Texture Progression
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Transcript of Texture Progression
S H A R O N M . G R E I S , M A C C C / S L P , B R S - S
S T E P H A N I E M . H U N T , M S , O T R / L
Texture Progression: The Effects of Oral Sensory Defensiveness on Oral
Motor Function in ASD
Or
The effects of Autism on a child’s ability to tolerate the sensory properties of food
The effects of neurological, cognitive, sensory, and biobehavioral differences on a child’s ability to advance feeding and oral motor development
The manifestation of ASD symptoms on eating behavior and advancing texture
( Twachtman-Reilly, Amaral, & Zebrowski, Apri, 2008)
At the end of this session the participant will be able to:
Define the nature of feeding disorders in children on the spectrum
Discuss the specific presentation of feeding difficulties that are typically experienced by children on the autism spectrum
Discuss the factors which influence the normal progression of texture
Identify the oral sensory motor patterns and feeding problems of children on the spectrum
Explain intervention strategies to progress food texture acceptance and functional manipulation
International Classification of Functioning, Disability, & Health (ICF)
World Health Organization developed a framework for coding functional status
Benefits for SLP’s and OT’s working with children with feeding and swallowing problems
ICD and ICF codes are complimentary
ICD codes classify health conditions
ICF codes classify descriptions of the impact of health conditions on function
And ICF classifies severity of deviation from normal
(Lefton-Greif & Arvedson, 2007)
Nature of Feeding Disorders in ASD
Neurobiological differences of children on the autism
spectrum
Restricted range of foods
Food refusal behavior
Utensil requirements
Stringent mealtime requirements
Unusual eating behaviors (food cravings & pica)
Typical Atypical
Reflexive suck
Vocal play
Oral exploration
Sensory modulation
Progression of liquid, smooth food, soft solid food and table food
Intact constitutional capabilities
Impaired sensory modulation (sensory seeking, sensory avoidance)
Aversion to oral care and absence of oral exploratory phase
Sensitivity to taste, texture, smell, sight of food
GI disorders (GER)
Factors which Influence Feeding Development
Eating abnormalities may include:
Mechanical eating
Gulping, shoveling, stuffing food
Not chewing
Throwing food
Spitting or vomiting
Avoidance of utensils or food to lips
Excessive fads or refusals
Holding food in the mouth for long periods
(Stroh, Robinson, & Stroh, 1986; Arvedson & Brodsky,2nd edition 2002)
Atypical Oral Sensory Experiences
49% of children with ASD were orally defensive.
67 % of children with ASD were described as picky eaters.
69% had difficulty with texture progression
30% of the parent’s of children with ASD described the impact of sensory processing and mealtimes as negative
17 of 30 children with ASD selectivity for food type or texture
DeMattei, Cuvo and Maurizio (2007), Williams, Dalrymple, and
Neal (2006), Dickie, et al. (2009), Ahern, et al. (2001)
Sensory Food Aversion
A. Refusal to eat certain foods with specific taste, temperature, smell for at least one month.
B. Onset occurs with introduction of a new or different type of food
C. Aversive response and refuses all similar foods
D. Refuses all newE. Dietary deficiencies, oral motor or
speech delay or avoids participationF. No traumatic event to oropharanxG. Not related to GI or food allergies
(Chatoor, 2009)
Hyper-sensitivity Hypo-sensitivity
Oral Tactile
Negative response to specific textures
Aversions to use of feeding tools
Dislikes messiness around mouth
Olfactory and Gustatory
Prefers bland foods
Smells elicit vomiting
Extreme selectivity
Gagging
Food refusal
Oral Tactile and Proprioceptive Pocketing in cheeks or buccal
cavity Swallowing whole pieces Lengthy chewing Choking or vomiting Atypical chewing patterns Poor bolus formation
Olfactory and Gustatory Food holding Prefers crunchy and highly
flavored Disinterested in eating without
enhancement of smell
Oral
Sensorimotor Behaviors
Is it motor or sensory difficulties?
