Applied behavior analysis (ABA) therapy may be a useful feeding intervention for children with autism.
This case study was designed to see if a type of ABA therapy (positive behavior support) could help a child with autism learn to accept food. This type of family-centered therapy seemed to result in lasting changes in the child's eating behavior. The therapy also involved a larger support process that improved family life. The six-year-old boy began to accept food (scrambled eggs, hot dogs, etc.) that he had stopped eating before the study started. The authors suggest that studies be done with children of different ages and different types of families.









Please comment on this autism topic.
Drinking buddies
Aug 31, 2009 by AnonymousWell, I was worried about the wrong kid.
How long did we wring our hands and experience gut-wrenching anguish over Thomas’ surely difficult and confusing transition to all-day, eat-lunch-at-school first grade? On the first day of school, he kissed me goodbye and walked in the building. Okay, so long! See you later! Hayley, on the other hand, was rather upset, sobbing loudly. I have a bit of a dilemma on my hands that I have to drop Hayley off at the Kindergarten entrance and Thomas gets dropped off at the First Grade entrance. So on the first day, it was pouring outside (naturally) so we had to walk into the hall. I left Hayley, who wasn’t listening to me and when I told her that I’d be right back after I found out where Thomas needed to go. I walked about ten feet away when I heard her crying. One of the aides who knows Thomas offered to take him to his class so that I could stay with Hayley, which I did, until it was time for me to leave her. She was crying – loudly and a lot.
Jonathan and I were completely confused by this behavior. Hayley had been in that classroom once every week for the past school year! However, Jonathan made the sensible point that I had been with her the whole time she was there. This was the first time I left her there. Okay, that makes sense. Anyway, Hayley stopped crying shortly after I left and ended up having an okay day. Since it rained for the first three days of school this year, Jonathan was able to pick up the kids with me which was nice for him and the kids. Thomas was very excited to see Jonathan after his first day of school. We immediately noticed that Thomas had forgotten his lunch box and home folder so we had to go back in for them. His teacher said that he did a fine job and the social worker said that the few times she poked her head in the room, he was doing great. So Thomas is off to a surprisingly smooth start. Of course, I remember last year when there was a “honeymoon period” right at the beginning of the year and then things went downhill a bit. I might be remembering a couple years ago when Thomas was in preschool. I don’t know. I just hope we keep grooving like this.
Thomas is doing fine eating lunch at school, although he rarely finishes. I guess he eats like Jonathan – slooooooowly. Most days, he brings his bag home with leftovers. He always asks for a snack when he gets home which is not that weird – most kids have after-school snacks. But I hope he’s getting enough time to eat. Rather, it’s probably that he doesn’t stay focused and eat when it’s time to do so. He might be socializing with the two girls he sits next to. Anyway, he likes recess and he likes eating lunch at school. We’ve managed to put other edible (to Thomas’ standards) items in his lunch box so that we don’t have make pizza every night to put in the lunch box the next day. He eats chicken nuggets and chicken sandwiches too. We put a juice pouch or chocolate milk in there along with maybe a granola bar and fruit snacks. The fruit snacks are always finished when we get his lunch bag back. It’s usually the nuggets, pizza or sandwich that is half-eaten.
Part of the program in first grade is learning to read, so we have to read with Thomas for twenty minutes every night. I have modified this program to reading one book at night. Making Thomas try to do anything he doesn’t enjoy for twenty minutes is frustrating for him and us. He’s able to recognize words when prompted, so he’s got a good foundation. I just wonder when he’s going to start trying to sound out words on his own. He makes the word sounds but doesn’t put them together. And then there’s Hayley, who’s prone to know-it-all-ism, hanging over my shoulder, shouting, “Mommy! I know that word!” It’s hard getting her to keep quiet while I’m trying to get Thomas to read. I’ll have to put her in her room while we’re trying to read from now on.
It’s hard, too, to try and get everything ready for school on nights when I work. I try to get lunches made and homework done before I go to work at 5 p.m. But I suspect I’m preaching to the choir of my readers here…I don’t even work full-time, so I have little room to complain about trying to keep everything running smoothly. Things are going well for me at work, though. They really seem to like me and I won Employee Of The Month while we were in Florida and they want me to start training new people as a “Neighborhood Expert” which I am not officially yet as I have to attend some sort of “expert camp” or retreat or something before. At least it’s nice to be appreciated.
