October 28, 2011

The Pickiest Of Eaters: Part 2

The following is written by Bonnie Marquis, a Positive Behavior Support Trainer for the West Virginia Autism Training Center. Bonnie continues her series on supporting individuals with ASD who can be described as picky eaters.

Once we understand why those on the autism spectrum might have an especially narrow range of acceptable foods, we need to look at both the developmental and behavioral principles that seem to conspire against us in our efforts to expand the diet.

Looking at development, we start with the assumption that those on the spectrum, while unique and perhaps progressing at a vastly different pace , will go through many of the same stages and are more similar to their neuro-typical peers than not. Nearly all children will go through periods of “picky eating” relative to their normal preferences. This has to do with physiological as well as social development factors. Children do not grow at a steady rate, but instead they go through spurts and plateaus. This means the appetite too will fluctuate rather wildly depending on where the child is in the growth cycle. But as adults, we expect them to eat more or less the same quantity every day, more as they get older but never less! So when they don’t eat the healthy (hopefully) option set before them, parents naturally offer them more appealing foods (they must eat!) and this is the beginning of how the child shapes our behavior. Very young children quickly learn “If I just hold out long enough I don’t have to eat the veggies and I can get the good stuff!”

And from a social development perspective children will want to exert some control over their environment (it’s why we hear the "No!" from a typical two year old) A child on the spectrum may go through this somewhat later and communicate differently and perhaps with more challenging behaviors, but the drive to do this is normal and to be expected, if not exactly welcomed. And food, along with sleep and toileting, are the areas where children have the most, perhaps the only, control over their lives. And again when you combine these factors with anxiety and resistance to change, we see how easily power struggles over food can develop.

Before we move on to strategies it’s worth a brief discussion about the function of behavior.

Behavior always communicate something, and often it's used to communicate a desire to get something or avoid something. Those ‘somethings’ are often cataloged into three main categories: attention needs, sensory needs, and tangible needs. But in the real world behavior is never ‘simple’ and to complicate things we know one behavior can fill many functions. Using picky eating dynamics, let’s put this into context:

 At meal time, Tim is offered baked chicken and roasted potatoes and green beans (his preferred foods are French fries and chicken nuggets) He makes a face and refuses to eat the food (avoiding sensory -different taste & texture ). You beg and plead and explain they are his favorite foods they just look a little different, " . . . please please please just TRY it!" ( gains attention). He whines and cries until you give him his preferred foods because you know he is hungry (gains a tangible). In this scenario his behaviors have helped to fill multiple functions and we have reinforced all these behaviors making it more likely he will do this again at the next meal.

If you are reading this, chances are a similar scene has repeated itself many times, or perhaps you skip it all together and only bother to serve what you know will be acceptable. Given all the other multiple challenges faced by those caring for a person on the spectrum the last thing they need is a challenge that can easily be avoided (see how we all avoid unpleasant experiences).

The problem, however, is that by overly accommodating these narrow food preferences, we actually make them worse. Eight foods become six, which then becomes three and soon your whole world revolves around maintaining a supply of these few foods. This impacts not only their nutritional wellbeing (even if they take supplements they still need fiber and other phytonutrients only found in whole foods) but just as importantly, the social wellbeing of the whole family. As stated in part one, eating is at the heart of nearly every social activity and there is not going to be chicken nuggets at every one of them. Such behaviors are not helping the person develop typical relationships or contributing to an improved quality of life.

Tackling this issue is not easy and will take time, but it is possible to greatly expand the diet of even the most entrenched “ picky eaters”. Change will not happen overnight and in the beginning it is more about changing our behavior and our responses than anything else. But six foods may become seven, then eight, then twelve. And while the person may never be an adventurous eater, power struggles will cease and quality of life can improve dramatically.

Remember however, if the person on the spectrum has extreme oral sensitivities or challenges with chewing and swallowing teaming with an experienced Occupational and/or speech therapist in conjunction with behavior modifications is essential. Either way, some real work lies ahead for everyone, but the payoff can be enormous for all involved.

October 25, 2011

Challenges To Providing Services To Adults With ASD

As many folks recognize, services are scarce for adults with ASD in the US. And services that exist do so without legal mandates.

Click the following link to view the PBS News Hour segment: "Autism Now: For Adults With Autism, Few Support Options Past Age 21." Dr. Peter Gerhardt is featured in the discussion, and gives insight into the challenges that exist for adults on the spectrum and their family members.

October 10, 2011

The Pickiest Of Eaters: Part 1

The following is written by Bonnie Marquis, a Positive Behavior Support Trainer for the West Virginia Autism Training Center. Bonnie will be writing a series of posts on supporting individuals with ASD who can be described as picky eaters.

We all know that kids can be notoriously picky in their eating habits, but if you have a child on the spectrum chances are you just roll your eyes when you hear others complaining about their neuro-typical child and their eating habits.

They. Have. No. Idea!

And while many kids can be called ‘picky eaters’ this challenge can be particularly vexing for the parent of a child on the spectrum. Beyond just not eating vegetables, some have such a narrow range of acceptable foods that parents can count them on one hand. And for many even just a change in brand can cause a normally favored food to be rejected outright.

While the nutritional problems this presents may be obvious, there are also social implications which can actually have a significant impact on the child and family’s overall quality of life. As most of us can attest, eating is at the heart of nearly every social activity.

Before we can expand food tolerances it’s helpful to understand a few of the characteristics common among people with autism, as well as some basic behavioral principles so we can learn how our own actions might actually be contributing to the issue.

People on the spectrum are notorious for being resistant to change and find predicting events very difficult. On the flip side, they find great comfort in known routines and activities. Trying new foods is hard – it involves change and removes the security of the familiar. Anxiety can build to the point where the person gags or worse. This can be frightening to everyone and common sense tells us to avoid this if at all possible.

Most of us are also well aware of the sensory challenges faced by people on the spectrum – extreme sensitivity to textures AND tastes can compound the challenges of the new and different. And we often end up back to the gagging, particularly if the person has never developed the oral motor muscles necessary to successfully navigate chewing and swallowing various textures. If you find yourself in this position simple behavioral strategies are not likely to be effective and it will take a coordinated effort with occupational and speech therapists in conjunction with behavioral changes in order to make any real progress.

And while a small number of families may be in this position, most situations respond quite well to basic behavioral strategies once the general principles are well understood. For many on the spectrum, what began in the early toddler years as a sensory issue has developed over the years into a predominantly behavioral one. And again, when we return to the common characteristics we can see why and how a person would refuse new and different foods. But how do we change behaviors?

As usual, it really starts by changing our own.

Over the next few months we’ll explore strategies to expand the range of acceptable foods, reduce or eliminate the power struggles and move toward greater meal time harmony.