Gagging
Drooling
Tooth grinding
Immature spoon feeding skills
Immature cup drinking skills
Immature biting & chewing skills
Sensory Motor
Sight of food
Smell of food
Taste of food
Delay in chewing development
Premature swallowing
Atypical pattern of bolus transit
Gagging
Sensory Motor
Decreased oral awareness
Open mouth posture/ Low muscle tone
Inattention to the task of eating
Absence of chewing: need for sensory input to tempo-mandibular joint
Drooling and Tooth Grinding
Sensory Motor
Aversion to touch
Avoidance of molar surfaces
Food texture preferences (soft smooth)
Intact ability to initiate the task
Motor planning difficulty
Intact ability/potential to manipulate food/liquid
Immature Feeding Skills
Holistic Approach to Specific Needs of ASD
Eating Sensory
ProcessingOrganic
Learning and Behaviors
Developmental
Skills
Oral
Sensorimotor
Communication
General Guidelines for Holistic Treatment
Gradual and slow changes
Match child’s developmental level
Acknowledge sensory responses and treat respectively
Begin supportive mealtime practices as early as possible
Offer new foods at snack time or during therapy
Create a positive learning and communication environment
(Morris & Klein, 2nd edition, 2000)
Dynamic Assessment Drives the Treatment
Swallowing whole pieces
of food
Modify food texture to chopped
present in smaller pieces
Pocketing food/delayed oral transit
Increase sensory
properties of food
Pacing of bites
Visual and Verbal cues
Refusal to accept
modifications
Reduce the demand
gradual, subtle
changes
Oral Sensory Treatment Strategies
Gustatory
Cooking (gradual introduction to smells)
Learn to label smells as possible flavors
Proprioceptive
Chewing on non-food items
Facial expressions (muscle movement)
Tactile
Firm touch with wiping face
Oral care
Increased positive touch (songs, etc.)
Oral Motor Tools
Oral Sensory Exploration
Utensil choice
Cups
“ E F F E C T I V E I N T E R V E N T I O N F O R S T U D E N T S W I T H A S D I S D E P E N D E N T O N A N
U N D E R S T A N D I N G T H A T T H E B E H A V I O R O F T H E S E I N D I V I D U A L S I S T H E R E S U L T O F A
C O N S T E L L A T I O N O F N E U R O B I O L O G I C A L I M P A I R M E N T S R A T H E R T H A N W I L L F U L A C T S O F N O N C O M P L I A N C E ” . D I R E C T T R A I N I N G I N
T H E U S E O F T H E I N T E R V E N T I O N T E C H N I Q U E S D I S C U S S E D I N T H I S
P R E S E N T A T I O N W I L L H E L P T O F A C I L I T A T E T H E P A R T I C I P A T I O N O F T H E S E C H I L D R E N I N
B O T H T H E A S S E S S M E N T A N D T H E R A P E U T I C P R O C E S S .
T W A C H T M E A N - R E I L L Y E T A L , 2 0 0 9
In Conclusion
References
Ahearn, W.H., Castine, T., Nault, K., and Green, G. (2001). An assessment of food acceptance in children with autism and pervasive development disorder-not otherwise specified. Journal of Autism and Developmental Disorders, 31 (5), 505 -511.
Dickie, V. A., Baranek, G. T. Schultz, B. Watson, L.R., and McComish, C.S. (2009). Parent reports of sensory experiences of preschool children with and without autism: A qualitative study. American Journal of Occupational Therapy, 63, 172-181.
DeMattei, R., Cuvo, A. and Maurizio, S. (2007). Oral assessment of children with an autism spectrum disorder. Journal of Dental Hygiene, 81(3), 1-11.
Ernsberger, L. & Stegen-Hanson, T. (2004). Just Take A Bite. Arlington, Texas: Future Horizons, 83-100.
Fischer, E. & Silverman, A. (2007). Behavioral Conceptualization, Assessment, and Treatment of Pediatric Feeding Disorders. Seminars in Speech and Language, Volume 28, Number 3. 223-231.
Lefton-Greif, M. and Arvedson, J. (2007). Pediatric Feeding and Swallowing Disorders: State of Health, Population Trends, and Application of the International Classification of Functioning, Disability, and Health. Seminars in Speech and Language. Volume 28, Number 3. 161-165.
Linscheid, T. (2006). Behavioral Treatment for Pediatric Feeding Disorders. Behavior Modification, Vol. 3, No. 1. 6-23.
Scheerer, C.R. (1991). Perspectives on an oral motor activity: The use of rubber tubing as a “chewy”. American Journal of Occupational Therapy, 46 (4), 344-352.
Twachtman-Reilly, J., Amaral, S., and Zebrowski, P. (2008). Addressing Feeding Disorders in Children on the Autism Spectrum in School-Based Settings: Physiological and Behavioral Issues. Language, Speech and Hearing Services in Schools. Vol. 39. 261-272
Williams, P. G. and Neal, J. (2000). Eating habits of children with autism. Pediatric Nursing, 26 (3), 259-264.
Thank you!
Questions?
Sharon M. Greis
Stephanie M. Hunt