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 case highlights the struggles of a little peanut who reminded us of a cherub–hence the name Little Cherub. She was angelic, beautiful, and gentle (except when you asked her to eat). She was fair-skinned, fair-haired, and fair-tempered (unless you asked her to take a bite).
Little Cherub was a twin who developed normally until she was 18 months old. She once spoke 30 words–until she regressed in to autism. Then one day, the words started disappearing one by one. What a horrible nightmare for families to live. Our sympathy goes out to each and every one of you who have lived (or who are living that nightmare).
Not only did Little Cherub lose her words and her desire to live in our world, she lost all of her eating skills. She no longer loved salmon. She no longer enjoyed cantaloupe. In fact, by the time we got our hands on her, she had whittled herself down to just two foods. Yes, you heard us correctly–just two foods. Can you imagine the stress for her family? (yes, some of you may be living that stress right now.) She loved pretzels and she loved peanut butter. She drank her almond milk from a bottle and she refused to drink it from a cup (although she could drink water from a cup).
As if her case wasn’t hard enough, Little Cherub had been diagnosed recently with celiac. Celiac is a condition when a person cannot digest the protein found in gluten. If you are uninformed on this topic, you should know that gluten is found in almost every yummy food: bread, pasta, crackers, cookies, batter-fried food, and anything else with flour. Living a gluten-free (or GF) lifestyle is not that hard but it can certainly complicate matters–particularly when you only eat 2 foods.
Little Cherub’s parents agreed to have us come in to their home for a week of therapy. During that time, Little Cherub stayed home from school and focused on eating and toileting. Yes, we sought to address both eating and toileting because we have found in our practice, that children respond well when they are challenged. So, with that, we started both treatments on the same day.
The first day started with Little Cherub putting on her big girl panties. She had the cutest little panties–Hello Kitty and Cinderella. She was not particularly interested in her new panties though. We put her on the toilet and she didn’t produce. We made the mistake of putting her clothes on and turning our backs. Bam! She wet herself. We quickly rushed her to the potty and told her that pee goes in the potty. She did not produce since she had already peed it all out. So she got dressed and washed her hands. Oh yes, toilet training is a great time to work on those self-help skills because you get to practice them over and over and over.
Then she proceeded straight to breakfast. Little Cherub was somewhat confused as to why she wasn’t having peanut butter. She was angry when she found out that eggs were on the menu instead. During breakfast we tried to shape up a self-feeding response. We wanted her to pick up the spoon, touch it to her lips and put it back down. In return, she could watch her favorite movie, The Backyardigans.
We also threw away the bottles. If she wanted her almond milk, she would have to drink it out of a cup. She fought this for at least two days straight. It was almost as if the cup had cooties—except she drank water out of an identical cup. It made no sense to us either. We are certain that when she starts talking one day, she will tell us. None the less, the first meal was not easy but she soon figured it out. Breakfast lasted over an hour.
Next it was time to potty again. We had learned from her teachers that Little Cherub could hold it all day so we did not need to stop breakfast to potty. She did not produce after breakfast either. This time we kept our eyes on her while we waited for lunch. During this time she asked for pretzels and peanut butter. We simply told her that breakfast was over and that lunch would be soon. Then the crying ensued. She was clearly unhappy about these new rules.
We finally got her to pee on the potty after what seemed like hours (oh yeah, it really was hours). We sprinkled warm water down there and she made the connection. We gave her GFCF pretzels as a treat. She was happy. She managed to pee on the potty once each day and then she would have a soaker over night. This is pretty common when children are rigid and have already learned to hold it. Eventually, she will figure out that the only way she is going to get pretzels is to pee on the potty. By the time we left after 6 days (thanks to a snow storm that kept us longer), she had peed on the potty at least once each day and sometimes twice depending on her liquid consumption.
The feeding was turning out to be much more difficult. In fact, Little Cherub proved to be the toughest case we have had to date (we reserve the right to change that–though we hope to never meet anyone more difficult). As we said, on the first day, she was willingly picking up the utensil and touching it to her mouth. On the second day, she would willingly eat a food if it was mixed with the peanut butter. We were also successful at putting some food on a chip–a once favored food. However, after two days, she was still not interested in eating food that was not accompanied with another preferred food. So, on day 3, we got tough. We no longer allowed mixing foods. She needed to eat it plain. She put up an awful fight. You would not believe us even if you saw it on video. For a tiny little peanut, Little Cherub was fierce. She fought us for the first meal on Day 3 and then it was as if nothing had happened. She came to lunch ready to eat.
Thus, lunch and dinner on Day 3 were great. She was eating all the foods (we ask parents to bring 4 NEW foods to each meal–protein, fruit, vegetable, and starch). She was feeding herself all the foods. So, at dinner, Mommy took over with us coaching. She tried to fight it but she soon realized that Mommy was no longer playing the old way–she meant business. On the 4th day, Daddy did breakfast. It is funny because Little Cherub thinks she can convert people back to her world. That is until she realizes that they have been trained. No more peanut butter, no more pretzels. Uh oh.
During breakfast we discovered that Little Cherub does not like eggs. She fought and fought and eventually self-fed the eggs. (Sadly, even after 6 days, she was still not thrilled with eggs. Her parents will continue presenting eggs for a few more weeks before deciding if they are simply non-preferred).
Next, we were off to school. It is important to generalize these skills to new people. Remember, Little Cherub put up a fight for Mommy and then Daddy. You know she is going to fight her teachers. We arrived at school during snack. Little Cherub tried to eat her friends’ snacks! What a pleasant surprise! However, due to her allergies, she cannot eat her friends’ food. We started off the lunch session and after a few bites, we transitioned in her assistant teacher. Wouldn’t you know, Little Cherub decided to try out the fight again. Quickly she realized that all the teaching staff were “in on it” so she settled down and ate her blueberries, coconut milk yogurt, and chicken soup with carrots and chunks of chicken.
When the snow cleared and we could travel, we said our good byes. We arrived home to the most brilliant email. Little Cherub ate (and I quote you from Dad’s email), “Steak sautéed in onions, home fry style potatoes and onions, peas, and strawberry for dinner. She loved the steak and potato and asked for several helpings!” We wanted to know if she ate them willingly or if she put up a fight. To this, Dad replied, “she grabbed that steak like a hungry NFL lineman. I started with a few small pieces and she probably ate about 2 oz in total. I had to push with the potato for the first bite but that was her second favorite food of the meal”
Let’s pause to cheer for our Little Lineman. Way to go Little Cherub! Hats off to your Mom, Dad, Grandpa, Mimi, and wonderful teachers. You have the best army possible fighting for you. Mom and Dad, it was a wonderful journey. Thanks for taking us along for the ride.