Eating
Possible issues
- limited range of foods in diet
- refusal to sit with others
- messy eating
- eating others' food
- over-eating
- exhibits problem behaviours during meal times
- Pica (eating, chewing or mouthing non-food items).
Possible reasons for issues developing
- sensory processing differences: resistance or reaction to specific and or new textures, tastes, smells and colours
- eating time may be busy, very loud, overly stimulating and or overwhelming
- flexible thinking: resistance to new or different foods and routines
- executive functioning: unaware of how much to eat, how to choose foods, how to organise self and equipment
- eating times can be very busy and yet unstructured which is overstimulating for some students; challenging behaviour usually indicates an attempt by the student to communicate that something is wrong with the situation.
Suggested strategies and tips
- teach skills to request assistance
- use desk or table map to indicate where to sit, put drink bottle, lunch box etc and where the student's personal space begins and ends
- have separate lunch boxes for morning tea and lunch so student does not have to decide what is lunch food and what is morning tea food
- manage (limit) group size whenever possible such as allowing student to start eating earlier than others or sit in a quieter area
- limit sensory input (movements, noise and smells) as much as possible by staggering transitions and other movements and sitting in smaller groups
- trial using cut tennis balls placed over the bottoms of chair legs or mats to absorb chair scaping and other movement noises
- explicitly teach social rules of eating: sit at the table, eat from your lunch box, clean up mess, pack away
- check for any medical or medication issues that may affect diet
- individual concerns regarding an excessively limited or restricted diet may benefit from support from an occupational therapist and or speech-language pathologist with experience with students with ASD
- Pica generally is best managed by providing the student with something else to do: chew a pencil chewy, play on the slide not in the sand pit, and have crunchy crackers for a snack (teaching the student to learn to choose which items are for eating and which are not generally has varying results depending upon the student's ability to understand this concept).
Toileting and personal hygiene
Possible issues
- soiling or wetting pants
- resistance to using school toilet
- unable to request toilet
- awareness of personal hygiene issues such as washing hands or eating food from floor.
Possible reasons for issues developing
- sensory processing differences: resistance or reaction to specific and or new smells sounds (echo, hand driers) and sights (bright lights, reflections)
- bathroom areas may be busy, crowded, and noisy
- flexible thinking: resistance to new or different routines and environments
- executive functioning: planning and reasoning skills may be irrational or illogical.
Suggested strategies and tips
- determine if the student is aware when they soil or wet their pants; if so, they may benefit from being taken to the toilet at regular intervals in order to 'catch them' using the toilet successfully
- regular toileting may be represented on an individual timetable or schedule
- use video modelling such as
Are you ready? A toilet training package.
- manage (limit) group size whenever possible such as allowing student to go to the toilets when they are not crowded or busy
- teach the skills to request assistance and to go to the toilet; use a symbol or photo as a prompt or as an alternative method of requesting the toilet
- teach the student to go into the toilet area by providing an incentive to do so - "Look at the toilets first, then go to swing" - without the expectation that they will use the toilet; progressively increase demands e.g. wash hands only, sit on toilet and wash hands etc
- use a story-based intervention to teach alternative behaviour (using the school toilet)
- individual on-going toileting concerns may benefit from the support of an occupational therapist
- use a list to prompt student of all steps (including washing hands and flushing toilet)
- explicitly teach personal hygiene and social rules such as binning or washing found that has touched the floor.
Getting organised to go out to play
Possible issues
- packing away lunch box
- wearing a hat
- lining up.
Possible reasons for issues developing
- executive functioning: planning, organising and prioritising skills may be ineffective in some situations so it can be difficult for the student to know what to do first
- flexible thinking: resistance to new or different routines such as wearing a hat
- wearing a hat can often be 'the last straw' in a line of verbal instructions the student has had to comprehend and follow in a noisy and busy environment, so avoiding this may be an indication the student is stressed, overwhelmed and has reached their limit
- sensory processing differences: lining up can be invasive (touch, smells, noisy); the hat may feel different; and eating areas and movements can be busy, noisy and confusing.
Suggested strategies and tips
- provide
visual cues (list, schedule, next activity prompt)
- ensure
routine is clear, simple and predictable
- provide more structure (limited choice, list of jobs, set place to sit, painted line to line up along), during unstructured time if difficulties arise
- use routine cues such as set songs to indicate task e.g. song to put hat on
- have two bags: one for extras (spare clothes, swimming gear etc that does not need to be unpacked); one bag for main (lunch box, drink, book, hat) so it is easy to locate /pack away equipment
- allow the student to be at the front or back of the line to avoid having to touch or be touched by others
- stagger or modify the time the student goes out to play to minimise
sensory issues and to provide more structure
- when specific issues consistently arise such as refusal to put lunch box away, provide a
reward for compliance to give the student a reason to change their behaviour; use simple language such as "Lunch box away, then car to take outside"
- use a 'finished box' to pack up items (see
packing up and finishing tasks).
Further information
More suggestions for developing toileting independence may be found in the families section.
For information about occupational therapist and or speech-language pathologist read The role of allied health professionals.