What is ADHD?
Attention-Deficit Hyperactivity Disorder or ADHD affects 2% to 5% of school aged children in the U.K and about 9.4% of school aged children in the U.S.1,2 ADHD is a disorder characterized by continuing inattention, hyperactivity, and/or impulsivity. Inattention relates to a difficulty with staying focused, organized, or on task. Many children with ADHD struggle with picky eating more than their peers.
Hyperactivity relates to difficulty keeping still; this may look like fidgeting or talking excessively. Impulsivity relates to acting without thinking or having difficulty with self-control. If someone acts impulsively, they have a greater desire for instant reward and feelings of pleasure.3 The severity of these characteristics can vary and may interfere with a child’s development or typical daily functions, such as, reading, writing, staying focused, and challenging eating behaviors.
Sensory processing disorders and ADHD
Research has shown a presence of abnormal (or atypical) sensory responsiveness in ADHD children. This can be referred to as a sensory modulation disorder (SMD). Children with SMD have a harder time responding to environmental stimuli appropriately and may either be sensory over-responsive (SOR) or sensory under-responsive (SUR).
A child with SOR can experience a sensation more intensely and for a greater period of time than normal. SOR may cause a child to be put into a state of “fight or flight” as a response to overstimulating situations or environments. Additionally, ADHD children with SOR may experience greater anxiety as a result of the sensory information feeling unpredictable and uncontrollable to them.
A child with SUR can lacks awareness of a sensory stimuli in their environment and therefore does not respond. SUR children may come off as apathetic as they show little to no interest or enthusiasm in response to different stimuli.4 This sensory processing disorder can have an impact on a child eating behaviors as well
How does ADHD play a role in picky eating?
Many children with ADHD struggle with picky eating more than their peers. Of course, children of typical development (TD) can be picky eaters too, however, their picky eating tendencies tend to decrease by the age of six. In children with neurodevelopmental disorders (ND), such as ADHD however, picky eating is more common and continuous.5
Let’s breakdown sensory responsiveness a little further.
Our 5 Senses
Our 5 senses and their corresponding sensory systems include:
- Sight (visual system)
- Hearing (auditory system)
- Smell (olfactory system)
- Taste (gustatory system)
- Touch (tactile system).
If we have a sensory modulation disorder such as SOR or SUR in ADHD, these senses either become heightened (over-responsiveness) or reduced (under-responsiveness). For those who have SOR, the smell of a food may be overpowering and unbearable. The same can be true for the foods texture (touch), flavor (taste), appearance (sight), or even the sound of the food as it is being chewed.
Impaired sensory processing abilities can result in a child either being overly responsive or under responsive to stimuli. Over-responsiveness can result in increased picky eating. Whereas, under-responsiveness can result in the desire to eat foods that are sweet, salty, and/or high in fat. Regardless of the sensory processing issue, the range of food consumed and the social enjoyment of eating is often limited.6
Research has found that children with ADHD have higher levels of visual, auditory, tactile, taste, and scent sensitivities. Therefore, they are more sensitive to sensory information such as color, sound, temperature and texture, flavor, and smell in relation to both the foods they eat and their environment.5,6,7 This often results in a reluctance to try new foods or eat foods with less appealing textures such as fruits and vegetables.
Some children strongly dislike the feeling of certain tactile sensations such as the fabric, labels on their clothing, or sand on their skin. These children are more tactile sensitive. This sensitivity to touch often translates to the texture or temperatures of their food and how the food feels in their mouth.8
High Fibre Foods
High fiber foods such as fruits and vegetables, nuts and seeds, and certain grain products may have a texture that is stringy, crunchy, crispy, slimy, chewy or wet in texture. These textures are commonly not the most palatable to children with tactile sensitivities. Typically, children with tactile sensitivities prefer foods that are uniform, smooth, creamy, fluffy, and/or tender in texture.
How does the social environment impact eating in children with ADHD?
Children with ADHD tend to have a difficult time eating in certain social settings. This is commonly due to environmental stressors such as the sound of music and/or conversation, different smells, as well as, bright lights and/or bright colors. External cues, such as the time of day may also act as a stressor for a ND child.5 All these factors alone or together can lead to overstimulation. This can then cause a child to feel unsafe or anxious, therefore making eating less comfortable and enjoyable.
Nutritional deficiencies commonly found in ADHD picky eaters
It is reported by many parents with a picky eater (with or without ADHD) that their child will almost always refuse fruits and vegetables, legumes, wholegrains, and seeds during meals.7
Long-term picky eaters can struggle with deficiencies in certain micronutrients (vitamins minerals), macronutrients (specifically protein), and fiber from carbohydrate sources like whole grains, fruits and vegetables, legumes, and seeds.
Researchers have found picky eaters consume fewer foods containing vitamin E, C and fiber. This is believed to be a result of a low intake of fiber rich foods like fruits and vegetables. Due to a lack of nutrient-dense foods in their diet, other common nutrient deficiencies in picky eaters include magnesium and iron deficiencies.5 A lower than recommended number of calories, protein, and micronutrient intake can result in impaired or slowed growth and development.
Simple Ways to reduce picky eating in children with ADHD
Don’t apply pressure.
It is common for parents of picky eaters to place pressure on their children after repeated attempts of encouraging their child to eat certain foods without success. This pressure can take place in the form of “encouragement, reassurance, praise, healthy eating information, physical or verbal prompts, using incentives and rewards.”.7
This frustration is easily understood, however, pressuring a picky eater to eat may only end up being counter-productive as it results in more stress during mealtime for both the parent and child.
Be patient and creative
Experts suggest parents apply a gentle and non-invasive approach when encouraging children to try new foods. This helps prevent the child from becoming anxious and overstimulated. An example may look like adding a piece of broccoli onto a dish with foods they love without applying pressure to eat it. If we place too much food in front of them, it has the potential to become overwhelming. Instead, we can supply them with smaller portions, as they can always choose to have seconds after.
Keep food separate
In all picky eaters, there is a tendency to prefer having foods that are not mixed together such as pasta with sauce, chicken salad, or soups.6 If your child will not eat pasta with tomato sauce, for example, try serving it as plain pasta with a small bowl of sauce for dipping on the side. Giving your child autonomy of which foods mix together can be a helpful tactic.
The Spider Approach
Allow your child to play with their food. To put things into perspective, if I was to serve you up a spider, how would you go about eating it? You’d likely take a really slow approach to it. You’d probably touch it, smell it, maybe add sauces to it, or try to disguise the taste by putting it in breading. This is how your child may feel when they are served a certain food. Allow them to slowly discover the new food. Don’t expect your child to go from eating chicken nuggets to broccoli, its small steps and there are little wins along the way.
Family Style Meals
Another helpful strategy is eating family style meals, this allows the child to serve themselves and others. Allowing a sense of autonomy and greater sense of intuition when eating a meal.
Don’t give up!
Continue offering the new foods! The more a food is offered, the more familiar the food becomes and the more likely your child is to try it. It can be stressful to prepare a meal, only for your child to not eat it, however, it is important to not give up on offering a food after many failed attempts of reintroduction.
If you are struggling and would like more support I offer one to one consultations and I have a fussy eating package or a dietary assessment.
Thank you to Paige Courtier, Student Dietitian for helping with researching and writing the blog