Monthly Archives: May 2017

Invisible disabilities 

Definition: Invisible Disability (Hidden Disability, Invisible Illness)
Invisible disability, or hidden disability, is defined as disabilities that are not immediately apparent. Some people with visual or auditory disabilities who do not wear glasses or hearing aids, or discreet hearing aids, may not be obviously disabled. Some people who have vision loss may wear contacts. A sitting disability is another category of invisible impairments; sitting problems are usually caused by chronic back pain. Those with joint problems or chronic pain may not use mobility aids on some days, or at all. Although the disability creates a challenge for the person who has it, the reality of the disability can be difficult for others to recognize or acknowledge. Others may not understand the cause of the problem, if they cannot see evidence of it in a visible way.
Main Document
What are Invisible Disabilities?
Invisible Disability, or hidden disability, is an umbrella term that captures a whole spectrum of hidden disabilities or challenges that are primarily neurological in nature.
Do people sometimes have difficulty understanding how your symptoms such as extreme fatigue, dizziness, pain, and cognitive impairments can be so debilitating to you but can even be met with hostility by society at large?
People with some kinds of invisible disabilities, such as chronic pain or some kind of sleep disorder, are often accused of faking or imagining their disabilities. These symptoms can occur due to chronic illness, chronic pain, injury, birth disorders, etc. and are not always obvious to the onlooker.
Invisible Disabilities are certain kinds of disabilities that are not immediately apparent to others. It is estimated that 10% of people in the U.S. have a medical condition which could be considered a type of invisible disability.
Nearly one in two people in the U.S. has a chronic medical condition of one kind or another, but most of these people are not considered to be disabled, as their medical conditions do not impair their normal everyday activities. These people do not use an assistive device and most look and act perfectly healthy.
According to the Americans with Disabilities Act of 1990 (ADA) an individual with a disability is a person who: Has a physical or mental impairment that substantially limits one or more major life activities; has a record of such an impairment; or is regarded as having such an impairment.
Generally seeing a person in a wheelchair, wearing a hearing aid, or carrying a white cane tells us a person may be disabled. But what about invisible disabilities that make daily living a bit more difficult for many people worldwide
Invisible disabilities can include chronic illnesses such as renal failure, diabetes, and sleep disorders if those diseases significantly impair normal activities of daily living.
For example there are people with visual or auditory impairments who do not wear hearing aids or eye glasses so they may not seem to be obviously impaired. Those with joint conditions or problems who suffer chronic pain may not use any type of mobility aids on good days, or ever.
Another example is Fibromyalgia which is now understood to be the most common cause of chronic musculoskeletal pain. Sources estimate between 3 and 26 million Americans suffer from this hidden condition.
Other Types of Invisible Disabilities:
Chronic Pain: A variety of conditions may cause chronic pain. A few of those reasons may be back problems, bone disease, physical injuries, and any number of other reasons. Chronic pain may not be noticeable to people who do not understand the victims specific medical condition.

Chronic Fatigue: This type of disability refers to an individual who constantly feels tired. This can be extremely debilitating and affect every aspect of a persons every day life.

Mental Illness: There are many mental illnesses that do qualify for disability benefits. Some examples are depression, attention deficit disorder, schizophrenia, agoraphobia, and many others. These diseases can also be completely debilitating to the victim, and can make performing everyday tasks extremely difficult, if not impossible.

Chronic Dizziness: Often associated with problems of the inner ear, chronic dizziness can lead to impairment when walking, driving, working, sleeping, and other common tasks.

