Expert: Trey McGowan - 3/8/2008

Question
QUESTION: Hi,My 2 year old son has been diagnosed with ADHD with Autistic features. Psychologist has advised me to start him on self-feeding. I want some tips on developing this skill. For now, he refuses all finger foods, refuses to eat even biscuits or chocolates. How do I get him to start feeding himself? Any tips, books would be appreciated. I live in India so as far as I know no operational therapy is available here for so young a child. Please help.

ANSWER: Hi there, Saratha!

As I'm sure you're noticing, with some autistic children, even the simplest life skills can be a chore. Potentially for both sides! And in the case of eating, unfortunately, autistic children are notoriously picky about their food a lot of the time. However, it's often not the taste of food, but rather the texture of it.

Basically, what I'm getting at is: what is your son eating right now? You say that he's refusing finger food. Is he eating baby food, though? Because if so, try him with finger foods that are softer than the average ones. Banana, for instance, might go down well, if you'll pardon the choice of phrasing. He may even be able to be encouraged to use a spoon if you carefully wrap his fingers around the handle and guide him through eating his favorite applesauce.

If he is not eating any foods and not weaned, or if this doesn't seem to be working, try a few more exotic fares. I don't mean 'Passion fruit veal with a red wine' level of exotic, but it may be that instead of the usual Cheerios, cookies, and toast, you might find your child has a passion for chunks of pickle, egg, or garlic bread. it would at least be a start. Mix up the textures a bit. Stay away from the texture you've been using up until this point (whether crunchy cookies or mushy baby food) and try the opposite end, or something in between.

If it is genuinely feeding himself that is the issue (as in, he'll eat anything you feed him but not give it to himself), you may need to try a little trickery or goading. I don't suggest the 'starve him until he eats' method, but try some rewards that he does like. Get him to eat a little bit of this or that, and then he can have his reward. Television? Video games? Music? Maybe an obsession that he'd be allowed to indulge? Bribery never goes out of style when it comes to the under-five. You can also try the 'one from you, one from me' method. If he eats a bite himself, you'll feed him one. Again: not the ideal answer, but it's a good start for getting him into the habit of eating with his own two hands.

If finally neither of these tricks work, you may need to take it to a genuine expert. Watch him while he's eating (or not eating), take note of his reactions to this or that, and bring them to his therapist/doctor. See if maybe there's some sort of sensory issue that can be dealt with, or if they can at least figure out if the issue is a physical one or a different underlying issue.

Hopefully these suggestions will be a help for you! Feedback, questions, comments, follow-ups, or whatever can be directed here, as always. Bon appetit!

Trey

---------- FOLLOW-UP ----------

QUESTION: Hi Trey, Thanks for your suggestions. I have watched him eat and I feel the problem is his hands. He does not want to put anything in his hands into his mouth for eating (even from my hands). He does not mind from a spoon though. He probably thinks its not clean ...not sure how to deal with this. Not just foods, if he touches something which he is not used to - a different texture like a flower - he finds it nauseating. Let me know your ideas.

Answer
Hi again, Saratha!

You are very likely right about the 'touching' thing. It may be that he feels that it's not clean, but more commonly with autistic children, the issue is a matter of texture. Certain sensations can literally be sickening to them, or painful, or otherwise uncomfortable to the point where they don't want to deal with contact with them.

If you can look around you, you might be able to find a therapist who works with 'Sensory Integration'. You can also try yourself, by finding things that he's willing to touch but uncomfortable about, and getting him used to it a little at a time. See if that might help with it. It may well be that he'll have this issue throughout his life, though, so try not to get too hopeful that it will spontaneously go away. More likely, he will learn to adapt and deal with it, rather than not having it any more. Fortunately, as he gets older, he should be able to adapt, especially if you are working with him to do so!

As for the feeding, see if you can get him using a utensil. A spoon might be a big help for it. Just get him used to wrapping his hand around the spoon's handle, and show him how to get the food into his mouth from there. A spoon with a solid handle would probably be best, rather than something 'squishy'. Hard plastic would probably be the best bet here, though metal or wood should work well, too. Expect some messes (as you would for any young child), but it might help some self-feeding if his hand doesn't have to touch any of the nasty-feeling things.

Hopefully that'll help you out with those feeding issues, as well as the sensory ones. As always, toss me a line if you need or want more detail on the answer!

Trey