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AN OVERVIEW OF AUTISM SPECTRUM DISORDER AND NUTRITIONAL PROBLEMS



Research Assistant - Fırat University, Faculty of Health Sciences, Department of Dietetics

"Children with Autism Spectrum Disorder may have different characteristics and feeding problems"

OTİZM SPEKTRUM BOZUKLUĞU VE BESLENME SORUNLARINA GENEL BİR BAKIŞ

What is Autism Spectrum Disorder (ASD)?

It is known that the term 'autism' was first used by Swiss psychiatrist Eugen Bleuler in the 1910s to describe an individual who completely isolates himself from the outside world. Autism spectrum disorders (ASD) are a complex neurodevelopmental disorders characterized by varying degrees of limitations in communication and social interaction and atypical, repetitive behaviors that often begin before the age of three.

What are the causes of Autism Spectrum Disorder?

Although its causes are still not fully understood, ASD is stated to be a multifactorial disorder caused by genetics (the interaction of many genes with each other), epigenetic, and environmental factors (the environmental factor with the most evident is parenting at a late age).

Prevalence

Autism spectrum disorder is stated as a social problem that can occur all over the world, affects every segment of society, and is becoming increasingly widespread. ASD, which can be seen in all racial and ethnic groups at every socio-economic level, is approximately 4 times more common in boys than girls. According to the 2020 report published by the Centers for Disease Control and Prevention (CDC), the prevalence of autism, which was previously 1/44 for 8-year-olds, reached to 1/36withan increase of approximately 20.0%.

Diagnosis

For young children, a doctor is usually consulted for reasons such as speech delay, the child's lack of interest in the outside world, and not responding when called, and not making eye contact. Diagnosis is quite difficult as there is no medical tests or biochemical parameters for diagnosis. To make a definitive diagnosis, the child's behavior and development are examined. Although the physical appearance of children with ASD is not different from other children, their behaviors differ. Autism spectrum disorder is diagnosed by specialists (child psychiatrists) by performing developmental tests, asking parents questions about the child's development, and observing the child.

Characteristics

The primary characteristics of autism spectrum disorder include deviations and limitations in the social-emotional domain, limitations, and deviations in verbal and non-verbal skills, and ritualistic and repetitive movements and behaviors.

Social disability

Characteristics such as the inability to establish relationships with people, and to understand other people's reactions, to share interests and experiences with other people social isolation, abnormal use of gestures and facial expressions, and the inability are observed in individuals with autism spectrum disorder.

Communicative limitations in children with Autism

Individuals with ASD experience communication problems at different levels. While some cannot develop verbal skills, some can speak extremely fluently. There are also problems in non-verbal communication (gesture, facial expression use, atypical speech, prosody disorder).

Repetitive interests and behaviors in children with Autism

Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities; It is are among the basic features of ASB. These patterns include limited interests, preoccupation with parts of objects, repetitive motor movements, insistence on sameness, sensory behaviors, and strict adherence to certain routines or rituals. Behaviors such as hand rubbing, hand clapping, turning, rocking, repetitive games with non-functional objects, tiptoe walking, and lack of interest in typical toys and games are also frequently observed.

Treatment

There is no treatment yet that can eliminate the symptoms of autism in a short time. Drugs treatments can be used mostly for the child's problems such as restlessness, mobility, anger, and sleep problems. However, the main treatment for individuals with ASD is education (The most effective educational treatment for autism is stated to be Behavioral Therapy method). An appropriate education program should include the development of the child in the social field (eye contact, imitation, mutual interaction, etc.), the development of language skills (understanding, taking commands, using meaningful sentences, etc.), the reduction of unwanted repetitive behaviors (turning around, rocking, etc.), the development of self-care skills ( eating, toilet training, tooth brushing, etc.) should be targeted.

Nutritional problems

Nutritional problems are quite common in children with autism. Common nutritional problems include food selectivity (based on the type and texture of food), food rejection, motor problems (such as chewing, moving the tongue and closing the mouth), difficulty in swallowing and gastrointestinal disorders (such as constipation, diarrhea and abdominal pain). It also includes avoiding liquid foods, holding food in the mouth for a long time, and eating quickly.

Food selectivity

Food selectively or 'picky eating' occurs frequently in children with ASD and often causes families to worry. Some children may be hypersensitive to the smell, taste, temperature, brand, appearance, and even color of food. This may cause them to reject food. Such behaviors cause nutritional deficiencies (some vitamin and mineral deficiencies) in children, excessive consumption of high-energy foods, and negatively affect their growth and development.

Recommendations for feeding problems

Nutritional management is very important for the growth and development of children and the treatment of behavioral problems and gastrointestinal problems. However, there is no guide for the nutrition and nutritional problems of children with autism. It is stated that some nutritional problems may continue into adolescence or adulthood as a result of the nutritional problems in children with autism not being resolved after diagnosis. To better understand the factors related to nutritional problems and to develop interventions for this problem, it is important to evaluate the nutritional status by the expert dietitians and question the causes of the problems. It should be questioned whether the child who eats restricted foods is restricted by his or her parents. Parents must observe their children's nutrition (size of bites, taste, smell of food, shape, eating utensils, etc.) and describe it in detail to understand nutritional problems. It should not be forgotten that there are always individual privileges in the diets applied. As in all other areas, early nutrition education and adequate and balanced nutrition are essential for children with autism and their parents in many respects.

Summary

The fact that the prevalence of autism spectrum disorder is increasing day by day all over the world and the lack of a definitive treatment is a very worrying situation for experts and parents. In addition to the many behavioral problems seen in children with autism, the prevalence of gastrointestinal and nutritional problems forces parents to deal with many situations at the same time. Feeding problems commonly seen in these children include food selectivity, food rejection, motor problems, difficulty in swallowing, and gastrointestinal disorders. It is stated that if the nutritional problems in children with autism are not resolved after diagnosis, these problems may continue into adolescence or adulthood. As in all other areas, providing adequate and balanced nutrition through early nutrition education is essential for children with autism and their parents in many respects.

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