Thanksgiving and Autism: Coping with Family Hubbub and Limitless Food

This teen with autism loves Thanksgiving, but needs help avoiding emotional meltdown and gorging that ends in extreme stomach upset

“We have a big extended family full of good cooks. So Thanksgiving is a big deal. Unfortunately it often doesn’t end well for our 13-year-old who has autism. The combination of family hubbub and limitless food tends to be too much. Do you have some tips for avoiding the usual meltdown and, er, “upheaval.”

Today’s “Food for Thought” response is from behavior analyst Kara Reagon, Autism Speaks associate director for dissemination science.

I’m glad to hear that your Thanksgiving holiday is filled with family and good food. Thank you for reaching out with your question. There’s no doubt that your son’s issues are shared by many children and adults with autism.

The good news is that there are many ways to help your child cope with the excitement and bustling activity, as well as the unaccustomed over-abundance of delicious food.

Start building skills
It sounds like your son’s difficulties indicate a need to develop a number of important skills that can be taught in a stepwise manner. Ideally, you’ll want to start working on these well before the holidays. For example, you could work with your child’s teacher and/or behavioral therapist to develop goals such as the ability to self-monitor or take your signal that a break from the excitement is needed. Additionally, teaching children to ask for what they want is important. Often, disruptive behavior stems from wanting something but not knowing how to communicate that want. Of course, we also need teach that “sometimes we don’t get what we want.” That involves teaching coping skills around disappointment, including how to show disappointment inappropriately, making alternative choices and dealing with time delays.

Teaching appropriate mealtime behavior can be time intensive, but the payoff is worth it. It will allow you and your families to enjoy meals together both at home and with others. For more tips on these subjects, see “The Importance of Table Manners,” and “Helping a Messy Eater to Reduce Teasing at School.”

Try a social story
An illustrated social story is one way to help your son calmly prepare for the big day. Social stories can be particularly useful in helping an individual on the spectrum understand the changes in routine occurring on Thanksgiving. The Autism Speaks Family Services department has developed a social story specifically for Thanksgiving (right). (Download it free here.)

Visual supports are another way to help your teen prepare. The Autism Speaks ATN/AIR-P Visual Supports and Autism Spectrum Disorder tool kit provides a step-by-step, easy-to-understand introduction to visual supports with practical examples of how to use them to help your child. (Download it free here.)

You might create a visual calendar to help count down the days until Thanksgiving, as well as separate daily schedule of events for the day itself.

A visual schedule to slow down eating
You can also use visual supports to help your son slow down the pace of his eating. For example, you can build a visual schedule that first shows a fork with a bite of food. The next picture shows an empty fork placed back on the plate. The third picture shows a child chewing. The fourth – the child wiping his mouth with a napkin, and so on. Prior to Thanksgiving, start bringing this schedule to the table at mealtime. You or your son can move a token marker down the schedule to help him keep track of which step he’s on. (Also see, and “Help! 10 Year Old with Autism Gorges Till He Throws Up.”)

Tip for Thanksgiving Day
When Turkey Day arrives, here are some general tips for enjoying a holiday meal with a child or adult with autism:

* Dress comfortably. This probably isn’t the best time for your son to wear something new or different – especially if this has been an issue in the past. (Pick your battles.)

* Talk with your family about keep conversation, music and TV volume at an appropriate volume. This may be difficult if your family is anything like mine. Another option is to have your son use noise-reducing headphones – either alone or with some music he enjoys. Wearing headphones may not be appropriate for the entire day. But it can be very useful when you sense that your son is becoming overstimulated.

* Create a quiet room where your child can retreat and relax while waiting for the big meal. This is a great place to keep a bag of your son’s favorite toys, books and other independent activities.

* Most importantly, remember to catch your child being “good” – that is, playing, socializing or eating in an appropriate and healthy manner. Be sure to provide plenty of positive feedback. You know what your son likes – be it praise, a hug or a small reward such as a sticker or favorite toy. I understand that it can be hard to remember to reward a well-behaving child while you’re juggling the demands of preparing a holiday meal. Consider having a kitchen timer in your pocket or set your cell phone alarm as a reminder to touch base with your child and provide that positive feedback before disruptive behavior occurs.

* Consider minimizing table décor, including scented candles. Remember, the day will be filled with the savory and sweet aromas from all the delicious food you’re preparing. It can help to reduce other sensory input at the table.

* If you’re worried that your child will gorge on snacks and appetizers prior to the meal, consider moving these treats out of sight or under cover. You may need to enlist the help of understanding family members. For example, consider placing the appetizers in one place in bowls and platters that have covers. Ask family members to take turns monitoring the “snack zone” and assist children with appropriate portions.

* Once at the table, you can help an over-excited eater slow down by placing small portions of food on his plate. You can always serve seconds.

* If your son has difficulty controlling his impulse to grab food, consider sitting him immediately next to you or someone else who can provide support and reinforce appropriate table manners.

* Another option – if the family is willing – is to plate food in the kitchen rather than pile the table with serving platters. This avoids grabbing and encourages more of a pause between servings.

I hope these tips prove helpful. Please let us know in the coming weeks with a comment below or by writing us again at foodforthought@autismspeaks.org.

Need more help with issues around food, eating behaviors or special diets? Send your questions to FoodForThought@AutismSpeaks.org.

Also see the Autism Speaks ATN/AIR-P Guide to Exploring Feeding Behavior in Autism. Research suggests that more than half of individuals with autism struggle with food issues that can affect health and emotional wellbeing. This tool kit provides guidance from experts in the Autism Speaks Autism Treatment Network.

Subscribe to Autism Speaks Science Digest to receive research news, “Food for Thought” and all our expert-advice columns delivered biweekly to your inbox.

 


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