1. Facilitating Successful Mealtimes Kelly Milne Occupational Therapist Therapy and Clinical Services

2. “One of the more common myths about eating is that it is easy and instinctive. Eating is actually the most complex physical task humans engage in. It is the only physical task that utilizes all of the body’s organs: the brain and cranial nerves, the heart and vascular system, the respiratory, endocrine and metabolic systems, all of the muscles of the body and the entire GI tract. Swallowing alone requires the co- ordination of 26 muscles and six cranial nerves.” Kay Toomey, PhD Director of Colorado Paediatric Therapy and Feeding Specialists

3. Outcomes To explore the key characteristics of Autism that directly impact successful mealtimes To discuss a framework around which to identify contributing factors impacting on mealtimes for your child with Autism To discuss practical strategies to support the child with Autism in your setting

4. Mealtimes in an Early Learning Environment During morning tea or lunch time, children are required to: Eat the food provided by the centre Sit at the table close to their peers Share food from a shared platter Ask for what they want or need Ask for help or tell you they don’t feel hungry Feed themselves using cutlery Talk to their peers Tolerate smell and taste of the food they are given Eat at given times

5. Mealtimes & Autism Common difficulties Limited or restrictive diet Limited food categories Difficulty sitting at the table Distress during mealtimes or when trying new foods Unable to communicate needs Tolerating different environments and associated activities Picky Eaters versus Problem Eaters

6. The Mealtime Pie

7. Social Communication Expressive communication Receptive communication Social understanding Emotional response or anxiety

8. Behaviour and Thinking Style Predictability Generalising skills between environments Restricted interests Attention and planning Theory of mind Visual learners

9. Sensory Preferences Environmental impact Food preferences

10. Motor Skills Core stability and strength Hand-eye coordination Fine motor skills Oral motor

11. Additional Factors Medical Nutrition Culture

12. How Do We Get Started?

13. Make Mealtimes Positive Comfort Routine Predictability Supportive environment Stay calm and positive Celebrate the small achievements Visual supports Provide choices

14. Predictable Routines Same time of the day Consistent routine every session Repetition with small changes

15. Supportive Environment Positioning at the table and in a chair Distractions around the room Motivating plates Non-slip mats Movement cushion Easy grip cutlery

16. Visual Supports

17. Food-based Activities Most early years learning programs include valuable food-based activities such as: Pretend play with food items Food themed songs and stories Grow a vegetable garden Potato stamping Raw pasta necklaces Children with Autism may need more opportunities and different strategies to explore food.

18. Identifying the Challenges

19. Creating a Plan Use checklist to select a priority area Create a goal – Start with something that will be achievable for both you and the child – Introduce the goal during a time when the child is most likely to cope and be successful – Decide on a time frame to reassess the progress

20. Introducing New Foods 12 steps to acceptance Activities for acceptance Food pyramid Food pass the parcel Cooking books Grocery shopping Grow a garden Looking plate Helping / Watching cooking Food matching games Watching cooking programs

21. Introducing New Foods Food chaining – A list of foods that have the same features as the foods your child currently eats – Only change one thing at a time, e.g., shape, brand, colour, texture – It may take up to 20 presentations of a new food for a child to accept it!

22. Structured Program at ASELCC Children should feel safe enough to have fun Food exploration vs cooking 5 week food focus WatchGive it a goTry moreBy myselfWhat else?

23. Take-home Messages Keep mealtimes positive and fun Observe the environment Introduce whole group strategies Keep expectations realistic Introduce new foods slowly Don’t force a child to eat Remember: A child with Autism probably wont ‘eventually eat’ just because they are hungry In a school environment families may need support