Understanding Autism: Restaurant Meltdowns

asd

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:

  1. Social interaction, often including social reciprocity or that back and forth communication exchange known as conversation.
  2. Restricted behaviors and the need for “sameness” or the inability to be flexible with change.
  3. 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.

A Creative Approach to Food Allergies and Trick-or-Treating

Oct 32

 

Ever notice how many kids who are in feeding therapy also have food allergies?  With Halloween just around the corner, I’m encountering parents in my practice who are scared to let their food-allergic kids go Trick or Treating.  As their child’s feeding therapist, I try to offer creative strategies to ease their minds and still allow their little munch bug an evening of safe but spooky fun!

Trick or Treat Nirvana (What’s a Parent to Do?) 

Halloween is one of my favorite holidays.  My neighborhood is a child’s Trick or Treating nirvana; street after street of tightly packed  houses, much like enormous Pez® candies crammed inside a spring-loaded Casper the Ghost container. It’s the perfect setting for little fists holding giant plastic pumpkins to collect as many pounds of sugar as humanly possible in the shortest amount of time.  The neighbors are obsessed with decorating their homes to the hilt and consequently our sidewalks are packed with little Batmans, Disney Princesses and giant Rubik’s Cubes negotiating their way to each and every over-the-top decorated home and loading up on anything the neighbor’s offer when the kids shout “TRICK OR TREAT!”

So what’s a parent to do when their child with food allergies so desperately wants to join in on the door to door fun?  Well, keep this in mind: For the kids, Halloween is about ringing a doorbell, shouting “TRICK OR TREAT”,  remembering to say “thank you” as they scurry off to the next house and most of all – giggling non-stop with their friends.  It’s truly about the social experience, and not so much about what gets thrown in the bag.  But for many of my clients, what ends up in their bags is vitally important for safety reasons. Here a few strategies for parents to consider.

Enlist the Help of a Few Neighbors 

1.    Secret Passwords Nobody wants a child to miss out on the big night.  Most friends and neighbors will be thrilled to stash your candy alternatives by their front door.  If your alternative treat needs to be kept separate from other food substances,  be sure to let them know.  If your child is old enough and/or you are not present,  just tell them that  Mrs. Smith needs to hear the secret password (e.g. “monster mash”) because she is saving something just for them.  The last thing you want is Mrs. Smith accidently giving some random fairy princess your child’s special allergen free treat!

2.    Create a “TREASURE HUNT” with clues that lead your little pirate to the buried treasure where X marks the spot.  Give ten clues to ten neighbors; use brown grocery bag paper, black ink and even singe the edges for that authentic “treasure map” look.  Each piece of paper provides the next clue on where to go:  “Yo ho ho, ye pirate gents! Go to the next house with the white picket fence!”  Little do they suspect that the 10th clue will send them back to their own house, where they will discover a giant X and a special treasure buried beneath, just for them!

Tangible Alternatives to Candy

Whether you are planting a few of these with your sweet neighbors or giving them away to the little creatures knocking on your door that night, here are a few tangible alternatives to traditional candy:

1.    Eyeballs (and other spooky treats):  Google that Michael’s coupon or head to your favorite craft store to stock up on creative options for candy.  Whether you are trying to avoid sugar or the top 8 allergens, bringing home a pillow-sack of party favors such as blood-shot super ball eyes, miniature magnifying glasses, Halloween stickers or a tiny decks of cards is still a nice pile of loot for your little goblins to dump on the living room floor when they get home!

2.    My favorite treats are glow-in-the-dark bracelets.  We activate all of them just before the doorbell starts to ring and put them in a clear plastic bowl so they give off an eerie glow when we open the front door.  Trick or Treaters pop them on their wrists and run off to the next house, literally glowing.  Because my nick-name is “safety-mom,” I feel better knowing that everyone’s kids are a bit more visible running around in the dark.

3.   Think outside the box.  Most toy or craft stores have bins of whistles, harmonicas and bubbles to use in replace of candy.  Don’t forget small packets of origami paper, craft buttons, jewelry kits and beads, etc.  There are isles and isles of wonderful candy substitutes that will keep your child busy long after the other kids’ candy is eaten.  Believe me, parents all over town will be eternally grateful to see something creative in their children’s sacks rather than yet another pack of sour gummy worms.  Create a little karma for yourself!

Allergen Free Candy

A spectacular list of allergen-free candy (many, free of the top 8 allergens) is available on The Tender Foodie blog.  Be the “good house” that the kids rave about with the really cool candy.

Got Too Much Candy?  Here’s How to Get Rid of it FAST!
1.    Hold a Candy Auction:  Dig into that Monopoly game and grab those pastel paper bills!  Here’s your child’s chance to hold a candy auction! When all the bidding is over, he gets to count out how many paper bills (dollar amount is now a moot point) he received and trade those in for real money, but half goes into his savings account.

2.    Worth Their Weight in… Dollars:   Finally, a chance to use your bathroom scale and rejoice as the numbers go UP!  Kids get to weigh their loot and get paid $5 for every pound.  The next day, extend the family fun by going to the toy store or a favorite “haunt” to buy something together.

