Oral Sensitivity in Children with Aspergers and High-Functioning Autism

"My son with aspergers (high functioning) will often have a gag response or a strong reaction to certain textures of food, for example, whenever he tries to eat an apple or any other hard fruit. Is this something we should be concerned about, or is it a trait of aspergers (similar to picky eating)?"

In contrast to motor-based swallowing problems, difficulties with eating can also stem from dysfunction with the sensory system. The act of swallowing does require both motor and sensory functions to complete the act.

All of us have a range of sensory tolerance, some of us more sensitive than others. If you have a low sensory threshold, you may have an affinity for stronger tasting foods or perhaps crunchy foods. Conversely, if you are on the other end of the sensory spectrum, you may prefer milder foods or soft foods. Kids also have taste and texture preferences and tend to prefer milder, simple foods.

Hypersensitive oral reactions are exaggerated responses to touch in the mouth or around the face. Younger Aspergers and HFA kids with hypersensitive oral reactions may not let you into their mouths for feeding, tooth brushing, or play. They may have problems moving from one food texture to the next, spitting out or gagging on any food but puree. They may gag when a spoon touches the tip of their tongues. A tiny lump of food may be gagged on instead of swallowed.

The following are red flags for sensory-based eating difficulties:
  • Able to bite and chew solid foods, but not swallow them
  • Gag on foods that require chewing
  • Hypersensitive gag only with solids and not with liquids
  • May try to swallow foods whole to avoid contact for chewing
  • No problems with taking liquids
  • Will separate textures from smooth food and pocket or expel them

Some kids become so sensitive and emotional, that their reactions go one step beyond hypersensitive and become “aversion reactions” (these are stronger, more emotional, and less logical reactions). These kids may cry, fuss, pull away, push food away, or refuse even to let you near their mouths. Gagging may turn into vomiting in an aversive reaction.

Fears can develop around eating or any touch around the mouth. Aspergers and HFA kids may try to control all aspects of a meal in an effort to protect themselves from uncomfortable situations. They may want only certain food textures, certain spoons, certain plates, and certain cups. Moms and dads become frustrated because their youngster will eat only a few foods prepared in very specific ways. Face washing and tooth brushing can seem impossible.

For most Aspergers kids, mouth hypersensitivity is one part of an overall body sensitivity to touch or changes in touch. These kids have a hard time handling touch on other parts of their bodies as well. Therefore, treatment for the face and mouth needs to be part of a treatment plan of relaxing or desensitizing touch reactions throughout the body

Because most hypersensitive kids have body as well as mouth over-sensitivities, they may allow touch or cuddling only if it is their idea. If you try to approach them, they may push you away, or rub or scratch the spot. The touch may be quite agitating.

Helping your youngster handle deep pressure or firm touch is usually a good starting place. Light ticklish touch can be too over-stimulating. Massage can be an excellent activity for these kids. Deep pressure touch, given in an organized, predictable way can be very helpful with touch sensitivities. When your youngster can anticipate the touch, it makes it easier to handle. A variety of other firm touch activities may be described by your youngster's therapist.

Let your Aspergers youngster know that you are going to touch. Approach the youngster within his/her vision so that the touch is not a surprise. Often, touch is handled well if the youngster sees it coming. Kids seem to be able to "prepare" themselves for the touch and sometimes can react more appropriately. Also, your youngster needs to learn that touch around the face and in the mouth can be fun.

Remember that the mouth is the most sensitive part of the face. Start by touching places away from the mouth and work toward the mouth. Consider starting on the trunk or back of the arms, and make a game of moving toward the face. In this playful way, the game becomes a distraction, so your youngster isn't just worrying about the touch. You also are moving in a predictable fashion that is less scary.

Tips for helping your child accept touch:
  1. Kiss your youngster's face with the stuffed toy, and then let him/her kiss the toy or your face.
  2. Play face-touch games with stuffed toys and dolls.
  3. Playfully taking turns with touching can help your youngster handle play around the mouth.
  4. Tooth brushing with regular or electric toothbrushes can help
  5. Wipe the face regularly (slowly and softly) with warm cloths, using deep pressure. This can be calming to an over-reactive youngster.
  6. Singing is nice to combine with touch activities. The predictability of the tune helps your youngster prepare for the touch.

Eating involves many different types of touches that the parent needs to understand. The spoon, fork, and cup touch the lips as they bring food to the mouth. The food temperature is a touch. Food texture (e.g., lumpy, wet, thick, etc.) is an important touch of eating. Some kids remove food from the spoon with their teeth very rapidly, so that the spoon doesn't touch their lips. Try gradually keeping the spoon or cup at the lips longer. Use the youngster's most favorite foods for this activity.

