For many families, particularly those with small children, the dinner table can be a minefield of stress. Young children are often notoriously picky eaters, eschewing vegetables for chicken nuggets, drowning dishes in ketchup and refusing to even consider new foods if they look or smell unappealing.
But when a family member has Autism Spectrum Disorder (ASD), meal-time pressure can be ratcheted to near-crisis levels. Researchers have long known of a link between eating difficulties and people on the autism spectrum. One study found that children with ASD are five times more likely to face meal-time challenges—from extremely narrow food selections to ritualistic eating behaviors to meal-related tantrums—than their typically developing peers. In some cases, people with ASD may be hyper-sensitive to food textures. And some endure a range of physical difficulties from swallowing issues to gastrointestinal distress.
“People often downplay eating problems with young people and say they’ll grow out of it. Well, many young people with autism don’t,” said Greg Wallace, assistant professor of speech, language and hearing sciences, whose research has focused on both brain imaging and behavioral development in ASD. Wallace has talked to parents who are besides themselves at meal-time and young people who describe swallowing crunchy food as feeling like knives down their throats.
And now Wallace is investigating another possible autism-related eating irregularity: overeating. Studies have shown that children with autism are more likely to be “picky” eaters than their same-age peers, a state which is usually associated with being underweight. But they are also, paradoxically, more likely to be obese, Wallace noted. Along with a team of graduate and undergraduate assistants, Wallace is searching for a connection between selective-eaters and overeaters in an attempt to devise better behavioral therapy solutions for both groups.
“Issues of eating can be destructive in so many ways,” Wallace said. “It goes well beyond being picky. Selective eaters may be dealing with nutritional issues. And, of course, we know the dangers of obesity. These are issues that have real effects on people’s health and their quality of life.”
Making Connections
Backed by a $74,000 National Institutes of Health contract, Wallace conducts several lines of research into both the brains and the behaviors of people with autism. As director of GW’s Lab of Autism and Developmental Neuroscience, he collaborates with the Center for Autism Spectrum Disorders at Children's National Health System and with the Laboratory of Brain and Cognition at the National Institute of Mental Health. Much of their work involves using magnetic resonance imaging to map structural brain development and examine neuropsychological functioning in people with ASD.
Over the past several years, Wallace has found his lab branching increasingly beyond neuroscience and into addressing the practical implications of eating-related behaviors. “Our research takes a facet of autism— eating difficulties—that has profound ramifications on the wellbeing of those on the spectrum and seeks to understand their underlying mechanisms,” said Emily Richard, BS ’17, Wallace’s senior research assistant and lab manager.
Wallace’s pilot study on overeating, funded through a $25,000 grant from the Maternal and Child Health Research Program of the U.S. Department of Health and Human Services, involves employing questionnaire-based data to determine if children with autism are more likely to be rated as overeaters than typically developing children. Phase two of the study will center on in-person testing of children with autism to examine any cognitive underpinnings of a possible increased propensity to overeat.
While his work is still in its infancy, Wallace’s findings appear to point to a link between overeating in children with autism and difficulties in behavioral flexibility, such as struggling to shift between tasks or settings. That link may explain the connection of autism with selective eaters, who tend to show greater inflexibility. Indeed, Wallace theorizes that there may even be a subset of people with autism who could be both selective eaters and overeaters. “In other words, you restrict what you eat, but if you like it, you really like it and you indulge,” he said.
Discovering these types of connections between different aspects of autism may lead to potential research and therapy breakthroughs. While Wallace warns that any firm conclusions are a long way off, cognitive behavioral therapy that has shown success with selective eaters may eventually be adapted and modified to create a similar program for overeaters.
Making assumptions for autism treatments, however, is always hazardous, given the highly individual nature of the disorder. “There’s a common saying: If you’ve met one person with autism, you’ve met one person with autism,” Richard said. “But finding similarities and exploring where differences originate helps us guide future research to better serve the many people who are on the autism spectrum, regardless of how different from one another they may be.”