“Our son, age 9, has a lot of food aversions. Just the sight or smell of many foods make him feel sick. Besides making it difficult to get him to even taste a new food, it’s a real problem at school where just walking into the cafeteria makes him start to gag. Suggestions?”
This week’s “Got Questions?” answer comes from psychologist Emily Kuschner, of The Children’s Hospital of Philadelphia, a member of the Autism Speaks Autism Treatment Network. With the support of an Autism Speaks research grant, Dr. Kuschner is developing and testing a cognitive behavioral treatment program that addresses the complex reasons behind narrow food choices in many individuals with autism. Also see Dr. Kuschner’s earlier blog: “What Is It about Autism and Food?”
Thanks for your question. As you may know, food aversions and avoidance of situations that involve food are common among individuals with autism. In general, slow and steady, repeated exposure is key to getting past them.
“Exposure” is when you help your son practice something that can be stressful or anxiety provoking. The more practice he gets in a safe environment, the less stressful the situation will become. On the flip side, the more energy he puts into avoiding something he fears, the more stress it will likely provoke. Research shows that avoidance tends to foster more anxiety! So therapy for food aversions generally involves gradual exposure to the related foods, as well as more general exposure and practice with food-related situations like your son’s cafeteria.
I encourage you to work with one or more your son's therapists when developing this type of exposure plan. Psychologists have experience with cognitive behavioral exposure strategies, and many occupational therapists and speech-language therapists incorporate graduated exposure to sensory experiences into their treatments.
In general, the following strategies for managing anxiety are based on cognitive behavioral therapy.
First and foremost, we want to ensure your son has coping strategies to use while practicing stressful situations. You don’t want to purposely expose your child to something that makes him anxious without providing self-calming methods he can use to manage his emotions. Slow, deep breathing is a good example of a technique he can use to calm his body. At the same time, he can slowly count back from 10 to help clear his mind of stress-provoking thoughts. I also recommend teaching him some confidence-boosting statements such as, “I can handle this. It’s just a quick walk through the cafeteria.” (To prevent teasing, have him keep these statements internal, rather than say them out loud.)
With coping strategies in place, I recommend thoughtful planning to gradually increase his exposures, or “practice steps,” toward the larger goals. Start with something relatively stress-free and manageable. It might be simply encouraging your son to think about going to the cafeteria. Or perhaps you can look at a picture of the cafeteria together.
Then plan small steps that build on your son’s progress. I recommend enlisting the support of a trusted adult in your son's school such as a counselor, psychologist or teacher. Your son will likely benefit from having one of you accompany him during at least some of his practice exposures with the cafeteria.
For example, he could start by standing down the hallway from the cafeteria for, say, a minute. The next step might be moving to a spot closer to the cafeteria. Naturally, the tougher challenge will to walk into the cafeteria. You might suggest that he start with a brisk and brief walk through. When this becomes relatively comfortable, suggest that he try walking through at a slower pace. On subsequent days, he can try standing in the cafeteria for gradually increasing amounts of time.
Remember that this practice involves bravery and hard work. I suggest generous praise and positive reinforcement. Consider some small rewards as your son practices each small step toward his goal. For example, some extra video game time or a few quarters. You might want to hold out a bigger reward – such as a new video game or gift card – when your son achieves the ultimate goal of being able to have lunch in the cafeteria.
You can use these same strategies to gently help your son manage other food and smell aversions, as well.
In the meantime, it’s important for your son to have ways to handle overwhelming situations in a socially acceptable way. Instead of having a meltdown outside of the cafeteria at lunch, could he be part of a lunch group that eats somewhere other than the cafeteria? Perhaps you could talk with your son’s teachers and counselors about forming a group where children can practice their social-skills during lunchtime.
Could he volunteer to help a teacher during the lunch hour and eat in the teacher’s classroom? Work with the school to find strategies that make the situation manageable until your son has built the skills he needs to move forward.
Gradual exposure strategies such as these are an important part of the Facing Your Fears program, developed with the support of an Autism Speaks research grant by Judy Reaven and colleagues at the University of Colorado, Denver. Its techniques are designed to treat anxiety in children and teens who have autism. Learn more about the program here.
Thanks again for your question. Please let us know how you’re doing in the comment section below or by emailing us at firstname.lastname@example.org.
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