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NAS AGM Understanding and managing fussy eating in children and YP with an ASD 21 st November 2013. Roz WEEKS: ASD Outreach Service Manager/SALT. OUTLINE:. Background and Theory Sensory issues Anxiety Practical strategies. What do we know?.

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nas agm understanding and managing fussy eating in children and yp with an asd 21 st november 2013

NAS AGMUnderstanding and managing fussy eating in children and YP with an ASD21st November 2013

Roz WEEKS: ASD Outreach Service Manager/SALT

outline
OUTLINE:
  • Background and Theory
  • Sensory issues
  • Anxiety
  • Practical strategies
what do we know
What do we know?

62% of parents of neuro-typical toddlers describe more than one ‘feeding concern’ (Reau et al., 1996)

13-80% of children with developmental problems have a ‘feeding disorder’ (Schreck et al., 2004)

90% of children with ASD have ‘mealtime problems’ (DeMeyer, 1979)

mealtime myths and facts for children with an asd
Mealtime myths and facts for children with an ASD

Facts

Myths

Caused by poor parenting

More likely to be underweight/ overweight

More likely to lack essential nutrition

Choose what they eat to gain attention

Have families with a poor diet

Are naughty

  • Most children have some selective feeding
  • Can be caused by sensory sensitivities
  • Can be caused by difficulties managing change
  • Families have a high risk of stress around mealtimes
  • Children have less awareness of when they are hungry or full
slide6

Thething I absolutely hate the most is trying anything new. There are hardly any foods I eat at all. I especially hate any foods with bits in it, or things mixed together with each other….I don’t like to eat any food which is the wrong texture….Pringles are my favourite food. I like the way they look, and taste, and the colour, smell and texture of them.”

Hall, 2001, p.46-7

understanding feeding in asd
Understanding feeding in ASD

rigid

thinking

sensory differences

Selective feeding

Picky,

selective feeder

(low tolerance)

Always eating,

never full

(high tolerance)

Maintaining factors

Reluctant feeder, anxiety

Learning experiences

Highly restricted feeding

Adapted from Strudwick and Lister Brook, 2009.

activity
Activity
  • Put foods into one of 3 categories – like, tolerate, dislike
  • In small groups compare your food preferences. Are they the same or different?
  • Discuss what it is about certain foods that cause you to either like or dislike them.
sensory differences
Sensory differences
  • “The way a person processes sensory information is just that-the way the person processes sensory information. No way of processing sensory information is inherently good or bad-it just is.”
  • “People with every pattern of sensory processing are living successfully and unsuccessfully…”
  • [A sensory difference] “is not a problem to resolve; living a satisfying life is the challenge to address.”

(Dunn, 2001)

types of sensory differences
Types of sensory differences

Always eating,

never full, constantly nibbling or stuffing food.

Obsessive / compulsive feeder

Doesn’t know when to stop eating

Picky / Selective Feeder

Never hungry. No interest in food/drink

Refusing

Controlling behaviour

Rigid eating patterns

Sensory sensitive/ defensive

Low tolerance

High tolerance

Sensation seeking

slide11

I was supersensitive to the texture of food, and I had to touch everything with my fingers to see how it felt before I could put it in my mouth. I really hated it when food had things mixed with it like noodles with vegetables or bread with fillings to make sandwiches. I could never, never put any of it into my mouth. I knew if I did I would get violently sick.

