Foods/Eating

The long-term goal of expanding the amount and varieties of foods that your child eats can be challenging for many reasons. Many children with ASD experience eating difficulties as the result of sensory issues (for example, your child may refuse to eat eggs because they do not like the texture), or distractions at mealtime. This can manifest in several ways, including a strong preference for certain types of food, limiting the types of foods eaten to particular categories, textures, or tastes, or an unwillingness to try or eat an entire category of food, such as dairy products. These eating challenges can result in deficiencies in nutrients, slowed physical growth and development, and dental problems, among other things. By helping your child master the short-term goals of identifying edible vs. inedible foods, touching new food to lips, and introducing a new food / expanding their food tolerance, it may be possible to work towards mastering the long-term goal of expanding the amount and varieties of foods that your child eats. This may also help to prevent or reduce mouthing on inedible objects or materials, which can result in choking or ingesting something harmful. 

Identifying edible vs. inedible foods. In order to help your child work towards mastering the long-term goal of expanding the amount and varieties of foods that your child eats, you may want to start by helping them work towards mastering the short-term goal of identifying edible vs. inedible items. To help your child identify items that are edible and those which are not, try the following:

• Use visual aids. Use flashcards or printed images. You can make your own, or use some of the free resources below. Whatever images you choose to use  should be a mixture of edible and non-edible items with a single item on each card for simplicity. Go through several examples with your child in which you provide a prompt. For example, you may start by showing your child a picture of an apple and saying “Apple. Eat.” followed by an image of a bicycle and saying “Bike. Don’t eat.” After you have gone through several examples, show your child a new image and state what it is. For example, you can say “car” while you hold up an image of a car. Wait a moment or two to see if your child will respond appropriately by saying “Car. Don’t eat,” or something similar. If your child does not respond without a prompt, say “Car. Don’t eat.” If your child responds incorrectly by saying “Car. Eat.” or something similar, gently say “No. Car. Don’t eat.” When your child correctly identifies something that is edible or inedible, provide positive reinforcement and praise by saying something like “Yes! Apple. Eat!” If you have a real apple available,  immediately provide your child with a piece of the apple, and demonstrate the relationship between the image of the edible apple and the real apple by eating a piece of apple yourself. Alternatively, if the reinforcer for the behavior is a tangible item besides a piece of an apple, such as a different small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behaviors to be supported solely by social reinforcement.

Food flashcards | LearnEnglish Kids (britishcouncil.org)

Everyday objects flashcards | LearnEnglish Kids (britishcouncil.org)

Food - Super Simple

• Practice at mealtime. You can set your dining area with edible and non-edible items at mealtime to practice identifying food and non-food in a natural setting. Provide prompts as you pick up and show your child various items by asking “Eat?” When your child answers correctly, provide positive reinforcement and praise and give your child the item that they have correctly identified as edible (or a small piece). If your child answers incorrectly, gently say “no,” identify the item by name (for example, you can say “book” if you are indicating a book). Then say “Book. Don’t eat.” Try to avoid the use of non-edible props that may be confusing for your child due to their association with eating initially, such as utensils and napkins.
• Make it fun. Use a song or video to begin or accompany identifying edible vs. inedible items (see below). Alternatively, find or make bingo sheets with edible and inedible items and cards with an image that depicts a person eating. Have your child place the cards on the edible items until they get a Bingo! If your child selects incorrectly, remove the card from the sheet and indicate what the item is, and provide a gentle correction. When your child gets a “Bingo!” provide positive reinforcement, praise and a reward. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behaviors to be supported solely by social reinforcement. 

Edible vs Inedible. Kids song | Mike and Alice World

TOGETHER WITH POLLY-EDIBLE OR INEDIBLE (EDUCATIONAL CARTOON FOR KIDS)

For the short-term goal of identifying edible vs. inedible foods, you can choose a target such as distinguishing between a group of foods vs. a group of toys or specific edible foods (e.g., a carrot) vs. specific inedible foods (e.g., candle wax).