People with psychiatric disabilities make up a large segment of the invisibly-disabled population covered under the Americans with Disabilities Act of 1990.
Invisible disabilities can also include chronic illnesses such as renal failure, diabetes, and sleep disorders if those diseases significantly impair normal activities of daily living. If a medical condition does not impair normal activities, then it is not considered a disability.
96% of people with chronic medical conditions live with an illness that is invisible.
Many people living with a hidden physical disability or mental challenge are still able to be active in their hobbies, work and be active in sports. On the other hand, some struggle just to get through their day at work and some cannot work at all.
List of Invisible Disabilities

ADHD

Anxiety disorders

Allergies

Arachnoiditis

Asperger Syndrome

Asthma

Autism

Bipolar disorder

Brain injuries

Charcot-Marie-Tooth disease

Chronic fatigue syndrome

Chronic pain

Circadian rhythm sleep disorders

Coeliac Disease

Crohn’s disease

Depression

Diabetes

Ehlers Danlos Syndrome

Endometreosis

Epilepsy

Fibromyalgia

Food allergies

Fructose malabsorption

Hereditary Fructose Intolerance

Hyperhidrosis

Hypoglycemia

Inflammatory bowel disease

Interstitial cystitis

Irritable Bowel Syndrome

Lactose Intolerance

Lupus

Lyme Disease

Major depression

Metabolic syndrome

Migraines

Multiple Sclerosis

Multiple Chemical Sensitivity

Myasthenia Gravis

Narcolepsy

Personality disorders

Primary immunodeficiency

Psychiatric disabilities

Reflex Sympathetic Dystrophy

Repetitive stress injuries

Rheumatoid arthritis

Schnitzler’s Syndrome

Schizophrenia

Scleroderma

Sjagren’s syndrome

Temporomandibular joint disorder

Transverse Myelitis

Ulcerative Colitis

Quick Facts: Invisible Disability in Society
Invisible disabilities are the most common type of disability among college students. For example, students with learning disabilities, Attention Deficit Hyperactivity Disorder and/or psychiatric disabilities may request accommodations even though they do not appear to have a disability. There are numerous other hidden or invisible disabilities such as heart condition, Chronic Fatigue Syndrome, Fibromyalgia, and Seizure Disorder.
A growing number of organizations, governments, and institutions are implementing policies and regulations to accommodate persons with invisible disabilities. Governments and school boards have implemented screening tests to identify students with learning disabilities, as well as other invisible disabilities, such as vision or hearing difficulties, or problems in cognitive ability, motor skills, or social or emotional development. If a hidden disability is identified, resources can be used to place a child in a special education program that will help them progress in school.
Statistics: Invisible Disability
About 10% of Americans have a medical condition which could be considered an invisible disability. 96% of people with chronic medical conditions live with a condition that is invisible. These people do not use a cane or any assistive device and act as if they didn’t have a medical condition. About 25% of them have some type of activity limitation, ranging from mild to severe; the remaining 75% are not disabled by their chronic conditions. Although the disability creates a challenge for the person who has it, the reality of the disability can be difficult for others to recognize or acknowledge. Others may not understand the cause of the problem, if they cannot see evidence of it in a visible way.

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The controversy on prenatal tests and autism

