Information gleaned from an Eating Strategies workshop for parents of ASD kids

Look familiar?

I recently attended a workshop run by the Geneva Centre for Autism (www.autism.net) called “Eating Strategies”. The workshop is designed for parents of children who are on the autism spectrum and have difficulties eating a varied diet. Most of the parents in attendance had children who were younger than 7 but the behavioural therapists running the workshop said that the same principles could be used for older children (with age-appropriate modifications).

Approximately two-thirds to three-quarters of children with ASD are believed to have challenges with eating a variety of food (Lorna Wing, 2001 and Mayes and Calhoun, 1999) so I thought it might be a good idea to share here some of the things I learned during this parent training session. I have completely re-organized/summarized/added to the materials in a way that suits my sensibilities (Hopefully it also suits yours 😉 ). Please bear in mind that any strategies you decide to use with your children would best be implemented after consultation with their pediatrician and/or other relevant professionals like occupational and behavioural therapists.

Does your child have an eating challenge that should concern you?

Typically developing children will usually experience some eating issues and even as adults will continue to have food preferences. However, restricted eating patterns are considered atypical if:

• The person’s diet consists of less than 7 foods
• Nutritional requirements are not being met
• The presentation of new foods results in severe behavioural challenges

Is it a medical problem?

When you have a resistant eater, its important to rule out any medical causes or contributing factors as these need to be addressed first. Examples would include pica, gastro-intestinal problems (see a pediatrician about these) poor oral-motor skills, postural problems and fine motor deficits (consult with an occupational therapist).

Communication

For these strategies to work effectively your child needs to be able to understand what your expectations of them are and they need to be able to tell you ‘no’ (in a constructive way). In the case of Owen and Oliver this involves the use of visuals – they understand the concepts of ‘First/Then’ and their receptive language is supported by visuals and modelling. Oliver can say ‘No’ and whilst Owen is non-verbal he can clearly communicate the same thing. 😀

First steps: a food-positive environment is more likely to result in success

We need to consciously do all we can to foster a food-positive environment. This is particularly important for children like Owen who are neophobic (new stuff makes them anxious). Having your children comfortable with food before trying to get them to eat it will hopefully make the experience of introducing new foods less fraught and therefore more likely to succeed. Some strategies we can deploy in order to do this are listed below.

Good example of what we're not going to be doing 🙂

• Never, ever, attempt to force feed your child.
• Meal times should be stress-free. Make it clear to your kids that you don’t expect them to eat everything. Model this for them by sometimes leaving food on your plate. Never pressure them to eat.
• Whenever possible, eat your meals together.
• To the extent that its developmentally appropriate, involve your children in meal planning, choosing what foods to buy, food preparation and setting the table. Build a sense of positive anticipation about mealtimes (rather than dread!).
• Give the kids control over some things – for example, let them choose the plates, cups and utensils they want to use.
• Serve foods that you know they like at all meals.
• Mix it up – if there are breakfast foods that they love, sometimes give them those foods for dinner.
• Incorporate developmentally appropriate food experiences into your kids’ play. You know what kind of things motivate your kids and what they will tolerate from a sensory perspective, so use your imagination. Some ideas for younger ones:
• Songs, books and games about food
• Play with plastic food – if your kids love bathtime, then take the food toys there.
• Play with actual food – potato stamps, squishing bananas or avocados and finger painting. (I know, yuck, and this might not work for sensory kiddos but the idea is to get them comfortable with touching food)
• Make food animals
• Deliver food in toy trains
• Create pictures with dried food
• Move flour or cornmeal around “construction sites” with toy dump trucks
• Pour rice or dried lentils into clear plastic bottles and use them as rainsticks or maracas
• Make homemade play dough
• Use dried fruits to make necklaces and bracelets
  

  He won't eat it, but making a dog with it might not be so bad...

 Second step – collect data and make a plan.

At this point you may be screaming at the screen – “Broccoli dogs? COME ON! Tell me how to get my kid to actually eat new foods?!”

