Accepted abstract - Creative Tastebuds Symposium 2020

Gathering at the table: taste education for children with neurodevelopmental disorders and their families

Opinion paper

By Sigrun Thorsteinsdottir and Anna S Olafsdottir, University of Iceland, School of Education, Faculty of Health Promotion, Sport and Leisure Studies, Iceland

The health benefits of a varied and balanced diet rich in plant foods are well-documented.1 It is proposed that fruit and vegetables are a crucial component in a global and sustainable diet strategy.2 The content of fibre, high nutrient density along with low energy density are among factors contributing to the important health benefits of consuming fruit and vegetables.3 According to the recent summary report of the EAT-Lancet Commission a transformation to healthy and environmentally friendly diets by 2050 will require substantial dietary shifts towards a diet rich in plant-based foods. Global consumption of fruits, vegetables, nuts and legumes will have to double.4 However, across most countries, daily fruit and vegetable intake remains well below the recommendations of five portions a day for both children5 and adults6 despite considerable focus being put on increasing intake.7

Children’s eating behaviour has received increased attention in recent years and more focus is now put on modifying the behaviour into healthier directions.8 The term Eating behaviour broadly encompasses preference, liking, acceptance, willingness to taste and food neophobia. 'Picky or fussy' eating is defined as the rejection of a large proportion of novel and familiar foods leading to a habitual diet where the person’s intake of consumed foods is particularly low in variety.8 Food neophobia has been defined as the rejection of novel or unknown food items.9 Since fussy eating includes food neophobia, both terms will hereafter be referred to as fussy eating.

Several studies on 8-12-year-old children have shown that taste education, repeated exposure, and introduction of unfamiliar food items increase the liking for these foods and children’s willingness to eat more of them.10,11 The positive effects of these interventions have been both short-term and long-term.

Despite the attention on fruit and vegetables intake in children, only one study has specifically targeted increased consumption in children with neurodevelopmental disorders such as Autism Spectrum Disorders (ASD).12 Furthermore, no study has to date specifically targeted children with Attention-Deficit/Hyperactive Disorder (ADHD). Children with neurodevelopmental disorders have been found to have poor diets compared to their typically developing peers, eating even fewer fruit and vegetables and smaller amounts in addition to relying mostly on highly processed foods.13 Furthermore, they are often drawn to smooth textures and foods such as pasta, rice and bread that do not include any wholegrains, a behavioural trait often described as ‟white-food syndrome“14. Feeding issues in children with ASD and ADHD are known to be associated with poorer parental mental health and greater levels of parental and spousal stress.15 Parenting stress has been defined as the experience of distress or discomfort that results from demands associated with the role of parenting (i.e., a child’s difficult behaviour) by engaging in their regular family-coping strategies.15,16 The factors associated with distress and the impact of a child with a disability are, to name a few, marital discord, depression and/or anxiety.16 It has also been shown that stress around mealtimes with fussy eaters is extremely high for parents and other family members.17

The approaches which work on healthy children could potentially suit children with neurodevelopmental disorders, however, there is a lack of research on how to best implement this in children with neurodevelopmental disorders and whether it will prove fruitful. The purpose of our current study is to provide taste education and increase skills in food preparation in a school setting as a means to combat fussy eating. The intervention will focus on children with and without neurodevelopmental disorders and their families, encouraging participation of significant caregivers. Research on taste education has mostly been performed in schools without any parental involvement. Parental involvement is seen as a necessary part of an intervention for children with neurodevelopmental disorders who often need more support in life at home and in the classroom. Schools in general are settings that children are familiar and comfortable with8 and tasting lessons have been shown to be enjoyable and fun for children.18 The added impact of parents for modelling and creating a healthy food environment at home should increase the impact of the intervention, increasing the likelihood of changed eating behaviours in the long term. Generally, for Icelandic schools, parents’ participation in children’s education and school activities is emphasised and encouraged.19 Although most studies report the involvement of mothers when examining children’s food related behaviours, interest in investigating fathers’ role in children’s food preferences and food behaviours is increasing.20 

The development of taste education in the school environment is a feasible option as it is built within a pedagogical framework and has ecological validity.18 When translating into practice, the programme may fit into the school setting without parental involvement if supporting staff is available for children with neurodevelopmental disorders, as would be expected in an inclusive school environment. The programme may also benefit more severe ASD cases in special needs schools but would require adapted material and further testing. Future research could look at tailoring the outcomes to suit a broad teaching environment since creating simple educational materials for all children irrespective of neurodevelopmental disorders status, increases the feasibility of implementation. Although several parent-led home-based interventions exist,21 approaching children with neurodevelopmental disorders and their families with taste education is novel.