One funny story and then I’m off to collect Hayley from school: The last time the kids were at the cottage, they went out for ice cream. Hayley and Grandma ordered the same flavor, so Mary said that they were “ice cream buddies.” Fast-forward to this past Friday when Hayley and Thomas both chose to have grape Kool-Aid for dinner. Hayley looked at her cup and his and declared, “Thomas! Look! We’re drinking buddies!” Jonathan and I laughed until there were tears in our eyes.
A magical vacation...
Aug 20, 2009 by AnonymousOkay. Here goes.
We had a wonderful vacation. I can only say that now, a few days later, after I’ve been given time to ponder and reflect. I wrote a blog on the airplane home, but after reading it now a few days later, I think it was a little harsh so I’m doing a re-write. I liken it to childbirth. After the baby is out and you’re thrilled to be a parent, you don’t really remember the agony of it all. You even start thinking about when you’ll have another one.
To be honest, most of the trip was exhausting to us. We learned a lot, which is a good thing. We’ll do things a bit differently next time, whenever that turns out to be. We think the kids had a great time; at least they’re saying that they did now. They were not very well-behaved for a large portion of the vacation. In fact, Donald Duck himself had to break up a fight between Thomas and Hayley at Chef Mickey’s at the Contemporary Resort. We were suitably mortified, I can assure you. We were, needless to say, disappointed in the kids and their behavior. We had hoped that they would be magically wonderful, since every Disney employee we ran into wished us a “magical” day. Even when I called the front desk for extra towels, I was wished a “magical” evening. I should have asked for “magical” towels.
There were two main pieces of advice that we received prior to our vacation that we should not have taken as gospel truth. The first was that autistic children can improve dramatically (magically!) while at Disney World. I really thought that this would happen for Thomas, since he is one of those kids who requires more stimulation than other kids. And Disney World is sensory overload extraordinaire. I’ll just say that Thomas has never acted more autistic in his life. I was quite disappointed. I’m not saying that I thought we’d spend ten days (too long, by the way, but more on that later) in Disney World and come home with a cured boy, but I at least thought that he might be better while on vacation. He was worse. And his badness rubbed off on his sister. Hayley copped an attitude most of the time which I’m sure has nothing to do with the fact that every Disney employee who crossed her path called her “princess.” I was called princess a couple times, but I know I’m not a princess. Trust me, I know. For Hayley, the jury in her brain is still out.
The second thing that we were told to do over and over again by everybody we talked to was to take a break in the middle of the day. Go back to the room, go swimming, take a nap, have a snack, re-charge the old batteries and then go back to the parks in the evening, fresh as daisies. Here’s what happened to us: We got on the bus to go back to the hotel, and during the bus ride the kids fell asleep. We made the trek back to the hotel room where the kids, having rested quite enough on the bus, would be bouncing off the walls just as Jonathan and I wanted to curl up and take a nap. Ha! So we maybe would take them swimming or watch cartoons for a while and then head out again. So this way, the kids were great for the rest of the day but Jonathan and I were completely frazzled and every little thing the kids did wrong set us off. The grown-ups were the cranky ones by day’s end. So some of the best days we had were ones where we went all day long, taking for our “break” a sit-down meal for lunch.
Despite our “go all day long” routine, I managed to pack on twelve pounds! Yes, despite walking around in the hot and humid Florida sun, sometimes toting a child on my back, I managed to gain several pounds over the course of the ten days. I can sum it up in two words: brownie sundaes. We did the basic Disney Dining plan which included one snack, one “quick-service” (fast food) meal and one sit-down table-service meal per person per day. Both the quick-service and the sit-down meal included a dessert for adults. Well, what are you supposed to do but order the dessert and scarf it down? We’d already paid for it! Next time, we think we’ll skip the dining plan, although it was very nice not to have to budget for food which can be a very inexact science. The food was all paid for before we left so that any extra money we brought could be used for incidentals and suchlike. We actually spent very little cash because we didn’t have to pay for food while we were there.
