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

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Repetitive Routines and Rituals in Aspergers Kids

Confusion about coping in a world that is overwhelming influences this behavior, so the youngster with AS responds to this uncertainty by being in control of their immediate environment, the objects in that environment, and the people in it. Repetitive motor mannerisms may occur when some kids are excited, anxious, or worried. For others, sensory sensitivities and physical enjoyment may drive repetitive jumping, arm flapping, twiddling of fingers in front of their eyes and covering ears and eyes with their hands.  

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Aspergers Children and Poor Concentration

Why children with Aspergers and High-Functioning Autism have difficulty concentrating -- and what parents and teachers can do about it:



Teaching Students with Aspergers and HFA
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