three mealtime issues that tend to receive a lot of attention due to their medical and health implications include:
- Not eating enough food to sustain weight
- Not eating enough food that is “developmentally or nutritionally appropriate” [6]
- Lack of variety of food
If any one of these conditions are left untreated, malnutrition, and subsequent health consequences can occur, making these top priorities for practitioners to address.
Three mealtime issues that have important medical and health implications include, 1.) not eating enough food to sustain weight, 2.) not eating enough food to match development and nutritional needs, 3.) and lack of variety of food.
Applied Behavior Analysis, Mealtime Behaviors, and Food Selectivity
Applied behavior analysis (ABA) is the science behind learning and behavior. Being that there are a number of behaviors involved in mealtime (i.e. selecting food, bringing food to table, sitting down, touching food, utensil use, bringing food to mouth, etc.), ABA can be a helpful tool in helping your child to overcome food selectivity and improve mealtime behaviors in general.
ABA Methods to Increase Appropriate Mealtime Behaviors
Once medical issues, physical issues, eating disorders, and sensory issues have been ruled out, behavior modification can be a pretty powerful tool to increase appropriate eating behaviors (including increasing quantity and quality of food), as behavior analysts help to make shifts in the environment to best support teaching new mealtime skills.
However, it is important to keep in mind that there is no one size fits all approach. Intervention should be tailored by a specialist to accommodate an individual’s needs and their environment.
7 Examples of ABA-Based Strategies Used to Improve Mealtime Behavior
1. Reinforcement: The most successful interventions include reinforcement. So, find out what your child would be most motivated to work for. Does he/she have a favorite game? Favorite movie? If so, include these items/activities in your mealtime improvement plan.
It is important to note that while some children prefer tangible rewards (things, activities), others love soaking up attention. Conversely, some children just prefer to be alone. The reward given should be specific for the individual.
Remember what is rewarding to you may not be rewarding to others (and vice versa!)
Real World Tip: Deliver reinforcement 1-3 seconds after the behavior so the individual can make a direct connection between their behavior and the reward.
2. Response Shaping: Shaping is a common strategy used in ABA. It essentially reinforces small successive steps needed to perform a specific behavior. For example, a child may be reinforced for touching food with his/her hand. Once the child has had success for a predetermined period of time touching the food, the intervention will shift slightly. Rather than being reinforced for touching food with their hand, they may then be reinforced for touching the food with his/her tongue. So on and so forth. Shaping will occur until the individual is able to perform the full target task (i.e. chewing and swallowing all food placed in mouth).
Shaping is less intrusive (and therefore less aversive) than some other commonly applied strategies. For this reason, shaping may be a preferred approach.
3. Planned Ignoring: This includes ignoring the undesirable behavior. This can be effective for individuals who like attention from others.
It should be noted that planned ignoring can often be misused, as people tend to think that they should ignore the individual. This is not the case. I repeat, this is not the case. I cannot stress this enough. You are simply ignoring the inappropriate behavior. For example, if your child is yelling, you only ignore the yelling while providing attention to the other behaviors. This can be tough to do correctly. But when done with consistency, it can be effective for individuals who like attention from others.
Real World Tips:
1.) Planned ignoring will likely not work for individuals who are not seeking attention. For example, if the individual just wants a toy or they want to escape from mealtime, this strategy should not be used.
2.) Planned ignoring works best when individuals provide over the top attention for appropriate behaviors. In ABA terms, this is called differential reinforcement of alternative behaviors (DRA) because you are reinforcing alternative and appropriate behaviors. (See below)
4. Differential Reinforcement of Alternative Behaviors (DRA): This includes reinforcing appropriate behaviors and withholding reinforcement for inappropriate behaviors. For example, assuming your child is motivated by attention, if your child cries when he is given carrots, you would ignore the crying. While it is just as important to ignore the crying, it is just as important to quickly acknowledge all appropriate behavior the second it occurs.
In order to use this strategy correctly, you must immediately provide reinforcement the moment your child engages in any other appropriate behavior (i.e. talks nicely, picks up a fork, asks for a break, etc.). It is best to be specific when providing feedback so your child knows why they are being reinforced. You might say something like, ”really nice job picking up your fork.”
5. Premack Principle AKA “first-then” (also fondly known as “Grandma’s Rule”): When using grandma’s rule, tell your child what you would like them to do and also what they will be able to do as a result of doing the first behavior. It would go something like this: “first you eat your carrots and then you get your ice cream.” So, once the individual performs the initial behavior, they will be allowed to do the more desirable behavior.
