Help me to encourage DS2 to eat less messily

[sphil]

He is 7 with ASD. Eats everything with his fingers. Takes a single bite out of each piece of food, puts it down, takes another bite out of another piece, puts it down etc. While he is doing this he is crumbling the food with his fingers. Sometimes he takes some of the food back out of his mouth again.

When he's eating food like chips, sausages etc it's not too bad, but crumbly foods like fish cakes, his gf bread and shepherds pie go everywhere. He drops bits on the way to his mouth, on the way back from his mouth and then wipes his fingers down his jumper. Often about a quarter of his food ends up on the floor.

Up to now we haven't worried about it too much tbh - there are other things we see as more important. I also know how lucky we are that he eats fairly well - his diet is limited but mostly healthy and he has a good appetite. But now he's seven, we feel that his eating habits are marking him out as even more 'different' - in private we can cope, but in public.....well, I wouldn't want to watch him eat tbh!

We give him a spoon every meal time and he will use it once or twice if we ask him to - but then he just refuses. We tried giving him a very small portion that he had to eat with a spoon before he got the rest - he would do this, but we never ever progressed from this point.

So lovely ladies......over to you!

PS: DS1 said tonight that we 'have to teach DS2 to eat properly because if he wants to have children when he's older he'll need a wife and girls don't like messy eaters'.

just marking lol. ds1(8) has some similar sensory issues with food (the touching, crumbling etc) and sometimes rubs it on his face/ cheeks or round his lips too... (ds1 does not have any dx lol, although we do have a referral pending for his quirks...)

sorry, not helpful, just interested!

Does he have any other fine motor problems? This sounds very like my ds1 (now 6) who has very poor fine motor skills. A friend who is an OT advised us to get chairs which support back and feet as you need either strength in or support to the back and shoulders to use your fingers with any dexterity. We ended up getting tripp trapp chairs at huge expense and they have made a difference. We're waiting for OT assessement report to see if they have any suggestions for helping with use of cutlery and so on. For ages we thought that it was simply that he was refusing to eat properly but now realise that he simply can't manage cutlery very well -- he'll start with knife and fork, then abandon the knife and end up with fingers as he gets tired (very quickly). Apparently things like clay and playdough help to build up finger/arm strength, chalking on an outside wall, any kind of climbing.
We also have lots of anti-social table habits, like taking food out of the mouth and so on that you describe. I've started giving everyone bits of kitchen roll when I lay the table so that they can wipe hands and faces, and we all try and do that to teach him what to do. This has started to make a bit of difference.
I think it'll be a long journey to seeing him eat in public and not having to put my thick skin on.

DD has improved (she's 11yo) but I still have a 'splat mat' under her chair as she eats like a pig is still very messy and eschews cutlery about halfway through. And at school she grabs a fajita (every day) as she says 'everyone makes a mess with them so no-one notices'...

not much help i know ds 4,7 still uses fingers is unable to use a knife and find forks get to heavy .as for eating out found i just devloped thick skin

Thanks for your replies. He does have poor fine motor and motor planning skills, but is able to use a spoon, albeit slowly. He uses a Tripp Trapp.

The kitchen roll idea is a good one - I'll try that. The problem is he doesn't care at all what other people think - and doesn't mind making a mess.

He doesn't like holding anything for long in his hands - pencils, cutlery etc. So maybe I need to work on that as well.

sphil, do you think the not holding anything for long is a sensory thing? BIBIC gave us a very good ahnd desensitisation programme when we visited, which really got dd1 over a LOT of sensory issues.

She si the opposite (for once !) in a way - she would never touch any foods at all, so was fed by us until she mastered using a spoon.

Is the weight of it anyhting to do withit? dd1 still uses a teaspoon rather than a "normal" spoon, and although she used to use a fork she doesn't any more. I have been asked lots (PIL, step children, etc) when she is going to start using cutlery "properly", my standard answer is always "when she's ready to"

dd1 has recently got very sensory with food, and so although she never used to make much of a mess, now she will spill a bit accidentally onpurpose and then smear it around the table, thanks to the sheer amount of playing with food she was given to do at her last school

ds2 was a nightmare with food, it was like sharing the table with a fly as he would chew everything, spit it out & then re-eat it...bloody disgusting!

We have had to tackle it like anything else repetition & consistency.
Constantly saying NO ds 7 removing any items of food that were spat out, every time he tried to eat with his fingers I would remove his hand wipe it with a wet flannel (he hated that) & put the cutlery in his hand.

No he knows if cutlery is on the table he MUST use it. I do still occasionally find little piles of spat & chewed foods hidden around the house as he loves the sensation but it is miles better.

He did initially react with refusing some foods & limiting his diet even further but gradually they ahve returned... I guess he is like his mother & a bit of a pig

His co-ordination is still crap & he can be messy but he is doing the best he can, but at least he is not using his hands & spitting!

I'm a huge fan of TAGteach which I have used with great success to promote tidier eating habits in my own children.

It focusses only on positively reinforcing desired behaviour-no nagging, whingeing or punishing.

