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Dear Steve,

You left us too soon. You left us before you could possibly know what your work has done for us. The iPad combined with many, many different applications, including the Proloquo2go software has helped us and our loved ones tremendously. Children have learned to communicate that they want to eat, children have learned to communicate when they are upset, children have learned to communicate when they are scared.

Thank you for being brave enough to think differently. Thank you for making a difference for our children with autism who also think differently.

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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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