(Click here or here for a glimpse of what it is like to eat with Gabe)
( You can click on the picture of the data to enlarge. After it is enlarged, place cursor on the bottom right of picture and a square will appear with arrows. Click on it to make even larger)
Now, what exactly does the data mean?
The whole process began with taking four preferred foods from four different food groups. These are foods that Gabe easy accepts on a daily basis.We began with doing a preference assessment. This enabled us to find out the most preferred out of the four foods chosen. It would be the first to slowly turn into table food. We took baseline data for 3 days to show statistically that Strawberry Banana Stage 3 baby food was indeed the most preferred.
Gabe's four foods are
1. Broccoli, Carrot, Cheese stage 3 baby food (BC in data),
2.Turkey Rice stage 3 (TR in data),
3.Strawberry Banana stage 3 (Target food or the food that will slowly turn to a real banana)
4.Pears stage 3
After 3 days of baseline data, we started with adding 1/4 mashed banana, no chunks, to the strawberry banana stage 3 baby food. Gabe is seated in an educube across from the person delivering the food and a VCR that he can view, along with a very powerful food reinforcer (wheat free cookies with sprinkles. He's allergic to wheat). It begins by taking data on each food presented. Each of the four foods are presented 5 times in groups of four, the target always rotating within those four foods. He is scored on six different categories, Accept, Expulsion,Negative Vocalizations, Disruptions,Self Injurious Behavior and Gag/Vomit. Have I lost you yet?
The only time the VCR is turned on is when he "accepts" the TARGET food only. (The banana) He is given 5 seconds to accept (He is told to open as the spoonful is presented) If he accepts within 5 seconds, it is recorded as "accepted". He has 30 seconds to "accept" the food. The quick
er he accepts the TARGET food, the longer he gets to watch the video within the 30 seconds and he gets a little cookie. The other 3 foods, when "accepted" are followed by smiles, cheers and arm rubs. We do everything possible to make it comfortable. We also make it so that when he eats a banana, he is treated like a king and the will to get those reinforcers, like the Dora video for 30 seconds and a cookie, has more worth than the need to scream and pull away created by the anxiety that he associates with table food. Gabe's Banana blends have increased over the course of this past week. Today he graduated to a banana cut up in small chunks. He did it 5 times with out any Negative Vocalizations (Screaming "No!"), Disruptions (Putting hands in way of food being presented),Self Injuring Behavior(Hitting himself or others) or Expulsions (Vomitting or letting food roll off of tongue)!!! When he accepts at 80% at school, then we will continue at home for every meal. We will be taking data, video taping and buying a lot of bananas for awhile. Then we will move onto Pears stage 3, since it was the 2nd preferred food . Small and very few chunk's of mashed pear will be added until he graduates to pieces of pear. Each of the four foods will graduate to a "table food", Broccoli, Cheese, Carrots stage 3 baby food will become cooked broccoli or just cooked carrots.
One behavior we did notice with Gabe and his eating, is that he has a texture issue. He does not chew the banana, but tries to swallow it whole. If you notice from the data, Gabe gags every time he eats the banana chunks. He can chew French fries, chips, popcorn and other assorted salty snacks, therefore he does not have a "chewing issue" per se. We have also had him evaluated by an Occupational Therpist that concluded it was not a physical challenge to eat.I think eventually he will graduate to chewing the banana, but now he swallows it whole in order not have to deal with the texture. I sit beside him saying "Chew Gabe! (smile) "Like this, yum, yum, yum!" acting like Cookie Monster.
Here is the procedures for Gabe's Eating program. It will help explain the data a little more. (Click on the picture for a larger view, then on square with arrows) I am, by no means, saying this will work for all kids with eating difficulties. I also want to state that I have not, nor do I know, all that encompasses an eating program as such. I have not yet seen what happens if he does not except. I have an idea, because I have read the research that this program is based on and am well informed due to the very professional and certified staff that run Gabe's eating program. I wanted to show what an eating program can look like. The world of eating disorders is very "Hush Hush." Occupational Therapists, which most of us use for our children's eating problems, are not trained very well when it comes to difficult eating issues, nor do they provide the intensity and consistency that is needed for a successful eating program. I also found that they could not give me a concrete idea of the steps we needed to take to get Gabe to eat. It was more like, "Let's see if he eats this." At Gabe's ABA School, his program occurs every day (5 days a week), at the same time and will occur 3 times a day, every day at home. This is something that would be hard to schedule and maintain with a regular Occupational Therapist. Gabe has professionals that are not Occupational Therapists, but are certified Behavioral Therapists and certified in ABA with an extensive background in Autism. If he had more of a medical problem that physically prevented him from eating, an Occupational Therapist would be ideal to consult with and possibly an intensive inpatient eating program would be needed.
There is little information out there, books and internet, that go beyond explaining what causes an eating disorder. I read enough books and sites on the internet to fully understand the basis and reasoning in Gabe's mind about WHY, I so desperately needed the HOW. How can I get my son to eat? He can not survive on baby food alone. I feel very strongly that Gabe is on his way. I will forever smile at the sight of a banana.
