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Oral Sensitivity in Children with Aspergers and High-Functioning Autism

"My son with aspergers (high functioning) will often have a gag response or a strong reaction to certain textures of food, for example, whenever he tries to eat an apple or any other hard fruit. Is this something we should be concerned about, or is it a trait of aspergers (similar to picky eating)?"

In contrast to motor-based swallowing problems, difficulties with eating can also stem from dysfunction with the sensory system. The act of swallowing does require both motor and sensory functions to complete the act.



All of us have a range of sensory tolerance, some of us more sensitive than others. If you have a low sensory threshold, you may have an affinity for stronger tasting foods or perhaps crunchy foods. Conversely, if you are on the other end of the sensory spectrum, you may prefer milder foods or soft foods. Kids also have taste and texture preferences and tend to prefer milder, simple foods.

Hypersensitive oral reactions are exaggerated responses to touch in the mouth or around the face. Younger Aspergers and HFA kids with hypersensitive oral reactions may not let you into their mouths for feeding, tooth brushing, or play. They may have problems moving from one food texture to the next, spitting out or gagging on any food but puree. They may gag when a spoon touches the tip of their tongues. A tiny lump of food may be gagged on instead of swallowed.

The following are red flags for sensory-based eating difficulties:
  • Able to bite and chew solid foods, but not swallow them
  • Gag on foods that require chewing
  • Hypersensitive gag only with solids and not with liquids
  • May try to swallow foods whole to avoid contact for chewing
  • No problems with taking liquids
  • Will separate textures from smooth food and pocket or expel them

Some kids become so sensitive and emotional, that their reactions go one step beyond hypersensitive and become “aversion reactions” (these are stronger, more emotional, and less logical reactions). These kids may cry, fuss, pull away, push food away, or refuse even to let you near their mouths. Gagging may turn into vomiting in an aversive reaction.

Fears can develop around eating or any touch around the mouth. Aspergers and HFA kids may try to control all aspects of a meal in an effort to protect themselves from uncomfortable situations. They may want only certain food textures, certain spoons, certain plates, and certain cups. Moms and dads become frustrated because their youngster will eat only a few foods prepared in very specific ways. Face washing and tooth brushing can seem impossible.

For most Aspergers kids, mouth hypersensitivity is one part of an overall body sensitivity to touch or changes in touch. These kids have a hard time handling touch on other parts of their bodies as well. Therefore, treatment for the face and mouth needs to be part of a treatment plan of relaxing or desensitizing touch reactions throughout the body

Because most hypersensitive kids have body as well as mouth over-sensitivities, they may allow touch or cuddling only if it is their idea. If you try to approach them, they may push you away, or rub or scratch the spot. The touch may be quite agitating.

Helping your youngster handle deep pressure or firm touch is usually a good starting place. Light ticklish touch can be too over-stimulating. Massage can be an excellent activity for these kids. Deep pressure touch, given in an organized, predictable way can be very helpful with touch sensitivities. When your youngster can anticipate the touch, it makes it easier to handle. A variety of other firm touch activities may be described by your youngster's therapist.

Let your Aspergers youngster know that you are going to touch. Approach the youngster within his/her vision so that the touch is not a surprise. Often, touch is handled well if the youngster sees it coming. Kids seem to be able to "prepare" themselves for the touch and sometimes can react more appropriately. Also, your youngster needs to learn that touch around the face and in the mouth can be fun.

Remember that the mouth is the most sensitive part of the face. Start by touching places away from the mouth and work toward the mouth. Consider starting on the trunk or back of the arms, and make a game of moving toward the face. In this playful way, the game becomes a distraction, so your youngster isn't just worrying about the touch. You also are moving in a predictable fashion that is less scary.

Tips for helping your child accept touch:
  1. Kiss your youngster's face with the stuffed toy, and then let him/her kiss the toy or your face.
  2. Play face-touch games with stuffed toys and dolls.
  3. Playfully taking turns with touching can help your youngster handle play around the mouth.
  4. Tooth brushing with regular or electric toothbrushes can help
  5. Wipe the face regularly (slowly and softly) with warm cloths, using deep pressure. This can be calming to an over-reactive youngster.
  6. Singing is nice to combine with touch activities. The predictability of the tune helps your youngster prepare for the touch.

