Autism Spectrum Disorder and the Importance of Family-Centered Practice in Pediatrics

By Shannon Frizzell

I am currently completing my dietetic internship through the coordinated program at the University of Pittsburgh. Through this program I have had the exciting experience of being involved in Pitt’s Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) Program as a nutrition and dietetics trainee. The LEND program has provided me with many unique opportunities to gain professional experience in interdisciplinary practice and further develop my advocacy skills. LEND has also provided me with the opportunity to learn much more about autism-spectrum disorder, as the condition is a large focus of the program’s curriculum.

Autism spectrum disorder (ASD) is a neurodevelopmental disability that results in sensory, behavioral, and communication challenges that vary in severity. As of 2018, the CDC estimates the prevalence of ASD to be 1 in 59 children.1 While the answer is not truly known, it is believed that a combination of genetic and environmental factors may result in children developing ASD. Some of the environmental factors suspected to be involved in the development of ASD include zinc deficiency (prenatal and early development) and prenatal viral infection. However, more research is still needed to uncover if there is an actual cause and effect relationship between ASD and these variables.2 Dietitians should be aware there is a lack of evidence to support Gluten-free and casein-free diets in the treatment of ASD.3 The Academy of Nutrition and Dietetics cites evidence-based practice guidelines as a key component of professional goals and ethical standards. There is currently no reputable evidence to support the use of either of these diets in the treatment of autism-spectrum disorder.3 In addition to proven practice guidelines, it is important to utilize the family’s experience as they truly are the experts on their child. Often times families have tried so many therapies and alternative treatments that trialing a modified diet may feel like another hopeful opportunity to help their child. While nutrition advice in the sense of an “autism-diet” may not exist, there are still many ways nutrition interventions can be utilized to help families of children with ASD. Key areas of focus for potential interventions can include easing meal-time conflicts, offering strategies to increase food selection, and providing education on drug-nutrient interactions.4 It is important to work with families to understand how to best prioritize the focus of nutrition interventions.

Limited food selection and picky eating behaviors are common in children diagnosed with ASD. Food selectivity in this population can be attributed to a variety of factors including sensory issues and extreme color and shape preferences.5 Sensory issues create difficulty for children with ASD to accept foods of specific textures making trying new foods a challenge.6 Trying new foods can be discouraging for parents, but we can provide helpful strategies to implement meal-time routines that can be extremely beneficial for children with autism. In addition to creating structure and routine, teaching parents and siblings to model appropriate behavior can be an effective strategy to ease meal-time conflicts. Modeling behavior is a key component of Applied Behavior Analysis (ABA) which is used widely in the treatment of ASD.7 These are just a few examples of the various implications of nutrition interventions for ASD.

The LEND program has also provided me so many opportunities to practice my interdisciplinary communication skills. Building these skills has been a very meaningful experience for me, and I hope to emphasize the importance of interdisciplinary collaboration to other students entering the dietetics field. I believe this is essential in behavioral health nutrition as so many other medical disciplines are often involved in the care of our patients. It is especially important to have an appreciation for the perspective patients and their families can bring to the table. If we can look at our patients and their families as members of our healthcare team, it will drastically increase the quality of care we can provide as future dietitians.

 

References:

  1. Autism Spectrum Disorder (ASD). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/index.html. Published 8/2719. Accessed 1/20/20.
  2. Grabrucker AM. Environmental factors in autism. Front Psychiatry. 2013;3:118. Published 2013 Jan 18. doi:10.3389/fpsyt.2012.00118
  3. American Dietetic Association. Nutrition Care Manual®. Autism – Nutrition Intervention. Link. Accessed 1/20/20. https://www.nutritioncaremanual.org/?err=NLI#.
  4. Ansel K. Autism Spectrum Disorders and Diet. EatRight. https://www.eatright.org/health/diseases-and-conditions/autism/nutrition-for-your-child-with-autism-spectrum-disorder-asd. Published 4/2/18. Accessed 1/20/20.
  5. The National Autistic Society – eating. Autism support – leading UK charity – National Autistic Society. https://www.autism.org.uk/restricteddiet. Published 7/26/16. Accessed 1/20/20.
  6. Sensory Integration in Autism Spectrum Disorders. Autism Research Institute. https://www.autism.org/sensory-integration/. Published 5/4/19. Accessed 1/20/20.
  7. Association for Science in Autism Treatment. https://asatonline.org/for-parents/learn-more-about-specific-treatments/applied-behavior-analysis-aba/aba-techniques/modeling/. Accessed 1/22/20.

 

ABOUT THE AUTHOR

Shannon Frizzell headshotShannon Frizzell is a second-year student at the University of Pittsburgh in the Coordinated Master in Nutrition and Dietetics program. She received her bachelor’s degree in public health from Slippery Rock University of Pennsylvania in 2017. She is currently involved in the University of Pittsburgh’s Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) Program. Here she works as part of an interdisciplinary team to help children with disabilities and their families gain access to resources in their communities. Shannon aspires to become a registered dietitian nutritionist specializing in pediatric nutrition care. She has a passion for learning and is hopeful to make a difference in the quality of healthcare that her patients receive.

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