Again, in hindsight, it was a wonderful vacation but not without its ups and downs. We thought the kids would be better than they were. At the end of the trip, we decided that the kids were still a little too young to truly appreciate what they were enjoying. I don’t mean that we expected them to sit us down, look us in the eyes and say, “Mom, Dad, we know just how great an undertaking this has been for you, we understand the cost involved and we truly appreciate everything you’re doing for us. We will always treasure this time with you in our memories.” I don’t think I’ve even said that to my own parents now, who took us all to Disney World when I was in eighth grade. I can say that I have a huge appreciation for them having done it, and I understand what kind of planning and budgeting went into it.
Also, as I hinted at before, ten days was just straight-up too long. Next time, we’ll stay for maybe a week and get better accommodations. The All-Star Movies Resort was fine, but it was clear that it was Disney’s version of the nosebleed section given its proximity to the parks and the clientele. It was rather noisy and we dealt with rude people a lot. Really, at Disney in general, it’s every family for themselves, and those who realize this sooner rather than later will have a better time in general. Jonathan and I, being pushovers, care about other people’s feelings and were shocked at some of the rudeness we witnessed.
So next time – this hypothetical “next time” – we’d stay for shorter in a better hotel, rent a car so that we weren’t constantly at the mercy of the Disney Bus System and ditch the dining plan so that we could eat (less) outside the World and probably spend less. Everything at Disney is so expensive! I read that Disney will ride a money horse until it drops and boy, was that ever true! Plus, if you do the Dining Plan, Disney’s got you – all your money and you’re never leaving the parks until they shuffle you onto the bus to the airport and drop-kick your luggage to its final destination, and they don’t really care where that might happen to be. Our bags did show up, but somewhat smashed.
So that was our trip. If you have any questions, let me know. Now, we gear up for school! Hayley had her kindergarten assessment with Mrs. H. yesterday and she did a swell job! Pre-school really paid off in that respect. After her little interview, we went and visited Thomas’ new classroom and saw his teacher again. After seeing his teacher and class again, Thomas is much more…okay…with going to first grade. Plus, I told him that I’d make him cold pizza to eat for lunch. So that was great! I feel like he’ll be okay now and that he understands he’ll be at school all day and eat lunch with his friends. He’ll get a recess which will really help him out and Mrs. H. said that he will have sensory breaks in her classroom a couple of times per day or as needed. Thomas was pleased to hear that. When we were in his new classroom, he noticed many similarities between his kindergarten room and the first grade room which made him very happy. There was a chart on the wall for the weather, lots of numbers to count the days and the old “green-yellow-red light” cards on the wall to track everyone’s behavior.
As we walked home from school, I asked him again how he felt about it. I said, “So how do you feel about first grade now? Do you think you’ll like it?” He replied, “I think it’ll be great!” I really, REALLY hope he means it! School starts next Wednesday.
I can’t wait, for my own sake. It’s been one hell of a rough summer.
Happy tears and tooth fears
Feb 20, 2009 by AnonymousSo much has been happening lately that it’s been hard to find time to write. The GFCF diet will have to be put on hold for now, at least. The good news – an improvement that could help us avoid that kind of major dietary inconvenience indefinitely – is that the Strattera seems to be working really well for Thomas. He’s been more attentive, making more eye-contact and telling me loads about things that have happened at school. Last Thursday, Thomas told me that there were three “stations” in gym class: a running station, a hopping station and a beach ball station. I asked him which one was his favorite and he said that he like the beach balls the best. I said, “Beach balls? That must have been a little crazy, with beach balls flying all over they gym.” Thomas said, “No. Mr. M. put up a little blue fence around the beach ball station.” All I could say was “Wow!” He’s never given me so much information about school before. Granted, gym does seem to be his favorite subject.
