roz weeks: asd outreach service manager/salt

Name of presentation

NAS AGM

Understanding and managing fussy eating in children and YP with an ASD

21st November 2013Roz WEEKS: ASD Outreach Service Manager/SALT


OUTLINE:

• Background and Theory

• Sensory issues

• Anxiety

• Practical strategies


What do we know?

• 62% of parents of neuro-typical toddlers describe more than one ‘feeding concern’ (Reau et al., 1996)

• 13-80% of children with developmental

problems have a ‘feeding disorder’ (Schreck et al., 2004)

• 90% of children with ASD have ‘mealtime problems’ (DeMeyer, 1979)


Activity: myths and facts about mealtimes


Mealtime myths and facts for children with an ASD

Facts• Most children have some

selective feeding

• Can be caused by sensory sensitivities

• Can be caused by difficulties managing change

• Families have a high risk of stress around mealtimes

• Children have less awareness of when they are hungry or full

Myths• Caused by poor parenting• More likely to be

underweight/ overweight• More likely to lack

essential nutrition• Choose what they eat to

gain attention• Have families with a poor

diet• Are naughty


The thing I absolutely hate the most is trying anything new. There are hardly any foods I eat at all. I especially hate any foods with bits in it, or things mixed together with each other….I don’t like to eat any food which is the wrong texture….Pringles are my favourite food. I like the way they look, and taste, and the colour, smell and texture of them.”

Hall, 2001, p.46-7


Picky, selective feeder(low tolerance)

Always eating, never full

(high tolerance)

Selective feeding

rigid thinking

sensory differences

Learning experiences

Highly restricted feeding

Maintaining factors Reluctant feeder, anxiety

Understanding feeding in ASD

Adapted from Strudwick and Lister Brook, 2009.


Activity

• Put foods into one of 3 categories – like, tolerate, dislike

• In small groups compare your food preferences. Are they the same or different?

• Discuss what it is about certain foods that cause you to either like or dislike them.


Sensory differences

• “The way a person processes sensory information is just that-the way the person processes sensory information. No way of processing sensory information is inherently good or bad-it just is.”

• “People with every pattern of sensory processing are living successfully and unsuccessfully…”

• [A sensory difference] “is not a problem to resolve; living a satisfying life is the challenge to address.”

(Dunn, 2001)


Types of sensory differences

Sensory sensitive/ defensive

Low tolerance High tolerance

Always eating, never full, constantly

nibbling or stuffing food.Obsessive / compulsive

feederDoesn’t know when to

stop eating

Sensation seeking

Picky / Selective FeederNever hungry. No interest in

food/drinkRefusing

Controlling behaviourRigid eating patterns


I was supersensitive to the texture of food, and I had to touch everything with my fingers to see how it felt before I could put it in my mouth. I really hated it when food had things mixed with it like noodles with vegetables or bread with fillings to make sandwiches. I could never, never put any of it into my mouth. I knew if I did I would get violently sick.

(Barron, 1992)


Appearance of food and it’s importance for some children with an ASD


The importance of appearance


A different way of thinking that influences feeding patterns

• Perseveration i.e. inflexibility (Attwood, 1998)

• Conceptual categories i.e. not making the links between different items e.g. all makes of custard creams (Bogdashina, 2003)

• Central coherence theory (Frith, 1989) e.g. noticing the bruise on an apple and rejecting the whole apple


If my son eats crisps, you have to open thepacket a particular way, and it must be a bluepacket or he won’t eat them. Kit-kats must bebroken a certain way, and he has to have thewrappers laid out next to him to read as heeats. Tomato sauce must be in a bowl besidefood not on it.”


Fear of new things (neophobia)

There is a genuine fear of food. It’s not that he doesn’t want to try it, sometimes his whole body is arching away because of something I’ve put in front of him


Neophobia & anxiety • Protects us from eating the wrong things• Contamination & disgust fears• Anxiety in situations where they might be offered food

Some foods taste yucky – yoghurt stinks like dog poo” (Carl aged 7)

“I don’t like cheese because it’s too milky and it’s only for mice” (Nicolas aged 11)

“I wouldn’t try food if it was smelly or coloured brown or green that I didn’t know…the smell gives me a clue as to whether food is good” (Christine aged 10)


HOW CAN WE TRY AND ALTER WHAT OUR CHILDREN ARE EATING AND DRINKING?