Eating involves many different types of touches that the parent needs to understand. The spoon, fork, and cup touch the lips as they bring food to the mouth. The food temperature is a touch. Food texture (e.g., lumpy, wet, thick, etc.) is an important touch of eating. Some kids remove food from the spoon with their teeth very rapidly, so that the spoon doesn't touch their lips. Try gradually keeping the spoon or cup at the lips longer. Use the youngster's most favorite foods for this activity.

Food temperature often can cause over-reactions. Remember that room-temperature foods tend to be easier to handle. Notice the temperatures your youngster handles easily. Make temperature changes very slowly and with foods the youngster likes.

When Aspergers kids over-react by gagging when you try to switch to thicker, more textured or lumpy foods, you probably need to make the transition more slowly. Aspies usually will do better moving from strained foods to thickened strained foods, to blended foods, to thickened blended foods, to thickened blended foods with tiny, very soft lumps. Remember, it is easier to hide lumps in thickened foods. They are much too obvious when presented with strained foods. Good food thickeners include cereal, dehydrated foods, instant potatoes, instant puddings, and ground cracker crumbs.

When you present new body or mouth touches or new food textures, always start with familiar touches or textures. Making games of the touching helps kids think that the touch or the eating or the new texture o" their idea. Move at your youngster's pace, but be persistent.

Provide crunchy foods, and separate textures during meals. Keep crunchy foods on hand for your sensory-sensitive youngster, as these foods facilitate an important "sixth sense" called proprioception, in which sensory feedback makes the child aware of movement and body position. Crunchy foods may help your youngster to develop better proprioception. Also, avoid mixing foods together that have conflicting textures, such as mashed potatoes and gravy.

A speech-language pathologist or occupational therapist (OT) that is trained in oral sensitivities can implement an oral-sensory treatment program to help desensitize the child and reduce the sensitive gag response to textures. Also, the therapist can assist the mother or father with activities to transition the child to age-appropriate textures and tastes of food. If the sensory problem is more pronounced or pervasive, an OT with a background in sensory integration can provide more involved sensory intervention. These therapies may need to be preceded by resolution of medical problems first, especially reflux, before treatment activities can have an effect.

Advice to parents with Aspergers kids who have sensory-based eating problems may include to avoid forcing the child to eat certain foods, maintain a routine mealtime, have at least one preferred food available each meal, and to have the youngster join the family at mealtime versus eating alone.

Aspergers and High-Functioning Autistic kids with hypersensitive reactions to touch in the mouth and around the face need extra help learning to handle the touches of everyday life, especially for eating. You do not have to struggle with this one alone. Your youngster's pediatrician, dietitian, or therapy team can work with you and your youngster to figure out the best way to help.


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 COMMENTS:

