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Increasing Healthy Eating with ABA Therapy for Children with Special Needs

March 1st, 2016

Meredith Kimener, B.A., BCaBA, Junior Behavior Consultant at Continuum Behavioral Health. At Continuum Behavioral Health, their mission is to collaborate towards discovering the best way to ensure each individual’s right to meaningful participation within their community, and most of all, to assist every learner in reaching their highest potential. They are expanding the availability and access to culturally-sensitive behavioral health services for individuals living with autism, behavioral disorders, learning differences, and other developmental disabilities through high-quality, individually programmed/designed behavioral health services. Fitness for Health is a proud partner of Continuum Behavioral Health and their seamless continuum of care starting with diagnosis and extending through assessment and treatment. Enjoy! ______________________________________________________________ I started providing ABA therapy to children with special needs about 6 years ago.  Now, I am a certified behavioral consultant at Continuum Behavioral Health, and my job is to help children who have behavioral problems including noncompliance, aggression and food selectivity.  So of course when I became pregnant with my first child, I thought parenting would be easy for me.  I am a professional, and I work with kids for a living.  Fast forward two years, and my son is sitting at the dinner table refusing to eat his vegetables with a pile of peas thrown on the floor. If you have a selective eater, you know how difficult it can be to get your child to eat healthy foods. Many nights I feel like a short order cook, making multiple meals to appease everyone.  My children’s nutritional needs are always a main focus of mine, and I am constantly trying to increase their tolerance of healthy foods.  After too many nights struggling with my own children during dinner, I have started to use ABA strategies to encourage healthy eating. ABA (applied behavior analysis) is a therapy proven to help children with Autism Spectrum Disorder, however, it is effective with everyone. A book often used as a reference for behavior analysts [Coooper, Heron, and Heward (2007)] defines applied behavior analysis as “…the science in which the principles of the analysis of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variable responsible for behavior change.” So what does that really mean, and how can every parent use this?  The main principle used is positive reinforcement, which is rewarding a behavior so that it occurs more frequently in the future.  Therefore, if I want my son to eat more healthy foods, I need to reinforce him by giving him a reward for eating those foods. Here are a few tips for increasing healthy eating in children with special needs:

  1. Introduce slowly – when introducing new or non-preferred foods, take it slow to avoid aversion. Start with one non-preferred food, and stay with that until your child tolerates it easily.  First, just require the food to be on your child’s plate so they become accustomed to seeing it.  Second, have him simply touch the food with a finger.  Third, have him lick the food, but not chew or swallow.  Fourth, have him take one bite and swallow.  Then add more and more bites as he tolerates the food.  Remember to move slowly through these steps.  You may be able to move through all five in one night, or you may need to do one step for one or more nights.  It depends completely on your child.
  2. Provide choices – allow your child to make as many choices as possible while eating. Choices allow your child to feel more in control of his or her environment and create ownership over the food, even simple choices.  You can let your child pick the plate, utensil, drink or vegetable.  I always present choices in pairs, as providing too many choices can be overwhelming.  For instance, as I am getting dinner ready, I show my son two different options of each and let him choose: blue versus red plate, big versus little fork, green versus yellow straw, peas versus carrots.  He does not have the choice to eat, that is required, but allowing him to choose other things allows him to feel more in control.
  3. Use momentum – when presenting foods that are not preferred, pair them with preferred foods. If I am trying to get my son to eat his peas, I will have macaroni and cheese and chicken, both preferred foods, on the plate as well.  Then I use momentum to get him to eat his peas.  So I have him eat a bite of the most preferred food (macaroni) first because that is the easiest to consume, then a bite of the chicken, then a bite of peas (I might suggest going straight from the highest preferred to the non-preferred?).  I use the momentum of eating the more preferred foods to help me get him to eat the more difficult foods.
  4. Model eating – have everyone at the table eat the healthy foods that you want your child to eat. Family style dinners are extremely effective at getting your child to eat healthy foods.  One option is to put the food on platters so everyone serves themselves.  If your child scoops the non-preferred food onto his plate they may feel they have ownership over the food.  Then have everyone eat the non-preferred food to model how to eat the item.
  5. Give rewards – reward your child every time he attempts or successfully eats the non-preferred food item. Every time my son eats a pea, I make a big deal out of it and have a mini party for him.  This gets him very excited and makes him want to eat more.  I also use a token board for him to work up to earning a reward for eating a specific amount of the non-preferred food.  A token board can be very simple.  I use a piece of construction paper cut into a long rectangle and stickers.  For every bite he takes of peas, he gets one sticker.  Once he gets five stickers, he earns a fruit snack.  Then I start over, and work back up again until all of the peas are gone.  You can use this in conjunction with the behavior momentum stated above.  The token board is a visual representation of how many bites he needs to eat in order to earn his reward.  Here is an example (my son loves Curious George and fruit snacks):
[caption id="attachment_1666" align="aligncenter" width="300"]Increasing Healthy Eating in Children with Special Needs Sample Reward to Help Increase Healthy Eating in Children with Special Needs[/caption] Getting your child to have healthy eating habits can be difficult and take time.  So many times I hear parents say “I just want him to eat his vegetables!”  Well that is like your employer saying “I just want you to work for free!”  We expect to be rewarded when we do something well, so why should we expect anything different from children?  We all enjoy being praised and rewarded for doing a good job, especially children.  So continue to give praise and reinforcement for your child’s healthy eating habits. If you have serious concerns about your child’s health or eating, always seek advice from your child’s pediatrician and also consult their doctor before making any major changes to their diet. About Fitness for Health: A finalist for About.com’s Readers’ Choice Award for Best Special Needs Resource in the D.C. Region, Fitness for Health, founded by Marc Sickel who also suffers from ADD, specializes in creating personalized, therapeutic programs for children with a broad range of special needs. At Fitness for Health, you get a complete team—including pediatric fitness specialists, physical therapists, and occupational therapists—working together to create a full-service plan of care that’s expertly tailored to your child’s developmental, skill and comfort levels while providing fitness for kids. As a parent, you’re involved every step of the way.  Learn more about our therapeutic exercise, occupational therapy services, and physical therapy services today.]]>

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