Medications for Food Seeking Behaviors in Autism Spectrum Disorder
Risperidone is the most effective medication for treating food seeking behaviors in autism spectrum disorder, with FDA approval specifically for irritability associated with autism that can include food-related behaviors. 1
Understanding Food Seeking Behaviors in ASD
Food selectivity and abnormal eating patterns are common in children with ASD, with prevalence rates ranging from 21-76% 2. These behaviors typically manifest as:
- Food selectivity (limited food repertoire)
- Selective overeating (combination of food selectivity and eating in absence of hunger) 3
- Food seeking behaviors (actively searching for food, eating non-food items)
- Food-related tantrums and behavioral issues
Pharmacological Management Algorithm
First-Line Medication:
- Risperidone: FDA-approved for irritability in ASD
- Starting dose: 0.25-0.5 mg/day (based on weight)
- Titration: Gradually increase to clinical response
- Target dose: 0.5-3.5 mg/day (mean effective dose ~1.9 mg/day)
- Mechanism: Significantly improves scores on the Aberrant Behavior Checklist-Irritability subscale, which includes food-related behaviors 1
Monitoring and Side Effects:
- Common side effects: sedation, increased appetite, weight gain
- Monitor: weight, metabolic parameters, extrapyramidal symptoms
- Consider combining medication with parent training for better outcomes 4
Behavioral Approaches Before Medication
Behavioral interventions should be attempted before pharmacotherapy:
Behavioral food controls:
- Lock cabinets and refrigerators
- Limit food-related exposures
- Maintain strict mealtime routines 4
Educational interventions:
- Taste or cooking sessions
- Behavioral interventions specifically targeting food selectivity 5
When to Consider Medication
Consider pharmacotherapy when:
- Behavioral approaches have failed
- Food seeking behaviors reach crisis levels
- Behaviors significantly impact quality of life
- Child is at risk for nutritional deficiencies or obesity 4
Important Considerations
- Food seeking behaviors in ASD often stem from sensory sensitivities to food texture and taste (2-10 times more frequent than in neurotypical children) 2
- Selective overeating group tends to favor calorie-dense, nutrient-deficient diets 3
- Somatic consequences of food selectivity can include constipation and obesity 2
Multidisciplinary Approach
While medication can address the behavioral aspects, optimal management requires:
- Speech therapy for oral motor skills
- Nutritional counseling
- Psychological support
- Parent training in behavioral management 5
Caution
- Medication should target specific symptoms (food seeking, irritability) rather than ASD itself
- Risperidone may increase appetite as a side effect, which could potentially worsen food seeking behaviors in some cases
- Regular monitoring is essential to balance behavioral benefits against potential metabolic side effects
Remember that the goal of treatment is to improve quality of life, reduce morbidity associated with poor nutrition, and facilitate the child's ability to engage in educational and social activities.