Food temperature often can cause over-reactions. Remember that room-temperature foods tend to be easier to handle. Notice the temperatures your youngster handles easily. Make temperature changes very slowly and with foods the youngster likes.

When Aspergers kids over-react by gagging when you try to switch to thicker, more textured or lumpy foods, you probably need to make the transition more slowly. Aspies usually will do better moving from strained foods to thickened strained foods, to blended foods, to thickened blended foods, to thickened blended foods with tiny, very soft lumps. Remember, it is easier to hide lumps in thickened foods. They are much too obvious when presented with strained foods. Good food thickeners include cereal, dehydrated foods, instant potatoes, instant puddings, and ground cracker crumbs.

When you present new body or mouth touches or new food textures, always start with familiar touches or textures. Making games of the touching helps kids think that the touch or the eating or the new texture o" their idea. Move at your youngster's pace, but be persistent.

Provide crunchy foods, and separate textures during meals. Keep crunchy foods on hand for your sensory-sensitive youngster, as these foods facilitate an important "sixth sense" called proprioception, in which sensory feedback makes the child aware of movement and body position. Crunchy foods may help your youngster to develop better proprioception. Also, avoid mixing foods together that have conflicting textures, such as mashed potatoes and gravy.

A speech-language pathologist or occupational therapist (OT) that is trained in oral sensitivities can implement an oral-sensory treatment program to help desensitize the child and reduce the sensitive gag response to textures. Also, the therapist can assist the mother or father with activities to transition the child to age-appropriate textures and tastes of food. If the sensory problem is more pronounced or pervasive, an OT with a background in sensory integration can provide more involved sensory intervention. These therapies may need to be preceded by resolution of medical problems first, especially reflux, before treatment activities can have an effect.

Advice to parents with Aspergers kids who have sensory-based eating problems may include to avoid forcing the child to eat certain foods, maintain a routine mealtime, have at least one preferred food available each meal, and to have the youngster join the family at mealtime versus eating alone.

Aspergers and High-Functioning Autistic kids with hypersensitive reactions to touch in the mouth and around the face need extra help learning to handle the touches of everyday life, especially for eating. You do not have to struggle with this one alone. Your youngster's pediatrician, dietitian, or therapy team can work with you and your youngster to figure out the best way to help.

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•    Anonymous said... Great ideas.
•   Anonymous said... I have a grandson with aspergers and he has a strong gag reaction when he tries to take a drink of water or other liquid that he doesn't normally drink. He wants to try new foods but it's very difficult for him because the look and smell will cause him to gag. His Dr told us it's normal for asperger people. They are highly over sensitive to everything.
•    Anonymous said... I'd say it could be related to a trait, but he might just hate apples, don't worry too much, try cooking or juicing apples, my lad does love fruit and will eat a bag of apples in 10 minutes, but he gets a lot of vitamins from juice too (in those times when he just won't actually eat fruit)
•    Anonymous said... I'm not sure if it's an Asperger's trait, but I'm the same. That's why I get my vitamins by squeezing a lemon each day.
•    Anonymous said... Indeed it's a trait, the apple was just one example I'm sure. My son does that all the time, he has aspergers too.
•    Anonymous said… Have you got a slinky maker!! Thats awesome for hard food. My step son is sensitive to hard food and sound.. I bought the slinky n its made a world of difference. Maybe it might help you
•    Anonymous said… It could be a sensory issue. An occupational therapist can evaluate and help. My son with Aspergers eats apples and other hard fruits and vegetables all of the time.
•    Anonymous said… My 5 year old does it... Especially if she has fluff or hair around her while eating... Or if she dislikes the food smell or texture... It's just the sensativity issues
•    Anonymous said… My son has sensitivity to his teeth and can't have certain things touch his teeth it sends him into orbit. This has also created a problem with brushing
•    Anonymous said… My son has the same issue. Not with apples though. He eats them to the core. Lol but with other foods. It may be controversial but I force my boys to try foods wether they want to or not. It can be a very stressful moment at the table. All 3 boys have issues with food. But if I did not stay firm on the issue they would only eat chicken nuggets and fries. My pickiest eater is actually my one son who is not autistic. But my point is my 3 boys have a very developed pallet, especially for being autistic because I make them try foods and keep trying them. They learn to like them. I read somewhere it takes children 19 times to acquire taste to new foods. For all children. Not just autistic children. They put up a huge fight sometimes. They will sit at the table for a long time. They will gag and cry but I don't back down.
•    Anonymous said… My son with Aspergers also has a sensory problem....lots and lots of food issues. ex: chicken tender "ends" can't be eaten....he would prefer microwaved food over baked....mac n cheese can only be leftover, not fresh....
•    Anonymous said… This may sound odd .. But maybe it could signal an allergy? I have an extreme gag reflex to certain cheeses (some that I used to be able to eat) .. After some testing I found it was certain strains of mould that caused it. It was so bad with some cheeses that I would gag uncontrollably just being near them at work (I used to work in a grocery store).

