If your child is a picky eater, mealtimes may be accompanied by feelings of worry, frustration, and distress. You just want your child to eat after all. These valid feelings that you encounter daily are shared by many parents and caregivers of children with autism. Ledford and Gast (2006) reviewed 16 studies and found “that up to 89% of children with ASD exhibit an unusual pattern of food acceptance” (p. 162). After medical concerns have been ruled out, our Board Certified Behavior Analysis (BCBAs) at Connec-to-Talk have experience implementing feeding procedures that are based on scientific evidence. The suggestions you find below are all based on verified research and should be implemented under the direction of a BCBA.
Copy Me: Utilizing Social Modeling
You may be utilizing this method without even realizing it. Legge (2002) found that some parents reported success with social modeling. Social modeling is a teaching technique where the learner imitates the behavior of a peer or family member. During mealtime, this could be as simple as you blowing on your hot soup and your child copying this behavior. The more fun the better! Maybe the noodles are ‘diving’ into your belly for a quick swim. Maybe the green beans are exploring a dark, scary cave (aka your mouth). The goal is to ensure you aren’t making mealtime aversive and working to make the behaviors you want your child to copy, fun!
Multiple Presentations of Nonpreferred Foods
Legge (2002), found that multiple presentations of nonpreferred food during mealtime could lead to the child being less fearful of the new food. This could be as simple as placing some of the nonpreferred food on the child’s plate during mealtime. The idea is that they don’t need to consume the nonpreferred food item, they are simply being exposed to it. The nonpreferred food can be placed on the same plate as the preferred food items.
First Your Peas, Then Your Pudding
The Premack principle, developed by psychologist David Premack in 1965, is frequently used in Applied Behavior Analysis (ABA). The instructor first presents a less desirable activity (for example, eating peas) with the promise of a desirable activity on completion (for example, the child then gets pudding). There are many ways to implement this during mealtime. A fun method I’ve come across is a ‘dinner winner’ tray. Structured like a board game, the child must first eat the less desirable food to reach the favored treat at the end. You can find an example of a dinner winner tray here: https://a.co/d/e14ulKl
Leveling-Up Food Intake
Hodges et al. (2017) created a hierarchical acceptance scale composed of 4 levels of acceptance. At the beginning, level 0 is a total refusal of the food item. As you progress through the levels, more interaction with the food item is required to earn the reward. Level 0 equated to total refusal, level 1 has the learner touching the food to their lips, level 2 has the learner putting the food in their mouth but not swallowing it, and finally level 3 has the learner swallowing the food. You begin by having your child identify a toy or activity they want (the reward). Then deliver the instruction. For example, “touch the chicken to your lips”. When the child follows the instruction, you provide 30 seconds of access to the toy/activity that they selected earlier. As they demonstrate mastery with level 1, you then move to the next level. So now to earn access to the toy/activity they have to put the food in their mouth. The goal is to slowly increase the amount your child interacts with the undesired food item, until eventually they are swallowing it. Please consult with your BCBA before implementing this procedure at home.
Here at Connec-to-Talk, we work together as a team with caregivers in service development and delivery. If you are concerned about your child’s eating habits, please reach out to your BCBA or click the link to begin the intake process! Together, we can collaborate and develop a plan to increase the quantity of food your child eats and/or the variety of foods they eat.
Hodges, A., Davis, T., Crandall, M., Phipps, L., & Weston, R. (2017). Using shaping to increase foods consumed by children with autism. Journal of Autism and Developmental Disorders, 47(8), 2471–2479.
Ledford, J. R., & Gast, D. L. (2006). Feeding Problems in Children With Autism Spectrum Disorders: A Review. Focus on Autism and Other Developmental Disabilities, 21(3), 153-166.
Legge, B. (2002). Can’t eat, won’t eat: Dietary difficulties and autistic spectrum disorders. London: Jessica Kingsley.
Maria Carolina Correa Martone, Ricardo Correa Martone & Ana Karina Leme Arantes (2019) The use of shaping by relatives of autistic children to increase food intake, European Journal of Behavior Analysis, 20:2, 261-273.
Piazza, C.C., Patel, M.R., Santana, C.M., Goh, H.-L., Delia, M.D. and Lancaster, B.M. (2002), AN EVALUATION OF SIMULTANEOUS AND SEQUENTIAL PRESENTATION OF PREFERRED AND NONPREFERRED FOOD TO TREAT FOOD SELECTIVITY. Journal of Applied Behavior Analysis, 35: 259-270.