**6. Conclusion**

(vitamins and micronutrients) should be part of a nutritional evaluation. A particular chal‐ lenge is the peculiar eating habits of children with ASD; they may be of normal weight, hence pose no major 'medical problem', but their diet may consist predominantly of sug‐ ars, fats and salt. Such diets may also eventually lead to obesity. To assist parents in their daily mealtime struggles a number of evaluations also focus on parent perceptions of their successes and difficulties [80, 81]. We are not aware of any standardized dietary evalua‐

Although some standardized sensory evaluations exist [125-127], they cover sensory reac‐ tions in many domains of ADL and so, only a few items deal directly with feeding and eating. Hence, the greatest need in this area is an assessment that will fully cover the sen‐ sory domains associated with feeding and eating. Preliminary data are available from a study by Tessier [124], but now need to be subjected to a full psychometric evaluation. Common sensory characteristics should include color, texture, consistency, taste, smell, shape, size of a bite, and appearance which may have an influence on the variety of foods eaten. A study of how language and social skills affect feeding ability and the cognitive aspects that are involved for or against eating a certain food may be appropriate to in‐ clude, since meals are social events. We are also still lacking self-report studies from indi‐ viduals with ASD who may help us understand the challenges they associate with eating. An update of evaluation guidelines or even new guidelines for clinicians and researchers may well arise from the research suggested in this section and would immediately benefit

A combination of treatment strategies, based on a holistic evaluation is, in our opinion, the most promising approach to intervention. Regardless which treatment approaches are chos‐ en, intervention based on the contextual factors suggested by the ICF will facilitate the trans‐ fer to different environments, maintenance of the gains over time and hopefully further improvement. Early parent education may be critical to prevent the establishment of feeding

We have seen that careful manipulation of foods, the mealtime environment or the nutrient content of the diet may lead to some success in the acceptance of a new food, but one of the challenges remaining is that success with one food or domain does not necessarily general‐ ize to other foods or domains. Such progress will probably only happen once children's cog‐ nitive decisions/intuitive reactions for acceptance/rejection of foods will be more clearly understood. We have suggested that one approach may be to study the more highly func‐ tioning children with ASD or Asperger's syndrome where some communication skills and insight are present. It may also be helpful to begin work by letting the child determine his

Typically developing children also go through food jags, i.e. phases where they will only eat a limited variety of foods over an extended period of time. One of the authors (E.G.) recalls a parent telling her that his three-year-old son ate only pasta for three months and once he had his fill he 'returned' to eating the well balanced family diet. What this 'fill' was, the pa‐

tion for children with ASD.

622 Recent Advances in Autism Spectrum Disorders - Volume I

the population we are trying to serve.

problems but will need further study.

food preference to facilitate co-operation.

**5.3. Treatment**

This literature review has illustrated how common feeding problems are in children with ASD. However, it is not yet definitively established whether these problems are different from the general pediatric population. There is no consensus yet on the terminology to be used to describe these problems, on evaluation methods, and use of different diagnostic classification systems. This makes comparisons of different studies very difficult at present. Some feeding problems are similar to the sensory problems described in the DC: 0-3R. This would justify the use of the sensory integration approach, as well as hierarchic desensitiza‐ tion in the treatment of children with ASD and feeding problems. Updating guidelines for diagnoses and clinical practice will contribute to knowledge translation from research to general practice. Preventive approaches, and teaching parents how to handle feeding prob‐ lems also seems promising. Further research is needed to support these beginnings.
