Presentation on theme: "Mealtime Challenges and the Autism Spectrum"— Presentation transcript:
1 Mealtime Challenges and the Autism Spectrum Marsha Dunn Klein MED OTR/LMealtime Connections, LLC, Tucson AZMealtime Notions, LLC, Tucson AZ
2 What is a “mealtime”…….? All about sensory All about social & communication All about transition
3 Autism SpectrumAll about sensory All about social and communication All about transitionAnd ORDER….Sameness
4 DSM IV Diagnostic Criteria Autism Disorder Qualitative impairment in social interactionQualitative impairments in communicationRestricted repetitive and stereotyped patterns of behavior, interests and activitiesInflexible adherence to specific, nonfunctional routines or rituals
5 Feeding Issues Commonly Associated with ASD Sensory processing difficultiesSmell (36%) , touch, visualOral sensory hypersensitivityUncomfortable with touch to mouth or toothbrushingTastes (45%), texture (69%)Temperature (22%)Developmental Disabilities Williams et al 2008
6 Feeding Issues Commonly Associated with ASD Social Skill DeficitsPoor response for following directionsLess imitationCommunication Skill ChallengesDifficulty Transition and Novel SituationsPrefer routines (46%)Sameness (69%)Developmental Disabilities, Williams et al 2008
7 Eating Habits of Children with Autism Williams, P Eating Habits of Children with Autism Williams, P. et al, Pediatric Nursing; May/Jun 2000, Vol. 26 Issue 3, p259, 6p344 parent questionnairesReported factors that influenced food selectionAppearance 58%Taste 45%Smell 36%Temperature 22%37% Relationship between eating and behavior
8 Eating Habits of Children with Autism Williams, P Eating Habits of Children with Autism Williams, P. et al, Pediatric Nursing; May/Jun 2000, Vol. 26 Issue 3, p259, 6pLargest challenges (by parent report)Trying new foods 69%Taking medicine 62%Eating new foods 60%Mouthing objects 56%
9 Eating Habits of Children with Autism Williams, P Eating Habits of Children with Autism Williams, P. et al, Pediatric Nursing; May/Jun 2000, Vol. 26 Issue 3, p259, 6pSocial AspectsSituations and people influence eating 35.5%Child ate differently in different settings 41%Fewer reported frequenting fancy restaurants87% drive through restaurantDegree Frustration13% Upset a great deal of the time19% Easy going68% Upset with reasongModerately u
10 Eating Habits of Children with Autism Williams, P Eating Habits of Children with Autism Williams, P. et al, Pediatric Nursing; May/Jun 2000, Vol. 26 Issue 3, p259, 6p67% Described child as picky eater 73% Good appetite for foods they liked 6% Reported poor appetite for most foods 19% Good appetite for most foods 62% Adequate nutrition 49% Fairly balanced nutrition 35% Food supplements 97% Not picky more often described as good nutrition 69% Not trying new Picky eaters equally divided between adequate and inadequate nutrition.gModerately u
11 Parent Challenges Picky eating? Can’t change the menu, texture? Unable to eat with family?Poorly balanced diet?Huge emotional impactCan’t change environment?Doctor not concerned?Family/friends do not “get it”?Choices are not logicalIsolation?
12 Child Challenges Poor nutrition High stress and anxiety Difficult transitioning to mealsHighly suspicious of changeNo mealtime enjoymentSkill deficits
13 Food ListSafe FoodsSometimes FoodsUsed to foodsNever/no way foods
15 Diet themes……personal….but….. Narrow choicesImbalanced dietNarrowed color ranges…tan, brown, white, or………..Particular sensory aspect importantVisual appearance, smell, textureBrand specificity?Personal logicChange is very difficult
16 Common parent solutions Offer the same foods in the same way in the same environment with the same brands so as not to create mealtime stressFeed child separatelyNo eating outSeek help!
17 “Behavioral”Schreck et al. (2004) “Separation of physiological aspects of feeding difficulty from behavioral aspects is especially difficult in ASD because physiologically based difficulties in this population are often subtle and difficult to pinpoint, and “behavioral” difficulties are not always behavioral (i.e., willful or volitional acts of noncompliance), but rather a reflection of the characteristics and symptoms of this multifaceted disorder.”
