Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.
Today we would like to introduce you to a cute little fellow named Mikey. Mikey was 33 months old when we started intervention. Mikey was a typically developing toddler in every way except for his eating. Mikey preferred to drink his milk and he drank lots of it. His mother reported going through a gallon of milk in just one weekend. Mikey had some sensory processing issues which led to oral motor therapy from a speech and language pathologist (SLP). During oral motor therapy, he learned to tolerate having a toothbrush in his mouth and he learned to eat a few new foods.
Before we started intervention, Mikey occasionally ate cream cheese and jelly sandwiches on white bread. He also occasionally ate cheese sandwiches on white bread. His mother reported to us that she was very interested in Mikey becoming toilet trained.
We sent Mikey’s mom some written instructions on how to toilet train her child. We suggested that she start toilet training the weekend before we started feeding therapy. We have found, in our clinical practice, that children respond well when multiple areas of growth are targeted simultaneously. For Mikey, we could say that he was becoming a “big boy”. Big boys learn to pee on the potty and they learn to eat big boy food!
Mikey’s mom was a champion. She followed the toileting protocol that we provided and by the time we arrived for feeding therapy, Mikey was already urinating regularly on the toilet. He was also accurately reporting if he had to urinate when asked! His daytime diapers were gone and he was wearing big boy underpants.
The other curve ball we threw Mikey was that he was no longer allowed to drink from a sippy cup. He was starting preschool and big boys drink out of regular cups. We told Mikey that he could only have his sippy cup if he needed to drink while riding in the car to keep from spilling.
Prior to therapy, we encouraged Mikey’s mom to work with a nutritionist to determine if Mikey had any food sensitivities. Unbeknownst to her, Mikey was reactive to a number of common foods such as avocado. Additionally, Mikey suffered from a zinc deficiency. So, prior to therapy, Mikey’s mom started him on a few nutritional supplements. We believe that well-rounded nutrition is one of the best mechanisms to ensure success in our therapy sessions.
For Mikey, we provided all services in his home and his mother was present for every session. Mikey’s father attended one session to ensure that he knew how to support Mikey when therapy was finished. In addition to having well-rounded nutrition, we have found (along with other researchers) that hunger inducement is one of the best strategies for feeding intervention. When children are hungry, they are more likely to want to eat. For Mikey, this meant that multiple cups of milk were eliminated each day. Unfortunately, Mikey’s mom had to deal with Mikey’s unhappiness about this change in the early morning hours before the first session. As we said previously, she is a champ and she handled this challenge like a true fighter. Mikey was definitely hungry at mealtime and he soon learned to get along without all that milk.
Mikey received services over the course of 4 days. On the first and second day he received services at breakfast, lunch, and dinner. Mikey’s mom took over the meals starting at dinner on the second day. On the third day, Mikey received services for lunch and dinner. On the final day, he received services for breakfast. So in just 9 one-hour sessions, Mikey learned to eat new foods when asked.
We had several pleasant surprises when working with this client. First, Mikey had never eaten protein in solid form. We were all pleased that protein was becoming a fast favorite for Mikey. Additionally, Mikey loved fruits. We couldn’t find a fruit that he disliked. Despite the great progress that Mikey made in such a short period of time, Mikey will still need to work on chewing his new foods. As his mouth becomes accustomed to all the textures and flavors, he will become desensitized and more willing to use all of his mouth when eating. Additionally, as he learns to use his mouth to chew all of these foods, his overall motor function should improve.
Mikey, congrats on your progress. And to Mikey’s mom—he could not have done it without you. Now go get yourself that manicure, pedicure, or date night that you deserve. Tell your husband “it’s the doctor’s orders!”