Saturday, June 29, 2013

Food Selectivity- Not Just a Health Problem

Working with kids with autism I frequently come across children with food selectivity.  This of course is not at all surprising, considering the varied sensory sensitivities these kids may have and that food plays into both the sense of taste as well as the sense of touch.  Though there are many other programs that I work on with multiple clients that I either currently have or had in the past, the eating programs really stand out to me for personal reasons.

I have to admit, I also have some food selectivity.  And when I say that, I don't mean I am your run of the mill picky eater.  I mean, I eat the diet of your average 8 year old.  Chicken nuggets, french fries, and pizza make up the majority of my diet.  I don't eat vegetables.  And when I say that, I don't mean "I don't like to eat vegetables" I really mean that I do not eat vegetables, unless you count grains (corn) or starch (potatoes) as vegetables.  I also do not eat sauces, except pizza sauce on pizza and even that I did not used to eat.  I have myself on my own program to work on this, and have a strong reserved reinforcer (Rolos!) I can only eat if I take a bite of a new or non preferred food.  When people say "if you had nothing else to eat, you would eat it" they never believe me that I would starve first.  Unless I had my Rolos.

Because of my own food selectivity I have vivid memories of not being able to leave the table until I ate my peas.  Let me tell you, I still do NOT eat peas.  I may, on rare occasion, swallow a couple of peas whole.  Usually when I am visiting my parents.  But you will never see me chewing up and swallowing peas like food is typically eaten.  For health purposes, I have used my reserved reinforcers to eat small amounts of other vegetables, however, the health effects are not my biggest concern with my food selectivity.

The biggest effect that my food selectivity has had has been in my social life.  It is embarrassing.  I cannot be invited over for dinner by people who aren't already accepting of my food choices without either turning them down, or bringing my Rolos but still feeling mortified that I only eat a few bites of what they are offering me, which is, by most standards, great food.  I can't go to a new restaurant without scoping out the menu first to make sure there is something I will eat.  Nice restaurants are the worst, because the more unique or complex or fancy the food, the less likely I am to eat it.  This puts a huge crimp in the works when I am with a group of people and a restaurant is chosen where there is nothing I eat, then I have the choice of leaving myself out, or being embarrassed by how little I eat.  When I was younger and naturally thin I constantly worried that people would think I was anorexic, because of how little I ate at times out in public.  Strangers had no way of knowing why I left my plate mostly full at a new restaurant, or at a pot luck gathering, or a party where there's little I eat.  The latter being what finally got me to write this blog, after attending a birthday party for my brother in law where all I would eat was chips and cake.  

In high school, I was fortunate enough that my first boyfriends mother catered to my food selectivity and kept hot dogs and frozen pizzas for when I was there for dinner.  She certainly didn't have to do that.  She could very well have chosen to not allow me to stay for dinner.  When I started dating my now husband, he mentioned that his mother wanted to have a big family dinner when we went to visit.  That sort of statement always raises the alarm bells in my head, what kind of impression am I going to make on his ENTIRE family if I don't eat anything his mother has cooked?  Thankfully he'd already mentioned to his mother about my eating habits and she planned to cook food I eat.  

All of these things cross my mind when I begin with a new client who has food selectivity issues.  My first thought, of course, is about their nutritional well being, but after that my mind always moves to the social repercussions of food selectivity.  Particularly for the kids who are more socially motivated, I can't help but think "I want you to be able to stay at your friends houses for dinner in high school.  I want you to be able to eat food in the dining hall at college regardless of the menu.  I want you to be able to go out on a date to a restaurant and not order off the kids menu."  While of course there may be other social skills to work on and plenty of time before these situations arise, I don't want any of the kids I work with to be held back after making so much progress simply because of what they do not eat.

With applied behavior analysis, one of the dimensions of behavior we consider is the "applied" aspect.  The social importance.  When working with food selectivity, I consider what foods the client is likely to come across not only with what the family typically eats but also what will be most likely available to them outside the home at friends houses, at school, and at restaurants.  I also try to build in some way for the client to have choice, so they aren't always being required to eat foods that they really do not and will never like.  Most people have foods that they simply don't eat, my goal is to get the client eating a greater variety so they are likely to find foods they will eat anywhere and will have a more balanced diet.  My goal isn't to get them to accept any and all foods.

It is my hope that other behavior analysts and other professionals who work with individuals with autism consider the social effects of food selectivity when working with clients who may have nutritionally acceptable diets that are extremely limited.  Particularly for individuals who are more socially motivated, and are likely to run into situations where their food selectivity limits their social opportunities.

~KVL

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