How do I Know if My Child has a Feeding Disorder?

Challenge Detroit was founded in 2008, with a mission that reads; “We develop, support and connect emerging and existing community-minded leaders, amplifying the positive impact on our diverse, cultural vibrant city.” Challenge Detroit is making a difference.

MetroEHS Pediatric Therapy is proud to be a host company with Challenge Detroit.

MetroEHS is excited to introduce Dezha Willoughby, one of two Challenge Detroit Fellows MetroEHS proudly hosts! Dezha was born and raised in Detroit and places like Belle Isle were the norm on the weekends (when the weather was nice). She attended and graduate from MLK High School (#GoCrusaders) and she went on to attend college at Michigan State University where she honed in her skills to work with and serve people. Dezha studied Human Development and graduated with her Bachelor of Science Degree in Human Development and Family Studies. Dezha enjoys being outside and enjoying nature. Dezha is very determined and ambitious about being an agent of positive change.

According to the company, “Challenge Detroit cultivates diverse, innovative, community-minded leaders from the city and across the country, fostering their talents to support local initiatives that move Detroit forward. While they spend four days a week accelerating their professional careers with our Host Companies, each Friday Fellows take a day out of the office to bring social impact challenge projects to life in collaboration with our local nonprofit partners. They work in multi-disciplinary teams, bringing their vision, creative muscles, and entrepreneurial spirits to address some of Detroit’s greatest challenges and opportunities. We believe that to move our city forward, positive change starts with an individual and is ignited by a community of leaders who bring innovative perspectives to their work, and most importantly, the nonprofits already making an impact within our Detroit communities.”

Once a child has been diagnosed with a Pediatric Feeding Disorder due to oral dysphagia or sensory processing disorder or, if diagnosed by a psychologist, ARFID (Avoidant/Restrictive Food Intake Disorder), they will likely be referred for treatment. Eating is a learned behavior. It is only instinctive for the first 6 months of life. Older children must either teach themselves, or be taught (Toomey). Treatment for a feeding disorder can be completed by a Speech-Language Pathologist (SLP), Occupational Therapist (OT), Board-Certified Behavior Analyst (BCBA), Dietician, or Psychologist. All of these disciplines have overlapping and unique approaches to treatment, so a Pediatric Feeding team that involves more than one specialist may be best for your child. As an SLP who is part of a feeding team that involves an OT and BCBA, some approaches to treatment that I utilize alongside the team include the Food Chaining Approach, The Sequential Oral Sensory approach (SOS), and the Escape Extinction approach.

Food Chaining has become recently popular due to a book written by Fraker and Cox called Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. To summarize this approach, clinicians and parents would “chain” from food that children currently enjoy by changing 1 aspect of the food at a time: either color, texture, flavor, or shape. For example, if a child enjoys cheetos, you might “chain” to orange veggie sticks (changing flavor), then to green veggie sticks (change in color), then to green veggie chips (change in shape), then to zucchini cut in a circle and placed on the chip (change of texture), then remove the chip. The child is now eating zucchini, and it was introduced slowly in a non-threatening manner! In this procedure, food is not forced on children- they are able to touch and explore it themselves, the clinician models eating it, and children are encouraged to take a bite, but they decide if they would like to try it or not. Using food chaining, children will slowly and positively increase their repertoire of acceptable food.

The Sequential Oral Sensory (SOS) approach was developed by Dr. Kay Toomey, a psychologist who specializes in Pediatric Feeding Disorders. This procedure includes another slow process of children having repeat exposures to foods prior to being forced to take a bite. For example, a child would tolerate a new food, let’s say apple slices, on their plate without expectation of eating it. Once that is tolerated, the apple will slowly and systematically move closer to their mouth, again without expectation of eating. They will touch it first with a fork or toy, then their hand, then put it on their arm, then their cheek, then kiss it, then lick it, then take a bite and spit it out, then chew, and finally swallow the apple slice. This could take a couple of days or even weeks. The idea is to allow children to have positive interactions with the food so that eating is enjoyable and they control what is placed in their mouth according to their comfort level. Eventually the child will be able to more quickly and independently follow the above steps with a new food to independently increase their diet. Children will gain confidence and learn that new foods aren’t as scary as they once thought.