It is our aim to give a demonstrable contribution in terms of benefits to individuals, families, communities, schools and organisations. From the public health perspective, finding ways to increase intake of fruit and vegetables and other low-processed plant-based foods is an important goal in tackling childhood obesity and shaping healthy habits and is crucial for the future health of our planet. The combination of taste education and food preparation skills may, if successful, be developed further and integrated into the school curricula as a part of home economics teaching as materials built on teaching syllabus will be created. An important impact will include measures on parental psychological wellbeing. Being able to provide education and training for parents on their children’s fussy eating, both typically developing children and children with neurodevelopmental disorders, would be of utmost communal importance, as despite higher prevalence rates, children with neurodevelopmental disorders tend to be excluded from similar interventions22, stressing the importance and novelty of our study. Also, the potential for contributions to the mediascape in terms of public education reaching a broad audience is high and will increase the possibilities of collaboration across disciplines.

 

References

1.     Appleton KM, Hemingway A, Saulais L, et al. Increasing vegetable intakes: rationale and systematic review of published interventions. Eur J Nutr. 2016;55(3):869-896.

2.     Lock K, Pomerleau J, Causer L, Altmann DR, McKee M. The global burden of disease attributable to low consumption of fruit and vegetables: Implications for the global strategy on diet. Bulletin of the World Health Organization. 2005;83(2):100-108.

3.     Liu RH. Health-promoting components of fruits and vegetables in the diet. Adv Nutr. 2013;4(3):384s-392s.

4.     Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. The Lancet. 2019;393(10170):447-492.

5.     Bergamaschi V, Olsen A, Laureati M, Zangenberg S, Pagliarini E, Bredie WLP. Variety in snack servings as determinant for acceptance in school children. Appetite. 2016;96:628-635.

6.     Riordan F, Ryan K, Perry IJ, et al. A systematic review of methods to assess intake of fruits and vegetables among healthy European adults and children: a DEDIPAC (Dterminants of DIet and Physical Activity) study. Public Health Nutr. 2017;20(3):417-448.

7.     Brug J, Tak NI, te Velde SJ, Bere E, de Bourdeaudhuij I. Taste preferences, liking and other factors related to fruit and vegetable intakes among schoolchildren: results from observational studies. The British journal of nutrition. 2008;99 Suppl 1:S7-s14.

8.     DeCosta P, Moller P, Frost MB, Olsen A. Changing children's eating behaviour - A review of experimental research. Appetite. 2017;113:327-357.

9.     Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite. 2015;95:349-359.

10.   Morgan PJ, Warren JM, Lubans DR, Saunders KL, Quick GI, Collins CE. The impact of nutrition education with and without a school garden on knowledge, vegetable intake and preferences and quality of school life among primary-school students. Public Health Nutr. 2010;13(11):1931-1940.

11.   Ratcliffe MM, Merrigan KA, Rogers BL, Goldberg JP. The effects of school garden experiences on middle school-aged students' knowledge, attitudes, and behaviors associated with vegetable consumption. Health Promot Pract. 2011;12(1):36-43.

12.   Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite. 2015;95:349-359.

13.   Beighley JS, Matson JL, Rieske RD, Adams HL. Food selectivity in children with and without an autism spectrum disorder: investigation of diagnosis and age. Res Dev Disabil. 2013;34(10):3497- 3503.

14.   Matson J, Fodstad J. The treatment of food selectivity and other feeding problems in children with autism spectrum disorders. Research in Autism Spectrum Disorders. 2009;3:455-461.

15.   Hutchison L, Feder M, Abar B, Winsler A. Relations between Parenting Stress, Parenting Style, and Child Executive Functioning for Children with ADHD or Autism. Journal of Child and Family Studies. 2016;25(12):3644-3656.

16.   van Steijn DJ, Oerlemans AM, van Aken MA, Buitelaar JK, Rommelse NN. The reciprocal relationship of ASD, ADHD, depressive symptoms and stress in parents of children with ASD and/or ADHD. Journal of autism and developmental disorders. 2014;44(5):1064-1076.

17.   Crowe TK, Freeze B, Provost E, King L, Sanders M. Maternal perceptions of nutrition, stress, time, and assistance during mealtimes: Similarities and differences between mothers of children with autism spectrum disorders and mothers of children with typical development. Journal of Occupational Therapy, Schools, & Early Intervention. 2016;9(3):242-257.

18.   Jonsson IM, Ekström MP, Gustafsson I-B. Appetizing learning in Swedish comprehensive schools: an attempt to employ food and tasting in a new form of experimental education. International Journal of Consumer Studies. 2005;29(1):78-85.

19.   Iceland. The Icelandic National Curriculum Guide for Compulsory Schools: General Section 2011. Ministry of Education, Science and Culture,  https://www.stjornarradid.is/verkefni/menntamal/namskrar/#Tab0. Published 2011.

20.   Guerrero AD, Chu L, Franke T, Kuo AA. Father Involvement in Feeding Interactions with Their Young Children. Am J Health Behav. 2016;40(2):221-230.

21.   Holley CE, Haycraft E, Farrow C. ‘Why don’t you try it again?’ A comparison of parent led, home based interventions aimed at increasing children's consumption of a disliked vegetable. Appetite. 2015;87:215-222.

22.   Mari-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-Gonzalez A, Morales-Suarez-Varela M. Food selectivity in autism spectrum disorders: a systematic review. J Child Neurol. 2014;29(11):1554-1561.