The Autism NoteBook — April/May 2014
How to Encourage Positive Mealtime Behaviors and Expand Accepted Foods
For most families, the ideal dinner is a time when everyone gathers around the table, talks about the highlights of the day, enjoys the company of others, and eats a well-balanced meal. For families with a member on the autism spectrum, dinner can be a chaotic mess of tantrums, arguments about what is being served, and power struggles over inappropriate behavior. Eating out at a restaurant or at a birthday party adds another layer or two of stress to the activity, and because of previous “failures”, most parents are forced to continue offering the same five or ten accepted foods, in the same fashion, to avoid a meltdown.
Setting the Stage
Think about what your mealtime currently looks like and what you’d like it to be. Does your picture include sitting together at the table without any distractions? Does it involve everyone eating an adequate portion from each food category? Is conversation flowing? Many families report that a typical mealtime includes at least two different menus, various times of when each person eats, and an iPad or other distractor at the table – if it occurs at a table at all.
As your child is prepping himself for the meal, make sure the environment is conducive for a calm gathering. Dim the overhead lights if it is bright enough outside. Play soothing music in the background. Be sure nothing you have cooked fills the room with a strong aroma (steamed broccoli and fish sticks can trigger sensory responses).
During the meal, you may find it helpful to set a visual timer so your child knows how long he is expected to stay with the family. If he needs a break, allow him to retreat for a few moments before rejoining everyone at the table. If he seems to only need a break to get the wiggles out, try putting a disc on his chair so he can fidget, but make sure his feet touch the floor. Try talking to your child about his day or his interests. If your child is nonverbal, try to engage him in interactive games to encourage the social nourishment that mealtime provides.
Expanding Foods Your Child Will Accept
Making mealtime more predictable and routinized can take away most of the stress, but expanding a child’s diet is a different, and typically more challenging, undertaking. There are systematic ways you can alter currently-accepted foods to encourage trying new ones.
To expand a food that your child already eats, consider the various aspects of the food. While texture and taste are often the most obvious components to why your child eats a particular food, temperature, consistency, appearance (shape, color, presentation), and smell may also play a role in why the food is preferred or rejected. With this in mind, find patterns in your child’s repertoire, which will aid in their growing list of accepted foods.
If your child eats only Chick-fil-A chicken nuggets, there are several directions in which you can go. Try serving them on a different plate, or cut them up. You could offer them with a sauce, or you could buy the sandwich instead and take the patty off the bun and/or present them together with another brand of nugget.
If your child only drinks water, add some ice cubes or warm it up a bit. Present it in a different cup or through a straw. In addition, you could add a drop of juice for a hint of flavor.
Make only one change to the current food item and be sure the change is small. It may take 15 or more presentations before the alteration is accepted, but continued exposure, without pressure to try it, increases the chance your child will find something new he likes. “Trying” it may mean he will allow it on his plate, or smell it curiously. This can eventually lead to tasting and swallowing the new food.
Professional Help and Available Resources
Starting out, it may be easier to work on mealtime behaviors separately from expanding his diet. Food play, crafts, and activities away from mealtime might be best so that he does not become overwhelmed with too much change. However, after following some (or all!) of these tips, you may still feel as though direct intervention would be beneficial. Both occupational and speech therapists can treat children with feeding disorders, but check with them first to see if they are knowledgeable and comfortable with this aspect of their practice.
Additionally, there are feeding specialists who have websites with articles, hand-outs, and links to other valuable information.
• Marsha Dunn Klein, occupational therapist: http://www.mealtimenotions.com/
• Katja Rowell, physician: http://thefeedingdoctor.com/
• Suzanne Evans Morris, speech pathologist: http://www.new-vis.com/
• Cheri Fraker & Laura Walbert, speech pathologists: http://www.cheriandlaura.blogspot.com
• Ellyn Satter, dietician: http://www.ellynsatter.com
So, whether you tackle this obstacle on your own, or obtain professional advice, the potential result is a happier family around the kitchen table… and who doesn’t want that?
Rachel Wehner, M.S., CCC/SLP, is a speech-language pathologist at the UTD Callier Center for Communication Disorders in Dallas, TX, specializing in autism and feeding. She evaluates and provides individual and group therapy, and serves on the multidisciplinary diagnostic team at the Center for Autism and Developmental Disabilities.