Effects of familiarization on odor hedonic responses and food choices in children with autism spectrum disorders

Junk food or healthy food? The relationship between odor identification performance and dietary patterns among children and adolescents

PURPOSE

Children and adolescents with an insecure dietary pattern are at risk of experiencing adverse health effects. In general, olfactory capacity is particularly important in shaping food-flavor perception, affecting nutritious food intake, and ultimately influencing eating behaviors such as food selection, appetite, and consumption. Therefore, the present study aimed to explore the relationship between odor identification ability and dietary patterns in this population.

METHODS

607 children and adolescents (275 boys and 332 girls) aged 6-17 years from China were recruited for this study. Odor identification performance was assessed using the Universal Sniff (U-Sniff) test, and dietary patterns were measured using the Food Frequency Questionnaire (FFQ).

RESULTS

Children and adolescents who poorly behaved in the U-Sniff test exhibited a greater tendency to choose processed foods, beverages and snacks, while this tendency was mainly observed in children aged 6-8 years.

CONCLUSIONS

Better odor identification ability has a positive impact on children and adolescents' choice for healthier foods in their daily dietary intake.

Role of Odor Novelty on Olfactory Issues in Autism Spectrum Disorder

Sensory processing abnormalities are a hallmark of autism spectrum disorder (ASD) and are included in its diagnostic criteria. Among these challenges, food neophobia has garnered attention due to its prevalence and potential impact on nutritional intake and health outcomes. This review describes the correlation between novel odor perception and feeding difficulties within the context of ASD. Moreover, this review underscores the role of odor processing in shaping feeding behaviors within the ASD population. It examines the psychophysics of odor perception in individuals with ASD and evaluates the behavioral and neurophysiological assessments conducted using novel odor stimuli in mouse models relevant to autism and wild-type mice. Additionally, we explore the mechanism on how odor novelty affects neuronal circuitry, shedding light on potential underlying mechanisms for the effect of odor novelty on ASD.

Case report: Multicomponent intervention for severe food selectivity in autism spectrum disorder: a single case study

Food selectivity is common in children with Autism Spectrum Disorder (ASD). The treatment used can be invasive and difficult to implement, necessitating the exploration of multicomponent approaches. This study presents the case of a 9-year-old autistic girl with severe food selectivity, who ate exclusively liquid and semi-solid foods. A multicomponent intervention protocol was developed, including stimulus fading and positive reinforcement techniques, to increase acceptance of new textures and foods. Treatment sessions showed significant improvement in acceptance of semi-solid and novel foods, with a reduction in problem behaviors associated with mealtime. This study suggests that a multicomponent intervention can significantly improve food acceptance and reduce mealtime distress, proving to be a practical and effective treatment strategy in an autistic child. The intervention led to an increase in food acceptance and a reduction in mealtime-related distress, potentially improving the child and family's quality of life.

Amygdala hyperactivation relates to eating behaviour: a potential indicator of food addiction in Prader-Willi syndrome

Prader-Willi syndrome is a rare neurodevelopmental genetic disorder characterized by various endocrine, cognitive and behavioural problems. The symptoms include an obsession for food and reduced satiety, which leads to hyperphagia and morbid obesity. Neuropsychological studies have reported that Prader-Willi patients display altered social interactions with a specific weakness in interpreting social information and responding to them, a symptom close to that observed in autism spectrum disorders. In the present case-control study, we hypothesized that brain regions associated with compulsive eating behaviour would be abnormally activated by food-related odours in Prader-Willi syndrome, as these can stimulate the appetite and induce hunger-related behaviour. We conducted a brain imaging study using the olfactory modality because odours have a high-hedonic valence and can cause stronger emotional reactions than other modalities. Further, the olfactory system is also intimately associated with the endocrine regulation of energy balance and is the most appropriate modality for studies of Prader-Willi syndrome. A total of 16 Prader-Willi participants were recruited for this study, which is a significant achievement given the low incidence rate of this rare disease. The second group of 11 control age-matched subjects also participated in the brain imaging study. In the MRI scanner, using an MRI-compatible olfactometer during 56 block sessions, we randomly presented two odours (tulip and caramel), which have different hedonic valence and a different capacity to arouse hunger-related behaviour. Our results demonstrate that Prader-Willi participants have abnormal activity in the brain reward system that regulates eating behaviour. Indeed, we found that these patients had right amygdala activity up to five times higher in response to a food odour (caramel) compared with the tulip odour. In contrast, age-matched control participants had similar activity levels in response to both odours. The amygdala activity levels were found to be associated with the severity of the hyperphagia in Prader-Willi patients. Our results provide evidence for functional alteration of the right amygdala in Prader-Willi syndrome, which is part of the brain network involved in food addiction modulated by the ghrelin and oxytocin systems, which may drive the hyperphagia. Our study provides important new insights into the functioning of emotion-related brain circuits and pathology, and it is one of the few to explore the dysfunction of the neural circuits involved in emotion and addiction in Prader-Willi syndrome. It suggests new directions for the exploration and remediation of addictive behaviours.