18 Research is beginning to define the complex pattern of neuro- biological differences that characterize ASD as well as its influence on behavior. (Just, Cherkassky, Keller, & Minshew, 2004; Minshew, Sweeney, & Luna, 2002) “At a basic level, this research has con- firmed that the atypical behavior that is exhibited by people with ASD is a direct result of neurobiological differences.”
19 Food Neophobia “Neo”………New “Phobia”……..irrational fear Nightline show Personal Logic????Nightline show
21 “When two year olds were given varying numbers of opportunities to consume new foods their preferences increased with frequency of exposure.”5-10 Exposures to a new food necessary to increase preference for it (Birch, LL, McPhee L, Shoba, BC, Pirok, E., Steinberg, L., 1987 What kind of exposure reduces children’s food neophobia? Appetite 9:171-78)
22 Neophobia changes during development Neophobia changes during development. Evidence for familial similaritiesLinked to other temperament and personality characteristicsMothers who were more neophobic food environment with new and presented uncommon foods less frequently. (Hursti and Sjoden 1997, Food and General Neophobia and thei relaionship with self reported food choice, Appetite 29, )
23 Olfactory Memory Nature of Olfactory system Alerting Accommodation Limbic SystemEmotionsMemory and memory storage
24 Where to focus? Diet..............? Sensory………………..? Oral Motor…………………..?Behavior……………………………?Rituals, Fear, Anxiety, OCD………..?A combination……………………………………..??
25 Various Treatment Components Oral MotorSensoryApplied Behavioral AnalysisBehavioral TherapyNutrition/Diet“Phobia” supportDesensitizationExposure TherapyIndividual work with childFamily workTeam
27 Life Long Learning Skills People eat things you do notBe at the table (in the same room?) with others who eatBalance the diet (vitamins, new food groups)Discover how to try a “New” foodLearn how to refuse an offer politely
28 Feel Well Diet – Narrow, wheat, dairy, allergies Sensory issues-Overload, Transition,GI issues- Dyspepsia, Constipation, MotilityBrain-Gut Connection (The Second Brain, Michael Gershon)Fight /Flight does not work well with digestion
29 Mealtime PeaceStart with peaceful and tip toe towards new experiences so as not to disrupt the whole family.New food trying time may need to be NOT a family meal to start.
30 Change Happens Rigidity, ritual and routine is common For peace, we reinforce that…..become routine “enablers”Eating can become comfortable if child knows exactly what is next.Child needs to learn that change happens at mealtimes and they can deal with it.
31 Change Continuum Start with safe and less emotional parts of the meal. Start with change that does not effect the entire dietTip toe towards changeAt mealtime or non mealtime?
33 An important CHANGE goal Gradually eliminate PACKAGING and Brand specific presentations. (or avoid it from the start)
34 Sample Change Sequences Cup……sticker to color to shape?Waffle…….Strip off edge, strips, Rectangles…..Squares….bite size…….or even triangles.Plate……Color……picture…..paperFavorite foods in containers………
35 Multiple Exposures Safe Pretend Food or Non Real Food Interactions Looking at pictures of foodReading books about food and eatingPlay with plastic foodsMatching food picturesWatch video about food (www.Cosmeo.com)
36 Multiple Exposures #2Distant food interactions Help grocery shop Help put food in grocery cart Help put away groceries
37 Multiple Exposures #3 Non-Eating Real Food Interactions Food PreparationsServing foods to others with spoons, tongs, forks, fingersCooking and clean upIncorporating food into playIncorporating food into pre-academics
41 Re-Define “Try It” In the same room Re-Define “Try It” In the same room? At the same table Near the plate Serving/ Helping prepare On the plate Smelling Touching hands/mouth Handing to others Licking Try and spit out Mousebites Eat some
49 Food Science/Food Detectives Compare various food qualities Chart sames and differents Foods that float/sink Mixing food colors Designing with foods (Colorforms) Measuring
50 Photo BooksKiss BookLick BookNoisy Lick BookMousebite book
51 Food Selection Similarity to preferred? Stretch from preferred Minute changes (add to familiar)Safe Skill trainingNutrition groupRepetition then KEEP it in the food rotation so as not to lose it.
52 Ways to Support Families Parent Support GroupIssues unique to ASDTeam Discussions (Combine input from dietitians, psychologists/ABA, sensory therapists, speech, MD, with parents as the center!)Way of lifeDirect therapeutic supportCombine with direct ABA
53 The “Just Right Challenge”….B. Clawson Team WorkThe “Just Right Challenge”….B. Clawson
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