The Child Can't Chew: Another Reason for Selective Eating

Background: Sally Asquith, MS, CCC-SLP, is the owner/executive director of Carolina Speech & Language Center near Charleston, SC. She has extensive experience with Pediatric Feeding Disorders, has been accepted for Board Certification in Swallowing/Swallowing Disorders, and is on the Executive Council of the International Association of Pediatric Feeding and Swallowing Disorders. In the course of treating children with ASD who were highly selective eaters, avoidant, and neophobic, the role of arrested oral-motor skills became a clear aspect of the feeding disorder. Reliance on soft, non-resistant foods is a typical hallmark upon intake. Children remain fixed on these foods due to a number of factors such as habit, neophobia, "sticky attention" with packaging, AND failure to advance the necessary mechanics to lateralize and crush age-appropriate foods. This poster aims to raise awareness of this issue, commonly overlooked by physicians, other professionals, and parents.

Objectives:

• Review current literature pertinent to the role of oral-motor development to the diagnosis and treatment of PFD in autism, as seminal textbooks (J Arvedson & L Brodsky; SE Morris; J Sheppard) advise.
• Complete a 5-year retrospective chart review of ASD patients with PFD in an outpatient clinic.
• Assess the incidence of poor oral-motor skills as an “unsung villain” and key variable in dx and tx of PFD in ASD.

Methods:

• Literature review
• Review all intake evaluations in a 5-year period
  • Code for oral-motor/chewing skills age-equivalent
  • Code for absence or presence/type of aversive reaction

Results:

• While there is an abundance of studies exploring behavior management of PFD and selective eating in autism, and there are also numerous studies on poor chewing/poor oral-motor in the neurotypical adult population, studies are minimal at best in examining the role of mechanics and ability to manage age-appropriate foods safely in pediatrics.
• 80% of pts with autism and PFD in chart review had significant oral-motor deficits, regardless of age.
• 60% of cases were also positive for aversive reactions

Conclusions:

Functional mechanical deficits are a key aspect of PFD in autism, across ages, and should be a basic consideration when diagnosing and treating selective eating.