One unfortunate side effect of Strattera is having difficulty sleeping and Thomas seemed to not sleep at all for three nights running last week. I made an alternately frantic and comatose call to the neurologist who decided to add another half Clonidine around 3 or 4 p.m. to help ease Thomas into the evening. Jonathan and I were really skeptical about that. I kept wondering how much Clonidine his little body could take, for one thing. For another thing, I wondered if the Clonidine patch would be a better solution. The neuro still wants to use the pills and surprisingly, it did seem to help. The problem was that Thomas would get up around 1 or 2 a.m. and get into our bed which is his usual routine. The bad thing was that he’d get into bed with us and not go to sleep. He’d flop around like a suffocating fish, kicking us and waking us up. We’d send him back to his bed and hear his TV click on. Then Hayley would get up and come into our room. She said that Thomas came into her room and woke her up - I guess to play with him. So there was that one awful Sunday night where nobody got any sleep and it affected everyone negatively. Thomas didn’t think anything of it, but the rest of us were dead on our feet all day. With the extra half-pill in the afternoon now, he still comes into our room at some point but he sleeps peacefully at least. Hayley has been sleeping very well, in her bed all night until she sees Jonathan get up for work and then she comes in for a snuggle. Since the Strattera dose seems to be working well for now, we’re not going to increase it. Thomas hasn’t had any tics, so that’s great. It’s what we were afraid of. Luckily, the one that he developed while on Focalin went away as soon as we stopped the medication. I’ve heard that they can develop tics that never go away, even if the medicine is discontinued.
Thomas’ IEP meeting was on lucky Friday, February 13. It was a great meeting; very positive and everyone, as per usual, just LOVES my boy. Thomas has so far this year met or very nearly met all of the goals his service team set for him last May. His meeting last year was at the end of the school year, so he still has a couple of months to meet his goals and there’s no reason to suppose that he won’t. Thomas’ teacher, whom shall now be called “Mrs. H.” because I’m getting tired of calling her “The Teacher,” actually cried twice during the meeting, thus making me cry. The last time I cried at an IEP for Thomas was what I like to call “The Worst Day of My Life,” the meeting when autism was brought up. Thomas has come such a long way since then that now I can look forward to crying tears of joy. And watching his teachers do the same, I guess. Mrs. H. has become very fond of and attached to Thomas. He manages to endear himself so to all of his therapists and teachers. I understand why Mrs. H. was so emotionally moved; she is educated in early childhood development and therefore recognizes immediately when Thomas makes a breakthrough or reaches an educational milestone. She sees it for the huge leap that it is. At the beginning of most days, Mrs. H. has the kids draw a picture and then encourages them to write a few words about it. Most of the time, Thomas scribbles and makes up some story about it but won’t write. The Monday before his IEP, he drew a picture of an orange “race car,” colored it in and started writing that it was “An orange race car, going very fast.” I mean, this thing really looked like a car! It had wheels and everything! Mrs. H. told me that when I saw it, I would cry, but I didn’t. (That is, until she did in the meeting.) I was excited; I said, “Wow, that’s cool!” I think I just don’t understand the gravity of such things the way that Mrs. H. and the OT understand them. Either way, Jonathan and I are very touched by the tender and loving way teachers speak about Thomas. I found myself having to reassure Mrs. H. that she would see us plenty next year, because she’ll have Hayley and Thomas will be in first grade and I see no reason why I can’t volunteer in Hayley’s kindergarten classes too. She felt better after that. But Thomas is showing pre-reading skills; better than many of his classmates in some cases, continues to improve his writing and recognizing letter sounds and shocks us all from time to time with his amazing memory.
My job search continues, and I feel I’m very close to landing that perfect foodservice job I’ve been wanting. I have a second interview at a restaurant tomorrow and I papered all eateries within a five mile radius yesterday afternoon with applications and a winning smile. I’m hoping to be able to wait tables two or three nights during the work week and two shifts of various hours on the weekends. There are so many good reasons for me to find a part-time evening and weekend out-of-the-house job, the more I ponder it. One big reason (cash is numero uno, of course, but…) is that the kids will begin to see their father as more of a caregiver. One thing that happens frequently and always fries my cookies is that I’ll be deeply engrossed in some chore or activity like running on the treadmill, folding laundry or even taking a shower. Jonathan will be sitting on the couch in the living room, watching TV. Hayley will come in and ask for a snack. My immediate question is, “What’s Daddy doing?” She tells me so I send her to ask Daddy to get her the snack. Fifteen seconds later, she’s back and she says, “Daddy wants to know if it’s okay if I have a snack.” See, Hayley went and asked Jonathan if she could HAVE a snack, she didn’t tell him that I asked HIM to get HER the snack. “Yes! For the love of God, child, you may have a snack!” Now I’m getting irritated. Fifteen seconds later, Jonathan comes into the room. “Did you say it was okay for Hayley to have a snack?” He thinks she’s trying to pull a fast one. By then, I’m so frustrated that I start raving like a madwoman and nobody understands why. So maybe – maybe – if I’m completely out of the house, Jonathan can decide for himself if the children are worthy of our pantry full of snack foods. And the kids won’t even be able to consider asking me in the first place.
