Friday, December 29, 2006

Veggie tales

We had a wonderful Christmas. Bud woke us early, but not too early, and made his way downstairs, excited but not frenzied. He read the tags before he opened each present, and he was delighted with each gift he opened. He got lots of things he loved - a Fisher Price camera, a new mini-trampoline, a "banana farm" that grows real bananas, a bevy of Curious George books and toys - but his favorite present was a low-tech stuffed Roly Mo, a BBC character he knows from the CBeebies website. (He quickly recruited several of his stuffed Boohbahs to play the roles of Roly Mo's friends.) I waited all day for the Holiday Letdown, the big crash of emotion that tends to follow holidays with big build-ups, but it never came. Bud stayed upbeat and well-regulated all day.

As the day wound down, Bud opened the Mickey Mouse Clubhouse DVD that Santa had tossed in his bag as a last minute add-on. (Santa had heard a rumor that Bud developed an intense Mickey Mouse fascination after all the Christmas shopping was done.) Inside the DVD case, Bud found an advertisement for the Mickey Mouse Clubhouse toy - a replica of the house from the show, complete with all of his newly-beloved character friends (in other words, EXACTLY the sort of toy that Bud loves best of all) - and Bud realized that he'd missed his opportunity to request the toy from Santa. Calmly, he brought the ad to me and said, "I want this for my birthday."

As the evening wore on, Bud must have done the math and realized he'd be in for a long wait for his September birthday. He called me from his bed long after I thought he was asleep, and asked, "Mama, can I have a sticker chart?"

Sticker charts are a technique we've used as an incentive for Bud to do things that are difficult - going to sleep by himself, remembering to use the toilet, swallowing pills. Bud earns a sticker each time he successfully completes the designated task, and after a predetermined number of stickers he earns a much-coveted prize. Bud desperately wanted the Mickey Mouse Clubhouse without waiting until his birthday, and he guessed that a sticker chart would be the most likely route to getting it.

I told Bud that we'd talk about it in the morning, then set about considering our options. Bud's motivation for this toy would be high, and I knew it provided an opportunity to work on a particularly daunting challenge. Two things came to mind: nighttime pull-ups and vegetables.

I ruled out pull-ups after only a few minutes' consideration. We use sticker charts for behaviors over which Bud has control. Sticker charts allow him to make choices - do the thing and get a sticker, or don't do the thing right now with the knowledge that you can do it and get a sticker some other time. No pressure. Low stakes. All in your own time. But I'm not sure that staying dry at night is a choice that Bud would be able to make, even if he wanted to. Lots of seven-year-olds - even those without autism - use pull-ups at night. Bud may not be biologically ready yet, and I didn't want to risk setting him up for failure or, perhaps worse, making him feel self-conscious or ashamed.

So veggies it was. Bud has always been good about eating vegetables, as long as they're pureed and in a jar marked "Gerbers." He likes the taste of vegetables, but he balks at chunks of them. Maybe it's the texture. Maybe it's just the idea. Either way, Bud has refused to let a solid vegetable pass his lips for years.

In the morning, when Bud asked again about a sticker chart, I pitched the vegetable idea - and, eager to do whatever it took, Bud signed on happily. We put together a sticker chart with 32 boxes for stickers followed by a picture of the Mickey Mouse Clubhouse, and we hung it on the refrigerator.

At lunchtime, when it was time to start trying to earn stickers, Bud balked again. I'd started with green beans - one of his favorites - but he could barely get past licking them. He finally choked one down by tossing it back with milk, like he was swallowing a pill, then suggested that we start with celery instead. He munched a celery stalk and a raw carrot (I have a hunch he's been eating these at school), and earned three stickers - one for each kind of veggie he'd eaten. We were off to a good start.

At dinner, it was time to try again, but Bud was in the mood for negotiation. He would eat a vegetable, he said, if he could have ALL of his stickers in exchange for it. He whined and wheedled, but I stayed firm as the veggies on his plate grew cold. Finally, he tried another green bean, and he gagged.

Maybe this is too much for him, I thought. Maybe he really can't do this.

I suggested to Bud that for this sticker he could go back to baby food, but that he would need to feed himself. (Another veggie quirk of Bud's is that, although he feeds himself everything else, he will only eat his pureed veggies if they are fed to him - but then he eats them happily.)

Bud sat at the table with his pureed green beans untouched in front of him as he continued to negotiate and complain ("How about cake? Cake could be vegetables!"). Slowly, the rest of the dinner dishes were cleared and Bud wandered away from the table. The green beans sat cold and menacing like something out of a scene in Mommy Dearest. I picked them up and told Bud that dinner was over, and that he could try again tomorrow.

