Families with autistic children frequently report patterns of issues related to oral restrictions (tongue, lip, cheek ties) when their child may have difficulty with feeding, language, sleep or oral sensory issues. There is much discussion of the link between oral restrictions and autism, and how these can impact the child’s comfort and function.
Oral restrictions do not cause autism. Autism is not caused by oral restriction. Autism is a multifactorial developmental (there is a helpful breakdown at nimh.nih.gov) disorder. However, the coexistence of oral restriction-related issues alongside the common developmental signs of autism makes them a relevant topic to address.
What Are Oral Restrictions?
Oral restrictions refer to tight or restricted connective tissue in the mouth, and can impact tongue, lip or cheek mobility.
Examples include:
- tongue tie, which limits the movement of the tongue
- lip tie, which restricts movement of the upper lip or lower lip
- Cheek tie, which can restrict the movement of cheek tissue
Some of these restrictions are quite visible, but often it is more noticeable based on function. A child can have a difficult time moving food within the mouth, clearing the cheeks, making speech sounds or resting the tongue in a comfortable position.
child oral restriction assessment
Why Discuss Oral Restrictions and Autism?
We often start to discuss these conditions because there are some shared signs and symptoms. For instance, many children with autism can have:
- oral food aversions
- oral sensory issues
- language delays
- sleep issues
- altered muscle tone
We often also see children with oral restrictions that demonstrate these signs and symptoms. This can create confusion for parents and clinicians alike in regard to what is related to the development of the autistic child and what is related to oral function or both. If a child avoids a food they may not be able to chew it, they may be reacting to the sensory nature of it (texture, size, etc), or may feel uncomfortable if their tongue cannot move well.
Issues with Food Texture
One of the areas where there is an overlap in issues is in relation to the child’s eating. Children with autism may be particular about what foods they eat, including their preferred temperature, color or presentation. They may follow strict mealtime routines or have certain rules in the family mealtime environment. They may not tolerate food with mixed textures. All of these issues are commonly experienced by a child who is having sensory issues.
However, some of these behaviors can also be present in the child with a restriction. If a tongue cannot move well, then a child may require increased effort to chew or swallow a food, particularly one that is more chewy or has mixed textures. A child may avoid a specific food, like a sticky food, if they cannot manage the movement necessary in the mouth to eat it.
Signs of potential oral function issues can include:
- Food pocketing in the cheeks
- Gagging on a specific texture of food
- Prolonged time for mealtimes
- Food left in the mouth
- Difficulty moving food side to side to clear the cheeks
- Messy eating (past the age of expected self-feeding ability)
child feeding texture challenges
The presence of these does not automatically mean that there is a restrictive tissue causing the issue, but it can be an indication that the child’s oral motor function is being impacted in some way.
Speaking, Comfort and Daily Function
Language delays are common in autistic children. A child may not be speaking, may have a delayed vocabulary or have other communication issues. These oral restriction-related issues can also create issues for the child if there is a restricted tongue or lip and the child needs more than what is possible in order to make speech sounds that may require more precise tongue movement.
Breathing and Sleep Concerns
It is also worth noting that tongue posture can affect nasal breathing and therefore a child’s ability to rest and be calm. If the tongue is resting low in the mouth, it may mean that the child will mouth breathe or sleep with an open mouth. Some children with autism may be prone to oral sleeping, and the sleep issues (resources) that often occur can also contribute to issues with attention, behavior, learning, mood, etc. If we can reduce a contributing factor to these issues, perhaps a child may sleep a bit better.
In Closing
The connection between these two conditions is complex, and should be viewed as function-based rather than visual-based. An oral restriction that is visible may or may not require intervention, based on the ability of the mouth and tissue to work appropriately. An oral restriction that is not visible may or may not require intervention, based on the ability of the mouth and tissue to work appropriately.
We do not know that an oral restriction is causing autism, although some children may have additional challenges in the areas of feeding, sleeping, communicating or overall comfort if they have restricted connective tissue as well. By examining the function of the mouth and the function of the child in daily life, families can take a proactive and well-informed approach to their child’s development and seek appropriate support for their specific needs.