In So Many Words

Many of you know that I am a big fan of the parenting site Root & Sprout, and the related social network Grow Together. Over the last few months, Root & Sprout has experienced much growth and many changes, including hiring a core team of writers while still providing opportunities for both paid articles and voluntary submissions to the ezine.

Starting this month, articles will be published one or two per day instead of all on the first of the month. They will continue to range in category, covering ages from pregnancy to the teenage years and including other topics relevant to parenting. There will be giveaways each week, too, so subscribe to the feed today to stay informed!

Now that the site is using a blog platform (where you can also comment on the articles – hint, hint!), each post has its own permalink, which is great for referencing previous articles and sharing them with others. My newest article has just published today, and I have written two previous articles:

• Potty Training Your Special Needs Child – May 2009
• Using Play Dough as a Therapy Tool – February 2009
• How Did You Know? Early Signs of Autism – August 2008

I am hopeful that sharing our potty training experience will give some hope to other moms who aren’t sure it will ever happen, whether your child has special needs or is just not responding the way you think they should be. I’d love to hear what you think!

Our TSS went to daycare a little later today so she could stay for part of the teaching time (they have a long playtime followed by structured time at desks). We have been told he is doing fine during that part of the day and didn’t need the extra support, but she wanted to see what “fine” meant. Now the word “fine” usually sets off red flags for me, but there is only so much I can do when I am not with him to explain things to him and for him.

Two things happened that are just breaking my heart, mainly because I work so hard to help him understand what is going on around him and be able to respond appropriately. The first thing is that sometimes when the class gets very loud during playtime, the teacher will raise her voice and tell them to quiet down or they will have a time out. So she does this today, and the Little Guy yells out and makes a growling noise and then stomps over to his desk and sits down. The TSS asks the teacher why he is sitting at his desk and is told he probably thinks he is in time out and that he will probably get up in a couple of minutes and start playing again – he does that sometimes.

Aargh!! So not only does he mistakenly think he is in trouble and supposed to be in time out, but he also thinks he gets to decide when the time out is over. And this is evidently not the first time this has happened. He doesn’t like being yelled at and obviously doesn’t really understand what she is saying. The TSS takes him out in the hall and tries to explain that he is not in trouble. He says he is confused and, when asked why, says he is confused because no one else is sitting down for the time out. So she explains what the teacher meant and convinces him that no one is in trouble right now because they quieted down when asked to.

Next they get into the teaching time and he responds negatively to the teacher’s directions several times by either yelling or by getting up and running around the room and then coming back to sit down. The TSS is told that he is okay, he just does this sometimes and he will come back when he is ready. Keep in mind, this is at a daycare center that is one of the most structured I have seen, and they would NEVER accept anything even close to this behavior from another child. I am blown away that it is being allowed for the Little Guy and fail to see how this is in any way helpful to us as we move towards kindergarten. We had agreed as a team to allow him to choose to sit out of some activities as an alternative to having a meltdown if he is very upset, but even that is supposed to be handled in a way that doesn’t allow yelling or wild behavior. Apparently that concept has gotten way off track.

Thank God for our TSS, who is going to switch her schedule around to be at the daycare center for more of the structured times and try to put into place some strategies to establish some new behaviors. I guess I will email the rest of the team and see if I can get some help with this one; it may be a bit too much for the two of us to change the tide.

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.