So simple and so fantastic.

I've had a quick look at the website Moondog and it looks fascinating. I remember telling my sister about ABA when we first started it with Ds2 and her saying 'Oh, it sounds just like the clicker training I do with my dogs!'.

Can you explain how you would use it in this situation? The problem with DS2 is that he doesn't understand deferred reinforcement - so beads or tokens wouldn't work. It's why I haven't been able to use ABA to help his eating skills up to now - I just can't find an effective reinforcer that it's possible to give during mealtimes (his only really strong reinforcers are physical play with an adult and food).

Anon - I admire your persistence. I just know Ds2 would kick off big time if I tried your approach - which doesn't mean I shouldn't try it I know! I'm often on my own with the DSes at mealtimes and focusing on DS2 exclusively would be very difficult.

Silverfrog - I need to think about cutlery, certainly. We've tried plastic spoons, teaspoons, the ones with a spongy handle and a 'spork'. I think something wider, so he wouldn't have to curl his hand round as much, would be good. What exercises did BIBIC give you - we didn't get any hand ones apart from massage?

I think you've been watching my DS1 eating! I wouldn't mind, but when he was a toddler, he hated dirty hands so much he was really good with a fork, but now, if he does use one, he puts the food on it with his fingers! He doesn't even have any fine motor difficulties. He just has to touch his food!

Sphil, depends on the child but key issue is that a desired behaviour (one at a time) is identified and then taggged ('clicked' if you like) when it occurs.

What is really fascinating is that for many (not all) the tag acts as reinforcer enough.It's as if taking out all the naggy language or even the frankly often quite meaningless verbal praise I see in a lot of ABA programmes and don't like ('Nice talking!' 'Fantastic!' 'Good job!') leaves the person in question time to think and self assess. which of course is vital as we do not want them relying on prompts.

The little nod a lot give when they hear the tag or the way they stop in their tracks when they don't hear it is quite amazing.

Look on youtube-loads of videos on Tag in action.I attended a workshop in the States last year.So inspirational. When I met Skinner's daughter (really!), Julie Vargas, who was involved with setting up Tagteach, she said her reply to people who say 'Ewww, it sounds like training an animal' was 'Yes, and aren't you glad we have checked out that this technology is safe to use on animlas before using it on your child?'

A really important point I think as nearly everything we use (pharmaceuticals, food, textiles) has been tested prior to be used with humans, and moreover, some of the most important dicoveries we have made, such as stuff on genetics, has come from work with beasts as lowly as fruitflies.

There's also a blog, a Yahoo group, all sorts.

With my kids, I tag when their mouth is closed when eating. When that mastered, will moveonto another behaviour (eg cutting properly) so it becomes shaping of a sequwence of events in many cases.

I'm fascinated now - have been reading the website all evening. Your point about unnecessary language really applies to DS2 - you can almost see his brain working to process it and then he forgets what he's supposed to be doing. An example of this is using the sentence 'I want X please' instead of just shouting 'X!'. We've managed to get him to do it using ABA (it's taken two years!) but he tends to say ' I want.....' and then stop, or just repeat 'I want'. It's as if his brain gets stuck. You can see him groping for the next word. If we prompt it, he'll say 'X please' but then the prompting makes him forget the 'I want' part. I can see that using a tag might help with this.

As far as eating is concerned do you think this would work?
He LOVES chips, especially oven chips. I could give him meals without chips for a few weeks, but cook a few to use as reinforcers. I put a spoon by his plate and say 'Use spoon'. If he touches the spoon, I tag and treat with piece of chip. When he's doing this frequently, I tag him picking up the spoon, then putting it to his plate, then scooping up food, then putting food into mouth.

(Ouryve - DS2 does the touching thing too - he puts the food on the spoon, raises it to his mouth, then takes the food off with his fingers and shoves it in!)

Sphil ,yes exactly re language, and it can work two ways, both expressively and receptively (in a way your ds's expressive output is also acting as receptive input as he is monitoring himself speaking and getting lost if that makes sense.)

Because we are such effective users of language and so socially conditioned to finding it reinforcing, we forget that it just isn't working that way for many people. So the premise is to remove the language until the focus of the task becomes clear, when the child experiences the lightbulb moment of 'Ah, so that is what you want me to do!'.

You can then reintroduce the language, hopefully in a more mindful way, using only what absolutely necessary.

Your plan sounds good as you are experienced with ABA.Give it a whirl (and take data of course). There is notihng to lose. As you say, reducing amount of ovn chips given generally will make them a stronger reinofrcer.

Have you watched some of the videos? In my training we saw some fantastic ones, one of which was of a child with ASD who was not able to approach peopel for help.Would just stand there passively waiting to be prompted.They worked on it in many situations, tagging him touching a shoulder lightly (got the whole school involved in setting up pratice scenarios-secretaries ,other pupils, dinner ladies) and managed to get it sorted. Fantastic.Made such a diffference to ihm.