As I said, the money will be great. If I can make a couple hundred a week, we’re going to go ahead a book a trip to Disney World in August, I think. We have some money coming to us that we didn’t even know we were supposed to get (it was really our money anyway; the county assessor was just “borrowing” it from us until we noticed, it seems) and that coupled with the extra income I hope to earn will make it possible for us to finally take our children to see The Mouse. We’ve been dreaming of it ever since we went to Disney World for our honeymoon and saw happy families riding the teacups and Flying Dumbos. “Wow, won’t it be great to take our hypothetical children here some day,” we’d say to each other. Actually, I can remember several times while we were there that I thought it would be nice if we had a kid or two with us for this show or that ride. It appears to be within reach. I know, it’ll be hotter than hell in Florida in August (ninety-two degrees is the average daily high), but we don’t want to take the kids out of school to go. We have two immediate family weddings in November, one of them over Thanksgiving weekend, we don’t want to go over Christmas and miss that with our families and I wouldn’t touch Spring Break with a ten-foot pole. So that leaves summer vacation, and we’ll need more time to save dough than a vacation in June would give us. That’s our decision. Now I just need to get hired and make a dazzling impression. Shouldn’t be too hard.
Jonathan took the kids to the Monster Truck Jam last weekend on Valentine’s Day, also our eleventh wedding anniversary. Hayley pretty much hated it; it was way too loud for her (Jonathan remembered to bring earplugs, but even so, it was too loud) but Thomas loved it. His favorite part was the motorcycle tricks. So Thomas would go again, but we’ll have to find some Mommy-and-Hayley activity the next time the Monster Trucks are in town.
The last bit of drama I’m going to share this evening is that Thomas has reached a physiological milestone: he has two loose teeth. The bottom two in the middle, the two that popped through right on schedule on his six-month birthday, are preparing to leave on a high-note. Thomas wants nothing to do with this whole process. We’ve mentioned it to him before, always with negative results so we’ve been kind of hoping that we had a little more time. Nothing doing, says Mother Nature. He spent most of today whining and complaining and actually crying at times. At one point, he asked me for some tape so that he could “fix” the ones that were loose. We tried everything we could think of to put him at ease. I drew him pictures like I used to in the old days. It only upset him more because I drew smiley faces on the kids who had lost teeth and he said that they should have had sad faces. I tried showing him Sophie the Dog’s puppy teeth which I saved (no idea, don’t ask), but he wanted to put them back in her mouth. At dance class, one of Hayley’s friends was missing both of her bottom middle teeth and she gleefully obliged when we asked to have a look, but Thomas didn’t really care. He is threatening that when one finally falls out, he’s going to “cram it back in.” Those are his words, not mine. He actually said “cram.” Losing teeth is fine for everyone else, but Thomas is completely against it. For one thing, he knows that the new teeth are called “adult teeth” and he wants to never be grown-up. We’ve started calling them “big-boy teeth,” but he doesn’t really want to be a big boy, either. Of course, all of this represents change, which Thomas is firmly dead-set against in all forms. Unfortunately, nothing can be done to stop baby teeth falling out, so we’re going to have to weather the storm.
Although very resistant to change, Thomas did show a great deal of enthusiasm for flying in an airplane to go to Walt Disney World. Go figure.
Down to the wire
May 1, 2008 by AnonymousAnother week closer to summer vacation and I’m not dreading it. Unfortunately, I am still pressing the green rubber nodule for an apostrophe, but it’s become a part of my life now and I’d miss it if it changed. Or not. Anyway, Thomas was off on Monday because I thought he had a cold. I still think he had a cold, but it didn’t knock him on his cute little bottom the way it knocks adults on our large, cellulite-ridden bottoms. As soon as the time came for the bus to have picked Thomas up on Monday, I realized that he would have been fine and I was in for a very long day.