Identifying Edible vs. Inedible Foods

Step 1: Select the item(s) that you would like your child to practice identifying as edible/inedible. For example, you can choose the target of distinguishing between a carrot as an edible item and candle wax as an inedible item while working on the short-term goal of identifying edible vs. inedible foods.

Step 2: A specific discriminative stimulus (SD) should be selected that will cue your child that the task is starting. This SD can consist of two pictures: a picture of food (i.e., a picture of carrots) and a picture of an inedible item (i.e., a picture of candle wax), as well as a verbal SD (i.e., “Which one can you eat?” or “Which one can you not eat?”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on what items were accurately identified independently. For example, you can count how many times your child is able to identify edible vs. inedible items independently in a given time interval (e.g., 5 min, 10 min, 15 min, etc.). As another example, you can count how many times in a row your child can identify edible vs. inedible items independently.

Step 4:  To begin the trial to monitor progress towards meeting the target (i.e., the target of distinguishing between a carrot as an edible item and candle wax as an inedible item), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, you can show your child the two corresponding images (images of carrots and candle wax) and say “I can eat these carrots! Yum! But I can’t eat this candle wax.”

Step 5: Collect data on how your child makes progress. For example, count how many times in a row your child can meet the target of distinguishing between a carrot as an edible item and candle wax as an inedible item independently. Alternatively, you can track progress by recording how long it takes your child to meet the target of distinguishing between a carrot as an edible item and candle wax as an inedible item independently. Or, alternatively, you can track progress by counting the number of successful attempts at distinguishing between a carrot as an edible item and candle wax as an inedible item during a session. 

Once your child has mastered the short-term goal of identifying edible vs. inedible items, next, you may want to help your child work towards mastering the short-term goal of touching new foods to their lips. Both of these short-term goals are important steps in helping your child work towards mastering the long-term goal of expanding the amount and varieties of foods that your child eats.

Touching a new food to lips. Many children with ASD experience eating difficulties as the result of sensory issues (for example, your child may refuse to eat eggs because they do not like the texture), or distractions at mealtime. This can manifest in several ways, including a strong preference for certain types of food, limiting the types of foods eaten to particular categories, textures, or tastes, or an unwillingness to try or eat an entire category of food, such as dairy products. This can result in deficiencies in nutrients, slowed physical growth and development, and dental problems. The short-term goal of touching new foods to lips can be an important step in helping your child become more comfortable with new textures, smells, etc., without needing to actually consume new edible items.

To help your child expand their diet by working towards mastering the short-term goal of touching new foods to their lips, try the following: 

• Caution! Some children refuse to bring certain foods near their mouth because they are allergic to a specific food item.  For example, while some children with ASD may not eat eggs because they do not like the texture of the eggs, other children may refuse eggs because they have an undiagnosed egg allergy. It may be the smell of the food that triggers an allergic child to refuse a specific food. Be mindful of potential allergens, and discuss with your child’s doctor whether it is safe to introduce a new food, especially if it is a known allergen (such as egg, peanut butter, soy, tree nuts, etc.).
• Introduce a single new food at a time. Choose the new food you would like for your child to try, and serve it with a meal every single day. Do not pressure your child to try the food, rather, wait patiently. It may take anywhere from days to months for your child to even decide to touch the food. If the food is large in size, cut it in smaller pieces. For example, if you would like for your child to try carrot, instead of placing a large carrot chunk on their plate, dice it or cut a few thin slices and place the smaller pieces on their plate. Be patient.
• Introduce the new food separately. Place the new food on a separate dish for your child. Alternatively, place a “discard plate” on the table, which can be the “no, thank you” plate, where your child can place any food they do not want. This way, your child will have to touch the food to remove it from their plate onto the discard plate, which may familiarize them with the texture of the food.
• Introduce the food at a different temperature. Some children find the temperature of a food to be overwhelming and discouraging. If possible, you can introduce the food at a different and safe temperature. It is important that the food is at a temperature that is safe for your child to touch and safe for consumption (i.e., no cold and raw meat, but cold and cooked meat is fine, and do not serve very hot food). For example, if your child likes room temperature yogurt rather than cold yogurt, consider if they may prefer different foods, such as oatmeal, at room temperature rather than hot or cold.
• Introduce similar textures. Choose to introduce a new food that is similar in texture to the food your child already likes. For example, if your child likes crunchy apples, try introducing carrots or celery sticks, since they are also crunchy.

