As promised, I am posting the notes I took at the ASA meeting last Thursday night. We had Dr. Keith Williams from the Hershey Feeding Clinic and were very impressed with what he had to say. They have had amazing success in expanding diets, even children that were not eating anything by mouth prior to coming to them. For those of you with typical children, I know you are not coming at this from the same frame of reference and may be unfamiliar with how difficult it can be to get a child with autism to accept something new (be it a new food or a new route driving to the grocery store). The Little Guy takes a lot of convincing just to think about trying a new kind of candy, and it is rare that he will actually try a bite even once we talk about it.
Dr. Williams started off by sharing some of the studies that show children with autism do have more feeding issues than typical children, but also shared his belief that even a non-verbal child with little receptive language can expand his diet as long as he is able to learn rules or routines over time. He suggested that a structured meal and snack time routine is ideal, and that it is best to get the child eating in the same place as the rest as the family, if not at the same time as them. A child who grazes all day long generally will take the edge off their appetite and only get the minimum amount of calories needed.
The most important thing is to be consistent over time. They are always calm and friendly, never strict or coercive, and they have the taste sessions separate from meals. Getting a child to eat a new food is first about just tasting it, not about the nutrition. Also, when selecting new foods, you only change one thing at a time – it may simply be a different brand. Favorite quote of the night was, “A new brand of chicken nugget is one step closer to broccoli.”
He shared two protocols they use, both of which could easily be done at home:
PLATE A/PLATE B: The child is presented with Plate A, which has tiny bites of the new food and Plate B, which has large bites of preferred foods. Once the child takes a bite from Plate A, he can have a bite from Plate B.
EXIT CRITERIA: The child is presented with a new food (again, starting with a tiny amount) and told once he eats it, he is done and can go play. The only other rule is that the child has to stay in the room until he eats the food (at the clinic, the other room has toys, DVD’s, video games, etc).
They treat both of these like a game and do whatever they can to make it exciting. Another thing they do is set a timer, and that is what ends the session. This way a child who is refusing or acting up doesn’t think that they ended the session by their bad behavior; it just ended because the timer went off.
He gave many examples, which was encouraging. One related to the exit strategy was about a young man with Asperger’s who took a couple of hours to take the first bite of food, but who later would come in and eat the food before the therapist even got the timer set. He would gloat, “Ha, ha – I beat you!” They would shrug and say, “Yeah, you win, you can go play.” I think he said the boy is now up to 85 foods:)
He listed several rules they use to avoid some of the pitfalls with rigidity:
1. Never feed from the original container. (Brand loyalty is not always a good thing!)
2. Rotate dishes, cups & utensils. (Some kids get stuck on a particular style, color or even one particular dish.)
3. Use a timer to show the end of the session.
4. For older or higher-functioning kids, you could allow them to keep the bite in their mouth for a couple of seconds and then let them spit it out into a specified bowl. As time goes on, extend the number of seconds they have to keep it in their mouth until they decide it is easier to swallow it than hold it long enough to spit it out.
I have felt really overwhelmed by this topic for a long time and just continue to buy exactly the same brands of the same foods, but now I think I have a plan. It is good to know that it is not a bad thing to start with a new kind of preferred food rather than being totally focused on needing him to eat a wide variety of things, which has been a losing battle. If I can get him to eat a flake or rice crisp cereal instead of only round ones, that will be a step in the right direction.
For those of you that made it this far, Dr. Williams did share one diet tip (off topic but interesting to know). He said that if you eat your fruits and vegetables first at mealtime, your body will over time adjust its intake to 12% less calories. And that’s with no other changes to what or how you are eating.
I'm a mom with Asperger's raising an amazing son with autism, which means I'm basically the case manager/advocate/cheerleader/chauffeur. The rest of the time, you can usually find me with my nose in a book!