Thomas still has a runny nose, but it doesn’t bother him nearly as much as it bothers me. I’ve never been very good at dealing with a runny nose. If I see another kid with a runny nose, I have to resist the impulse to whip a Kleenex out of my bag and wipe that nose. He’s been picking a lot, too. Charming. There’s no school tomorrow for a School Improvement Day. I wonder what they do, exactly, on those days.
On Monday night, Thomas’ teacher called to let us know that the kids would be walking to a fire station on Wednesday to see the trucks and talk to the firefighters. We got to talking about Thomas, as his IEP meeting is less than a week away at this point. Really, everyone at Thomas’ school says such nice things about him! The school social worker, whom I met with today, prefaced our meeting by saying that he’s so friendly and just a happy little guy that everyone enjoys having around. She wanted me to come in and complete a standardized questionnaire-type thing about Thomas’ habits at home; what he can do, what he can’t do, disruptive behaviors and the like. I have to say that I think he scored fairly well for a regular five year-old. The social worker helped answer some of the questions that I had to think about by saying, “I’ve never seen him do that at school.” She seemed really excited about Thomas’ progress over the past two years and what we can expect of him next year.
Jonathan and I had a big argument on Monday night about Thomas. Jonathan was listening while I was on the phone with Thomas’ teacher and he was getting pretty upset about what he was hearing just on my half of the conversation. I mentioned to the teacher that I was sure that the psychologist gave Thomas an IQ test but because of that test, Thomas would most likely not qualify for the MLP classroom. Today, the social worker told me that a child has to have an IQ of less than seventy to qualify. Everyone we’ve talked to believes that Thomas’ IQ is more than seventy (including us). Jonathan feels, however, that Thomas would do much better in an MLP classroom, which is all-day kindergarten. He is worried about how Thomas will do in a regular kindergarten class with thirty kids; he’s afraid Thomas will get left behind, that the teacher won’t have the special education background or support system she will need to educate Thomas and still give the other kids the time they need. Valid concerns, all – but I think that Thomas can do it. I’m really interested to hear what Thomas’ service team has to say on Tuesday, but I think they’re going to recommend that he be in a mainstream class and I’m all for it.
I’ve been talking to Thomas a lot about kindergarten next year. I think he understands that he’ll be going to a new school and he says he’d like to make new friends. I’ve asked him how he thinks he would do in a class with a lot more kids and he says, “You know, Mommy, I think that would be good.” The more I think about it, the more I think he can do it and I don’t think I have to explain to anyone reading this that it would mean so much for us and our family if Thomas could be in a mainstream classroom for kindergarten. He would still get “resource minutes,” which are minutes set aside during Thomas’ school day when he would go get occupational therapy or speech therapy – whatever he needs. I’m very excited about the IEP meeting because I have a feeling that they are going to say a lot of great things about Thomas, and who ever tires of hearing educators extol their child’s virtues?
I just really hope that Jonathan and I can go into this meeting with a united front. My position right now is “wait and see.” Jonathan seems to think that the teachers and therapists are pushing us to accept a mainstream classroom for Thomas because of money issues within the district. I personally think that this theory is cuckoo-bananas. The argument Monday got pretty heated at times, but I had my trademark smart-mouth comments locked and loaded and those drive Jonathan just crazy. My bottom line is that I don’t think the service team would recommend anything they didn’t think Thomas could handle. And no matter what we decide next week, nothing is written in stone and we can always change our minds before next year, or two weeks into the school year or any time at all. If Thomas will be in a mainstream classroom, that would mean he’d attend our home school – and I guess I should go and register him there after all. I was kind of short with the principal, too…maybe I’d better go and volunteer for something. My mom was the PTO president of our grade school for a few years…maybe I could do something like that. Nothing to it, right?
So we’re looking forward to next Tuesday. Jonathan will be out of town all weekend on a fishing trip with his brothers and boy-cousins…they put a treehouse-esque sign on the door that says “NO GIRLS ALLOWED” all weekend. The only possible exception is any female who will cook or clean for them. I think they even rib anyone whose wife calls while they’re on this sojourn, so I’m planning on Jonathan being basically unreachable all weekend. It’s supposed to rain here all weekend too, so I don’t know what we’re going to do. Thomas loves to play tennis on the Wii…he’s really good at it, too! We’ll find some way to fill the time until Monday. They sent the gluten-free kid’s leftover snack and Tupperware home with Thomas today, so he’s got to return that on Monday anyway.