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 is about a little girl named Bailey. Bailey was 7 at the time we served her. She was a petite and very quiet. She was also diagnosed with autism. Bailey enjoyed visual stimulation. She had her favorite pompom present at every meal. She also enjoyed watching movies like Toy Story and Finding Nemo.
Scheduling therapy sessions for Bailey was a bit complicated because of our schedule and her mom’s work schedule but we managed to make it happen. We started therapy on a Friday and her mom kept her home from school. Her teacher and BCBA from the school attended the breakfast session so they would be able to support Bailey when she returned to school the following week. Her ABA therapist also attended several sessions in order to fully support Bailey when intensive therapy was completed.
Prior to therapy, Bailey ate few foods. Like most children with autism, she preferred the white and crunchy diet. She also liked to have ice cream. Bailey was also a grazer. She preferred to eat small snacks throughout the day without actually ever sitting for a meal. As if this wasn’t bad enough, her family had never enjoyed a family meal in a restaurant due to her challenging behaviors and restricted eating.
Day 1: Lots of Behaviors
For breakfast on the first day, we had pancakes, grapes, carrots. Bacon was a highly preferred food so we made it available as a reinforcer for her. Right from the beginning, Bailey was willing to chew and swallow new food! This is unusual as most of our children are so frightened of new food that initially, they will only agree to lick it or touch it to their tongues. So Bailey at the tiny bite of pancake and chased it with bacon. Next we offered a tiny bite of grape. Again, she ate it and received a bit of bacon. This was followed by carrot. Again, we had success! On the very first session of therapy, Bailey ate 26 bites of food! Don’t get us wrong. It wasn’t a party. Sweet little quiet Bailey, screamed, cried, aggressed towards us, and engaged in self-injurious behavior (hitting herself). She also tried to elope from the table but we just asked her to come back and she did. We did not allow her to use any of those behaviors to get out of trying the new foods.
After we left, Bailey’s mom reported that she asked for her preferred foods. She told Bailey to wait until lunch. We came back a couple of hours later offered chicken, hot dog, more carrots, and bananas. We used bacon as the reinforcer again. Bailey chewed and swallowed 38 bites of food. Bailey’s challenging behaviors were much better during this session. She only engaged in a few instances of crying and elopement.
For dinner, Bailey ate sweet potato, mushrooms, pork, and potato. We used a KBar as a reinforcer. This session was a little harder because Bailey was not as hungry. She only swallowed a couple of bites of new foods. She also engaged in a new behavior: gagging! She had approximately 50 gags and she also expelled food many times. Her screaming increased as did her elopement.
Day 2: Improvement
We returned the following day and started all over again. For breakfast we offered watermelon, banana, waffle, and sausage. We continued to use bacon as a reinforcer following really non-preferred foods. Bailey swallowed 23 bites of food. She continued to engage in a lot of screaming, particularly around the sausage. however, her aggression, gagging, and expelling were much better.
Lunch was another improvement. We offered orange, pizza (yes, some children dislike pizza!), mashed potatoes, avocado, and a muffin. Bailey ate 37 bites of food! While she was a little “fussy” the screaming was gone and she only expelled 2 bites.
We continued to see more success at dinner. We started the therapy session and then mom moved in to the driver’s seat after the first few bites. We usually see an increase in behaviors when the parents take over and this was true for Bailey as well.
Her mom Bailey tried to run away and she screamed. She also started packing (holding) the food in her mouth. Silly girl! She didn’t realize that mom was in on it too! Mom held her ground and eventually Bailey ate for her as well. She ate pound cake, strawberries, cucumbers, and chicken parmesan. Bailey ate 27 bites!
Day 3: Discharge!
The next day mom supervised breakfast of egg, english muffin, ham, and cantaloupe. Bailey ate 25 bites of food but her behaviors were testy. She cried, fussed, and even threw a bite of food. Mom stood firm and eventually, the behaviors ceased.
Lunch was great as well. Bailey ate macaroni and cheese, grilled cheese, peas, and raspberries. For those of you who have not experienced picky eating, it may surprise you to know that children with autism and picky eating may avoid even the most preferred foods! Bailey ate 52 bites! She engaged in some fussy behavior but the screaming and aggression were gone.
For dinner, we all went out to a restaurant to celebrate. Bailey’s mom, dad, brother, and I all sat down together. Bailey ordered nachos with chili, broccoli, baked ziti, and french fries. It was a sight to see. Bailey ate 45 bites of food and she engaged in zero problem behaviors.
The next day, Bailey’s mom wrote to let me know that she ate some banana, a slice of bread with cream cheese, and her favorite bacon. There were no behaviors and she was off to school. School staff continued to support her good eating habits and Bailey has flourished. Bailey still needs encouragement to eat new foods. However, her mom has now learned how to successfully support her in trying and learning to like new foods. Intensive intervention is the boot camp that gets kids over the hump. The parents and teachers must continue to support the therapy after we are gone.
Seven months after therapy, Bailey’s mom wrote to us to let us know that Bailey had gained 7 pounds. Amazing! Congratulations to Bailey and her family. Your hard work has paid off.