(Barron, 1992)

a different way of thinking that influences feeding patterns
A different way of thinking that influences feeding patterns

Perseveration i.e. inflexibility (Attwood, 1998)

Conceptual categories i.e. not making the links between different items e.g. all makes of custard creams (Bogdashina, 2003)

Central coherence theory (Frith, 1989) e.g. noticing the bruise on an apple and rejecting the whole apple

slide16
If my son eats crisps, you have to open the

packet a particular way, and it must be a blue

packet or he won’t eat them. Kit-kats must be

broken a certain way, and he has to have the

wrappers laid out next to him to read as he

eats. Tomato sauce must be in a bowl beside

food not on it.”

fear of new things neophobia

There is a genuine fear of food. It’s not that he doesn’t want to try it, sometimes his whole body is arching away because of something I’ve put in front of him

Fear of new things (neophobia)

neophobia anxiety
Neophobia & anxiety

Protects us from eating the wrong things

Contamination & disgust fears

Anxiety in situations where they might be offered food

Some foods taste yucky – yoghurt stinks like dog poo” (Carl aged 7)

“I don’t like cheese because it’s too milky and it’s only for mice” (Nicolas aged 11)

“I wouldn’t try food if it was smelly or coloured brown or green that I didn’t know…the smell gives me a clue as to whether food is good” (Christine aged 10)

slide20

We have tried bribery, mixing foods, threats rewards, eating in different places and making lists of foods. We have tried having other children around at mealtimes and try to get her to join in, but she doesn’t. She stopped eating at school when they tried to insist she ate more. Nothing works. In fact the more we try to get her to eat, the less she will do it

what doesn t typically work
What doesn’t typically work?

Hiding/disguising food

Allowing the child to ‘go hungry’

“starve them and they’ll give in”

Force feeding

Withholding preferred food

Insisting on a healthy diet

Star charts & rewards

Imitating other children

how we can help by supporting you

Providing information/ reassurance

Facts and figures about feeding in ASD

How our understanding of ASD helps to explain the differences

Books/resources e.g. Can’t Eat, Won’t Eat (Legge 2002)

Sharing experiences

Giving permission to give child preferred food to maintain weight and reduce mealtime stress

Avoiding standard healthy eating advice where this is unsuccessful

How we can help by supporting you…
how we can help

Sensory Interventions

Addressing sensory needs

Calming techniques before meals

Oral desensitisation – teeth cleaning

How we can help ?
how we can help by altering the environment

Regular mealtimes

Familiar mealtime routines

Visual supports

Pictorial timetables & mealtime activity schedules

‘Eat-up’ book – scrapbook – pages for foods I can look at, smell, lick, nibble, bite, swallow etc.

Social stories

Picture books e.g. Charlie and Lola

How we can help by altering the environment…
introducing new foods
Introducing new foods

Activity

  • If you were having difficulties eating, put these in the order you think you would find easiest to do
hierarchy of eating

For each new food

Look at

Touch

Smell

Kiss

Lick

Nibble

Swallow

Hierarchy of Eating
eat up book
‘Eat-up’ book –

Scrapbook – pages for foods” I can.......”

  • look at
  • Smell
  • Lick
  • nibble,
  • bite
  • swallow etc.
selective eating interventions

Behavioural interventions

Desensitisation

Reducing fear of foods

Agreed behaviour management strategies

Broadening range of foods

Broadening food categories

Use of suitable rewards – non-food

Quantity charts

Selective Eating-Interventions
other things that can work
Other things that can work?
  • Category generalisation – ‘spreading the sets’
    • Introduce new foods from accepted categories, e.g. a new flavour of a known brand
    • 10-14 times
    • Desensitise to smell/taste of new food
    • Child has control over which foods
what can work
What can work?
  • Context specific foods
    • New foods in new contexts e.g. new class at school, respite
    • New food & context stored as a new ‘gestalt’
    • Often less confusing than changing foods within a familiar context
visual supports healthy eating

All about food book

Food categories e.g proteins, carbohydrates, snacks and sweets

Foods in each category that are eaten now

Foods in each category that might be eaten in the food

Child does survey of what other people eat in each category and selects what to try

VISUAL SUPPORTS: HEALTHY EATING
slide41

It is like being in a restaurant like when father takes me out to a Berni Inn sometimes and you look at the menu and you have to choose what you are going to have. But you don’t know if you are going to like something because you haven’t tasted it yet, so you have favourite foods and you choose these, and you have foods you don’t like and you don’t choose these, and then it is

simple : Mark HADDON