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Anonymous said...

My son has extreme reactions to food textures, colors, and temperature. It's good to know that we are not alone in dealing with this. Eating out is always difficult because the goal there is to get the food to the table hot. At home we put the prepared plate in the freezer before serving. At restaurants I beg the waitress to keep the food away from heating lights before it's served. My son will eat only certain colored foods and in a particular order. Needless to say meal planning is fun in our house.

Lucy said...

Great article and very helpful. My son has always had a problem trying new foods and is a very fussy eater. He is 12 and has decided to become a vegetarian but we are struggling to find foods he likes that have protien. we have resorted to protien shakes as he also has adhd and is on slow release ritalin. I appreciate these articles as you don't get much help from the docs!

Squiggly Rainbow said...

Very relevant for our family at the moment, we have gone from a time of only eating yellow and crunch foods to eating most colours and textures, but now chewing our sleeves! Waiting on the arrival of a chewable necklace in the mail!

Anonymous said...

Sadly, OT therapy for our son was denied as Autism-related conditions are not covered nor are "eating disorders" as they called it. None of the pediatricians we ever saw were of help, b/c as long as they are not malnourished and will take a vitamin, they are not concerned nor are they equipped to know how to help. Frustrating!

Anonymous said...

My asd son (high functioning) also was born with a cleft palate so because of his surgeries, he is even more sensitive. Its so hard to brush his teeth! He went to the dentist last week and it sure was a challange

Anonymous said...

This is one of the issues our son has that has Aspergers.

Anonymous said...

our son is almost 11 and I still have to brush his teeth severy morning and it takes about 20 min

Anonymous said...

our son is almost 11 and I still have to brush his teeth severy morning and it takes about 20 min

Mr DCT said...

I was a plain eater (high processed grain foods, milk, potatoes) until my late teens. Not sure of the long term heath problems but only started eating veggies in my mid 20's. Colours are my biggest challenge still.
Undiagnosed 33y.o. male.

Anonymous said...

Ours 15 and some days just refuses to get those teeth brushed ,and I still help. Foods haha another whole issue with Aspergers.

Anonymous said...

I can so relate to this one! My son was so thin his bones were showing through his skin. The doctor just sent us to a dietician who was of absolutely no help. She said that our son probably had an eating disorder but never helped us get admitted into any programs. We went through an eating school, but they didn't address any sensitivity issues either. Finally, we just gave up trying to force him to eat. He is still super thin but he seems healthy enough...he is active and rarely gets sick. But getting him to eat meat, vegetables, or mixed consistencies is a fight, so is brushing his teeth. Suzanne, what did you end up doing to encourage better eating?

Melanie Potock, MA, CCC-SLP said...

Truly appreciate the message to always seek assistance from a qualified OT or SLP who specializes in feeding and, be sure that they have experience with kids with ASD.

Angie said...

My nephew has very specific things he will eat. People often wonder why and this article is a great way to explain it. My nephew is strictly meat, bread, some cereals, and some sweets. It is impossible to get him to eat any vegetables. Thank you so much for this article!

Anonymous said...

my son is 10 years old. When he was little he ate normal kid foods, since the age of 3 his diet completely changed. He is very limited to the food he eats. And they have to be prepared a certain way! When he tries something new he gags every time. It is all about texture for him. He was diagnosed at three with Asperger's syndrome. When are still fighting to get him more help, his systems seem to be getting more serious.
Tuesday at 6:59pm · Like

Anonymous said...

I am ADHD, and I abhor anyone touching my face... My middle son who is not quite ASD cries when I have to trim his nails... and my youngest son with ASD won't brush his teeth at all...
4 hours ago · Like

Anonymous said...

My son (aged 3), has suddenly begun gagging at the sight of food, after being extremely consistent in trying and enjoying all foods. Now, he gags to the point of vomiting, in the matter of 2 weeks. I have an assessment appointment soon.

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