Oral Sensitivity in Children with Aspergers and High-Functioning Autism
http://www.myaspergerschild.com/2012/03/oral-sensitivity-in-children-with.html
In contrast to motor-based swallowing problems, difficulties with eating can also stem from dysfunction with the sensory system. The act of swallowing does require both motor and sensory functions to complete the act.
All of us have a range of sensory tolerance, some of us more sensitive than others. If you have a low sensory threshold, you may have an affinity for stronger tasting foods or perhaps crunchy foods. Conversely, if you are on the other end of the sensory spectrum, you may prefer milder foods or soft foods. Kids also have taste and texture preferences and tend to prefer milder, simple foods.
Hypersensitive oral reactions are exaggerated responses to touch in the mouth or around the face. Younger Aspergers and HFA kids with hypersensitive oral reactions may not let you into their mouths for feeding, tooth brushing, or play. They may have problems moving from one food texture to the next, spitting out or gagging on any food but puree. They may gag when a spoon touches the tip of their tongues. A tiny lump of food may be gagged on instead of swallowed.
The following are red flags for sensory-based eating difficulties:
- Able to bite and chew solid foods, but not swallow them
- Gag on foods that require chewing
- Hypersensitive gag only with solids and not with liquids
- May try to swallow foods whole to avoid contact for chewing
- No problems with taking liquids
- Will separate textures from smooth food and pocket or expel them
Some kids become so sensitive and emotional, that their reactions go one step beyond hypersensitive and become “aversion reactions” (these are stronger, more emotional, and less logical reactions). These kids may cry, fuss, pull away, push food away, or refuse even to let you near their mouths. Gagging may turn into vomiting in an aversive reaction.
Fears can develop around eating or any touch around the mouth. Aspergers and HFA kids may try to control all aspects of a meal in an effort to protect themselves from uncomfortable situations. They may want only certain food textures, certain spoons, certain plates, and certain cups. Moms and dads become frustrated because their youngster will eat only a few foods prepared in very specific ways. Face washing and tooth brushing can seem impossible.
For most Aspergers kids, mouth hypersensitivity is one part of an overall body sensitivity to touch or changes in touch. These kids have a hard time handling touch on other parts of their bodies as well. Therefore, treatment for the face and mouth needs to be part of a treatment plan of relaxing or desensitizing touch reactions throughout the body
Because most hypersensitive kids have body as well as mouth over-sensitivities, they may allow touch or cuddling only if it is their idea. If you try to approach them, they may push you away, or rub or scratch the spot. The touch may be quite agitating.
Helping your youngster handle deep pressure or firm touch is usually a good starting place. Light ticklish touch can be too over-stimulating. Massage can be an excellent activity for these kids. Deep pressure touch, given in an organized, predictable way can be very helpful with touch sensitivities. When your youngster can anticipate the touch, it makes it easier to handle. A variety of other firm touch activities may be described by your youngster's therapist.
Let your Aspergers youngster know that you are going to touch. Approach the youngster within his/her vision so that the touch is not a surprise. Often, touch is handled well if the youngster sees it coming. Kids seem to be able to "prepare" themselves for the touch and sometimes can react more appropriately. Also, your youngster needs to learn that touch around the face and in the mouth can be fun.
Remember that the mouth is the most sensitive part of the face. Start by touching places away from the mouth and work toward the mouth. Consider starting on the trunk or back of the arms, and make a game of moving toward the face. In this playful way, the game becomes a distraction, so your youngster isn't just worrying about the touch. You also are moving in a predictable fashion that is less scary.
Tips for helping your child accept touch:
- Kiss your youngster's face with the stuffed toy, and then let him/her kiss the toy or your face.
- Play face-touch games with stuffed toys and dolls.
- Playfully taking turns with touching can help your youngster handle play around the mouth.
- Tooth brushing with regular or electric toothbrushes can help
- Wipe the face regularly (slowly and softly) with warm cloths, using deep pressure. This can be calming to an over-reactive youngster.
- Singing is nice to combine with touch activities. The predictability of the tune helps your youngster prepare for the touch.
Eating involves many different types of touches that the parent needs to understand. The spoon, fork, and cup touch the lips as they bring food to the mouth. The food temperature is a touch. Food texture (e.g., lumpy, wet, thick, etc.) is an important touch of eating. Some kids remove food from the spoon with their teeth very rapidly, so that the spoon doesn't touch their lips. Try gradually keeping the spoon or cup at the lips longer. Use the youngster's most favorite foods for this activity.
Food temperature often can cause over-reactions. Remember that room-temperature foods tend to be easier to handle. Notice the temperatures your youngster handles easily. Make temperature changes very slowly and with foods the youngster likes.
When Aspergers kids over-react by gagging when you try to switch to thicker, more textured or lumpy foods, you probably need to make the transition more slowly. Aspies usually will do better moving from strained foods to thickened strained foods, to blended foods, to thickened blended foods, to thickened blended foods with tiny, very soft lumps. Remember, it is easier to hide lumps in thickened foods. They are much too obvious when presented with strained foods. Good food thickeners include cereal, dehydrated foods, instant potatoes, instant puddings, and ground cracker crumbs.
When you present new body or mouth touches or new food textures, always start with familiar touches or textures. Making games of the touching helps kids think that the touch or the eating or the new texture o" their idea. Move at your youngster's pace, but be persistent.
Provide crunchy foods, and separate textures during meals. Keep crunchy foods on hand for your sensory-sensitive youngster, as these foods facilitate an important "sixth sense" called proprioception, in which sensory feedback makes the child aware of movement and body position. Crunchy foods may help your youngster to develop better proprioception. Also, avoid mixing foods together that have conflicting textures, such as mashed potatoes and gravy.
A speech-language pathologist or occupational therapist (OT) that is trained in oral sensitivities can implement an oral-sensory treatment program to help desensitize the child and reduce the sensitive gag response to textures. Also, the therapist can assist the mother or father with activities to transition the child to age-appropriate textures and tastes of food. If the sensory problem is more pronounced or pervasive, an OT with a background in sensory integration can provide more involved sensory intervention. These therapies may need to be preceded by resolution of medical problems first, especially reflux, before treatment activities can have an effect.
Advice to parents with Aspergers kids who have sensory-based eating problems may include to avoid forcing the child to eat certain foods, maintain a routine mealtime, have at least one preferred food available each meal, and to have the youngster join the family at mealtime versus eating alone.
Aspergers and High-Functioning Autistic kids with hypersensitive reactions to touch in the mouth and around the face need extra help learning to handle the touches of everyday life, especially for eating. You do not have to struggle with this one alone. Your youngster's pediatrician, dietitian, or therapy team can work with you and your youngster to figure out the best way to help.
The Aspergers Comprehensive Handbook
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