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Archive for September, 2011

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’s success story is about Mary Lea, a sweet little peanut who had just turned 3 prior to coming to feeding clinic. In addition to being diagnosed with autism, Mary Lea had experienced some medical issues in her young life. However, her Mother’s biggest concern was Mary Lea’s eating. Mary Lea only ate with her fingers and she refused to use utensils. Mary Lea also drank out of one cup and she showed no interest in drinking from any other container.

Mary Lea loved to drink apple juice and almond milk. She consumed Lays Stax chips, mini muffins, McDonald’s french fries, and chocolate pop tarts. Mary Lea also had an affinity for Sonic Grilled Cheese. Her mother bought a sandwich maker, special bread, and Sonic wrappers so she could make them at home. Mary Lea wanted nothing to do with her mother’s grilled cheese. She cried and refused to eat until her mother bought her a Sonic grilled cheese.

Mary Lea and her mother packed their bags and made the trek to Austin, Texas where we were offering a week of intensive feeding therapy. Mary Lea and her mother attended sessions 3 times each day (breakfast, lunch, and dinner). It is hard work for the parents because they have to take off from work to bring their child to the clinic. The parents have to prepare all the food and bring it to clinic for each meal. Finally, parents watch all sessions for the first day or two so they can learn the strategies that we use.

In the initial stages of intervention, we target an easy skill to ensure that the child will get access to preferred items or activities (also known as reinforcers). For Mary Lea, we quickly learned that she loved the new coconut milk yogurt we offered her. We were able to use the new yogurt to get her to try other new foods. Within the first day, Mary Lea was taking food from our hand and placing it in her mouth. Our next goal was to teach her to eat from a utensil.

Mary Lea was not happy about this change in feeding expectations. Since she refused to eat from the utensil in one session, she did not get access to the yogurt. After one session with no access to yogurt, Mary Lea realized that the only way she could have the yogurt was to try new foods. Soon, she was self-feeding with the utensils. After this, we transitioned her mother in to sit next to her and her eating continued to improve.

Once Mary Lea mastered eating in the clinic, we moved therapy to a local restaurant. Mary Lea’s mom brought the yogurt in to the restaurant to use as a reinforcer. Mary Lea does not handle change well so she was initially unhappy about eating in a new place with new plates and new utensils. However, she quickly realized that the restaurant also had good food to eat. (As a side note, most restaurants are ok with families bringing in special food, you just need to clear it with them first. In our experience, restaurant staff are very understanding of the issues associated with autism including eating challenges. Restaurant staff have been most accommodating.)

Not only did Mary Lea learn to eat within the 5 days of intervention, she stopped using her pacifier and  she started walking everywhere instead of being carried! Finally, on the last day, we introduced the iPad2 equipped with Proloquo2go software. We offered dairy-free pudding as dessert at the end of the meal. Mary Lea was prompted to touch the “I want pudding” button after which she received one bite of pudding. On the third try, Mary Lea touched the “I want pudding” button on her own.

Congratulations Mary Lea on your success. You could not have done it without your mom. She rocks!

Happy eating!

.

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The topic of #pickyeaters has received a lot of attention lately. You can search for it on twitter (#pickyeater), there are blogs about it like this one,  and even Dr. Oz talked about it here.  Everyone has an opinion about how to help picky eaters.

After searching the internet to learn what others had to say, I found this great link on Whole Foods. I have to say, I really like the advice that was offered. I’ll summarize it here:

First, the author, Paige Brady, suggested talking to your children. Children are bombarded daily with advertisements for junk food, fast food, and candy. Paige is right! We have to get in as much good food talk as we can.

Next Paige suggests that we get real with our meals. I like that too! Serve food that looks like real food. Real food is more appetizing than processed foods. My mouth is watering as I’m typing.

Paige also suggests that we serve a rainbow. Look at your child’s plate. Is it all white? Strive to have varied colors for each meal. Real food has color. Let it shine.

Paige tells readers to hand over the reigns. In the intervention world, we call it choice making. Give children choices. You will eat a vegetable tonight. Is it going to be broccoli or brussels sprouts?

In our house, the kids help shop. They pick out the fruits for the week, they pick out the vegetables for the week, we allow them to pick the meats that will be cooked. By including them in the shopping and meal planning, they are much more likely to want to eat what is served. Moreover, when they are older, they will be empowered with the ability to make good choices on their own.

Happy eating!

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Hi and welcome to “Ask Missy Mondays”. On this day, I will answer questions submitted from readers. If you want to submit a question, email ask missy at Applied Behavioral Strategies dot-com.

Today’s question comes from Emily in Brooklyn. Emily writes: “My nephew, 8 years old with autism, won’t eat very many veggies.  The only veggie I’ve seen him eat willingly is tomato sauce.  He doesn’t seem to mind the taste of other veggies when they’re pureed and put into the sauce. However, if  he puts it in his mouth, he will not chew it. He swallows small pieces of it without chewing. How can I work on getting him to chew his food?  Does he just need more practice?  Are there other techniques I should be trying besides offering veggies and occasionally expecting them to be consumed?”

Emily, this is a great question! Rebecca and I see many children who do not want to chew their food. They do this to avoid the taste and/or to avoid the texture. When we enroll children in feeding therapy, we always start with one bite; one very small bite. Think about how you try new foods. You do not try a new food by ordering a huge plate and you certainly don’t fill the fork on that first bite. Children need the same approach.

Next we start with small expectations. First just have your nephew put the food to his lip. Once he can put the broccoli to his lip using a fork without fussing, then he is ready for the next step; touching it to his tongue. After he touches it to his tongue successfully, he is ready to put it in his mouth, followed by chewing and swallowing. During the meal, remove all the preferred food until he complies with touching the new food to his lip. When he does, give him more (but small amounts of) preferred food. After he consumes the preferred food and when he is ready for more preferred food, say, “oh, I need you to try my broccoli again”.

Within one meal, you should have him chewing and swallowing very small bites of broccoli. Keep in mind that an appropriate sized bite of new food is a dime or smaller.

Good luck with the veggies. Please let us know how it goes!

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We are happy to share some good news with all of you!

One of our clients who graduated from an ABS feeding clinic in February, is still going strong 7 months later! In this meal, he is eating grilled chicken, Texas caviar, raspberries, blackberries, and grilled vegetables.

Bravo to our client and his family for their dedication, hard work, and achievement!

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We are excited to announce a schedule of upcoming continuing education for BCBAs and BCABAs!

To sign up for an ABS workshop, click here: Continuing Education Workshops

Upcoming Courses – Click here to view the original flyer.

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