•    Anonymous said... Great ideas.
•   Anonymous said... I have a grandson with aspergers and he has a strong gag reaction when he tries to take a drink of water or other liquid that he doesn't normally drink. He wants to try new foods but it's very difficult for him because the look and smell will cause him to gag. His Dr told us it's normal for asperger people. They are highly over sensitive to everything.
•    Anonymous said... I'd say it could be related to a trait, but he might just hate apples, don't worry too much, try cooking or juicing apples, my lad does love fruit and will eat a bag of apples in 10 minutes, but he gets a lot of vitamins from juice too (in those times when he just won't actually eat fruit)
•    Anonymous said... I'm not sure if it's an Asperger's trait, but I'm the same. That's why I get my vitamins by squeezing a lemon each day.
•    Anonymous said... Indeed it's a trait, the apple was just one example I'm sure. My son does that all the time, he has aspergers too.
•    Anonymous said… Have you got a slinky maker!! Thats awesome for hard food. My step son is sensitive to hard food and sound.. I bought the slinky n its made a world of difference. Maybe it might help you
•    Anonymous said… It could be a sensory issue. An occupational therapist can evaluate and help. My son with Aspergers eats apples and other hard fruits and vegetables all of the time.
•    Anonymous said… My 5 year old does it... Especially if she has fluff or hair around her while eating... Or if she dislikes the food smell or texture... It's just the sensativity issues
•    Anonymous said… My son has sensitivity to his teeth and can't have certain things touch his teeth it sends him into orbit. This has also created a problem with brushing
•    Anonymous said… My son has the same issue. Not with apples though. He eats them to the core. Lol but with other foods. It may be controversial but I force my boys to try foods wether they want to or not. It can be a very stressful moment at the table. All 3 boys have issues with food. But if I did not stay firm on the issue they would only eat chicken nuggets and fries. My pickiest eater is actually my one son who is not autistic. But my point is my 3 boys have a very developed pallet, especially for being autistic because I make them try foods and keep trying them. They learn to like them. I read somewhere it takes children 19 times to acquire taste to new foods. For all children. Not just autistic children. They put up a huge fight sometimes. They will sit at the table for a long time. They will gag and cry but I don't back down.
•    Anonymous said… My son with Aspergers also has a sensory problem....lots and lots of food issues. ex: chicken tender "ends" can't be eaten....he would prefer microwaved food over baked....mac n cheese can only be leftover, not fresh....
•    Anonymous said… This may sound odd .. But maybe it could signal an allergy? I have an extreme gag reflex to certain cheeses (some that I used to be able to eat) .. After some testing I found it was certain strains of mould that caused it. It was so bad with some cheeses that I would gag uncontrollably just being near them at work (I used to work in a grocery store).

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"Face-Blindness" in Children and Teens with Aspergers and High-Functioning Autism

Many children and teens with High-Functioning Autism (HFA) and Aspergers have difficulty recognizing the faces of those they don’t know well. Prosopagnosia, also known as “facial agnosia” and “face-blindness,” is a neurological disorder that makes facial recognition difficult or impossible. Research suggests that up to two-thirds of children and teens with HFA and Aspergers have difficulty recognizing faces until they have interacted with a particular person on a number of occasions.

Research into Facial Recognition—

Most research into the facial processing abilities of kids and teens with HFA and Aspergers has focused on the ability to read and accurately interpret facial expressions. Research on facial recognition difficulties among children with Aspergers has been sparse, but there have been a few studies conducted. Findings indicate that many of children with Aspergers have difficulty recognizing the faces of people they have only met once or interacted with a few times, but have no trouble recognizing those they know well.



One research study found that some individuals with Aspergers performed well on tests of facial recognition, whereas others showed significant deficits in this area. However, all Aspergers individuals performed better on facial recognition tests than those whose “face-blindness” resulted from other causes (e.g., genetic predisposition, illness, stroke, etc.). The performance of children with Aspergers (who experienced difficulties with facial recognition) fell somewhere in between neurotypical control subjects and typical “face-blind” subjects.

Resultant Social Problems—

Failure to recognize people one has met before can act as a serious social problem. A “face-blind” youngster may meet someone, have an interesting conversation, and then not recognize that individual when he encounters her again, which can lead to social embarrassment and anxiety, and make it more difficult to establish friendships. “Face-blindness” is especially problematic in the workplace when the employee is unable to recognize coworkers and supervisors.

In addition to failing to recognize peers, the "face-blind" individual may also experience false positives, believing that a stranger is a known person because certain memorized features (e.g., hairstyle, glasses, hat, etc.) are the same. This can lead to embarrassing situations whereby the “face-blind” youngster or teenager greets a stranger as though he were an acquaintance.

Theories—

It’s hypothesized that the lack of typical social skills associated with HFA and Aspergers may result from “face-blindness.” However, because some of those with Aspergers have normal facial recognition abilities, it is unlikely that social dysfunction prevents the development of such abilities. No significant differences in social skills have been found between “face-blind” Aspies and those with good facial recognition, which indicates that there is no correlation between social abilities and the ability to recognize faces.

