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      Feeding and Swallowing Issues in Autism Spectrum Disorders

      review-article
      1
      Neuropsychiatric Disease and Treatment
      Dove
      autism, Covid-19, feeding management, fussy eating

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          Abstract

          Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children’s adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children’s restrictive diets supplant more healthy food options. When this is combined with the children’s noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices – aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.

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          Most cited references83

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          Food security: definition and measurement

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            The Possible Role of the Microbiota-Gut-Brain-Axis in Autism Spectrum Disorder

            New research points to a possible link between autism spectrum disorder (ASD) and the gut microbiota as many autistic children have co-occurring gastrointestinal problems. This review focuses on specific alterations of gut microbiota mostly observed in autistic patients. Particularly, the mechanisms through which such alterations may trigger the production of the bacterial metabolites, or leaky gut in autistic people are described. Various altered metabolite levels were observed in the blood and urine of autistic children, many of which were of bacterial origin such as short chain fatty acids (SCFAs), indoles and lipopolysaccharides (LPS). A less integrative gut-blood-barrier is abundant in autistic individuals. This explains the leakage of bacterial metabolites into the patients, triggering new body responses or an altered metabolism. Some other co-occurring symptoms such as mitochondrial dysfunction, oxidative stress in cells, altered tight junctions in the blood-brain barrier and structural changes in the cortex, hippocampus, amygdala and cerebellum were also detected. Moreover, this paper suggests that ASD is associated with an unbalanced gut microbiota (dysbiosis). Although the cause-effect relationship between ASD and gut microbiota is not yet well established, the consumption of specific probiotics may represent a side-effect free tool to re-establish gut homeostasis and promote gut health. The diagnostic and therapeutic value of bacterial-derived compounds as new possible biomarkers, associated with perturbation in the phenylalanine metabolism, as well as potential therapeutic strategies will be discussed.
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              Feeding problems and nutrient intake in children with autism spectrum disorders: a meta-analysis and comprehensive review of the literature.

              We conducted a comprehensive review and meta-analysis of research regarding feeding problems and nutrient status among children with autism spectrum disorders (ASD). The systematic search yielded 17 prospective studies involving a comparison group. Using rigorous meta-analysis techniques, we calculated the standardized mean difference (SMD) with standard error and corresponding odds ratio (OR) with 95 % confidence intervals (CI). Results indicated children with ASD experienced significantly more feeding problems versus peers, with an overall SMD of 0.89 (0.08) and a corresponding OR of 5.11, 95 % CI 3.74-6.97. Nutrient analyses indicated significantly lower intake of calcium (SMD: -0.65 [0.29]; OR: 0.31, 95 % CI 0.11-0.85) and protein (SMD: -0.58 [0.25]; OR: 0.35, 95 % CI: 0.14-0.56) in ASD. Future research must address critical questions regarding the cause, long-term impact, and remediation of atypical feeding in this population.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                ndt
                Neuropsychiatric Disease and Treatment
                Dove
                1176-6328
                1178-2021
                14 October 2022
                2022
                : 18
                : 2311-2321
                Affiliations
                [1 ]Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand , Johannesburg, South Africa
                Author notes
                Correspondence: Skye Nandi Adams, Department of Speech Pathology and Audiology, School of Human and Community Development, University of Witwatersrand , 1 Jan Smuts Avenue, Johannesburg, 2193, South Africa, Email skye.adams@wits.ac.za
                Author information
                http://orcid.org/0000-0002-6388-0960
                Article
                332523
                10.2147/NDT.S332523
                9579053
                36276431
                411f47de-78ab-4ce6-83db-154581fbf718
                © 2022 Adams.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 25 March 2022
                : 05 July 2022
                Page count
                Figures: 1, References: 84, Pages: 11
                Funding
                Funded by: the Consortium for Advanced Research Training in Africa (CARTA);
                Funded by: the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York;
                Funded by: Sida, open-funder-registry 10.13039/100004441;
                Funded by: Uppsala Monitoring Center, Norwegian Agency for Development Cooperation (Norad);
                Funded by: the Wellcome Trust;
                Funded by: the UK Foreign, Commonwealth & Development Office;
                Funded by: the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme;
                SA is supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No. G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Center, Norwegian Agency for Development Cooperation (Norad), and by the Wellcome Trust [reference no. 107768/Z/15/Z] and the UK Foreign, Commonwealth & Development Office, with support from the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme. The statements made and views expressed are solely the responsibility of the Fellow.
                Categories
                Review

                Neurology
                autism,covid-19,feeding management,fussy eating
                Neurology
                autism, covid-19, feeding management, fussy eating

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