Real World Tip: Premack Principle may be effective for mild, and possibly moderately picky eaters. This is unlikely to work for individuals who have high specificity for particular foods and very low tolerance to new foods.
6. Modeling: When used in isolation, modeling has not proven to be an effective strategy for individuals with developmental disabilities. [7] However, when coupled with other strategies, such as reinforcement, modeling can be effective for individuals with disabilities. [7] For example, a caregiver can model taking a bite of broccoli. As soon as the child takes a bite of broccoli, the caregiver must immediately provide reinforcement.
Real World Tip Reminder: Reinforcement needs to be delivered within 1-3 seconds of the behavior for it to be effective. It is also important to choose a reinforcer that the child really enjoys to make this intervention work well.
7. Escape Extinction (EE): This is a common method used in ABA. The goal behind this procedure is to prevent the individual from getting out of a task (e.g. eating a specific type of food).
For example, when a child is presented with broccoli, she may cry, and, as a result, may not have to eat the broccoli. If this happens frequently, overtime, the child will learn that when she cries she doesn’t have to eat broccoli.
Using the above example, if an EE procedure were to be put into place, a practitioner (or parent) would continue to give the child broccoli and not allow her to get out of eating it.
There are two common ways that practitioners implement EE, 1.) non-removal of spoon (NRS) and, 2.) representation of expelled food (RP).[8]
NRS is a practice in which a practitioner places a spoonful of food at the client’s lips and does not remove the spoon until a bite is taken. Once the bite is taken, the client accesses a reinforcer.
RP and NRS often go hand-in-hand because it is not uncommon for a client to take a bite of food, get their reinforcement, and then spit the food once they have their reinforcement. In order to teach the client that they have to take a bite of the food and swallow it, a practitioner will often scoop up the spit out food and represent it. This teaches the client that he cannot get out of eating the food.
As I am sure you can imagine, escape extinction procedures are quite invasive, aversive, and intensive. For these reasons, it truly requires a skilled practitioner to implement and determine if this intervention is the best approach to treatment.
Real World Tip: Escape extinction seems to yield the best results in increasing bites accepted. [7] However, it can be quite intrusive and create an aversion to eating. So, unless there is medical or nutritional urgency (i.e. failure to thrive, diagnosed malnutrition, etc.), it may be best to try some of the less intrusive steps mentioned above first.
As always, it is recommended to consult with your behavioral and healthcare professionals before selecting and implementing any of the above interventions.
Final Thoughts and Main Takeaways
Mealtime can be challenging under the most normal circumstances, this is particularly true for individuals who are picky or selective eaters. The terms picky or selective eaters are often used interchangeably and encompass individuals who will only eat certain foods (or food groups). Picky and selective eaters may require additional strategies and support personnel to help them work on increasing food tolerance as well as appropriate mealtime behaviors.
- Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: a longitudinal study to age 11 years. Eat Behav. 2010;11(4):253-257. doi:10.1016/j.eatbeh.2010.05.006
- Zulkifli M, Kadar M, Fenech M, Hamzaid N. Interrelation of food selectivity, oral sensory sensitivity, and nutrient intake in children with autism spectrum disorder: A scoping review. Research in Autism SPectrum Disorders. 2022;93 (101928).
- Williams, K, Seiverling,L. Broccoli Boot Camp. Bethesda, Maryland: Woodbine House, Inc. 2018
- Rowell & McGlothlin. Helping Your Child with Extreme Picky Eating. Oakland, California: New Harbinger Publications. 2015
- Fraker C, Fishbein M, Cox S, & Walbert L. Food Chaining. Cambridge, Boston: Da Capo Press. 2007
- Sarcia B. The Impact of Applied Behavior Analysis to Address Mealtime Behaviors of Concern Among Individuals with Autism Spectrum Disorder. Child Adolesc Psychiatr Clin N Am. 2020;29(3):515-525. doi:10.1016/j.chc.2020.03.004
- Chawner LR, Blundell-Birtill P, Hetherington MM. Interventions for Increasing Acceptance of New Foods Among Children and Adults with Developmental Disorders: A Systematic Review. J Autism Dev Disord. 2019;49(9):3504-3525. doi:10.1007/s10803-019-04075-0
- Turner VR, Ledford JR, Lord AK, Harbin ER. Response shaping to improve food acceptance for children with autism: Effects of small and large food sets. Res Dev Disabil. 2020;98:103574. doi:10.1016/j.ridd.2020.103574
