“We heard autism educator Peter Gerhardt talk about how important table manners are for social acceptance. Our 17 year old has come a long way in other aspects of his social life. But he still grabs food almost before it’s served, stuffs his mouth and generally makes a mess when eating. How can we help him learn to eat in a socially acceptable way?”
This week’s “Food for Thought” answer comes from autism educator Peter Gerhardt. Dr. Gerhardt is world-renowned for his work with adolescents and young adults on the autism spectrum. He shared his expertise at the Autism Speaks National Conference for Families and Professionals in both 2012 and 2013.
Thanks so much for your question. As you say, I’ve long emphasized the importance of a relatively small handful of skills as essential to adult independence and community integration. In addition to polite eating, they include good hygiene, appropriate sexual behavior and aggression avoidance. We need more research on how to best impart these skills to children and young adults who have autism.
Here’s how I would break down the skills your son needs in order to master what our society considers “good table manners.”
Waiting to be served
From what you describe, the first skill to work on is “waiting.” I’m sure there are many approaches to teach this skill. The one I use is as follows:
1. Identify the highly desirable item or activity (in this case the food being served).
2. Ask the individual if he or she wants the item or activity.
3. Assuming he or she indicates (in whatever manner) “yes,” then reply along the lines of “Great, just wait a second” with clear emphasis on the word “wait.”
4) After a brief interval (3 to 5 seconds) deliver the item or activity and provide positive reinforcement for “great waiting.”
5) Systematically increase the waiting interval to a reasonable amount of time.
Pacing the meal
The second skill to focus on is pacing. This, too, requires waiting skills. To teach pacing, consider using a signal such as a timer. When it beeps, you son takes another bite. If your son works better with visual supports, you might try sitting across from him with an appropriate “cue card.” Firmly block his attempts to eat before the signal and provide clear and strong positive reinforcement when he uses his waiting skills.
The third skill your son needs to master is wiping his face. This can be when it’s necessary or at regular intervals. I recommend the latter if he has trouble sensing food on his face.
For the “when necessary” approach, we sometimes practice by placing a small amount of food or other nontoxic substance at different locations on an individual’s cheek. We then model wiping the face in the correct place and provide positive reinforcement when the individual imitates.
If you opt to teach your son to wipe at regular intervals (regardless of food on the face), you can use a visual signal or audible timer to help him get into the habit.
Putting it all together
Finally, the goal is to chain all these skills into the larger behavior we call “good table manners.” In other words: The food arrives; wait to eat; pace appropriately; wipe face; pace appropriately; etc.
I hope you find this approach helpful. Please let us know how you’re doing.
Need more help with issues around food, eating or special diets? Send your questions to FoodForThought@AutismSpeaks.org.
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