The Escape Extinction approach is an effective, evidence based approach used to aid with feeding problems across all ages and is often utilized in ABA therapy by a BCBA or Behavior Technicians under the guidance of a BCBA. Eating novel food items and non-preferred food items is broken down into easier steps to aid your child with succeeding in their feeding journey. Keeping the presentation of bites and the bite sizes predictable decreases anxiety and allows the child to feel more in control during meal times. We never move up in bite size until we are certain your child is able to handle the bite at that size and has the skills needed to properly lateralize the food item, masticate the bite, and take consecutive bites. Furthermore, this approach reinforces appropriate feeding behavior while extinguishing inappropriate or disruptive feeding behaviors by not allowing the child to escape from taking bites by using a non-removal of the spoon. Often times, children will spit out food, swallow food without chewing, pack bites, turn head away from the bite, or engage in aggression. When these behaviors occur, we do not remove the bite from their lips until the bite has been taken, and provide prompts and reinforcement for taking bites and chewing appropriately.

Children enrolled in the feeding program Metro EHS Pediatric Therapy are evaluated and treated as unique individuals, so these approaches, along with others, are often combined to best help your child experience success with eating.

Sources

2019. Tooomey, Kay. SOS Approach To Feeding.
2020. Tarbox, J and Tarbax, C. Training Manual for Behavior Technician Working with Individuals with Autism Spectrum Disorder. Retrieved from Sciencedirect.com.
2021. Fraker, Fishbein, Cox, Walbert. Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. Da Capo Lifelong Books.

Gratitude is a valuable life skill that can enrich the lives of all individuals, including children on the autism spectrum. Teaching children with autism about gratitude can help them develop a more positive outlook, build stronger relationships, and improve their overall well-being. However, because children on the autism spectrum often have unique learning needs, it’s important to use tailored strategies to teach them about gratitude. Here are a few ideas.

1. Visual Supports

Visual supports are powerful tools for children with autism, as they process information in a more concrete manner. Create visual schedules or charts that incorporate gratitude activities into their daily routines. For example, you can design a “gratitude journal” with pictures or symbols representing things they are thankful for. During the month of November, you could draw a tree on a large piece of paper and add a leaf of gratitude every day with a drawn picture of what you are thankful or writing down simply one word. This can be a simple way to encourage them to reflect on positive aspects of their lives. As they add items to their gratitude journal, reinforce the positive feelings associated with each entry.

2. Social Stories

Social stories are narratives that describe social situations and appropriate behavior. You can create social stories that revolve around gratitude. Tailor the stories to your child’s interests and communication style. For instance, you might develop a story about a character who learns to express gratitude when someone helps them. Reading and discussing these stories with your child can help them understand the concept of gratitude and its importance.

3. Visual Modeling

Children on the autism spectrum often benefit from visual modeling, where they observe someone demonstrating a behavior or skill. Create visual examples of gratitude by using pictures, drawings, or videos. Show them how to say “thank you” or how to express gratitude through simple gestures. Repeated exposure to these visuals can help them imitate and internalize these actions. Make sure you are expressing your appreciation with the people around you while your child is watching.

4. Use Concrete Reinforcers

For many children with autism, immediate reinforcement is key to learning new behaviors. Use concrete reinforcers to motivate your child to practice gratitude. This could be as simple as providing a favorite treat or activity when they express gratitude, whether by saying thank you or engaging in a small act of kindness. The more they associate gratitude with positive outcomes, the more likely they are to embrace it.

5. Practice Mindfulness and Reflection

Gratitude often goes hand in hand with mindfulness and reflection. Teach your child techniques for being present in the moment and focusing on positive aspects of their lives. Simple activities like mindful breathing, meditation, or keeping a gratitude jar can help them develop an appreciation for what they have. Encourage them to reflect at bedtime about their day and share what they are thankful for, fostering a sense of gratitude as part of their daily routine.

Teaching children about gratitude is not only possible but also incredibly beneficial. Gratitude helps improve their emotional well-being, enhance their social interactions, and promote a more positive outlook on life. The key is to tailor your approach to their specific learning needs, using visual supports, social stories, visual modeling, concrete reinforcers, and mindfulness and reflection techniques. Remember that patience and consistency are crucial in helping children with autism develop this valuable life skill. By embracing these strategies, you can help them grow into more thankful, empathetic, and content individuals.