If that’s in fact the case then take a few deep breaths and mull over the following:

• Expanding your child’s food preferences will be a long process. When I say long I mean this is going to take months, years. So: relax. A video we watched in the workshop was of a 6 year old who would only drink milk. He could not eat even pureed food. We watched his 3, 6, 9 and 12 month progress. It took him 12 months to reliably eat solid food but by that point he was eating chunky pasta with meat sauce! A year is a long time but that’s amazing progress for a little guy that had a lot of sensory challenges.
• Kids pick up on stress and they will do whatever they can to avoid mealtimes if these are a stressful experience. So: relax
• Children pick up on their parents’ stress and become stressed themselves – and stress tends to decrease appetite. So: relax
  

  All relaxed? Awesome, let's collect some data!

You know what your kids will eat but having it listed in black and white in front of you is good information to have and also a way of tracking success over time. Try and record for a week exactly what your child eats and drinks.  Look for any patterns in texture, colour, smell, temperature and taste – for both foods that they  like and foods they refuse. In deciding the new food you want to introduce, choose something that’s similar to foods they already like. For example, if your child likes salty, room temperature crunchy brown foods, don’t choose cold strawberries as the first new food to try. Instead room temperature, crunchy and dark orange food might be a better option (e.g. sweet potato chips).

Once you’ve identified the new food that you want to introduce, try and follow these guidelines:

• No grazing.
• Rotate preferred foods. For example, if your child loves cheerios and also likes toast and eggs, ensure that they are not always getting a big bowl of cheerios for breakfast – give them toast or eggs occasionally. You want your child to know that there will not always be a big meal at one time of the day that they can rely on in order to fill up.
• Serve meals at predictable times. Use a visual schedule if these work for your child.
• Eat meals and snacks at the same place, preferably a table, with no distractions.
• In-between meals offer them water rather than milk or juice.
• If your child responds well to social stories, make one up about them meeting the new food.

Introducing the new food

FINALLY! Here we are, we’re gonna eat something new! I’m sorry to break it to you but no, we’re probably not.. yet. One thing that was a complete revelation to me is how we need to redefine what we think of as success and ratchet down our expectations. Here’s what its going to look like as you introduce the new food to your child. I’m going to use blueberries as an example:

• You want meal times to continue to be positive times where they are eating at least one preferred item. So, if you have a very food averse child, your best strategy is probably to introduce the new food as a snack, not during meal time.
• Introduce a tiny amount of the food. Think: one blueberry.

We can do this. We can look at the blueberry...

• Your expectations should be LOW. Anything that happens that is in line with these expectations is POSITIVELY reinforced. The idea is to gradually get your child comfortable with the new food item. Each step is celebrated as a success and your child should succeed at each step for about 3 or 4 times before moving on to the next one.
• Your expectations at each stage need to be communicated to your child. The ideal way to do this for kids that like visuals is to use a First/Then board.
•  The steps you want your child to achieve are:
• Tolerating the food on their plate
• Looking at it
• Touching it
• Smelling it
• Bringing it to their lips
• Touching the food with their tongue
• Putting the food in their mouth
• Swallowing the food

• So, for example, let’s say I’m introducing the blueberry to Oliver as his new food. We make up a social story where he, mummy and Thomas the Tank Engine meet blueberries. The first step goes well and he is fine with a blueberry on his plate – he gets lots of hugs and kisses. After he’s proved to me at 3 snack times that he can tolerate a blueberry on his plate then I start asking him to touch the blueberry. This will be harder for him so I use a First/Then board to say that if he first touches the blueberry then he will get his iPad (big reinforcer for him).
• Once your child has actually eaten the food 3 times then you can incorporate it into their regular meals and start introducing another new food.
• If you have asked your kid to put the food into their mouth but they never successfully swallow it, then after 10 times you should assume that they simply do not like it and move on to a different food item. You can always try again later.

Our kids may never eat as many different foods as we had hoped but every additional item that is incorporated into their diet will be beneficial and at the very least you will have built with them a foundation of positive feelings toward food that will pay dividends in the future.

Please share your thoughts in the comments!

@pluckymama on twitter also just wrote a blog post outlining how she has dealt with food adversions – check it out here: http://bit.ly/pUhXYG