Texture Progression: The Effects of
Oral Sensory Defensiveness on Oral
Motor Function in ASD
SHARON M. GREIS, MA CCC/SLP, BRS-S
STEPHANIE M. HUNT, MS, OTR/L
Or
The effects of Autism on a child’s ability to tolerate
the sensory properties of food
The effects of neurological, cognitive, sensory, and
biobehavioral differences on a child’s ability to
advance feeding and oral motor development
The manifestation of ASD symptoms on eating
behavior and advancing texture
( Twachtman-Reilly, Amaral, & Zebrowski, Apri, 2008)
At the end of this session the participant will be able to:
Define the nature of feeding disorders in children on
the spectrum
Discuss the specific presentation of feeding
difficulties that are typically experienced by children
on the autism spectrum
Discuss the factors which influence the normal
progression of texture
Identify the oral sensory motor patterns and feeding
problems of children on the spectrum
Explain intervention strategies to progress food
texture acceptance and functional manipulation
International Classification of Functioning,
Disability, & Health (ICF)
World Health Organization developed a framework for
coding functional status
Benefits for SLP’s and OT’s working with children with
feeding and swallowing problems
ICD and ICF codes are complimentary
ICD codes classify health conditions
ICF codes classify descriptions of the impact of health
conditions on function
And ICF classifies severity of deviation from normal
(Lefton-Greif & Arvedson, 2007)
Nature of Feeding Disorders in ASD
Neurobiological differences of children on the autism
spectrum
Restricted range of foods
Food refusal behavior
Utensil requirements
Stringent mealtime requirements
Unusual eating behaviors (food cravings & pica)
Factors which Influence Feeding Development
Typical Atypical
Reflexive suck Impaired sensory
Vocal play modulation (sensory
seeking, sensory avoidance)
Oral exploration
Aversion to oral care and
Sensory modulation absence of oral exploratory
Progression of liquid, phase
smooth food, soft solid Sensitivity to taste, texture,
food and table food smell, sight of food
Intact constitutional GI disorders (GER)
capabilities
Eating abnormalities may include:
Mechanical eating
Gulping, shoveling, stuffing food
Not chewing
Throwing food
Spitting or vomiting
Avoidance of utensils or food to lips
Excessive fads or refusals
Holding food in the mouth for long periods
(Stroh, Robinson, & Stroh, 1986; Arvedson & Brodsky,2nd edition 2002)
Atypical Oral Sensory Experiences
49% of children with ASD were orally defensive.
67 % of children with ASD were described as picky eaters.
69% had difficulty with texture progression
30% of the parent’s of children with ASD described the impact of
sensory processing and mealtimes as negative
17 of 30 children with ASD selectivity for food type or texture
DeMattei, Cuvo and Maurizio (2007), Williams, Dalrymple, and
Neal (2006), Dickie, et al. (2009), Ahern, et al. (2001)
Sensory Food Aversion
A. Refusal to eat certain foods with
specific taste, temperature, smell for
at least one month.
B. Onset occurs with introduction of a
new or different type of food
C. Aversive response and refuses all
similar foods
D. Refuses all new
E. Dietary deficiencies, oral motor or
speech delay or avoids participation
F. No traumatic event to oropharanx
G. Not related to GI or food allergies
(Chatoor, 2009)
Sensorimotor Behaviors
Hyper-sensitivity Hypo-sensitivity
Oral Tactile Oral Tactile and Proprioceptive
Negative response to specific Pocketing in cheeks or buccal
cavity
textures
Swallowing whole pieces
Aversions to use of feeding tools Lengthy chewing
Dislikes messiness around Choking or vomiting
mouth Atypical chewing patterns
Poor bolus formation
Olfactory and Gustatory
Prefers bland foods Olfactory and Gustatory
Smells elicit vomiting Food holding
Prefers crunchy and highly
Extreme selectivity flavored
Gagging Disinterested in eating without
Food refusal enhancement of smell
Is it motor or sensory difficulties?
Gagging
Drooling
Tooth grinding
Immature spoon feeding skills
Immature cup drinking skills
Immature biting & chewing skills
Gagging
Sensory Motor
Sight of food Delay in chewing
development
Smell of food
Premature swallowing
Taste of food
Atypical pattern of
bolus transit
Drooling and Tooth Grinding
Sensory Motor
Decreased oral Absence of chewing:
awareness need for sensory input
Open mouth posture/ to tempo-mandibular
Low muscle tone joint
Inattention to the task
of eating
Immature Feeding Skills
Sensory Motor
Aversion to touch Motor planning
Avoidance of molar difficulty
surfaces
Food texture Intact ability/potential
preferences (soft to manipulate
smooth) food/liquid
Intact ability to initiate
the task
Holistic Approach to Specific Needs of ASD
Communication
Learning Oral
and Sensorimotor
Behaviors
Eating
Sensory
Processing
Organic
Developmental
Skills
General Guidelines for Holistic Treatment
Gradual and slow changes
Match child’s developmental level
Acknowledge sensory responses and treat
respectively
Begin supportive mealtime practices as early as
possible
Offer new foods at snack time or during therapy
Create a positive learning and communication
environment
(Morris & Klein, 2nd edition, 2000)
Dynamic Assessment Drives the Treatment
Swallowing Modify food present in
whole pieces texture to smaller
of food chopped pieces
Pocketing Increase
sensory Pacing of Visual and
food/delayed properties of bites Verbal cues
oral transit food
Refusal to gradual,
Reduce the
accept demand
subtle
modifications changes
Oral Sensory Treatment Strategies
Gustatory
Cooking (gradual introduction to smells)
Learn to label smells as possible flavors
Proprioceptive
Chewing on non-food items
Facial expressions (muscle movement)
Tactile
Firm touch with wiping face
Oral care
Increased positive touch (songs, etc.)
Oral Motor Tools
Oral Sensory Exploration
Utensil choice
Cups
In Conclusion
“EFFECTIVE INTERVENTION FOR STUDENTS
WITH ASD IS DEPENDENT ON AN
UNDERSTANDING THAT THE BEHAVIOR OF
THESE INDIVIDUALS IS THE RESULT OF A
CONSTELLATION OF NEUROBIOLOGICAL
IMPAIRMENTS RATHER THAN WILLFUL ACTS
OF NONCOMPLIANCE”. DIRECT TRAINING IN
THE USE OF THE INTERVENTION
TECHNIQUES DISCUSSED IN THIS
PRESENTATION WILL HELP TO FACILITATE
THE PARTICIPATION OF THESE CHILDREN IN
BOTH THE ASSESSMENT AND THERAPEUTIC
PROCESS.
TWACHTMEAN-REILLY ET AL, 2009
References
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DeMattei, R., Cuvo, A. and Maurizio, S. (2007). Oral assessment of children with an autism spectrum disorder.
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Thank you!
Questions?
Sharon M. Greis
[email protected]
Stephanie M. Hunt
[email protected]
