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What to do with chewing and swallowing inedible objects in autism?


Ergotherapist on a common and dangerous problem that parents of children with autism

Source: Autism Speaks

Our son is 17 years old. He has been diagnosed with autism and developmental delay. Lately, he has started chewing his shirt collar, he also chews and sometimes swallows pen caps, erasers, and all kinds of paper. Sometimes I find objects at home with marks from his teeth. Why is this happening? nine0020

Occupational therapist Moira Pena from Holland-Bloreview Children's Rehabilitation Hospital in Toronto, Canada, answers the question.

Thank you for your question. Your family is far from alone in this problem. Chewing objects may be a form of repetitive behavior in autism. Swallowing inedible objects is called pika. Both phenomena are very common in people with autism.

As an occupational therapist, I often work with families with children with this dangerous tendency, so I would be happy to share my experience. Below I briefly describe some general strategies for dealing with this problem, but they are not a substitute for working with a behavioral analyst and/or occupational therapist who can develop a personalized intervention plan for your child. nine0003

Exclusion of medical problems

Rarely, a peak may be due to a nutritional deficiency. Pika can also be caused by serious medical problems such as lead poisoning. It is very important that you tell the doctor if your son has started eating non-edible items and that you have a medical examination.

Answering the "why" question

Any plan for dealing with problem behavior begins with a detective investigation into the possible cause of the behavior. Let's look at three possible reasons why your son developed this new habit: trying to deal with strong emotions, receiving sensory stimulation, and getting attention. nine0003

Could it be anxiety?

We know that anxiety is especially common in children and adolescents with autism. Some studies suggest that about 40% of children with autism suffer from an anxiety disorder.

In my practice, I often see children and adolescents who start chewing on inedible objects because they find it difficult to cope with feelings of anxiety or irritation. Here are some questions to answer, ideally with a child psychologist who has experience in the field of autism:

— Does your son chew shirts and other items more often in stressful situations? For example, when do you need to leave the house for school or homework?

Does he seem upset when he chews on foreign objects?

— Has there been a recent change in your son's life that could have increased his general level of anxiety?

Is this sensory stimulation?

Sensory problems are also very common in both children and adults on the autism spectrum. Sometimes this leads to seeking out certain sensory experiences, such as chewing on objects or clothing. nine0003

In your son's case, this sensory seeking may be indicated by the following signs:

- he has difficulty keeping his hands to himself

- he has difficulty sitting still (hyperactivity)

- he is attracted to strong smells

- he constantly seeks visual stimulation (may be expressed as joy from visual stimulation, such as a carousel, running fans, or bright lights)

Another sign that inedible eating may be triggered by sensory seeking is the change in son's mood during the behavior. Does he seem more happy than anxious when he chews on his shirt? If so, then chewing is a method of self-soothing for him. nine0003

Is this an attraction?

I remember working with a family where a teenager with autism started swallowing large batteries. After keeping records of behavior, it became apparent that he only did so in the morning at school. When I discussed this with the boy, he confessed that he was trying to avoid school and spend the day in the hospital with his parents by his side.

Each of us has this or that behavior to attract the attention of other people. It is important to remember that in the case of people with communication disorders - one of the main symptoms of autism - such behavior expresses a need for communication that they cannot satisfy otherwise. nine0003

What now? Strategies to reduce chewing and swallowing of inedible objects

I am not a behavioral therapist, but my experience as an occupational therapist suggests that the following general strategies may be helpful for families where a child chews and/or swallows inappropriate objects:

Track when this happens

This will help determine when your child is most likely to start chewing and/or swallowing objects. This will allow you to effectively prevent behavior by redirecting it to something else. nine0003

I recommend that parents start keeping a diary or record of when and where it happened.

You can use the diary to identify the triggers for this behavior. For example, it can be a phrase that it's time to get ready for school, or visible fatigue.

Determining what the behavior is about will allow you to change the environment appropriately. For example, if your son chews on clothes and other items when he has to get ready for school, you can prevent this behavior by distracting him with his favorite music or game at that moment. This switch to something else is a very important tool in the fight against bad habits and other problematic behavior. nine0003

Changes in the environment

Does your son look for things to chew on in a particular place, such as a particular cupboard? Lock him up. And it is better to shift the contents so that he does not see it and cannot get it.

If you think he chews on things when he is bored, try to liven up the environment. Play background music or add bright posters and other visual stimuli to the room. On the other hand, a "too busy" room can cause anxiety in some people with autism. If this applies to your son, then try to create a quiet, visually subdued environment. nine0003

In my experience, small changes in environment often attract attention, which reduces the impulse to tackle problem behavior. Experiment to see what works for your child.

