December Summary - Gina

December Summary

Question 1:

The most prevalent challenges noted was working with the parents to coordinate care and correctly interpreting symptoms. Parents may serve as a barrier in themselves if they are resistant to trying new nutritional approaches. Jenn also pointed out how parents or guardians are a key source of information for recognizing symptoms which may not be well communicated by the child. The plethora of anecdotal evidence of nutritional treatment adds even more confusion to what a parent should do. Carly complimented Jenn’s statement by suggesting parent education and child friendly tools, to help recognize and discern symptoms, as likely approaches to overcome barriers. Sophie built upon Carly’s idea by suggesting different modes of communication such as writing, if age appropriate. Des brought up the very important point of listening with an open mind. So many nutritional challenges can occur, it is very important to explore all possibilities. As mentioned by Amanda and Viv, repeatedly offering new foods and setting a good example, as parents, by eating the foods too may increase a child’s familiarity and potentially curiosity and acceptance of new foods. Patience is important with any pediatric population.

Question 2:

After reading the articles, many of us realized just how many different characteristics of food can be triggers for rejection. The even higher prevalence of food rejection in the ASD population would likely require some creative thinking to meet the nutritional needs of the child. Amanda mentioned how some of the questions and avenues to be explored in a thorough assessment are not necessarily aspects we would anticipate to be relevant. Jenn brought up the additional concern of food allergy prevalence as a place for expansion in future drafts of standards of practice. Carly had a great idea in using precise identification of the disliked sensory characteristic to help direct food modifications, even down to the texture, which may potentially expand a previously limited food repertoire. Des noted the unique psychological barriers in this population, making the interdisciplinary team all the more important to comprehensive treatment. Abby brought up the idea to seek additional education to gain experience to help better understand the complexities of food aversion. Vivian’s remark draws attention to respecting the child’s preferences while working to expand accepted foods.

Question 3:

Counselling can be a challenge in itself, even more so with the additional stress often experienced by the caregivers of ASD children. The parent is the gatekeeper. As Abby mentioned, they often serve as the advocate for the child. No matter how much we are opposed to current nutritional management tactics, we must be careful to use the appropriate tone and language to not criticize parents, as stated by Amanda and Vivian. Gauging the openness and readiness for change tells us where to start. As noted by many, we have to build rapport. Des expanded on the notion that we must fully understand where we’ve been and where we currently are in order to take steps in the right direction and of the right size together with the caregiver. Additionally, Jenn brought up the importance of caring for the whole person to build a strong and trusting relationship. Carly reiterated the need to ask the parents’ permission to share information with them and to validate their intent to care for their child in the best way they know how. Working closely with an interdisciplinary team can certainly convey the comprehensiveness of consideration before treatment plans are implemented, Sophie. We must show we too want to be an advocate for the child.

Recommendations for Future Practice:

ASD can be a very frustrating and challenging disorder to manage. With such a high prevalence of comorbidities complicating this management, an interdisciplinary team is critical. The framework provided in this month’s article can serve as a guide to help ensure we are asking the right questions and exploring different options as appropriate for individual ASD clients with possible GI issues. The ASD population has many special considerations we must take with regard to diet and nutrition. Asking probing questions in the different aspects of nutrition described in the framework can help us perform a more thorough assessment, and subsequently provide better care as we consider possible treatment options. Creativity in methods of collection of information may serve to open additional avenues of communication.

With regards to counselling, listening, really listening to the parent is a very important first step in working with a child on the Autism Spectrum. We must understand the opinions and beliefs of the caregiver and the habits and behaviors of the child to make appropriate suggestions. With interventions, we need to meet the parents where they are and remain open-minded and nonjudgmental as we work together with them to find realistic solutions for their unique circumstances. Patience is necessary as we work around food acceptance challenges. Food first is preferable, but dietary supplementation may be necessary to reduce risk for nutritional deficiencies. We must continually consider quality of life for both the caregiver and the child. Building a relationship with the parents and empowering them as caregivers is crucial to our success as a team.