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On this track, we will discuss teaching Table Manners. This will include how to get an Autistic Child to Sit Down and Eat, Eating Pace, Insisting on Proper Utensil Use, Cutting Down the Mess and Restaurants. As you listen, compare the techniques you might use with the ones listed on this track.
Saul, age 45, and Nadine, age 40, came to me regarding their daughter Rachel, age 11, who had diagnosed as having autism.
Nadine stated, "Eating with her can be a real hassle…at home, we usually let her come and go during the meal. She’ll come into the kitchen, grab a few bites and leave, and then come back for more when she’s ready. The problem is, she’s a mess when she eats! I’ve tried to get her to use utensils, but she just reverts back to using her fingers! There’s always food everywhere, and I’m constantly cleaning it up! And forget restaurants. We can’t go out as a family when eating problems are this big."
Saul stated, "Something else about Rachel’s eating habits is that her teachers have told us she eats abnormally slowly during her lunch period at school. Someone has to stand beside her and wait until she’s done, and often it’s not until recess is over! Then she’s missed any opportunity for playtime she might have had otherwise. What can we do?"
Nadine stated, "But what if she doesn’t eat enough? I don’t want to starve her!" I stated, "Don’t worry about her starving—if she doesn’t eat enough, it just means that next time she’ll come to the table even hungrier and sit down even longer. The idea is that Rachel has to learn that meals are eaten at the table."
Saul asked, "This is going to be a gradual process, right?" I stated, "At first, Rachel may stay in her seat only a few seconds, but you can gradually work this up to longer periods, until she’s remaining for the whole meal. This can be done with the amount of food Rachel eats, by gradually increasing the number of bites she takes before getting the reward of leaving. You may even want to serve Rachel very small portions, especially of foods she likes, so that she can use her communication skills to request more helpings.
"Not only will this reinforce her language, it will also give her an opportunity to interact socially at the table. Some families find it helpful to have a timer at the table with a treat, such as a cookie or other dessert, placed nearby. If Rachel remains calmly at the table until the timer goes off, she may then have the treat. Again, the length of time can gradually be increased until Rachel is able to spend the whole meal with the family."
Saul asked, "If Rachel were eating slowly for attention, do you mean that by asking her to eat more quickly we would only reinforcing her slow eating habits?" I stated, "Exactly." Nadine asked, "Well then how can we teach her to eat more quickly without giving her the message that it’s ok to eat slowly?"
I stated, "You may choose to only give Rachel the attention when she eats at a faster pace. You might talk to her, praise her with ‘Good job! You finished your carrots!’ or give her any other type of attention she desires—but make it contingent on the eating. If you do this at home, it might be a habit that carried over to her school life. I believe you said Rachel has an aide?" Saul stated, "Yes the school provided Rachel with an aide last year."
I stated, "You might ask the aide if she praises Rachel regularly for finishing quickly. Also, if Rachel is eating too slowly because she is either avoiding what comes after lunch or simply spacing out, you might ask the aide to try putting away her lunch when the other children finish. Rachel could learn pretty quickly that if she wants to fill up, she will have to eat more quickly."
"If you need an intermediary step, you can place the bite on the spoon or fork itself. You’ll probably want to make sure that Rachel likes whatever you put on the plate, so she’ll want to eat it. Rachel may need a little help at first getting it on the utensil or into her mouth. With practice, she may learn to do it on her own. Once she’s eating one bite, add another. Slowly and gradually add to the number of bites Rachel eats with the fork or spoon. The great thing about eating is that there is a natural reward associated with the task, especially if it’s yummy food, so Rachel will be likely to continue the task of learning to eat properly, even in the initial stages when it’s most difficult."
How might you encourage an autistic child to use utensils? Do you have another method other than the one I suggested.
#4 Cutting Down the Mess
Have you ever worked with an autistic child who was an extremely messy eater? How did you respond to the parents who are experiencing stress due to messy eating habits?
Nadine stated, "We would bring toys and other activities for Rachel anyway. She doesn’t tend to do well with waiting for long periods of time." I stated, "Once Rachel can sit at one of these less formal restaurants, you can try going to a restaurant where you have to order from a waiter, but there are still quite a few families with small children. And remember, you’re not alone. Most parents have to deal with restaurant behavior."
On this track, we discussed teaching Table Manners. This included Getting Rachel to Sit Down and Eat, Eating Pace, Insisting on Proper Utensil Use, Cutting Down the Mess and Restaurants.
On the next track, we will discuss Sleep Issues. These will include Keeping Your Child Awake During the Day, Bedtime Routines, Not Giving In and Dark versus Light.
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