Helping your child communicate

What if you suspect your son's behavior is a way to get your attention? In the case I described above of swallowing batteries, we developed a visual schedule for the week. In it, we planned regular “shared” time with our parents, when they played together, walked and did something together. nine0003

Try using a picture of a traffic light as a visual way for your child to communicate growing discomfort (yellow light) or an anxious need to chew or swallow something (red light).

We also made a picture of a traffic light for this boy and his parents to make it easier for him to communicate his needs to his parents in a constructive way. He learned to point at a red light when he had a desire to find and swallow a battery. It was a signal that his parents needed to take a few minutes to do something with him that calmed him down. (Most of all he liked to jump on a trampoline). nine0003

It was even better when the boy pointed to yellow in situations where he was uncomfortable. Then his parents could pre-switch him to a favorite activity or something else.

More recently, portable stress monitors have been developed that respond to increased heart rate and other signs. These can range from free phone apps to special devices costing several hundred dollars. They allow you to prevent problem behavior that is caused by severe stress in advance, but not every child or teenager will agree to wear them. nine0003

It is also useful to develop a system of rewards for the child's refraining from problem behavior. In the case of the boy who swallowed batteries, his parents started giving him a daily reward in case he didn't. Then we gradually made the positive encouragement rarer and rarer.

Working with sensory needs

Occupational therapists like me are trained to work with children who have sensory processing disorders, including chewing and swallowing of non-edible objects associated with sensory problems. Again, a personalized approach designed specifically for your child by a specialist is best, but there are a few general strategies to follow:

Highly stimulating food

Offer your son a variety of foods that provide the most sensory stimulation during chewing, such as crunchy foods that need to be chewed or chewed for a long time. It can be fresh carrots, dried fruits, muesli bars or licorice sticks.

Another way to get appropriate sensory stimulation in the mouth is to have him drink thick drinks through a straw. It can be applesauce, yogurt, milkshake and so on. nine0003

Sensory chew toys

Chew toys are another option. For example, it can be special tubes, sticks or pendants for chewing. They are made in such a way that they cannot be chewed or swallowed. However, I recommend using them only under supervision. I also recommend that you only order toys from American or Canadian manufacturers, as other countries may use unsafe materials and manufacturing methods.

Sensory diet approach

We need a variety of foods in our diet, and a sensory seeker needs two or three substantial "sensory meals" as well as a few "sensory snacks" throughout the day. We call this "sensory diet". It includes a variety of sensory activities that can balance mood and increase mindfulness.

The sensory diet may include: clay modeling, finger painting, jumping, running, and so on. Find what your child likes. nine0003

Add Deep Pressure to the Sensory Diet

Research shows that occupational therapy techniques such as deep pressure (proprioceptive stimulation) have a calming effect on the mind and body. If chewing inedibles is associated with anxiety, then deep pressure throughout the day will help him stay calm.

Some options include:

- Trampolining (with appropriate safety precautions)

- Stimulation of the oral cavity with an electric brush

- Activities that involve pushing, pulling, or lifting, such as wrestling or tug of war

Keep a diary of your son's behavior for a few weeks to see if any of these strategies help reduce chewing inedible.

Remember that any behavior can be explained by both behavioral and sensory problems. Ideally, the behavioral analyst and the occupational therapist should work together to develop an interdisciplinary approach to problem solving. nine0003

We hope that the information on our website will be useful or interesting for you. You can support people with autism in Russia and contribute to the work of the Foundation by clicking on the "Help" button.

Parenting Children with Autism, Sensory and Motor

Seven Tips for Toilet Training Non-Verbal Children with Autism


Psychologists on How to Help a Child with Very Limited Communication Use the Toilet Successfully Source:


30009 Autism Speaks

We need help with toilet training our 7 year old. His speech is very limited.

Answered by psychologists Courtney Aponte and Daniel Mruzek from the University of Rochester Medical Center, USA, which is part of the Autism Speaks Autism Treatment Network.

Great question! Many children with autism learn to use the toilet much later than their peers. This delay can be due to several reasons. nine0003

- Many children with autism have general mental retardation. This means that they learn new skills more slowly than other children.

— Many children with autism find it difficult to give up routine, in this case, diapering. In addition, there are relatively few opportunities for a child to practice using the toilet during the day, as the child only uses the toilet a limited number of times.

- Communication difficulties, such as your son's speech limitations, clearly complicate things for many children on the autism spectrum. nine0003

— It is quite common for children with autism to develop toilet anxiety.