Let me know how you gwt on.This has huge potential.

i1m liking the idea not so much for eating as with ds its more he cant hold/handle cultery but can see other areas could apply it especially with his delayed receptive

Important thing to remember is to use it with something where possibility initially of getting it right, so it doesn't become mad stab in the dark (which leads to more frustration)and also use it for short periods of time (say 10 mins.) at a go.

Also Tag advocate starting with letting the child know what is expected.So you say (even if child non-verbal 'The Tagpoint is.......' and you keep this fill in to 5 words or fewer. Then you do desired task and get someone to tag you while child watches.
Then have someone help child hand over hand to tag you while you do it or you help child to tag someone else doing it.
Finally, let child 'loose' and have a go tagging them.

Discrete easy to capture behaviours such as catching or kicking a ball or putting something in a box/slot are good ones to start with and a nice lead in.

I'm excited about this. Will look at videos today (another snow day) and start this evening. I'm going to use a clicker that we use for counting trials - that'll be OK won't it?

Am also thinking about ways to use it with DS1 (dyspraxic), for example to get him to form his letters correctly. I was explaining it to him last night and he watched the video of the girl learning to high jump - he got the idea straight away and is very keen to have a go. Especially as rewards are built in..

Yes, the clicker counter is a great idea 9also recommended) especially in presence of people who go because you point out you are merely counting instances of target behaviour (but your child hears the click and knows what is going on).
I used it very successfully with my ds to get him to properly order 1-100 cards. He adored it and so much more fun than the usual
'No, not that one, put it back! Listen to me!'

I've used it on a (behaviour analyst friend) who doesn't sit up straight.Tag achieved what years of her dh nagging about her slumping never could.

Sphil, watch this little lad doing letter formation with Tereses Mkeown who is MD of TAGteach. She is a top level gymnastics coach where she uses it. Lovely woman, she did our workshop in the States and I think is planning ot come and do first ever 2 day accreditation some time in the New Year here in UK.

Here

This sounds really interesting, and I'm having a think about how we could use it in some form -- though we don't do ABA or anything like that. But if it could help DS1 learn how to eat properly that would be an absolute godsend... and it might help him learn to play cricket, which is his current enthusiasm.

I tried it last night - with DS1 writing '6' s properly (ie, starting from the top, on the line, regularly formed). It worked brilliantly, though when he was doing his mental maths practice later he went back to writing them from the bottom up, saying that the pressure of being timed made him forget. But that's OK, because I could add in a timed element to the tagging.

We tagged DS2 just for touching his spoon - he got the idea quickly and began picking up his spoon and even putting food on it by the end of the meal. I just continued to tag him for touching it though - was that right MD? What do you do if a child does more than the tagpoint?

Does it have to be with an audible sound and if so where do you get clickers from?!!!

Sphil, I am finding that loading a smallish mouthful of food onto a fork for the child, is helping especially when you give praise each time, a simple 'Well Done' is working for this little chap (4). When he is about to put his fingers back into the food, I simply say 'use fork' (spoon) and he is redirecting himself to use the cutlery. At the moment I am having to spend time reinforcing this by my presence, the loading of the food onto the cutlery and verbal praise but will fade out these prompts eventually. We are not 'out of the woods' yet as I only work with him 2 days a week and this needs to be reinforced daily and at every meatime. Playing with food/chewing it and regurgitating it is probably a rewarding sensory experience for the child. Maybe introducing more sensory play experiences prior to mealtimes will help?

Hehe, brilliant Sphil!
You are shaping now, so if you feel picking up fork behaviour is solid, start tagging putting food on it. Then when that is ok, shape putting it to lips.Sounds like you are moving fast.

Remember golden rule-work on one thing at a time, so for your other ds, I'd leave timing out of it for now until he has really graspes and become fluent with the correct letter formation.

Carl Binder is the god of fluency and has some great stuff on why fluent behaviour is so important. This fluency website has some excellent stuff on it (even if it looks a little amateur). He's also involved in TAGteach.

Nikos, the idea is to eliminate confusing language (temporarily) and the mix of prais/info/correction that turns so many people off and is so hard for peopel with language difficulties.Theoretically, anything that marks the momnet when the desired behaviour has occured will do.I know of deaf people with whom a light is used or others who have a physical touch used (lovely footage on the website of a girl terrified of dogs learning to cope with being with one by adopting a non agressive stance.someone behind her touches her shoulder when she gets it right. They can't use a clicker as the dog is clicker trained.

Anything that makes a clear sharp sound will do.Look on the Tagteach website.I got a pile from them but threy could come from anywhere.

More progress tonight - putting food on spoon and putting it to lips .

Wow!
Brilliant Sphil Junior!
Are you using oven chips as reinforcers or is it just relying on the tag?
What to me is also so liberatiing is that it frees the parent/staff member from exhausting demoralising constant hectoring that sometimes goes on. The verbal overload of praise/correction/guidance that comes out of the parent's/staff member's mouth is actually as aversive to them as it is to the child but they continue doing it as they know of no other way.
Freeing peopel up from that is wonderful.

Keep us updated Sphil!