Prenatal tests and autism – a mother’s story

Charlotte Moore

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When my eldest son, George, was born, the Berlin wall had just fallen and Nelson Mandela was about to be released. Sometimes, those great images of freedom seemed ironic comments on my own situation. As I cradled my alert, healthy, bright-eyed baby, I had no way of knowing that he had an invisible lifelong condition that, 19 years later, would keep him almost as dependent as a toddler.
George is autistic. So is his brother Sam, born 22 months later. Knowledge of autism has galloped forward since their early days. Then, it hadn’t even been established that it was a genetic condition, with structural differences to the brain. Soon a prenatal test may be available, to indicate whether a foetus is likely to develop autism. I’m glad that test wasn’t available to me.
My first pregnancy ended in a termination. A mid-term scan showed the baby had no limbs. Such a child, I thought, would have no option but to be a hero. I considered this an unfair burden, and I ended his life, with great sorrow but without regret.
It would seem logical, then, that I would have made the same decision about an autistic foetus, that I would have chosen to sidestep a lifetime of dependency of a different kind. And yet there is no part of me that wishes away my sons’ lives, or the life I have with them.
I have a third son, Jake, 10, who is as unautistic as they come. When I outlined the abortion debate, he was indignant. “George and Sam aren’t sad about being autistic because they don’t know they are,” he said. “Anyway, what’s wrong with being autistic?”
Jake accepts the life he’s always known. His brothers break his possessions, gobble up his chocolate, render the lavatory unfit for use. But he blames them no more than he blames his beloved cat for tormenting baby rabbits. They’re autistic; that’s what they do.
Many articulate autistic people would argue that Jake’s right; there’s nothing intrinsically “wrong” with being autistic, it’s just that our neurotypical society is ill-adapted to their needs.
Unlike my sons, who I believe have no perspective on their condition, the more able often suffer from awareness of their differences. I doubt that a prenatal test would be able to distinguish between severe autism and the “high-functioning” kind, but in any case it’s a mistake to think that life is easier for the more able. However, would able autists agree that their potential suffering should have been terminated before birth? I suspect not.
Most autists are physically healthy. A minority have epilepsy, and gut problems are quite common, but, for most, “quality of life” depends on quality of care and understanding, appropriate education, and a living environment that takes account of their sensory hypersensitivities.
Such conditions are achievable – but at considerable cost to the carers, usually the parents. Not only is the caring hard work, but there’s no cut-off point. My friends’ children are away on gap years, starting university, finding partners. George and Sam are giant children, and my responsibilities towards them will continue until I die.
A prenatal test without a termination would have prepared me a little for what lay ahead; I would have wasted no time in barking up the wrong trees, which would have been a good thing. But the thought that I might well have opted for termination makes me shudder. I view abortion pragmatically. It’s always happened, and it always will.
When the prenatal test is introduced, it will make no sense to decree that a mother can choose to terminate, say, a Down’s baby, but is obliged to keep a potentially autistic one. It’s inevitable that many will be terminated.
Autism often means sleeplessness, eating problems, self-harming, aggression, destructiveness, bizarre behaviour of all kinds. It can destroy marriages, and it certainly doesn’t help your finances. I would never condemn a mother who decided that she couldn’t cope with these possibilities.
But autism also means unique perceptions, special talents, weird humour, a view of the world untainted by greed, envy, malice, vanity, ambition. Our family life is as rich and as meaningful as any other; my sons’ lives are not tragic, and nor is mine. A society that aims to remove all the variables that make human life so fascinatingly complex is not a society I want to live in.

Heavy risk on autism

ASD comes with a heavy risk of mental health complications, but this darker side of autism is one that is poorly understood by the broader community.By Cassie Brown 

18 APR 2016 – 2:10 PM UPDATED 19 APR 2016 – 4:25 PM

When an individual with Autism Spectrum Disorder (ASD) is diagnosed, the conversation inevitably turns to the scarily named ‘comorbidities’. A comorbidity is a condition that co-exists alongside the primary diagnosis. For individuals with ASD, these might be physical (like an increased risk of migraines, epilepsy, or gastrointestinal problems). The most prevalent comorbidities, however, are mental health conditions, and include anxiety and anxiety disorders, OCD (obsessive compulsive disorder), major or clinical depression, ADHD (attention deficit hyperactivity disorder), ODD (oppositional defiance disorder), and bipolar disorder. Statistics vary, but studies suggest that over 70 per cent of autistic individuals suffer from anxiety or depression, and up to three-quarters of children diagnosed with ASD are concurrently diagnosed with at least one, and often many, comorbidities.
 
