Q and A Do sugary foods make children with autism more hyperactive?

Sivakumari asks: My daughter loves to eat ice-cream and cake. She will get angry and scream if we do not buy it. How can I stop her from doing this? Also, it is true that sugary foods make children with autism more hyperactive?

Hi Sivakumari, thanks for your questions. Your daughter is a girl after my own heart! Cake and ice-cream are some of my favorites, too. But it sounds like you’re dealing with some really challenging behaviors in relation to her love of sweet treats!

Despite popular belief, research shows that there is not necessarily a connection between sugar consumption and hyperactivity. A large study done in 1995 looked at a number of other research reports and came to the conclusion that sugar intake does not make children more hyperactive (Wolraich et al, 1995). However, many children with autism react to foods differently than typically developing children, and anything we put into our bodies may have an effect on how we feel. My first question would be: Is it possible your daughter is reacting to the casein in the ice cream, or the gluten in the cake? Many children with autism have a sensitivity or an intolerance to casein (a protein found in milk) and gluten (found in grain products). I would recommend you consult with a doctor about whether or not your daughter has an allergy to these substances.

When she screams to get cake and ice-cream that is what we call “Access Motivated Behaviors.” In other words, she screams in order to get access to cake and ice cream. There are some strategies you can try before the behavior happens (pro-active) and after the behavior happens (reactive).

Proactive Strategies:
• Before you go grocery shopping, make a list of what items to get (you can use pictures if that is easier for her). Have her help you cross items off the list as she is shopping with you in order to give her something else to focus on. You can make it a game where she has to help you find what’s next on the list, help you grab it off the shelf, and help you count how many items are left on the list. If you’re buying cake and ice-cream, make it last on the list.

• Create a token system to have her “earn” sweet treats. You can use stickers, stamps, Velcro icons, or drawings as the tokens. Make sure the rules for earning the tokens are clear and consistent. For example: “Listen to mommy, calm voice, hands to myself.” Stay away from vague rules like “Be good,” and avoid telling her what NOT to do “No crying.” Then when she exhibits the behaviors in the rules, you reward her with a token and praise the good behavior you saw. You might say something like, “Wow, great job listening to mommy. You earned a happy face!” Once she has all the tokens, she can have ice cream. This will help her to tolerate the delay in getting what she wants, because she can see that she is working towards it. Here’s a simple example of what it might look like.

(In this example, 3 of the 4 tokens have been earned. Immediately upon getting the last happy face, you would give her the ice cream.)

• You can use cake and ice-cream as a reward for other behaviors. Tell her in a “First-Then” sentence that she can have her treats AFTER she does what you need her to do. Use what she is motivated by to encourage her to do other behaviors. For example: First dinner, then ice-cream. First get dressed then cake. First play with puzzles then ice cream. Make sure if you use this strategy that she gets the dessert immediately after she does what you wanted her to do. Don’t delay it! As soon as she does the “First,” give her the treat.

• You can create a visual schedule for her so that she knows when it’s time for ice cream. For example, you can put pictures of breakfast, school, playing at home, dinner, and then ice cream. Choose pictures that correlate with her everyday activities and once she is done with each activity she can pull the icon off of the schedule and see what’s next. By the end of the schedule she can have her ice-cream. This will help her see that she will get what she wants but needs to do other things in her day first.

• Create opportunities for her to tolerate waiting or being denied something she wants. Find little ways to help her practice this skill, for example: right before she steps into the bathtub “Let’s wait…1, 2, 3, 4, 5. Yay, good waiting, you can get in.” Or before turning the TV on for her, tell her “Wait please” and you can do a 10-second countdown. You might also find small ways to tell her “No” or “Not right now,” such as which crayon she wants to color with, or which pair of shoes she wants to wear. The items you choose to deny her are not important. The skill of tolerating when she doesn’t get what she wants is the goal. Learning to cope with not getting things her way all the time is absolutely essential. Make sure to practice this a few times a day, but not more than that. We don’t want her to feel frustrated that she doesn’t have any control over her own life. It’s a balance of giving her some control, and also helping her accept when someone is in control. This will help her learn to tolerate being denied bigger things, like cake and ice-cream.

• Give her a warning of when she is going to be done with the treats. For example, before you scoop her ice-cream, tell her, “Okay, I will get you 1 scoop. After 1 scoop we are all done with ice cream”. This way you are preparing her that she will only get a specific amount and she will not get more.

Reactive Strategies:
• Withhold cake and ice-cream if she begins screaming and crying for it. It’s not easy, but do not give in. Giving her cake and ice-cream when she screams and cries sends her the message that “Screaming and crying is the way to ask for what you want, keep doing that and you will get what you want”. We want to instead send the message that “Screaming and crying does not get you what you want.”

• Offer alternatives. If she really cannot have cake and ice-cream, you can offer her something she can have instead. Try to pick things she will be excited about. These can be activities, toys, or other edibles. You can tell her “No ice-cream, but you can have ______________ or ___________ instead.” She will most likely still be upset about not getting the cake and ice-cream, but that’s okay. Stay firm and make those other options available to her.

I hope these tips are helpful as you navigate dealing with your daughter’s behaviors and her love for cake and ice-cream. I’m so glad you asked this question, because you are not alone! So many parents struggle with the same type of issue. The last piece of advice I would give you is to seek out behavior analysis services in your area. Applied Behavior Analysis is proven to help decrease behaviors like tantrums, and increase more functional skills like waiting or tolerating when things don’t go your way. If these services aren’t available in your area, check online for resources, articles, websites, message boards, or online groups who could provide you with support. We hope this information is helpful for you and your daughter.

– Angelina M., MS BCBA
Board Certified Behavior Analyst

Angelina works as a Board Certified Behavior Analyst, specializing in treating children and adolescents with autism, down-syndrome, and other developmental delays. She began her career in Applied Behavior Analysis in 2006, following her youngest brother’s autism diagnosis, and has since worked with dozens of children and families. She also writes a blog about her experiences as both a professional and a big sister. Her brother, Dylan, remains her most powerful inspiration for helping others facing similar challenges. Learn more about Angelina and her blog, The Autism Onion, and www.theautismonion.com or www.facebook.com/theautismonion

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