Wearable Sensors to Evaluate Autonomic Response to Olfactory Stimulation: The Influence of Short, Intensive Sensory Training

In the last few decades, while the sensory evaluation of edible products has been leveraged to make strategic decisions about many domains, the traditional descriptive analysis performed by a skilled sensory panel has been seen to be too complex and time-consuming for the industry needs, making it largely unsustainable in most cases. In this context, the study of the effectiveness of different methods for sensory training on panel performances represents a new trend in research activity. With this purpose, wearable sensors are applied to study physiological signals (ECG and skin conductance) concerned with the emotions in a cohort of volunteers undergoing a short, two-day (16 h) sensory training period related to wine tasting. The results were compared with a previous study based on a conventional three-month (65 h) period of sensory training. According to what was previously reported for long panel training, it was seen that even short, intensive sensory training modulated the ANS activity toward a less sympathetically mediated response as soon as odorous compounds become familiar. A large-scale application of shorter formative courses in this domain appears possible without reducing the effectiveness of the training, thus leading to money saving for academia and scientific societies, and challenging dropout rates that might affect longer courses.

Food Selectivity in Children with Autism: Guidelines for Assessment and Clinical Interventions

Autisms Spectrum Disorders (ASD) are characterized by core symptoms (social communication and restricted and repetitive behaviors) and related comorbidities, including sensory anomalies, feeding issues, and challenging behaviors. Children with ASD experience significantly more feeding problems than their peers. In fact, parents and clinicians have to manage daily the burden of various dysfunctional behaviors of children at mealtimes (food refusal, limited variety of food, single food intake, or liquid diet). These dysfunctional behaviors at mealtime depend on different factors that are either medical/sensorial or behavioral. Consequently, a correct assessment is necessary in order to program an effective clinical intervention. The aim of this study is to provide clinicians with a guideline regarding food selectivity concerning possible explanations of the phenomenon, along with a direct/indirect assessment gathering detailed and useful information about target feeding behaviors. Finally, a description of evidence-based sensorial and behavioral strategies useful also for parent-mediated intervention is reported addressing food selectivity in children with ASD.

Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new?

Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.

VeggieSense: A non-taste multisensory exposure technique for increasing vegetable acceptance in young children

Vegetable consumption falls well below recommended levels for children in the UK. Previous research has found that repeated non-taste sensory exposure over the course of several days increases young children's willingness to touch and taste vegetables. The current study examined the impact of a one-off multisensory non-taste exposure intervention that took place on a single day on children's willingness to taste and intake of the exposed vegetables. Children (N = 110) aged 3- to 4-years-old were assigned to one of three intervention groups or to a control group. Children in all groups participated individually in a single activity session delivered in their nursery. Children in the intervention conditions took part in fun activities that provided either (a) visual exposure, (b) smell and visual exposure, or (c) smell, touch and visual exposure to six raw and prepared vegetables. Children in the control group engaged in a visual exposure activity with non-food items. After the exposure activities, all children were offered the prepared vegetables to eat; their willingness to taste and intake of the vegetables were measured. Results confirmed previous findings of sensory exposure activities increasing children's willingness to taste and intake of vegetables and revealed linear trends in both measures of acceptance with the number of senses engaged; children who took part in smell, touch and visual activities showed the highest level of acceptance. Findings suggest that multisensory exposures are effective in increasing consumption of vegetables in young children and that the effect of sensory exposure to healthy foods may be cumulative, with the more senses engaged prior to offering a food, the better.