There is a question of when ASD stops and a new, co-morbid condition begins. 
Undoubtedly, there is a question of when ASD stops and a new, co-morbid condition begins. At what point, for example, does extreme anxiety about social performance stop being an intrinsic part of ASD and begin being Social Anxiety Disorder? At what point does an individual’s need to order their world in often idiosyncratic ways become OCD? At what point does a person’s need for movement because of unusual proprioceptive sensory processing, or lack of focus because of an inability to prioritise sensory stimuli, become ADHD?
Regardless of the answer to these questions the undeniable fact is that ASD comes with a heavy risk of mental health complications, and this darker side of autism is one that it poorly understood by the broader community.
When his teacher once asked him what the worst day of his life was, he responded that it was the day he was born.
Research suggests that individuals with ASD are up to 28 times more likely to contemplate or attempt suicide than their neurotypical peers. Autistic individuals without associated learning disabilities are nine times more likely to die from suicide than the neurotypical population. They not only suffer from a significantly greater risk of clinical depression than the non-autistic population, but a recent study suggests that those with autism live on average between 12 and 30 years less (depending on their comorbidities) than those without it. That study also asserts that ‘autistic adults with a learning disability are 40 times more likely to die prematurely due to a neurological condition’. This discrepancy is stark, real, and sobering, especially when we think that premature mortality is not just a matter of statistics: people are dying unnecessarily.
My eldest autistic son first had suicidal ideations when he was five. At six, he began matching actions to his words. By the tender age of seven, he had experienced two periods of clinical depression, and emergence from that depressed state is arduous and slow. He still speaks impassively about feeling so different that his only escape from this world in which he feels he does not belong, is suicide. His mantra, ‘I’m done with this world’, is a matter of fact statement of his reality. When someone asks him what he wants to be when he grows up, he often responds that he doesn’t want to grow up. Not in a jingly Toy-World kind of way, but in an I-don’t-want-to-be-here-when-I-grow-up kind of way. When his teacher once asked him what the worst day of his life was, he responded that it was the day he was born. His ASD might have made him feel different in the first place, but his mental health problems exist outside of (if complicated by) his autism diagnosis.
I can’t really imagine how it must be to live as an exile from the world at any age, or how alienated you must feel to articulate such depth of sadness as my son has.
My son’s story highlights two critical points. Firstly, individuals with ASD and their families regularly have to face mental health issues alongside ASD: ASD is rarely the whole story. And, of course, the impotence of watching your child or children struggle not only with ASD but also with those (often times more debilitating) co-morbidities places substantial stress on parents’ (and indeed, siblings’) mental health also.
Secondly, labels and stereotypes don’t take into account the suffering of someone displaced and alienated by a foreign world in which they are forced to participate. We tend to locate responsibility for how autistic individuals cope in ‘our’ neurotypical world with the autistic individuals themselves (and perhaps with their family). But could you imagine feeling so dislocated in – and by – the world in which you have every right to live peacefully, that you genuinely wish you hadn’t been born? Some of the responsibility for that displacement rests at our door since it is we – broadly speaking – who do not actively find the ways to facilitate acceptance and belonging.
I can’t really imagine how it must be to live as an exile from the world at any age, or how alienated you must feel to articulate such depth of sadness as my son has. I often contemplate what I did (do) wrong, what I could have done better, and what I might do in the future to erase those thoughts from his mind. But the reality is that I can’t do it alone. As much as I can accept and embrace him as a unique, valued and respected autistic person, it is his community that needs to understand him to complete that process of belonging.
Their mental health comorbidities are often far more disabling than the autism itself.
The difficulty, of course, is knowing what we can do to make a difference to those suffering from ASD-related mental health difficulties. What can we do as a society to decrease their anxieties, increase their inclusion, and minimise their depression? What can we do as parents beyond the merry-go-round of psychology, psychiatry, and therapy appointments to which we dutifully take our children in the hopes that they might be taught the skills and resilience to cope in this world into which they have been born?
The answer is not easy, although awareness and acceptance informed by education is clearly key. Certainly, it is a question with which I struggle daily. But not having a ready, implementable answer doesn’t mean that the question isn’t worth asking of ourselves and each other. At a time when mental health difficulties are rising dramatically not only in our youth, but also in our younger, primary school aged populations, children with ASD are a particularly vulnerable group. As a community we are committed to talking about mental health problems and participating in open, respectful dialogue about mental health. We have a responsibility to include the autistic population in this discussion since for them, their mental health comorbidities are often far more disabling than the autism itself.

