Ben Sarcia
When it comes to concerns about autism and food selectivity, many caregivers have questions that are both specific and challenging. The starting point to answering them is oftentimes the pediatrician, which is a great first step, except that most pediatricians aren’t equipped to deal with the complexity of feeding issues and autism. So, here are a few questions on this important topic and some starting points for answers from an expert in pediatric feeding disorders.
“What’s the actual treatment method for treating food selectivity?”
Applied Behavior Analysis (ABA) is a type of therapy that has been used to treat Avoidant Restrictive Food Intake Disorder (ARFID) and other feeding challenges for years. There are many children without a developmental disability that have ARFID, yet ABA-based treatment is the same, regardless of diagnosis. Some of the outcomes we have consistently seen as a result of this treatment are: increased variety of food and drink accepted, increased volume consumed, reduced dependency on supplemental formula or feeding tubes and increased independence with eating and drinking.
“How does feeding therapy work? Does it work?”
Most caregivers have questions about how treatment works, what the clinical team will do during the sessions and how age-appropriate behaviors related to eating will take shape. The first thing to know is that feeders work hard to make meal sessions fun! You would not expect any child who has never eaten a vegetable to sit down at the table and be thrilled to see a green bean on the plate the first or second time. Feeders use rewards with the goal of reducing the need for the rewards over time as the child becomes more accustomed to new foods and develops preferences for them. With time, consistency and patience, mealtime can become enjoyable for the child and less stressful for caregivers.
“Is Force Feeding bad?”
This question is on people’s minds, as we all have heard different stories, both good and bad, when it comes to feeding therapy. It’s unfortunate that we have seen many caregivers avoid much-needed feeding therapy because they have heard from another provider that behavioral therapy will consist of forcing the child to eat. Often, this information is spread to the parent by someone who is not actually familiar with the treatment and has never seen it practiced. Behavioral therapy involves clear expectations, consistent rules and, of course, prompting with encouragement. Sadly, many children have suffered as a result of delayed treatment because of bad information. And speed matters when it comes to
effective treatment!
“Will my insurance cover feeding therapy?”
First, every parent should contact their insurance company and potential feeding therapy provider to understand what kind of coverage is available (and the details). With that being said, ABA services will likely require that a child have an autism diagnosis for in-network benefits to directly cover the cost of therapy. If the child does not have a diagnosis of autism, caregivers may seek reimbursement from their insurance company to cover out-of-pocket expenses for treatment or pay out of pocket. Bottom line: Parents should prepare to dig in and understand the aspects of diagnosis, coverage and types of feeding programs so that they have as much knowledge as possible to make the best decision.
“What about my own training for home after the program is complete?”
Any feeding program should include a caregiver training component, regardless of the type of therapy being provided. Appropriate mealtime behavior takes time to develop, and if there isn’t follow-through at home, then it is unlikely that gains made in the clinic will continue past the end of the program. This is a big one!
Ultimately, a great feeding program will be measurable, effective and set the stage for healthy eating behaviors long after the program ends as parents and caregivers implement and continue the program on their own. With food selectivity affecting so many children on the autism spectrum, it’s a resource worth exploring that can make an impact for years to come.
Ben Sarcia, MA, BCBA, has been providing treatment for pediatric feeding disorders for nearly 15 years. Prior to the establishment of the Healthy Beginnings program at Verbal Beginnings, he was a behavior analyst in the Feeding Disorders Continuum at the Kennedy Krieger Institute.
