Author: Lori Ernsperger, Tania Stegen-Hanson

Publishing Info: March 2004

Reviewed by Maureen Bennie

Director, Autism Awareness Centre Inc. 

One of the common complaints from parents of children with autism spectrum disorders is their children have picky eating habits. Some children eat only a few foods or foods from only two food groups such as meat and grains/carbohydrates, others refuse to try anything new, and some go on food jags eating the same food in the same manner over long periods of time. Parents are bewildered what to do; they worry about their child’s nutrition, health and development.

Lori Ernsperger, an autism behavioral consultant, and Tania Steger-Hansen, a pediatric occupational therapist, have written a book that answers the question why these children have the eating concerns that they do. Their solution is a 3-part plan to increase the variety of food in the diet and make eating a more pleasant experience.

Ernsperger and Steger-Hansen first examine how to identify a resistant eater listing 5 main points: a limited food selection - maybe 20 foods or as few as 3, limited food groups, adverse reactions to new foods, food jags, and being diagnosed with a developmental delay. The Food Nephobia Scale by Pliner and Hobden (1992) is provided as an assessment tool for a resistant eater.

Oral motor development is explored because poor skills in this area lead to feeding and eating problems. The authors outline the problems associated with poor oral motor skills such as gagging and choking, drooling, difficulty keeping food down, difficulty transitioning to different textured foods, and difficulty chewing, sucking and swallowing. Case examples are provided on these problems. Oral motor development is traced from ages 0-3 years to provide a guideline of what should be happening developmentally.
Eating does not simply involved putting food in your mouth and swallowing. Ernsperger and Steger-Hansen look at the environmental and behavioral factors that influence eating. They highlight food experiences in the Exercise in Eating sections that appear throughout the book. For example, one exercise is for parents or therapists to try a new exotic fruit or vegetable and ask themselves how they feel about it. Cultural roadblocks are also key to shaping attitudes about eating. How many times were we told as kids to clean our plates, don’t play with your food, sweets and desserts are rewards for eating, and only certain foods can be eaten for breakfast? The attitudes we were raised with about food are brought to the table in our parenting.

Two chapters are devoted to sensory and motor-based problems that affect resistant eaters. Several tables highlight the characteristics of sensory dysfunction issues that occur within the vestibular, tacile, gustatory, olfactory, visual, and auditory systems. The difference between a motor based eating problem which involves muscle tone and movement patterns and a sensory based feeding problem caused by sensory systems not supporting the eating and drinking process is explored. With all of the sensory and oral motor background provided, the design and implementation of a comprehensive treatment plan can begin.

The treatment plan is 3 part: environmental controls, physical and oral motor development, and stages of sensory development for eating. A sample plan is provided as a model, outlining 3 goals for 3 each section and plan templates are in the appendix. Guidelines are given for writing the treatment plan. An Exercise in Eating provides the action activities to make the treatment program effective. The physical and oral motor development plan is supported by illustrations and a list of materials is provided for each activity. Stage 3 of the treatment plan is divided into easy to deliver lesson plans that do not involve complicated or expensive equipment.

The final chapter of Just Take A Bite gives tips to ensure success. The pitfalls and underlying factors are examined that may affect an eating program such as working with an older child, medical issues, and working with a GF/CF diet.

Ernsperger and Steger-Hansen effectively answer the question of why children with ASD’s have eating problems and what can be done to help the resistant eater. This book is written in an easy to understand format. Occupational therapists, speech pathologists, parents and anyone who works with a child with ASD will find this book practical and helpful. There is nutritional hope out there.

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