Expert: Dr. Sharon A. Mitchell - 4/20/2007

Question
QUESTION: Hi Sharon,
Thank you for your very informative earlier answer re toileting.
I have hit the wall a bit with another child who likes to lick everything, especially hands, tables, tv, carpet, people, floors, toilets an so on.
I notice that sometimes this is an exploratory behaviour, however it is particularly habitual when required to sit at a table in school, or general during down time in the home.
We have tried oral stimulatulation types of activities, however they are not very long lasting.
We are starting a behaviour management approach and I would love some further ideas on how to make it a success, along with any further ideas you have on the subject.
Regards
Susi

ANSWER: Oral stimulation activities would have been my first tactic as well. Sometimes it's hard to hit upon the right one or a child's need may be so intense that it requires a number of different stimulants to satisfy.

Here's a list of possible oral things you can try. Hopefully I'll come up with a couple you have not already used:
- gum
- sour candies
- sweet candies
- chewy candies like gummy bears
- Cheerios, Shreddies and other crunchy dry cereals
- crunchy vegetable sticks like carrots, celery, sweet potato, jicama, zucchini
- fruits like apples and pears
- nuts
- pretzels
- corn, potato or rice chips
- crackers
- ice chips

Apart from food, there are substances made for chewing like:

- theratubing
- vibrating chew toy from Specialneedstoys.com http://www.specialneedstoys.com/usa/search.asp?search=chew+&searchprice=9999999
- chew tubes from Sensory Comfort http://www.sensorycomfort.com/HomeSchoolWk.htm#Chewy%20Tubes
- Achievement Products has an assortment of chew toys at http://www.specialkidszone.com/Product_Level1.asp?CategoryID=37
- TheraPro also has an interesting array http://www.theraproducts.com/index.php?main_page=index&cPath=6165&zenid=a2d27036

Rather than chewing, some kids like the feel of something vibrating in their mouth. Rather than just trying battery toothbrushes, there are other objects such as TheraPro's z-vibe products are interesting http://www.theraproducts.com/index.php?main_page=index&cPath=6165_245356

Some children take comfort from the mouth sensations they get from blowing:
- cotton balls
- windmills
- bubbles
- whistles
- you can find an assortment of high quality whistles from Southpaw catalog http://www.southpawenterprises.com/store/whistle-kit,Product.asp

If your child is developmentally quite young, some of this mouthing may be explorative. However, it's still inappropriate age-wise and health-wise.

When a habit become firmly entrenches, it's a difficult thing to eliminate. Generally you have more success if you can find something to substitute that will give the child similar pay-off. That's why it's worth the effort to seek to fill the sensory need the child may be experiencing.

Even though your child is using his mouth, his body may be craving sensory experiences not just through his mouth. The proprioceptive and vestibular senses are powerful and can help meet the body's sensory needs. If used regularly, they may even reduce the child's need for oral stimulation.

Weighted products like vests, lap weights, weighted blankets, exercise-type ankle weights may have a beneficial effect on your student. Products such as snug, neoprene vests may also help.

To help his vestibular system,  you could try things like:
- swinging
- jumping on a rebounder or trampoline
- rocking in a chair
- sitting or bouncing on a therapy ball
- air-filled cushions to sit on

If the mouthing happens when the child is required to sit at the table in school, is it something the child does when anxious? It sounds like the child is expected to follow class routines at that time. If he's unsure of what is expected of him, of what is coming next or uncomfortable in his ability to do what's asked of him, the increased anxiety may bring out the compulsive, sensory-seeking behavior.

Do you use visuals? They can have a truly remarkable effect on behavior and learning. Most kids with autism have some degree of auditory processing difficulties which increase under times of stress. Commonly, kids with autism taken in information more easily when it's presented visually rather than orally. Visual schedules, whether done in words for more able readers or in pictures tell the child what is going to happen next. They can see from the schedule that that math session they detest will not last forever and right after it comes library, a favorite activity.

Along with visuals, social stories or Carol Gray's Comic Strip Conversations also give the child needed information of what's happening, what is expected, how he should act, etc.

As adults, we treasure our leisure time. It's not necessarily so for some kids. If they don't know what to do with their down time, that's when some of the undesirable behaviors may come out. This may be what you're seeing with your student. He might need to be given choices such as two pictures that each represent a favorite activity. He needs to select one of the pictures then he can do that activity. Some kids find comfort in this and do not like the freedom to choose from a wide array of toys or activities on their own until they difficult for children with autism, it's not hard to see that given the directive, "Go play" could produce anxiety and then undesirable behaviors.

You might have success providing a sensory diet at regular intervals during the day. An Occupational Therapist with a sensory background could help you.

Here are a couple books that may interest you:

The Out-of-Sync Child Has Fun http://www.amazon.com/Out-Sync-Child-has-fun/dp/0399528431/ref=sr_1_4/104-119816

Answers to Questions Teachers Ask About Sensory Integration http://www.amazon.com/Answers-Questions-Teachers-Sensory-Integration/dp/19316150

A medical examination might not hurt. There's a possibility that a metabolic imbalance may be causing the child to crave certain tastes. In some instances, medication can be helpful in curbing obsessive behaviors that are interfering with the child's well-being and ability to learn.

Sharon A. Mitchell
www.autismsite.ca


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

QUESTION: Hi Sharon,
Thanks for your really informative answer. I think you've hit on some really relevant areas of need, as i do think he gets anxious without structure.
This child is also on an extremely restricted diet, and I do wonder if he is searching for some very certain tastes that he doesn't receive. He is on a no wheat, gluten, additives and dairy diet. I know for myself that I crave certain tastes myself when I cut these foods out.
can you elaborate a little more on what type of medical examination the parents should be requesting and types of medication that may help.
thank you again for your help
regards
susi

Answer
Some kids with autism seem to be helped by the gluten/dairy free diet, so I can certainly understanding the family giving it a try. Some allergists talk about children craving the very foods that are not good for them. Some autistic kids with oral sensitivities are very picky eaters. This and restricted diets can present nutritional challenges for parents. A physician may suggest dietary supplements or vitamins.

I can't be more exact about medical examinations as that is not my field of expertise. I have experienced kids with autism showing unwanted behaviors who it turns out, were experiencing undetected medical difficulties. Especially with nonverbal or lower functioning kids, they don't have a way of telling us how they feel, so we have to infer from their behavior.

A chronic, low grade infection, dental discomfort, tonsillitis, sinus conditions, polyps, ulcers, anemia or metabolic imbalances, vitamin deficiencies, etc. could be making the child feel poorly. Not understanding what's happening in their body, being unable to interpret their feelings or being unable to communicate how they feel may lead to frantic or obsessive-seeming behaviors. Before employing a strictly behavioral approach to altering a behavior, I feel safer first ruling out medical aspects and then sensory issues.

A general medical and dental checkup would not hurt and the physician may have some positive suggestions. If given a detailed description of the child's behaviors, and no medical complications are found, the doctor may feel a psychiatric referral is appropriate to look into the possibility of pharmaceutical help.

Sharon A. Mitchell
www.autismsite.ca