Another hypothesis asserts that the inability to recognize faces may stem from a relatively low social interest in others and the avoidance of eye contact, which may necessitate looking away from faces and thus not developing a clear memory of their characteristics. If such behaviors begin in childhood, perceptual skills for remembering faces and their unique elements may not develop. This hypothesis claims that social skills deficits cause “face-blindness” rather than the other way around.

Yet another hypothesis regarding “face-blindness” in children and teens with HFA and Aspergers has to do with detail orientation. Aspergers create a tendency to fixate on certain characteristics of the face, and so the child may fail to see the face as a whole. Strangely enough, some research studies have found that those with HFA and Aspergers may be better able to recognize faces when they are upside down.

Difficulty Recognizing Peers—

“Face-blind” kids and teens don’t easily commit whole faces to memory in the way that most people do. Rather, they must rely on unusual features and other aspects of the individual to make an identification until they know that person very well. In extreme cases, facial recognition is never achieved, even for family members and close friends, but this is quite rare. Most children with Aspergers can recognize the faces of those they know well and are capable of developing strategies for improving recognition of peers.

Strategies for Coping with Face-Blindness—

Aspergers children and teens with “face-blindness” often rely on hairstyles, clothing, context (e.g., an area of the school where the peer is most commonly seen), and objects (e.g., an person’s car, glasses, cologne, etc.) to identify acquaintances. This is a good initial strategy, but it creates problems when the particular individual gets a haircut, adopts different styles of dress, gets contact lenses, or appears in a different context. Someone who can be recognized in one place (e.g., school) may be difficult to identify during a chance encounter at the Mall.

Tips for Children and Teens with Face-Blindness:

Here are some effective strategies for improving identification and reducing social anxiety...

• Pay close attention to hand gestures and facial expressions the individual makes frequently (e.g., how loudly he speaks, his body postures, other expressive features that could be used to identify him in the future). Focus on features that are u NOT likely to change.

• Spend time with an outgoing buddy or family member and arrange to have him greet others by name until you know them well enough to recognize them on your own.

• Choose a pleasant spot to sit and watch people, identifying characteristics of movement, facial expression, and other aspects that could be useful for identification purposes.

• Tell teachers and peers about the problem on first contact so that they will not feel insulted if you don’t recognize them at a future time. In some situations it can be helpful to tell a funny story about a time when you didn’t recognize someone. Having a laugh together can ease the tension of talking about the problem.

• When meeting someone for the first time, silently describe the face in your mind to commit features to memory (e.g., a full lower lip, a short nose, arched eyebrows, etc.). Note particularly any unusual or interesting features that will help make quicker identification in the future.

Parents can teach these recognition skills and strategies to their child and practice them together. It can also be helpful to tell the youngster's teachers about the problem and ask them to identify other students by name whenever possible, particularly early on in the school year.
 
Resources for parents of children and teens on the autism spectrum:
 

Children with High-Functioning Autism: "Gifted" or Hyperlexic?

Parents who have discovered that their young child is "gifted" because he/she may be able to recite the alphabet at 18 months of age - or can read words by the age of 2 - may want to reassess the situation.

Hyperlexia often coexists with High-Functioning Autism and Aspergers. Hyperlexia is not seen as a separate diagnosis; however, with current fMRI research revealing that hyperlexia affects the brain in a way completely opposite to that of dyslexia, a separate diagnosis may be on the horizon.



Children with hyperlexia may recite the alphabet as early as 18 months, and have the ability to read words by age two and sentences by age three. Many are overly fascinated with books, letters, and numbers. However, the child’s ability is looked at in a positive light, so many moms and dads delay in getting their “precocious” youngster any help because they believe that he/she is a blooming genius.

Hyperlexia has many characteristics similar to Autism, and because of its close association with Autism, hyperlexia is often misdiagnosed. The main characteristics of hyperlexia are an above normal ability to read coupled with a below normal ability to understand spoken language. Many of the social difficulties seen in hyperlexic children and teens are similar to those found in Autism. Often, hyperlexic kids will learn to speak only by rote memory and heavy repetition. They may also have difficulty learning the rules of language from examples or from trial and error.

