Question: My 3-year old daughter has a diagnosis of PDD-NOS. She is a very sweet child and is learning new things every day, although she isn’t quite talking yet. Our biggest problem right now is dinner time – she absolutely refuses to sit at the table with the family. She starts screaming and I end up serving her dinner on the coffee table in the living room. She nibbles while she watches Blue’s Clues. Is this okay to do or should I make her be with the family?
Worried in Longmont
How difficult! We can certainly understand why, for the sake of family harmony, you’ve tried the “coffee table solution” to your daughter’s refusal to eat with the family. Sometimes those are the best decisions to make, and only you and your family can make that call. However, in this situation, your daughter’s difficulty sitting with other people at a table during dinner could also be looked as an important learning opportunity. She will need to learn to sit with others and participate in small groups in several different contexts in her life. Finding ways to help your child to participate actively in everyday family events is very important – both for her adjustment at home and in the community. Here are a few thoughts on how you might encourage more participation at the table during family meals:
1). Begin by practicing sitting at the table when it is not dinner time. Bring a few favorite toys or activities to the table and provide a firm and gentle prompt for her to sit (“Abby, please sit”). Consider patting the chair with your hand to also give her a gestural cue for what you want her to do. If necessary, silently physically guide her body into a sitting position. When she sits down, give her access to a special toy or activity. When she gets up to go, prompt her hands to make a sign for “all done” (maybe a wisking motion away from her body), say the words “all done”, allow her to get up and remove the toy. Keep all the good stuff at the table and when she sits, she gets the good stuff. When she wanders, she doesn’t. Practice when you can throughout the day.
2). Try to remember a simple rule about human behavior, which is true for all people, not just those with autism spectrum disorders: The more we avoid something we don’t like, the harder it is to cope with it. Avoidance leads to more avoidance. It will be very important to help your daughter to learn how to cope with her distress instead of avoiding the stressful event. This is perhaps the most important reason for addressing the dinner time issue, so that she can learn to regulate her own distress in a safe situation.
3). Before trying any new interventions, talk to your family about what you want to try to do, why it’s important, and how they can help. If you have other children, talk with them and listen to their concerns and complaints about all the yelling and screaming that will probably ensue when you try to teach your daughter to come to the table. Try to explain that it is important for your daughter to learn how to do this and enlist the other members of the family to help by being patient. Discuss how any change takes a little while to take hold and that there may be more chaos before there is peace again.
4). After you have practiced sitting at a table for a little while, you are ready to start a new dinner time routine. Consider the following:
a. Set a timer for 30 seconds.
b. Put some of your child’s preferred foods on her plate at her place at the table.
c. Say “ __ please sit” and pat the chair. Try not to say anything else.
d. Wait 3-5 seconds for a response. If she doesn’t get into the chair, guide her in. If she screams, don’t let that stop you.
e. Encourage good sitting by praising, singing, feeding, etc.—whatever works for your child. Do not let the screaming end the sitting.
f. When the timer sounds, say “all done” and move her hands through the sign. Show her she can leave the table if she wants to – but do not allow her to take food with her. From now on, when she wants dinner, she eats at the table. When she spontaneously sits, present her with the food. When she leaves, no food.
g. Gradually increase the amount of time your child is required to sit before earning the free up and down movement from the chair. For a child of 3, aim for 3-5 minutes.
In order for this approach to work, you need to consider eliminating eating anywhere but at the table for a while, until your child learns the rules. If you are worried that he/she is not getting enough nutrition, obviously, do what you need to do to get enough nutrients in. If you feel that you have to feed her “on the go” because she is not eating enough, then try to do it in a “special” kind of way, such as eating outside or in one part of the house. Do not re-introduce the grazing off the coffee table routine, as that will be very difficult to over-turn again.
5) For kids who love to eat in front of the television: consider developing a routine where they get to watch TV after sitting at the table for a few minutes.