I sat in a popular restaurant chain and watched an 8 year old boy have a major meltdown at his table. His mother cringed as lunch time patrons stared. An irritated couple at a nearby booth got up and moved, but only after glaring at the mother. I’ll be honest, the child was disrupting my lunch too, but one thing I suspected was that this child had autism. He appeared to be just like any other child, but the intensity of his outburst was out of proportion to the issue he was yelling about: The waiter had served him waffle fries and he had expected “skinny fries” just like the french fries served at home.
April is National Autism Awareness Month. The U.S. Centers for Disease Control and Prevention (CDC) reports that 1 in 68 children are reported to have autism (ASD) and most are boys. Chances are, you know someone with autism.
What distinctive characteristics of ASD can affect a child’s ability to adjust to unexpected life events, even something as incidental as waffle fries? Let’s look very briefly at some of the central features of ASD, while keeping in mind that this a spectrum disorder, with symptoms ranging from mild to severe and this list does not encompass all of the elements of a diagnosis. Just some of the central features that kids with ASD have difficulty with are:
- Social interaction, often including social reciprocity or that back and forth communication exchange known as conversation.
- Restricted behaviors and the need for “sameness” or the inability to be flexible with change.
- Hypersensitive and/or hyposensitive “to sensory aspects of the environment” which can hinder their ability to tolerate different tastes, temperature and/or textures of food and deal with change in general.
As a pediatric therapist, I assess and treat a child’s ability to allocate specific cognitive resources in the brain to manage day-to-day life. As adults, we too have to utilize many different parts of our brains throughout the day. But what happens when we are bombarded with sensory input and suddenly, we have to adjust to unfamiliar stimuli? To understand what it’s like, consider this example:
You are driving the minivan full of kids to soccer practice, radio blaring, kids chattering. Your brain is operating relatively smoothly, filtering auditory, visual, tactile and other sensations, while remembering to use your turn signal, maintain the speed limit, etc. Suddenly, the weather changes and it starts to hail. What’s the first thing you do? Turn off the radio and tell the kids “Shush…Mommy needs to concentrate on the road.” Perhaps you even slow down so that you can focus on the sudden change in driving conditions. You have eliminated as much sensory input as possible so that you can concentrate on the task at hand – driving safely. Isn’t it interesting that you were driving perfectly fine until one unpredictable event changed in your environment?
Now consider the child with autism as he attempts to engage in mealtimes. The reality is that daily life changes as easily as the daily weather report and for him, some days are just like driving through a hailstorm. This child is already challenged by poor sensory processing; he has limited ability to take in information through all of the senses, process it and filter out the unimportant info, and then act upon only the relevant sensory input.
Now, bring that child to the family dinner table, which is all about social interaction and conversation. Put a plate of food in front of him which looks and smells completely different from the last meal he was served. Then, tell him to try that steamed broccoli for the very first time. He doesn’t get to turn down the sensory input bombarding him at the table and focus just on the broccoli. Because he has autism, he can’t always filter out which stimuli might be inconsequential and it feels so much safer to follow rigid behavior patterns and never try anything new. Life for a child with autism is all about sticking to sameness. My role as a therapist is to help the child learn to deal with change.
A 2013 study from the Department of Pediatrics at Emory University indicated that kids with ASD are five times more likely to have feeding problems compared to their peers. Once feeding difficulties are addressed in the home, restaurants are the next step for their families. Here, the visual input is completely different and it changes constantly, the inconsistent auditory input can be overwhelming, the fluctuating smells may be interpreted as noxious, etc. Every input to every sense has changed. Once again, the child with autism is encountering a hailstorm and has to learn to tune out the distractions and focus on the task at hand – in this case, eating a meal away from home. In this young man’s case, waffle fries were just too much to handle after managing all of the other sensory stimuli at the restaurant.
Perhaps you are a parent of a child with ASD. Perhaps you have observed a child whom you suspect may be dealing with the daily challenges of autism. Thank you for considering what mealtimes feel like for him and his family. It does get better, but it is a journey that requires patience from family, friends and the community.
Please share this article with a friend so that we can continue to raise awareness of autism spectrum disorder and if you know someone who loves a child with ASD, do something special for them this month in honor of National Autism Awareness Month – thank you!
Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating. She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food! Melanie’s two-day course on pediatric feeding is offered for ASHA CEUs and includes both her book and CD for each attendee. She can be reached at Melanie@mymunchbug.com.