For the short-term goal of touching a new food to lips, you can choose a target such as touching a grape to the lips, touching carrot slices to the lips, touching room temperature cooked ham to the lips, etc.

Touching a New Food to Lips

Step 1: Select the food that you would like your child to practice touching to their lips.  For example, you can choose the target of touching a grape to their lips while working on the short-term goal of touching a new food to their lips. The task analysis for touching a grape to their lips could be as follows: 

1. Place a piece of grape on a plate or in a bowl.
2. Touch fingers to the grape.
3. Pick up the grape.
4. Touch the grape to the lips.
5. Put the grape back onto the plate.

• Caution! Some children refuse to bring certain foods near their mouth because they are allergic to a specific food item.  For example, while some children with ASD may not eat peanut butter because they do not like the texture of the peanut butter, other children may refuse it because they have an undiagnosed peanut allergy. It may be the smell of the food that triggers an allergic child to refuse a specific food. Be mindful of potential allergens, and discuss with your child’s doctor whether it is safe to introduce a new food, especially if it is a known allergen (such as eggs, peanut butter, etc.).

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as a piece of grape, or a verbal SD (“Time to touch the grape to your lips!” or “Let’s touch the grape to our lips!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child is able to complete the entire task analysis independently during a set amount of time (e.g., 1 min, 2 min, 5 min, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of touching a grape to their lips), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to touch the grape and pick it up, then touch the grape to your lips, followed by placing the grape back on the plate).

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at touching a grape to their lips during a session. 

Step 6: Track how your child makes progress to meet the target of touching a grape to their lips by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at touching a grape to their lips over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.

Additional resources:

Autism and Food Aversion | Otsimo - “Sensory Foods List”

Food modifications - BeyondAutism‍

Once your child has mastered the short-term goals of identifying edible vs. inedible items and touching new foods to their lips, next, you may want to help your child work towards mastering the short-term goal of introducing a new food / expanding food tolerance. All three of these short-term goals are important steps in helping your child work towards mastering the long-term goal of expanding the amount and varieties of foods that your child eats.

Introducing a new food / expanding food tolerance. Many of the recommendations suggested to help your child with the short-term goal of touching new foods to their lips (above) can also be applied to the short-term goal of introducing new food to your child and expanding their food tolerance. In addition to the above ideas, to help your child expand their diet by working towards mastering the short-term goal of introducing a new food / expanding their food tolerance, try the following:

• Use food chaining to introduce new foods. Food chaining is a process where you use the knowledge of your child’s eating habits to expand the list of foods that your child will consume. Your knowledge of your child’s eating habits should include whether your child prefers specific brands, as well as what temperatures, colors, flavors, smells, and textures that your child prefers. For example, if your child likes to eat bananas, perhaps they will only eat bananas that are yellow with no brown spots, and the banana must be at room temperature and cut up into bite-sized pieces. Also, perhaps they like that bananas do not have seeds in them. Using this information, you can find foods that are similar in texture, temperature, and size for your child to eat. If your child finds the creamy, mashable texture of the banana most important, you can try bite-sized pieces of ripe avocado. If your child finds the taste of the banana most important but does not care about the texture, you can try banana chips.