PRACTICAL STRATEGIES


We have tried bribery, mixing foods, threats rewards, eating in different places and making lists of foods. We have tried having other children around at mealtimes and try to get her to join in, but she doesn’t. She stopped eating at school when they tried to insist she ate more. Nothing works. In fact the more we try to get her to eat, the less she will do it


What doesnWhat doesn’’t typically work?t typically work?

• Hiding/disguising food • Allowing the child to ‘go hungry’ “starve them and they’ll give in”• Force feeding• Withholding preferred food • Insisting on a healthy diet• Star charts & rewards • Imitating other children


How we can help by supporting you…

• Providing information/ reassurance– Facts and figures about feeding in ASD– How our understanding of ASD helps to explain the

differences– Books/resources e.g. Can’t Eat, Won’t Eat (Legge

2002)– Sharing experiences

• Giving permission to give child preferred food to maintain weight and reduce mealtime stress

• Avoiding standard healthy eating advice where this is unsuccessful


What do you do to make mealtimes easier?

Talking mat activity


How we can help ?

Sensory Interventions

• Addressing sensory needs

• Calming techniques before meals

• Oral desensitisation – teeth cleaning


• Regular mealtimes

• Familiar mealtime routines

• Visual supports– Pictorial timetables & mealtime activity schedules– ‘Eat-up’ book – scrapbook – pages for foods I can

look at, smell, lick, nibble, bite, swallow etc. – Social stories– Picture books e.g. Charlie and Lola

How we can help by altering the environment…


Introducing new foods

Activity

• If you were having difficulties eating, put these in the order you think you would find easiest to do


Hierarchy of Eating

• For each new food

– Look at– Touch– Smell– Kiss– Lick– Nibble– Swallow


‘Eat-up’ book –

Scrapbook – pages for foods” I can.......” • look at• Smell• Lick• nibble,• bite• swallow etc.


New things I have tried this week

Smelt

Touched

Licked

Nibbled

Tasted


Social Stories.......

Sometimes I feel worried about trying new things to eat .....

This is OK and lots of people feel the same . I can ask to have a small portion..

I can try to taste a little bit . This is a good thing to do and I may like it after all.

Lots of people are fussy about their eating.

I will not throw my food when I don’t want to eat it .This will make my Mummy sad. I will just say I do not want to eat it.

She will be happy if I do this .


Choice boards/menu planners


CHOOSING BOARD


MEAL TIME SCHEDULE

DINNER PUDDING DRINK


This week’s dinners will be ……

Mon Tues Wed Thurs Fri Sat Sun

New things I will try are ……


Today’s meals will be …….

Breakfast

Lunch

Dinner

A few things I will try are ….


Picture books e.g. Charlie and Lola


Behavioural interventions

• Desensitisation– Reducing fear of foods

• Agreed behaviour management strategies– Broadening range of foods– Broadening food categories– Use of suitable rewards – non-food

• Quantity charts

Selective Eating-Interventions


Other things that can work?Other things that can work?

• Category generalisation – ‘spreading the sets’– Introduce new foods from accepted categories, e.g. a new

flavour of a known brand – 10-14 times– Desensitise to smell/taste of new food – Child has control over which foods


What can work?What can work?

• Context specific foods

– New foods in new contexts e.g. new class at school, respite – New food & context stored as a new ‘gestalt’ – Often less confusing than changing foods within a familiar

context


VISUAL SUPPORTS: HEALTHY EATING

• All about food book– Food categories e.g proteins,

carbohydrates, snacks and sweets– Foods in each category that are eaten

now– Foods in each category that might be

eaten in the food

• Child does survey of what other people eat in each category and selects what to try


It is like being in a restaurant like when father takes me out to a Berni Inn sometimes and you look at the menu and you have to choose what you are going to have. But you don’t know if you are going to like something because you haven’t tasted it yet, so you have favourite foods and you choose these, and you have foods you don’t like and you don’t choose these, and then it is simple : Mark HADDON

roz weeks: asd outreach service manager/salt

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