From the words of radical neurodivergence speaking 

If you voted republican, this is for you. Fuck you. You need to read the whole thing.
I have 2 easily controlled potentially fatal conditions. One is common and less easily controlled in my instance. The other is super rare but also super easily controlled.
Again, without treatment they will both be fatal. It’s a race to see which one.
The rare one is central adrenal insufficiency. I do not produce my own cortisol. Cortisol is required for basic homeostasis. Without cortisol, even a small injury or physical stress (spraining an ankle, high fever, anything) causes a cascade of effects that end in cardiovascular collapse. You lose blood pressure. Your heart stops pumping effectively. Your blood sugar crashes. You DIE of shock. Like the shock that they tell you to protect seriously injured people from, using blankets and such. Without medication, I will go into shock and die from the stresses of daily life.

And it’ll be your fault.
Unless I die of epilepsy related causes. The first is SUDEP, sudden unexpected death in epilepsy. The only way to prevent SUDEP is to treat seizures. Frequent seizures are the biggest risk factor. The other epilepsy related effect is status epilepticus, a seizure that doesn’t stop.
Hold onto your hats, you bigoted fucks. I don’t care that you’re uncomfortable. This is what you voted for, now own it.
In status epilepticus, a person has a seizure that won’t stop. The most commonly noticed status epilepticus is tonic clonic status, although partial complex and absense status also exist (and lead to all sorts of problems like subtle brain damage and getting hit by a goddamn car because you’re only 25% aware of the world around you). This is not good.
Your body is not made for every muscle to be contracting at once for an extended period of time. Neither is mine. The muscles start to break down. This floods the body with waste. The brain fries itself. Like, literally. It cannot deal with the fallout of the electrical activity. It is not made for that. You can seize yourself into a persistent vegitative state. If you are me, your seizures will dislocate joints. Remember that adrenal insufficiency thing up-post? That is the sort of injury that leads to adrenal crisis, as is everything else about status epilepticus. Your heart gives out. Your kidneys can’t cope. Your brain stops being able to not seize. 
This is an awful way to die.
You voted for this.
Fuck you.

#corpsesdontvote
From posted blogger 

Pre- existing conditions lost??

A list of pre-existing conditions lost under #Trumpcare:
AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer’s/dementia, anemia, aneurysm, angioplasty, anorexia, anxiety, arrhythmia, arthritis, asthma, atrial fibrillation, autism, bariatric surgery, basal cell carcinoma, ipolar disorder, blood clot, breast cancer, bulimia, bypass surgery, celiac disease, cerebral aneurysm, cerebral embolism, cerebral palsy, cerebral thrombosis, cervical cancer, colon cancer, colon polyps, congestive heart failure, COPD, Crohn’s disease, cystic fibrosis, DMD, depression, diabetes, disabilities, Down syndrome, eating disorder, enlarged prostate, epilepsy, glaucoma, gout, heart disease, heart murmur, heartburn, hemophilia, hepatitis C, herpes, high cholesterol, hypertension, hysterectomy, kidney disease, kidney stones, kidney transplant, leukemia, lung cancer, lupus, lymphoma, mental health issues, migraines, MS, muscular dystrophy, narcolepsy, nasal polyps, obesity, OCD, organ transplant, osteoporosis, pacemaker, panic disorder, paralysis, paraplegia, Parkinson’s disease, pregnancy, restless leg syndrome, schizophrenia, seasonal affective disorder, seizures, sickle cell disease, skin cancer, sleep apnea, sleep disorders, stent, stroke, thyroid issues, tooth disease, tuberculosis, ulcers.