And then, the post-Christmas crash I'd been expecting the previous day descended on Bud as he wailed and cried and shouted and, finally, dissolved. I hustled him into his pajamas and he fell into bed, dejected and discouraged.

"It's okay, Bud," I said. "You don't have to worry. You'll get all the stickers. We'll do it together."

"You will take care of me, Mama?"

"Of course I will."

"It will be okay?"

"It will be okay. I promise. But now it's sleeping time. Do you want me to read a book to you?"

"I just want mumblemumblemumble..."

"What's that, Bud?"

"I just want you to be my friend."

"Oh, sweetie," I said, climbing up beside him, "I am always your friend." Bud slid over and put his head on my chest. I clicked off the light, and he fell into a deep sleep.

The next morning, I woke to Bud's calm, clear voice in my ear: "Mama, may I try again?"

I assured him he could try again - and try he has. We're keeping the portions small. We're celebrating the small successes. We're working through a few gags here and there. He's spit out a mouthful or two. But he's eaten corn, carrots (raw and cooked), celery, peas, and even green beans. He's earned seventeen stickers and one big sense of accomplishment. The Fed Ex truck should deliver the Clubhouse tomorrow, right about the time we're posting sticker number 32.

Maybe we'll celebrate with some broccoli.


VTBudFan said...

I'm so happy for Bud about the clubhouse toy! :) Maybe that would have made me eat veggies before I became a vegetarian at 21 and needed to fill my plate with something! (My parents did have some early success with salad bathed in Pfeiffer Caesar dressing and frozen peas with butter sauce....)

My 9-year-old non-autistic daughter JUST stopped using pull-ups at night this fall. She asked us to get her one of those buzzers that wake up the parents and then, eventually, the child. It worked, just as it worked for my brothers years ago. She is delighted and my 5-year-old is asking for it now! And there are at LEAST 3 other non-autistic 9-year-olds in my daughter's class who still wet their beds. Each of their parents thought their child was the only one left.

:) Happy new year to you!

kirsten said...

that is such a good thing that bud asked for a sticker chart and was willing to try new things to get what he wanted. that is amazing, actually. what a good kid.

JenF said...

A sticker chart for veggies? Hmmm it never occurred to me! Great job to both of you!!! Bud for finding thinking of a solution to how to get the clubhouse sooner and you for - well - just being a great Mom!!!

gretchen said...

Cake COULD be vegetables. I'll have to side with Bud on this one.

Seriously, good for you for sticking to this. And good for Bud for understanding what would be required to obtain this toy.

I am going to share this story with Henry and see what he thinks. He will gag down a green bean in order to receive another hot dog or more mac & cheese.

What happens after this? Will Bud be expected to KEEP eating vegetables?

kristen said...

That is awesome. We are having trouble getting my son (who is 4 and has PDD) to eat veggies. Same idea....gags on them, won't even let them near his lips, etc. Unfortunately, he won't eat them pureed either. I wonder if the sticker chart would work for him. We have tried some other reward type things but they are more immediate (and haven't really worked). What's your opinion? Is he too young for the sticker chart idea?

And by the way, we are also totally obsessed with Mickey Mouse clubhouse....where did you find the toy???

Kristina said...

Pass the cauliflower from Charlie! (Don't know how he got stuck on this----you never know!)

Jan B said...

I love that he got the idea to do the sticker chart and it clicked for me that Charlie has been saying "sticker chart - get a prize" to us a lot lately. They use them a lot in his speech and OT classes. I should be doing this more at home. Thanks for the idea.

Camille said...

Did you think about carrot cake? zucchini bread? Huh? Perfectly good vegetables.

My ASD kid was a very picky eater and still won't eat cooked carrots (at age 26), but will eat them if they are sort of crisp in stir-fry or raw. You can sneak vegetables, like pureed carrots into spaghetti sauce, and grated vegetables into meat loaf.

I had to do a lot of sneaky things like that to my kids to get them to eat enough protein. The ASD kid would NOT eat eggs or tofu and most meat and fish for a long time. Dairy has always been a favorite though.

It's nice to see Bud being so brave. It's a big deal to eat something that you really don't like.

mike stanton said...

to this day there are foods I cannot eat because someone stood over me and made me eat them at school. My autistic son eats most things but his NT sister cannot eat eggs, fish (apart from tuna) or mushrooms and is just beginning to tolerate rice and onions aged 19. It is a texture thing with her. I am the same. But mealtimes are interesting as we both loathe different textures.
I think it is great what you and Bud are doing but just be ready for the foods that really make him gag and no amount of stickers are going to change that.

mom-nos said...