Food Chaining Final (apsva.us)

If you have a picky eater, try food chaining - Orlando Health Arnold Palmer Hospital for Children

• Expose your child to new foods repeatedly and in different forms. Studies have shown that the most successful way to introduce your child to new foods and expand their food tolerance is to expose your child to a new food repeatedly over the course of many different meals, and to do so in different forms, if possible. This will be dependent on your child’s exposure to foods, their eating habits, and your knowledge of whether your child prefers specific brands, as well as what temperatures, colors, flavors, smells, and textures that your child prefers. For example, if you are wanting to introduce your child to broccoli and expand their tolerance of different ways of eating broccoli, and you know they enjoy room temperature items and things that are a creamy consistency, you might try (1) making a cheddar and broccoli soup with small to medium pieces of broccoli for one meal; (2) making a broccoli cream soup (in which there are no pieces of broccoli or only very tiny pieces of broccoli, but the flavor of broccoli is quite pronounced); making steamed broccoli and serving it at room temperature with a creamy dip, like ranch dressing. In this example, you are relying on the textures and temperatures you know your child enjoys, and incorporating broccoli in a few different ways to expose your child to the food repeatedly and in different forms. Get creative, and use internet resources (like the ones below) for recipes and/or inspiration.

Allrecipes | Recipes, How-Tos, Videos and More

Easy Recipes, Healthy Eating Ideas and Chef Recipe Videos | Food Network

Yummly: Personalized Recipe Recommendations and Search

• Set the right expectations. Setting the right expectations can be helpful for you and for your child as you help introduce them to new foods and work to expand their food tolerance. Even if your child has successfully touched a new food to their lips, don’t expect them to eat an entire serving of that food the next time you serve it. And, similarly, even if your child has successfully eaten a new food that you’ve served once, don’t expect them to eat that new food every time you serve it going forward. Many foods are acquired tastes, and as your child grows and develops, their appetite and interest in different foods will vary. Be patient.
• Try not to take it personally. It can be disheartening when you spend time making a meal for your child only for them to refuse to eat it, especially if it includes a food they have tried and liked before. This happens to most parents. Remember, your child is going through a process of learning to try new foods and they will inevitably change their appetite, interest, and preferences as part of that process. While it can be tempting to get upset in these moments, showing your child that you are angry, frustrated, or disappointed won’t entice them to eat the food you’ve prepared. 

For the short-term goal of introducing a new food/expanding food tolerance, you can choose a target such as trying a new specific type of food for taste (e.g., broccoli soup), trying a food with a different texture (e.g., jello), or trying a food at a different temperature (e.g., room temperature milk vs. cold milk).

Introducing a New Food / Expanding Food Tolerance

Step 1: Decide what new food you would like your child to be introduced to / expand their tolerance for. For example, you can choose the target of tasting broccoli soup while working on the short-term goal of introducing a new food / expanding food tolerance . The task analysis for tasting broccoli soup could be as follows:

1. Pick up the spoon.
2. Use the spoon to scoop some broccoli soup from the bowl.
3. Touch the spoon carrying the broccoli soup to lips.
4. Put the spoon carrying the broccoli soup (partially or fully) into the mouth.
5. Taste broccoli soup.
6. (Optional) Swallow broccoli soup.
7. Return spoon to bowl or next to bowl.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as an image of a bowl of broccoli soup, or a verbal SD (“Time to taste some broccoli soup!” or “Let’s taste some broccoli soup!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during a set amount of time (e.g., 1 min, 2 min, 5 min, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of tasting broccoli soup), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to pick up the spoon, then use the spoon to scoop some broccoli soup from the bowl, followed by bringing the spoon to your lips and tasting the broccoli soup).

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at tasting broccoli soup over a certain number of sessions.

Step 6: Track how your child makes progress to meet the target of tasting broccoli soup by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at tasting broccoli soup over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target. 

Additional Resources:

Autism and Diet - How to get my child with Autism to try new foods - Bing video

Food and Autism: Five Tips for Introducing New Foods to Your Child with Autism (appliedbehavioranalysisprograms.com)

How to Get Your Autistic Child to Try New Foods (written by an autistic person!) (adayinourshoes.com)

Encouraging Kids With Autism to Try New Foods - Metro Parent