Thursday, September 8, 2011

Therapy and Hierarchies of Difficulty

In general, therapy consists of breaking complicated tasks down into a hierarchy of components and then working on those components from easiest to hardest. So in speech therapy we start with sounds in isolation, then at the syllable level, then at the beginning, middle, and ends of words, then in phrases, then in sentences, and finally in conversation.

In OT we've been working on getting Ava to try new foods. Prior to OT, the only options I could think of were to try to make her try a bite (ha, ha) or to just put it on her plate and hope that eventually she'd try it if she were hungry enough and if everyone else around her was trying it. Well, nothing was working. She was never hungry enough to try something out of her comfort zone. She didn't respond to playing (let's play airplane type activities). She didn't respond to comments that her brother was doing a good job trying it. She didn't even respond to bribery (eat just a little and I'll give you a treat).

Our OT introduced a hierarchy for getting Ava to try new foods. I never would have thought of it on my own, but it is working.

The lowest level is just getting her to touch the food. I used tricks like asking her to test if it is too hot for me while pretending to be busy pouring a drink so I couldn't do it myself. I wasn't asking her to eat it yet - just to touch it.

The next step was to get her to just give it a kiss. She didn't have to eat it, just kiss it. Now this required a combination with bribery. We needed to fill her plate with something she didn't like and something she did like. She didn't get more of the food she did like until she gave the other food a kiss. This step took a little longer, but eventually she realized that giving food a kiss was not a big deal.

The next step was to give the food a little lick (if it is solid - this would't work with a pudding or anything like that). So when she wouldn't eat sausage, I could put a piece on a fork and she'd lick it. Again, we have to bribe her to do it for a second serving of something she likes.

The next step is to eat some of the new food. Sometimes we cut it into a very, very tiny taste and put it on a fork for her. She'll put it in her mouth and wash it down with a big gulp of milk. She doesn't actually chew it, but still it is a big step in the right direction.

Other times we use a food mill. You can put food in it and the children can help grind it up by turning the handle. We tell them they're making "magic" food. Then she can try a small taste of the magic food before she gets to eat something else.

A month ago Ava would absolutely refuse to touch or even consider trying anything outside her comfort zone. She honestly preferred to go hungry. She rarely ate more than 1 out of 3 things on her plate. A month ago our OT introduced the hierarchy (touch, kiss, lick, tiny taste, regular bite...) to us. Now I can get Ava to at least taste a tiny amount of a new food at least 80% of the time. It is a huge change and I'm so proud of her. It's amazing what a little knowledge and some new strategies can do for a situation that seemed impossible to change.

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