Age: 13

Joshua is thirteen years old, with ASD. He has limited expressive language skills. Joshua attends his appointment with a care worker from his residential special school. Joshua can use a communication system called PECS (Picture Exchange Communication System) which relies on using pictures and words on cards to convey meaning. Joshua’s care worker has used this to good effect to help Joshua understand why he has attended this appointment. He sits quietly while his care worker explains why he has come to see you.

Joshua has a very limited diet and his parents and the care staff are worried that he may be under-nourished. His weight is becoming a cause for concern, as it is below average for his age. He has always preferred strong tasting, spicy foods and will refuse some meals because they do not match his preferences.


  • Despite Joshua’s limited communication, he may well understand some of what you say and you should base your approach on this assumption.
  • Describe in clear and simple language everything you are about to do and explain why.
  • Take his weight and measure height for the record and assess his general health.
  • Question the carer on his typical food intake and specific food preferences.
  • Suggest that the school keep a food diary so that Joshua’s diet can be regularly monitored.
  • Provide Joshua and his carer with resources on health and nutrition and suggest that these be used as a basis for adapting Joshua’s current diet and developing visual information that can be used with Joshua to develop his awareness of different foods.
  • Be aware that a preference for strong tasting food can occur for some people on the autism spectrum as they appear to have an under-developed sense of taste.
  • Arrange for regular follow-up appointments to monitor Joshua’s nutritional intake until this is at a healthy level.
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