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
 Oral Tactile
 Negative response to specific
textures
 Aversions to use of feeding tools
 Dislikes messiness around
mouth
 Olfactory and Gustatory
 Prefers bland foods
 Smells elicit vomiting
 Extreme selectivity
 Gagging
 Food refusal
Hypo-sensitivity
 Oral Tactile and Proprioceptive
 Pocketing in cheeks or buccal
cavity
 Swallowing whole pieces
 Lengthy chewing
 Choking or vomiting
 Atypical chewing patterns
 Poor bolus formation
 Olfactory and Gustatory
 Food holding
 Prefers crunchy and highly
flavored
 Disinterested in eating without
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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Thank you!

Questions?

Sharon M. Greis
greis@email.chop.edu

Stephanie M. Hunt
hunts@email.chop.edu