A Method for Computerized Olfactory Assessment and Training Outside of Laboratory or Clinical Settings

There are currently few ways to reliably and objectively assess olfaction outside of the research laboratory or clinic. The COVID-19 pandemic has highlighted the need for remote olfactory assessment; in particular, smell training at home is a promising method for olfactory rehabilitation, but further methodological advances might enhance its effectiveness and range of use. Here, we present Exerscent, a portable, low-cost olfactory display designed primarily for uses outside of the laboratory and that can be operated with a personal computer. Exerscent includes Radio Frequency Identification (RFID) tags that are attached to odor stimuli and read with a MFRC522 module RFID reader/antenna that encodes the odor in order to provide adaptive challenges for the user (e.g., an odor identification task). Hardware parts are commercially available or 3D printed. Instructions and code for building the Exerscent are freely available online (https://osf.io/kwftm/). As a proof of concept, we present a case study in which a participant trained daily to identify 54 odors, improving from 81% to 96% accuracy over 16 consecutive days. In addition, results from a laboratory experiment with 11 volunteers indicated a very high level of perceived usability and engagement. Exerscent may be used for olfactory skills development (e.g., perfumery, enology), and rehabilitation purposes (e.g., postviral olfactory loss), but it also allows for other forms of technological interactions such as olfactory-based recreational interactions.

Wearable Sensors for Assessing the Role of Olfactory Training on the Autonomic Response to Olfactory Stimulation

Wearable sensors are nowadays largely employed to assess physiological signals derived from the human body without representing a burden in terms of obtrusiveness. One of the most intriguing fields of application for such systems include the assessment of physiological responses to sensory stimuli. In this specific regard, it is not yet known which are the main psychophysiological drivers of olfactory-related pleasantness, as the current literature has demonstrated the relationship between odor familiarity and odor valence, but has not clarified the consequentiality between the two domains. Here, we enrolled a group of university students to whom olfactory training lasting 3 months was administered. Thanks to the analysis of electrocardiogram (ECG) and galvanic skin response (GSR) signals at the beginning and at the end of the training period, we observed different autonomic responses, with higher parasympathetically-mediated response at the end of the period with respect to the first evaluation. This possibly suggests that an increased familiarity to the proposed stimuli would lead to a higher tendency towards relaxation. Such results could suggest potential applications to other domains, including personalized treatments based on odors and foods in neuropsychiatric and eating disorders.

A network model of affective odor perception

The affective appraisal of odors is known to depend on their intensity (I), familiarity (F), detection threshold (T), and on the baseline affective state of the observer. However, the exact nature of these relations is still largely unknown. We therefore performed an observer experiment in which participants (N = 52) smelled 40 different odors (varying widely in hedonic valence) and reported the intensity, familiarity and their affective appraisal (valence and arousal: V and A) for each odor. Also, we measured the baseline affective state (valence and arousal: BV and BA) and odor detection threshold of the participants. Analyzing the results for pleasant and unpleasant odors separately, we obtained two models through network analysis. Several relations that have previously been reported in the literature also emerge in both models (the relations between F and I, F and V, I and A; I and V, BV and T). However, there are also relations that do not emerge (between BA and V, BV and I, and T and I) or that appear with a different polarity (the relation between F and A for pleasant odors). Intensity (I) has the largest impact on the affective appraisal of unpleasant odors, while F significantly contributes to the appraisal of pleasant odors. T is only affected by BV and has no effect on other variables. This study is a first step towards an integral study of the affective appraisal of odors through network analysis. Future studies should also include other factors that are known to influence odor appraisal, such as age, gender, personality, and culture.

Giving meaning to the social world in autism spectrum disorders: Olfaction as a missing piece of the puzzle?

Altered social cognition is a core feature of Autism Spectrum Disorders (ASD). These impairments have been explained as the consequence of compromised social motivational mechanisms that limit social interest and activate a cascade of social deficits. Following this rational, we argue that approaches capable of surpassing ASD usual restraints (e.g., deficits in verbal abilities), and able to assign social meaning, could be more effective at responding to these difficulties. In this framework, we propose that olfaction, as well as cross-modal integration strategies involving both visual and olfactory domains, may have such potential. In fact, most of socioemotional processing deficits in ASD have been shown in an uni-modal perspective, mainly with visual stimuli. However, the social environment involves other modalities and is typically multisensorial. Given the potential of olfaction as a gateway for socioemotional information in ASD, we argue in favor of studying olfactory perception, as well as visuo-olfactory integration, given the potential of these approaches to drive effective interventions and give the access to a meaningful social world in ASD.