Hyperlexic kids are often fascinated by letters or numbers. They are extremely good at decoding language and thus often become very early readers. Some hyperlexic kids learn to spell long words (e.g., elephant) before they are two years old and learn to read whole sentences before they turn three.

Hyperlexia may be the neurological opposite of dyslexia. Whereas dyslexic kids usually have poor word decoding abilities but average or above average reading comprehension skills, hyperlexic kids excel at word decoding but often have poor reading comprehension abilities.

Some experts denote three explicit types of hyperlexics, specifically:
  • Type 1: Neurotypical kids that are very early readers.
  • Type 2: Kids on the autism spectrum, which demonstrate very early reading as a splinter skill.
  • Type 3: Very early readers who are not on the autism spectrum though there are some “autistic-like” traits and behaviors which gradually fade as the youngster gets older.

The severity, frequency, and grouping of the following symptoms will determine an actual diagnosis of hyperlexia:
  • A precocious ability to read words far above what would be expected at a youngster’s age
  • Abnormal and awkward social skills
  • An intense need to keep routines, difficulty with transitions, ritualistic behavior
  • Auditory, olfactory and / or tactile sensitivity
  • Difficulty answering "Wh–" questions, such as "what," "where," "who," and "why"
  • Difficulty in socializing and interacting appropriately with people
  • Echolalia (repetition or echoing of a word or phrase just spoken by another person)
  • Fixation with letters or numbers
  • Listens selectively / appears to be deaf
  • Memorization of sentence structures without understanding the meaning
  • Normal development until 18-24 months, then regression
  • Self-stimulatory behavior (hand flapping, rocking, jumping up and down)
  • Significant difficulty in understanding verbal language
  • Specific or unusual fears
  • Strong auditory and visual memory
  • Think in concrete and literal terms, difficulty with abstract concepts
  • Youngster may appear gifted in some areas and extremely deficient in others

Hyperlexia appears to be different from what is known as hypergraphia (i.e., urge or compulsion to write), although as with many mental conditions or quirks, it is possible that this is more a matter of opinion than strict science.

Despite hyperlexic kid’s precocious reading ability, they may struggle to communicate. Their language may develop in an autistic fashion using echolalia, often repeating words and sentences. Often, the youngster has a large vocabulary and can identify many objects and pictures, but can’t put their language skills to good use. Spontaneous language is lacking and their pragmatic speech is delayed. Between the ages of 4 and 5, many kids make great strides in communicating and much previous stereotypical autistic behavior subsides.

Often, hyperlexic kids have a good sense of humor and may laugh if a portion of a word is covered to reveal a new word. Many prefer toys with letter or number buttons. They may have olfactory, tactile, and auditory sensory issues. Their diets may be picky, and often potty training can be difficult. Social skills lag tremendously. Social stories are extremely helpful in developing effective age-relative social skills, and setting a good example is crucial.

Many moms and dads have had their hyperlexic kids go through numerous evaluations, with various confusing and contradictory diagnoses applied – ranging from Autistic Disorder to Pervasive Developmental Disorder, Aspergers, ADHD, or language disorder. In other cases, there is no diagnosis applied except “precociousness” or “gifted.”

Controversy exists as to whether hyperlexia is a serious developmental disorder like autism, or whether it is in fact a speech or language disorder of a distinct and separate type, or, in some cases, it is simply advanced word recognition skills in a normal (neurotypical) youngster, especially when sometimes accompanying “autistic-like” symptoms are present.

Treatment—

The first step in treatment is to make the proper diagnosis. Then management of the condition follows. When precocious reading ability and extraordinary fascination with words presents itself in a young son or daughter – especially when accompanied by other language or social problems that might suggest an autistic spectrum disorder – a comprehensive assessment by a knowledgeable professional or team familiar with the differential diagnosis of the various forms of hyperlexia is indicated. 

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

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How to Prevent Meltdowns in Children on the Spectrum

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

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Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

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Older Teens and Young Adult Children with ASD Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

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Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

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to read the full article...

Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

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