#TrumpCare
Testicular cancer is not on the list, nor is erectile dysfunction…..
So basically I’m screwed if this passes

Picky eaters and autism

Autistic children are often very picky eaters, or have eating issues. Having your child refuse to eat any foods that are not white and soft in consistency can be maddening, but as a speech therapist and parent I’ve found it most helpful to have a clear understanding of why a child self-limits their diet. 
Eating is a multi-sensory experience. Each mouthful brings the possibility of a variety of flavors, textures and temperatures. A feeding specialist would break this down further, identifying “Flavors” including sweet, sour, salty, spicy, bitter and neutral; “Textures” including crunchy, chewy, soft, mixed, puree, thick liquids, and thin liquids; and “Temperatures” including cold, room temperature, warm, and hot. In addition, we experience food odors, and often the way they feel in our hands. Many children who are picky or problem eaters may have Sensory Processing Disorder (SPD). In her book The Out of Sync Child: Recognizing and Coping With Sensory Processing Disorder, Carol Stock Kranowitz, MA defines SPD: 

Sensory Processing Disorder is difficulty in the way the brain takes in, organizes and uses sensory information, causing a person to have problems interacting effectively in the everyday environment … SPD is an umbrella term covering several distinct disorders that affect how the child uses his senses.

As I see it, a child with SPD may by hypersensitive, hyposensitive, or a mixture of both. The hypersensitive child may experience flavors, textures, temperatures, and smells to a degree that is not perceived by most others, or they may under experience them. The smell and texture of grilled chicken may elicit the same noxious sensory response as being stuck in a room with skunk stench. “GET OUT OF HERE!” is the message the body will send. The hyposensitive child may seek out strong flavors and crunchy, hard textures to make up for experiences they are missing. They may like spicy food, sour flavors (lemon, vinegar), and only crunchy foods.
Food choices are based on individual children’s sensory experiences. Foods providing a favorable sensory experience will be selected over those that provide a noxious sensory experience. Because a child with SPD can have eating experiences that are altered and different from their parents’, it can be very difficult to understand their preferences.
Autistic children can have SPD, but autism has its own factors that can contribute to picky eating. Autistic children are often uncomfortable with a change in routine. This preference for sameness can show up at meal time as well. Children may want foods to be from same container, the same brand, served on the same plate. So they may want a steady diet of McDonald’s chicken nuggets (no other brand), Snapple raspberry tea (only from the Snapple bottle), and Dannon vanilla yogurt (no other brand or flavor) served on the same plate.
Eating involves the integration of a variety of sensory experiences and is influenced by the “mealtime experience.” So what is a “typical” eater and when is eating a problem? 
The Continuum of Eating Types
A “typical eater” will usually:

eat a variety of foods

show interest in foods

tolerate the presence of new foods and try new foods

A “picky eater” can: 

Have aversions to some foods, but still eat a variety

Eat foods from each texture group and food group

Tolerate the presence of new food

Be willing to touch or try new foods

A “resistant” or “problem” eater will often:

Eat 15 to 20 foods or fewer

Refuse of one or more food groups (often preferring carbohydrates)

Refuse of one or more texture type (often preferring crunchy or soft foods, not both)

Tantrum or melt down at meal times

Prefer one flavor (often sweet or salty)

Prefer strong flavors OR bland flavors

Prefer foods of the same color

Prefer certain foods to always be the same brand. For example, only chicken nuggets from McDonald’s.

Gag when trying new foods

Display anxiety over the presence of new foods on their plate, on the table or even in the room

