“My adult autistic son habitually over-stuffs his mouth with food to the point of not being able to close his lips. No matter how often we tell him to eat only "little bites,” he goes back to this habit. Any suggestions?”
Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.
Today’s “Food for Thought” answer is by occupational therapist Desiree Gapultos, who practices within the Autism Speaks Autism Treatment Network, at Children's Hospital Los Angeles.
This is a great question. You’re right to be concerned. Your son’s habit is dangerous. He could choke. What’s more “table manners” are among the most important behaviors for your son to master on his way to achieving social acceptance, greater independence and quality of life in adulthood.
The answer, I think, begins with understanding why your son overstuffs his mouth. As an occupational therapist, my approach is to consider your son’s needs and behaviors that he may be using to meet these needs. We also want to develop the abilities he needs to become aware of and change problematic behaviors.
For example, his habit may involve a variety of factors including behavioral issues, extreme hunger, sensory cravings and/or a lack of sensory awareness. In this regard, it’s important to discuss your observations with your son’s doctor and therapists. Work with them to explore these issues and how best to address them with your son.
For example, in order to understand why your son is overstuffing his mouth, I recommend that you and the therapist or doctor to watch your son eating. Consider the following questions:
* When your son overstuffs his mouth does he tend to do so with a particular kind of food? Consider the texture. Is it soft?
* When you give your son food with a different texture (e.g. crackers versus bread), does this change his tendency to overstuff his mouth?
* Does his overstuffing tend to occur at a particular time during the meal? For example, is it worse at the start of the meal versus the middle or end?
* Does your son socially engage with you or others during mealtimes? Does he slow down if you engage him in conversation or redirect his attention away from his food?
The answers to these questions can provide insights and suggest directions for reducing the problem.
Here are some strategies to try at home to help your son make lasting improvements in his eating habits. None are guaranteed fixes. But they can help your son become more aware and in control of his eating behavior.
Wake up his mouth
Many people with autism have what we call hypo-sensory issues. They’re not as responsive to sensory input, be it touch, taste or temperature. In other words, your son may not fully sense when his mouth is overfull.
If this is the case with your son, you may want to help your son “wake up” his oral senses before a meal. Before you offer a food that your son tends to overstuff, offer a carbonated and/or iced drink or a small amount of intensely flavorful or high-textured food. For example, a bite of something quite sour, sweet, spicy or crunchy.
Another way to stimulate his oral senses before eating is have him wipe his mouth and face with a washcloth.
Encourage sips between bites
Keep a glass of water or another favorite drink at hand and encourage your son to take sips in between bites. The liquid will encourage him to swallow before taking another bite. A cold or carbonated drink can also provide additional oral sensory input. You can increase the sensory experience with a straw. As a matter of safety, encourage your son to clear his mouth with a swallow before drinking to avoid choking
Make it visual
Many individuals with autism do best with visual cues. So try using a visual schedule or picture story to help your son become aware of the number of pieces he puts in his mouth at one time. For example, take three pictures of a small cracker and another of a glass of water. Attach them to a page or picture board in order and explain “You can eat up to three crackers. Then it’s important to take a sip of water before you have another cracker.”
Put this visual aid on the table where your son can see it as a reminder at snack time.
For help using visual supports, download Autism Speaks ATN/AIR-P Visual Supports Tool Kit here.)
Mirror, mirror on the table
Here’s another potentially effective visual cue: Give your son a handheld mirror and have him watch himself put food into his mouth and chew. The visual feedback of watching himself eat can help him gain self-awareness and self-control when verbal reminders fail.
Include “alerting” textures
Some foods are easier to sense in the mouth than others. So I recommend foods with some sense-alerting textures. For example, rather than a soft slice of bread, give your son a piece of warm and crunchy toast. Or, pair the bread with crunchy nut butter. Similarly, you can pair cheese with a hard cracker.
You can increase sensory input by offering a variety of textures in each of your son’s meals and snacks. Combinations might include chewy foods (dried fruit and jerkies), crunchy foods (nuts, granola, crackers) and soft foods (pasta, rice). By prompting your son’s mouth to “adapt” to different textures, this tactic may decrease his tendency to heedlessly overstuff his mouth.
Encourage “dipping” food into sauces to slow down the eating process. Chicken nuggets, carrots and bread sticks can be dipped in bowls of ketchup, barbeque sauce and/or bean dip. In addition to slowing things down, dipping increases the variety of textures and flavors.
Use a behavioral/reinforcement chart
Try a reward system to motivate your son to stop and swallow between bites. A reward system can involve earning points for each mealtime – or portion of mealtime – completed without overstuffing his mouth.
Consider using a reward chart such as the one at right, or make your own with grids for the day’s meals and snacks. Keep the graphic simple so your son can track his progress easily.
For each meal or snack completed without mouth stuffing, your son gets to place a stamp, sticker or check in the corresponding box .
When he has, say, three reward markers in place, allow him to select a reward. This can be a favorite food, a small toy, a special activity with you, etc.
Be sure to personalize his reward. To motivate him, you want it to be something he enjoys.
Coordinate with other caregivers
Be sure to enlist other caregivers such as adult-service providers and therapists. Explain your goals and your reward system. They may be able to integrate it into their programs. This will provide your son with consistency that reinforce his new skills and helps him carry these skills over into environments beyond your home.
Thanks again for your question. Please let us know how your son is doing in the comment section below or by writing us again at firstname.lastname@example.org.
Got more questions about food, behavioral or medical issues related to autism? Send them to email@example.com.
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