Case study on Food

Background

F. is an eight year old boy who attends a special school. He has a diagnosis of autism and has a dairy intolerance which results in fatigue, pain and thirst. He has many strengths and interests and is an energetic young boy who enjoys movement games, such as chase or the climbing frame in the playground. He also enjoys water play and visually stimulating materials such as a lava lamp. He has good memory and observation skills as well as excellent fine and gross motor skills.

F. is pre-verbal and uses the Picture Exchange Communication System (PECS). He has some word approximations, e.g. ‘duce’ for juice, however, this does not serve as functional to a novel listener. When he was referred to Middletown Centre for Autism (MCA) he had a restricted diet through choice and for several years he only ate porridge (he would only eat one particular brand of porridge) thus restricting holidays to visiting family or self-catering accommodation. His nutritional intake was also limited. As a result of his daily intolerance he often would suffer with digestive problems resulting in episodes of crying and screaming.

Triggers

After consultation with F.’s parents the following triggers were identified for behavioural outbursts.

• Trying to eat new foods
• Pain arising from digestive problems
• Frustration arising from lack of verbal ability

Strategies

After consulting with F’s family and school staff it was agreed to implement the following strategies:

• After considering foods with similar textures, colours, smells, taste etc. to porridge it was decided to trial natural yoghurt
• Identify strong reinforcers: A ‘Reinforcement Inventory’ was completed and identified water play, the IPad, a walk and using the photocopier as strong motivators
• Desensitisation i.e. gradual introduction of the new food using the following flow method:

The following method could take weeks or months to progress through all stages.

This approach was used to introduce all new foods and the variety of flavours was widened to include beans, fish fingers and curry.

• Visuals: use of visuals to display what he had to eat, how much and what the reward was enabled F. to understand what was expected of him
• Play: F. was allowed to explore food through play. For example, he would crumble a biscuit to use during an art lesson, help to decorate Gingerbread men that his siblings made or make a pasta picture
• Preparation: F. enjoys chores such as setting the table and emptying the dishwasher. He was taught new skills to include preparation of food, e.g. putting toast in the toaster
• Timing: during meal times F. ate porridge as normal and the new foods were introduced outside mealtimes and then gradually transferred to mealtimes when he was accepting of them
• Choice: Once F. began to eat more foods he began to take an interest in what others were eating. He was given a choice at meal times (displayed visually) similar to his peers and siblings
• Communication: pictures of new foods were inserted into his PECS book enabling him to request