Gretchen, if this sticker chart plays out like the others, he'll continue the habit even after he gets the prize. Time will tell, though. I'll keep you posted.

Kristen, we did our first sticker chart with Bud when he was 5 1/2. Maybe if you start with something that's not a huge challenge you could get a sense of whether or not your son grasps the concept. I got the clubhouse on ebay, but they also have it at the online Disney store.

Camille, funny you should mention that. In fact, the cake in question was a chocolate cake made with canned pumpkin instead of oil. I'd love to sneak veggies into his tomato sauce and meatloaf... if only I could get him to eat tomato sauce or meatloaf!

Mike, I hear you. This experiment is 100% challenge by choice. Bud picks out the veggies for each meal, and has the choice of opting out at any point. Today he picked out what he wanted to buy at the grocery store - very enthusiastically! Here's hoping.

for what it's worth said...

What a wonderful Christmas day. How great for you all.
I use sticker charts in my class all the time. And each child has their own set of goals that they want to work on towards "betterment". For one child it might be reading nightly, and another staying on task. I also give out stickers for "example" behaviour. We have done "Character-building" throughout the school. If the kids show an example of the desired schoolwide behaviour they get to tell the class of their success and encourage the others.

Veggies....ah veggies...what I wouldn't give to have crunchy veggies these days. We have experimented over the years with our own kids. Sometimes using a dip or something like a favored cheese sauce makes veggies a wee bit more exciting. I don't know how Bud reacts to "sauces" but it might offer a change to the usual presentation.

Dori said...

What is it with this selective eating?? I wish I knew.
Eating meals brings out Andrew's most aberrant behavior. I swear he could live on crackers and be quite happy.
I would be thrilled if he would willingly eat anything that was not a cracker and not shudder violently. The eating issue has been the most perplexing of all his behaviors.
I wish I knew what was going on in his head about food. Anyone out there know how I can get him off the bottle...I think he will be taking it to kindergarten!

Lisa/Jedi said...

Sticker charts have been an integral part of our lives since Brendan was 3 & giving up the binkie... We've used charts for getting off to school on time & potty training as well, & we still do a daily chart that's based on his overall behaviour, with clear specifics as to what is considered appropriate & inappropriate, & which evolves over time as he grows & behaviours change. He loves having the opportunity to earn things in between birthday & Chanukah/Christmas. One thing that I've found is that the more Brendan wants a particular thing, the harder the first few days are- probably because he's worried about how soon he'll be able to earn it.

Veggie-wise, have you tried edamame soy beans? Brendan has a friend with pdd who pretty much eats only white, mooshy foods, but we introduced him to edamame & he'll eat them. The flavour of edamame is very mild (it reminds me of popcorn), they are smallish & can be easily swallowed whole, & they are easy to cook. We have them at least once a week at home. Good luck with the veggie expedition!

Daisy said...

I've "hidden" veggies by grating them into sauces and casseroles, but you're looking for outright eating of vegetables. Does Bud like "sweet" vegetables like sweet potatoes and/or squash? good luck!

Dave said...

Reminds me abotu my son "Buddy" a few years back during Christmas... Thaks for the memories!

Mom to Mr. Handsome said...

AWESOME!!!!! With the right reward anything is possible :o) What a trooper Bud is. As you may remember, Gabe reacted the same as Bud does to food. It breaks your heart doesn't it, to see them struggle? But, they are so proud of themselves when it is all said and done. Great job mom! I know you have been trying to figure out a way to ease Bud into the idea of eating real vegetables. He maybe getting a great new toy, but the gift he is giving you is worth an untold amount of stickers!


Gabe has a real hard time with uncooked vegetables. We only do those every once in awhile. I was happy to see that Bud was open to them.

Rachel said...

About the not eating foods and gagging on them- I have Asperger's syndrome. There are only a few foods that I absolutely WILL NOT eat (peas, wholemeal bread, bread with seeds in, bread with butter, peanut butter or jam.) The reason for this is that the texture of them makes me unable to swallow them. I've tried to eat them, each time I end up gagging and spitting them out. I'm not sure what causes this, but it could be because many autistic people are overly sensitive to touch and because your mouth contains many touch receptors.
If they aren't accustomed to eating new foods that could also be a problem, I know that evn though I love tasting new foods I am very tentative with them, I will take very small bites and for a while have an "ewww, yuck" reflex because they are unfamiliar.
I think that the sticker chart is a great motivation, because it teache s planning and long-term goal-directed behaviour (neither of which tend to be strengths in autistic people.)
I hope I've helped.