Many families with a child diagnosed with autism spectrum disorder (ASD) may not look forward to mealtimes. A child might only eat a specific brand of each food in their diet or might just chew crunchy solids. Or, the child may only eat if he/she can move around the mealtime table. Because parents have a fundamental need to nourish their children in a socially acceptable manner, these behaviors, often seen in children with a diagnosis of ASD, can make meals extremely stressful for the whole family.
The best solution to this problem is to seek help from a licensed speech/language pathologist or occupational therapist who has experience with developing feeding programs for children. This is because there are many variables that need to be taken into consideration when developing a structured sensory-motor intervention program. The information gathered during the evaluation will help identify:
- The child’s functional level with regard to feeding skills
- The strategies most helpful for the child
- The sensory and motor aspects that should be addressed with the child
An example of a strategy, based on information from parents, teachers, and direct observation, would be to begin the feeding program at a table separate from the dinner table with minimal visual and auditory distractions.
There are additional plans and activities, described in this article that can help with snacks and meals at home and in the classroom. The basic components of changing mealtime struggle to mealtime success are to use:
- A structured sensory-motor approach
- Consistent daily effort
- Participation by all involved with the child
Many children with a diagnosis of ASD do not process sensory information well, which may cause eating foods to be an unpleasant experience. Sensory-motor based activities can help the child process sensory information through their touch, smell, auditory, balance, and proprioceptive systems. These activities can help to calm, organize or alert the child’s sensory systems.
Calming activities prior to a snack or meal might help the child who is over or hyper-responsive to information received through one or more of his sensory systems listed in the previous paragraph. The child described in the initial paragraph, who is in constant movement around the dinner table, would benefit from calming activities.
- Wrapping up in a blanket
- Rolling a weighted ball back and forth
- Using a weighted lap pad prior to and during a snack or meal
- Taking a warm bath (Kranowitz, 2006)
- Using a diffuser with vanilla or lavender scented oils
Alerting activities would be helpful prior to a snack or meal for the child who is under or hypo-responsive to information received through the sensory systems. These activities may help the child become more responsive to sensory stimuli presented during the meal or snack.
- Going for a walk around the block
- Blowing bubbles, whistles or cotton balls through a straw
- Chewing on mouth tools or gum
- Using a diffuser with peppermint or citrus scented oils
Organizing activities can increase attention and help the child to focus on relevant information for the snack or meal.
- Marching to music with a predictable beat
- Pushing chairs to the snack or dinner table
- Carrying milk jugs filled with sand from one place to another
- Sucking from a water bottle or through a straw
Sensory Based Routines
The “oral sensory diet” is a sensory-based routine that will help prepare the child’s touch or tactile system around and inside his/her mouth for a snack or meal. It is based on predictable touch input that is presented at an acceptable level for the child. It begins with lotion on areas of the body such as bottoms of the feet and palms of the hand. These body parts have large numbers of sensory receptors and help the child accept touch input that is later applied to the face, lips, and tongue. (Escalona et al, 2001)
The “oral sensory diet” can easily become part of the child’s home and school routine. The mouth tools are placed in a kit that can be presented to the child whenever there is a need for oral input. Some of the items that can be found in the oral sensory kit (Flanagan, 2008) are:
- Lip balm
- Tongue brush
- Tube for chewing
- Whistles, bubbles, straws
- Mini massagers
- Flavored gloves
- Flavored tongue depressors
A visual schedule can be used to indicate when these sensory-motor activities, snacks, and mealtimes will occur during the child’s day. This consists of picture symbols that list the sequential order of activities presented to the child. This helps the child know what to expect and lessens his/her anxiety. (Twachtman-Reilly, 2008)
There are other easy and important changes to the physical environment that will help with the success of the mealtime or snack. Some of these are:
- A stable position in a chair with feet firmly on the floor. The child will then be able to focus on the meal and not whether she might fall out of the chair.
- A timer. This will let the child see how long the snack or meal will last. Keep a snack to no more than 15 minutes and a meal to no longer than 30 minutes.
- Utensils that are the appropriate size for the child.
- Plates that are one color so the child is not overcome by the patterns on the plate.
- A small lunch plate. A dinner plate may be too overwhelming to the child.
Other strategies that may help with the snack or meal are reinforcements and prompts. A reinforcement is something that the child likes and is willing to work to earn. This reinforcement should be saved for use during the snack or meal. Examples of a reinforcement are:
- A preferred food
- A preferred toy
Prompts may help the child eat the targeted food. These can be verbal or physical. Examples of these are:
- Verbally say, “Put in your mouth”
- Physically point to the food and then to the child’s mouth
- Move your mouth up and down in a chewing movement
Pay attention to the quantity of food placed on the child’s plate. Initially, just a small amount of the new food should be presented to the child. An example of a small amount would be one teaspoon to one tablespoon of the targeted food.
Mealtime stress can be reduced for all involved with a child who experience eating difficulties. The strategies and sensory-motor activities listed throughout this article can make for a greater chance of acceptance of a variety of foods by the child in a socially acceptable manner. It is important, however, to understand that the child’s feeding behaviors have typically been occurring over a period of time. It will take time, but change can occur with patience, consistent daily effort, participation by all involved with the child, and a sensory-motor intervention program that is individualized to the child’s needs and developed by a feeding specialist.
Escalona, A., Field, T., Singer-Strunck, R., Cullen, C. & Hartshorn, K., (2001). Brief report: improvement in children with autism following massage therapy. Journal of Autism and Developmental Disorders, 31(5), pp.513-516.
Flanagan, M., (2008). Improving speech and eating skills in children with autism spectrum disorder. Shawnee Mission, KS. AAPC.
Kranowitz, C. (2006) The out -of-sync child. New York: The Penguin Group.
Twachtman-Reilly, J., Amaral, S. C., & Zebrowski, P. (2008). Addressing feeding disorders in children on the autism spectrum in school-based settings: Physiological and behavioral issues. Language, Speech and Hearing Services in Schools, 39, 261-272.
Maureen Flanagan is a speech/language pathologist certified by the American Speech-Language-Hearing Association and licensed in the state of Maryland. For the past 37 years, she has worked with children and adolescents from infancy through age 18 with a variety of diagnoses, including autism spectrum disorder. Maureen has been trained in many treatment techniques which have been incorporated into her therapy program. This has resulted in a successful and innovative approach to treatment. Maureen has written two books that have been published by AAPC publishing company. Her new book is Strategies For A Successful Mealtime. These books and the oral sensory kit can be found on her website: www.maureenflanaganspeech.com
This article was featured in Issue 54 – Surviving Family Challenges