M

cMaster Children’s Hospital (MCH) and Ron Joyce Children’s Health Centre (RJCHC) are home to one of the largest growing hospital-affiliated autism programs in Ontario. Services offered by the autism program at RJCHC include a clinical team which specializes in Applied Behaviour Analysis (ABA). ABA therapy focuses on building communication and daily living skills while reducing interfering or challenging behaviours. It can be provided in the clinic, at home, at school, and in the community.

As part of autism awareness we’re shining the spotlight on Lochlin, a young patient with autism who struggled to find food appealing. His ABA autism therapist, family, and healthcare team built a plan to develop and encourage healthy eating.

Aba Therapy Focus

Lochlin Baxter was diagnosed with Autism Spectrum Disorder (ASD) at RJCHC shortly before his third birthday. His feeding behaviour had become a major concern and he wasn’t gaining weight. Following a case of stomach flu, his aversion to solid foods worsened, requiring hospital admission and the insertion of a gastrostomy tube (G-tube). A G-tube is inserted through the wall of the abdomen directly into the stomach. It is used to provide liquid and food to people who are unable to meet their caloric needs with oral feeding.

Now nine years old, Lochlin continues to use his G-tube but has been working with the staff at RJCHC to decrease his dependence on the tube, and to expand the amount and types of foods he will eat.

Autism therapist, Kiley Lortie, facilitates direct therapy sessions with Lochlin and his parents to de-sensitize him to foods without overwhelming him.

Achieving Nutrition Goals

Lortie and the team had to be cautious when introducing new foods to Lochlin, making sure there were no problems with swallowing or choking.

“We started very small with Lochlin,” says Lortie. “We began with skills such as taking a lick of yogurt off a spoon and slowly worked our way up to expose him to larger amounts and different types of foods. Lochlin is such a fun, silly little guy and we were able to use that to find different ways of introducing food to make eating fun for him.”

Lortie also uses a reward-based initiative to help motivate Lochlin to eat meals and use positive coping skills. “He loves things like trivia and guessing games, so we have him take a certain amount of bites or finish a portion to earn clues or Google certain facts. It’s all about finding that middle ground and finding ways to keep him motivated.”

The team also worked at understanding why Lochlin struggled to accept new foods and helped him express his feelings about food in a positive way. Lochlin was extremely selective about the kind of foods he eats but by following the plan his health-care team developed, he has progressed very well with the program.

“Children with ASD can be turned off by food based on its texture, consistency, colour, or smell,” says Dr. Gillian Hogan, a pediatrician who works with Lochlin and Lortie. “It can take time to sort out why a child is struggling. For children who are fed by G-tube, progressing to oral feeding is often a lengthy process.”

Collaborating As A Team

“If it wasn’t for Kiley and the team, there’s no way Lochlin would be where he is today,” says his mom, Amanda Baxter.

Lochlin has come a long way and can now take snacks to school and enjoy them with his friends.

Hogan, Lortie and Lochlin’s parents work together as a team to ensure his nutritional goals are being met. “Family is a huge part of the care team in our program,” says Lortie. “It’s great when everyone can come together and collaborate. It helps to create consistency and routine for the patient.”

Lochlin will sit with his family and eat meals together while using positive communication to express what foods he likes or dislikes. “Eating and using emotional coping skills are both hard things to work on, and he manages both very well,” says Lortie who has also joined Lochlin during family meals.

“Kiley’s awesome,” says Lochlin. “I always get so excited every time she comes over and we get to do things together like build Lego.”

ENCOURAGING INDEPENDENCE AND CHEERING-ON POSITIVITY

Lochlin loves to be independent, and as he progresses, he is open to more options and choices. “Asking what he wants to eat, which spoon he would like to use, and things like this help give him a sense of control that helps to build empowerment,” says Lortie.

Recreational opportunities offered at the RJCHC have helped to provide Lochlin with a positive community as well. For example, as part of the RJCHC cheer team he loves to promote encouraging messages like, “I can do this” and “I’ve got this” in his everyday life.

Moving forward, Lochlin’s healthcare team and family are continuing to gradually increase his food intake orally while also boosting his independence and confidence.

“We should never put limits on where a child can go,” says Hogan. “Kids are resilient and Lochlin’s story is an example of pushing against those limits. I’m amazed at how far this young boy has come, and he’s grown so much since I’ve known him. It’s been a pleasure to work with him and his family.” n H

Shriners Children’s has been providing hope and healing to children for more than 100 years. Our compassionate, prestigious doctors and care teams are committed to excellence in care related to a number of different pediatric orthopedic conditions including muscular and neuromuscular conditions. Our individualized care plans can include physical therapy, occupational therapy, orthotics and prosthetics, care management and rehabilitation. Our services are available to children across the country as well as internationally.