For example, some children with communication difficulties may not be able to understand the question "Do you need to go to the bathroom?" Or they may not know how to answer it, or how to let an adult know that they need to go to the bathroom.

Even non-verbal communication can be difficult for children with autism. In our practice, parents often report that their children do not show the usual signs that they need to go to the toilet. For example, children do not cross their legs, do not hold their hands to the groin, and do not begin to fidget. In other words, some children "do it without warning" and it is difficult for parents to take the child to the toilet in time. nine0003

The good news is that there are several strategies that can help children with autism overcome toilet training problems. Here are our favorite strategies:

1. When it comes to communication, less is more!

Use simple and clear photos and images for a visual timetable or visual cues. Accompany visual cues with simple and clear phrases so that the child understands what you expect from him. For example, point to a picture of a toilet and say, “Time to go to the toilet,” instead of asking, “Do you want to go to the toilet right now?” nine0003

In our experience, the most effective approach is for parents to give verbal instruction along with visual support, and then immediately lead the child to the toilet without further discussion on this topic.

2. Change to regular underwear as soon as possible. Don't delay!

We understand that this step is intimidating for many parents. But in our experience it is very important. Let's face it - modern diapers are too absorbent. Children, as a result, do not feel urination at all. Switching to regular underwear helps the child begin to associate “gaffes” with the discomfort of wet underwear. nine0003

3. Don't make a fuss about "accidents"

If the child is dirty, don't comment, discuss, shame, coax, tease, or even focus on it. Otherwise, you risk reinforcing this behavior. Just calmly remind your child to use the bathroom next time. Then help the child change with minimal speech and attention. Save all your attention and fanfare for when the child uses or even tries to use the toilet. nine0003

4. Reward the desired behavior

Identify activities, toys or treats that will motivate your child. Save them for your child's success in toileting, and don't give them to your child at other times, just for success in using the toilet. Chances are your child will try harder to succeed if that is the only way they can get what they want.

It is very important to give the reward immediately after the child has used the toilet. Do not wait! The faster you provide the reward, the faster the child learns the skill. nine0003

And don't forget visual support. For example, if you are creating a picture toilet schedule, include a picture of the reward. Or use a two-image now-then board to illustrate the main idea: "Use the toilet first, then you'll get your reward. " An example of such a board is below.

In the early stages of learning, reward your child for every little success—even a drop of urine down the toilet. This is a very important behavior that can only be formed during consecutive trips to the toilet. nine0003

5. Use rewards to communicate

Sometimes rewards help you tell your child what you want from them. This is especially important for children who have difficulty understanding speech and “first, then” rules.

For example, your child may not understand the words: "If you pee in the toilet, you can play on the tablet." Perhaps he will understand better if you increase his chances of success and receiving a reward. How to do it? Try this:

1. On the day you are both at home, encourage him to drink more than usual. This will increase the chances that when you take him to the toilet, he will actually urinate into the toilet. Reward every trickle! nine0003

2. Analyze patterns of "accidents" in a child. It is helpful to record the times and places of each such occurrence for several days. That way you can see the pattern. For example, you may notice that after a glass of water, milk, or another drink, the child usually pees in about half an hour. Use this information to guide him to the bathroom at the most appropriate time.

3. Remember that rewards must be immediate and consistent. This increases the chances that the child will understand the connection between urinating in the toilet and receiving a reward. nine0003

6. Develop your child's ability to communicate

It is very important that children with speech disabilities communicate the need to use the toilet. Once your child starts using the toilet when you bring him there, it's time to teach him how to communicate what he "needs" to you.

Consider using visual support, such as a picture of a toilet bowl. Such an image can be attached on a string to a belt or shirt buttonhole so that he can always easily point to it. If your child is using a communication device, you can include an appropriate image that, when clicked, will sound a request to go to the toilet. nine0003

Ideally, you want your child to use these prompts every time they have a full bladder. To do this, you can increase the intervals through which you take him to the toilet without prompting. In other words, you are giving him the opportunity to feel when his bladder is full and also to experience the relief of urinating in the toilet. As we all know, this relief is the "natural" reward for using the toilet.

Once your child begins to feel better that he has a full bladder or bowel, he will show more signs that he needs to go to the toilet. You may notice that he begins to sway, hug himself, vocalize more often, or otherwise show that he is ready to go to the toilet. nine0003

Sometimes the child will simply stare at you or towards the toilet. It is important for parents and teachers to learn to notice these “signs” and immediately prompt the child to use the chosen communication method, for example, give you a card with a picture of a toilet or press the appropriate button on a communication device.

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