Safety Considerations
In addition to the general safety considerations for all trick-or-treaters noted here,  there are additional safety considerations for children with food allergies:

1.    SEPARATE CANDY:  Make it clear to other adults if alternative treats need to be separate from other food substances due to cross-contamination.
2.    Bring an EPI-PEN and if you are not accompanying your child, make sure his friends know where the pen is stored.

3.    Trick or Treating IN GROUPS only.  As for any child, stay together.

4.    Give your child a fully charged CELL PHONE with emergency numbers on top; make sure her friends know how to use it, too.

5.    Make sure your child is wearing an ID bracelet that is visible despite her costume.

6.    Ask the other children to WAIT to eat their candy until it can be inspected at home.  This is a general safety rule for all kids, but also prevents accidental contact via another child during the excitement of trick or treating.

Expectations – Your’s and Your Child’s
Consider your own expectations and how those may define your child’s expectations for Halloween.  Remember, “It is not necessary for children to have the full blown experience in order for them to have a good time”  Lori Lite (Stress Free Kids)

 

Ask your child what they would like to do.  Perhaps he just wants to be in charge of passing out the glow bracelets while the two of you wear matching glow-in–the-dark Vampire teeth!  So often as parents, we try to do make a huge production out of a holiday because we feel we owe it to our kids.  Funny thing is, most of the time, the kids are just thrilled to be a small part of it as long as they are sharing it with YOU.

So enjoy and be in the moment.  Wear a funny hat.  Tell a spooky story.  Take LOTS of pictures and video, too.  Stick a plastic spider on someone’s chair at dinner.  Don’t be afraid to scream – it’s the one night you can do so with abandon!   Happy Halloween!

 

Note: Portions of this article were originally printed on The Tender Foodie.

 

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.

Summertime Prep for the School Cafeteria

lunchbox

 

Summer!  Ten luxurious weeks of spitting watermelon seeds, munching on veggies straight from the garden and crafting the perfect s’more over the campfire.  As an SLP who focuses on feeding challenges in children, summer food skills are foremost in my mind this time of year.  However, once a week in the summer, my little clients and their families will focus on preparing to eat in the school cafeteria.  Before you know it, it will be mid-August and those little munch bugs will joining their friends at elementary school, or perhaps all-day kindergarten. For kids who are about to go to their very first day of school, it also means their very first day in a school cafeteria, and that can be quite overwhelming, especially for a child in feeding therapy.

Many kids are truly scared of the school cafeteria. In fact, one little boy I worked  with called it “the Café-FEARia.” Imagine a 5-yea- old, on his first day of school, as he tries to negotiate a sea of kids filing into the school lunchroom, attempting to locate his lunch box among 20 others piled into a giant bin and ultimately squeeze into a tiny place to sit at the assigned table. Now, unlatch that brand spankin’ new lunchbox (how does that latch work, anyway?) and peer inside … the clock is ticking … your little munch bug now typically has 20 minutes left to eat, clean up and get back in line with his class; not the most relaxing lunch for any kid.

 

Introduce Weekly Lunchbox Dinners

Feeding therapy is more than just learning the mechanics of biting, chewing and swallowing.  Generalizing skills to multiple environments is essential.  For kids transitioning to school lunch, introduce once a week “lunch box dinners” where the entire family pretends to eat in the school cafeteria.  At the entrance to the kitchen or dining area, one parent stashes a large bin, just like the kids will find at school.  Each member of the family has their own distinct lunchbox thrown into the bin, along with a few “old” random empty lunchboxes so kids can practice digging down to the bottom to find their own.

 

Once everyone is seated at the table, the child can practice the fine motor skills of unzipping zippers, unfastening Velcro® flaps and opening up containers.  Choose a lunchbox that is easy to open and holds all the food in one container.  It saves precious time!  My favorites are Easy Lunchboxes® and Yumbox® , both simple to open and perfect for cutting the food into bite sized pieces.  I call it “grab and gab” food.  Speaking of “gab,” many of my feeding clients also are working on pragmatic skills with their peers, especially when they are in unfamiliar situations.  As an SLP, I teach the parents to practice this little script: “I’ve got ____ in my lunch!”  In all my years of sitting in school lunchrooms and listening to young kids, it’s ALWAYS the first thing they say to each other.  It’s their traditional conversation starter, usually accompanied by them proudly holding up the celebrity food – the star of the lunchbox. I can attest that I hear just as many kids enthusiastically say “I have fruit today!” as “I have (fill in any junk food here) today!”  Try for  the veggies … it’s really okay … it’s just as cool to have vegetables cut up into stars or other fun shapes so they can announce, “I have CUCUMBER STARS today!”  Better yet, get the kids involved packing the lunches and creating fun shapes so they can exclaim “I made carrot triangles for lunch!”  FunBites® are child safe tools for doing just that.  They may not eat them that day, but they will be comfortable with carrots in their lunchbox, and that’s the first step to trying a new food in a new environment.

 

Once the meal is over, everyone latches their lunchbox and puts it back in the bin, just like at school.  The final piece of advice I offer to families is this: The most important word in the phrase family dinner is “family.”  Enjoy this time!  Happy Summer everyone!

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 kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is approved by ASHA and includes both her book and CD.  She can be reached at Melanie@mymunchbug.com.