**I have been completely MIA and totally slacked on keeping up with this blog. But I’ve been re-inspired and am ready to let these words flow through my fingertips and into this space again.**
Over these past few months my life has taken a turn in a new direction, one that I am very happy and grateful for. I was recently accepted into an Occupational Therapy Assistant program at Stanbridge College. It is one of ONLY four OTA programs in all of California. With the field expected to grow by 40% over the next ten years the demand for practitioners is very high. With a high demand and very low supply, the available programs that are near me were completely impacted! I’m talking a three year waiting list just to get into a program at the local community college and completing all sorts of prerequisites just to be considered (and no guarantee of acceptance). I’m lucky to have found Stanbridge and have been able to get this process moving a long quickly! The overwhelming benefits I saw from joining such a vibrant and evolving field and the intrinsic need I have to learn as much about care (mental and physical health) in order to best serve the needs of my brother has led me here. I have just completed Anatomy and Physiology and I have to say I have a brand new respect and fascination with the human body. Every system interacts with one another to create a unique and complex being. Every individual that lives and breaths in life is a miracle and should be treated as such. It has been an intense beginning to the program but I have learned A LOT and am hungry for all the knowledge I will be gaining over the next couples of years!
Speaking of hungry…
Let’s talk about Feeding, Eating, and Swallowing management (in OT terms 😉 haha) As you may know, eating is a highly complex multisystem skill that we often take for granted. So, it makes sense the causes of feeding disorders are often multifaceted. Feeding disorders are often not due to one variable alone but to a complex interaction of both biologic and psychological variables. In fact, research has shown that most feeding disorders can be characterized by medical, oral-motor, or behavioral problems.
Like many behaviors that Eric displays, I did not realize how dysfunctional his eating habits were until I started to understand autism and began looking at EVERYTHING in terms of “behaviors.” My training in Applied Behavior Analysis was the first thing that got me thinking about how important intervention would have been in managing Eric’s eating habits when he was younger.
Eric endured a minor heart surgery when he was 18 months old and right after that he eliminated everything but pasta, yogurt, and applesauce. I can remember opening the refrigerator and seeing stacks on stacks of yogurt, large ziplock bags full of noodles and marina sauce, jars of applesauce, and of course a grip of juice boxes filling the doors and shelves. Up until that surgery, he would eat some fruits like peaches, bananas, cantaloupe. He also ate rice, pretzels, french fries and chips!
Eric would alternate between the three and also enjoyed a special oats, yogurt, and powder multivitamin concoction for breakfast. Because his speech was so limited my dad thought it might be a good idea to undercook the pasta to make it harder to chew so that it would strengthen his muslces in his mouth. But after 3 or 4 days of uncooked pasta he refused to eat it at all. Remember, Eric is pretty much non-verbal (he can’t communicate by talking) so we really had no idea why he cut out so many foods.
As Eric grew from childhood into his teenage years, his body started to grow and change a long with his appetite. Currently, Eric eats FOUR large tubs of yogurt daily with ease, and now if my parents give him half of the tub of the big yogurt and put the rest away in the fridge, he will wait until they are gone and not looking to retrieve it himself, eat the other half of the tub, and then sneakily replace the EMPTY container back into the fridge for my parents to find hours later!! Sneaky eh!? Another example of the unleashed intelligence he’s got going on in that head. He knows what he is doing.
My brother didn’t go into the refrigerator by himself for years when he was hungry or thirsty to retreive his yogurt or juice. He would wait in his chair at his table until someone brought it to him until VERY recently and only under those certain circumstances does he actually go and get his food. Usually a spoon is given to him but he can feed himself. From there he could open the cups or tubs and usually put his straw in the tiny juice box hole (although that skill took a little while to master and sometimes he struggles).
When he finishes his meal he will leave his dirty bowl, yogurt cups (except the ones he sneaks back), and juice box trash on the table. Those items MUST stay there until his bedtime! ONLY then can he throw his trash away and place his bowl in the sink. If anyone attempts to change up that routine. He will be very frustrated and get everything out of the trash and the sink and put it back.
As far as eating as a social experience… Eric’s eating habits have affected the way our family experienced mealtime. Eric has a specific seat he HAS to sit in. And don’t even think about sitting in his chair, you’ll get booted! I’ve seen it happen before haha. When we went out to eat we always bring a lunch box full of little yogurts and tell the waiters when they ask that he eats special food.
So let’s review a little bit and talk about these behaviors…because after all, I’m trying to learn why Eric has developed these habits and how we can potentially help him! I’m going to do a little behavior analysis for you.
Behavior: Is not willing to try new foods.
Eric has A LOT of trouble with any transition and needs routines to feel calm SO as new foods were being introduced…Eric’s anxiety shot up! When Eric cried and screamed and threw his food or refused to eat (I’m talking refusal for hours, OR days) … that non preferred food was taken away and replaced with something we knew he would eat. SO what did he learn and what did my parents learn!?
The food refusal is reinforced because he was rewarded by getting access to the better tasting food (yogurt) AND he got more attention for it. My parents learned that Eric wouldn’t eat unless the yogurt was offered so they began to only offer the yogurt (but worried).
Behavior: Selectively by texture
It’s obvious that Eric prefers soft, pureed food. He will drink anything! He loves smoothies and milk shakes! Anything with a texture is a no-go.
We have gotten him to lick some chocolate and frosting on birthday cakes. Yep, that’s right. Eric LOVES birthday’s!! His favorite part is blowing out the candles. When we were little he would never wait for us to finish singing “Happy Bithday” before he blew them out! Oh and it did not matter who’s cake it was. Eric would usually make it his job to put out any candle in front of him. You can only imagine the reactions he got from classmates, cousins, and his little sister!
I’m really not sure there is much we can do about Eric’s eating dysfunction. Besides juicing fresh fruits and vegetables and continuing to get him multi-viamins in his oatmeal. Yogurt has been Eric’s one and only for thirteen years. Yogurt makes him happy.
I recently sat and ate a meal with him and watched the smile light up his face when his tummy was full. He was hamming it up for the camera and there’s nothing better then that face!