Find the smell of certain foods to be noxious

A child who may become a problem eater often starts to refuse foods when parents introduce chunky baby food. The presence of a solid requiring chewing and puree (or liquid) that does not require chewing is often perceived as noxious. This can play out in a child refusing to eat vegetable soup of diced vegetables and broth, but then eating the same soup when pureed. Many fresh fruits can present the same way. Citrus fruits, watermelon, ripe peaches and pears consist of a solid and juice combination. These are also often refused. Children may have “food jags” where they will request and eat the same food at every meal. The problem with this is that often children will suddenly refuse this food. For a child with a severely limited diet the elimination of a key diet item can be problematic.
What parents of problem eaters need to understand is that they did not create the feeding problem. Problem eating is the result of very real physical and neurological responses on the part of the child. Usually the parent of a problem eater has continually offered their child a large variety of healthy foods. When given the choice of a food perceived as noxious or not eating at all, these children will choose to not eat. They would do so over consecutive meals if made to. Withholding food or physically forcing a child to eat is never a successful method to get them to eat. In her book How to Get Your Kids to Eat … But Not Too Much, Ellyn Satter defines the role of a “good parent“ when feeding their children:

Good Parents are responsible for feeding their children … Parents and professionals working with children are responsible for preparing and providing a well balanced meal at an appropriate schedule and setting. The child is soley responsible for whether they eat and how much they eat.

What You Can Do

Create the Best Schedule and Setting for Successful Eating

Have meals and snacks at predictable times. A written or picture schedule can be helpful.

Eating and drinking done at the table during snacks and meals

Offer water to drink between meals

NO GRAZING. If children are allowed to eat through out the day they will not be able to regulate sensations of hunger and satiation. They may also snack on preferred foods during the day to fill themselves and eat fewer healthier foods at meal time.

Rotate foods and when they are served. For example, If a child can predict always having a large glass of milk before bed, they will eat fewer foods offered earlier in the day.

Meal time should be a non-stressful experience for a child. Stress decreases appetite and children will avoid mealtime if the perceive it as a stressful time.

Don’t use dessert as reward-reinforces idea of having to eat “bad food” to get “good food.” Incorporate small amounts of dessert items into meals.

It’s okay to leave food.

Mix it up. It is okay to have pancakes for dinner.

If needed, post behavior rules (written or pictured) near table. For example, no throwing food.

Include preferred foods at every meal.

Be a model. Eat with your children. Talk about the foods and their textures, flavors, smells etc.

Have children participate in meal planning and preparation as is developmentally appropriate. Include them in: shopping, choosing foods, preparing and cooking foods, setting the table, serving food etc.

Let children chose the plates and cups they use at meal times.

Redefine “Success.” Children are taking risks and showing progress when they do any of the following with new foods: smell, touch, poke with a fork, touch to lips, touch to chin, or lick. Even tolerating a new food in the same room or on the table is success. All of these activities are worthy of big praise. It is important to recognize these as signs of success, even though they have not actually taken a bite.

PRAISE, PRAISE, PRAISE any participation in food-related experiences.

Rethink What Foods to Offer
The “Food Chaining” method for working with problem eaters looks at individual child’s eating habits. In their book Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet, Cheri Fraker, Mark Fishbein MD, Sibyl Cox, and Laura Walbert offer a common sense approach to dealing with problem eaters. In short, an analysis of a child’s eating is done by looking at the characteristics of their preferred foods. Characteristics examined include: food groups, textures, flavors and textures. Foods which are highly similar to the preferred foods are selected to be introduced. I have had wonderful success in my practice using this approach and recommended their book for both parents and professionals. The Food Chaining courses are excellent as well.
An additional approach that has had excellent success is the the Sequential Oral Sensory (SOS) feeding program created by Dr. Kay Toomey. This program integrates sensory, motor, oral, behavioral/learning, medical and nutritional factors and approaches in order to comprehensively evaluate and manage children with feeding/growth problems. It is based on the “normal” developmental steps and skills of feeding. Information on this approach is available to professionals (and possibly parents) who attend SOS training.
What Else Can I Do? 

Consult your pediatrician and/or nutritionist with concerns regarding adequate growth, nutrition and hydration.

Continue to educate yourself about SPD and problem eaters (see Resources, below)

Seek out support from other parents of problem eaters

Incorporate developmentally appropriate food experiences and education into your child’s day:

Songs about food: “Apples and Bananas”

Children’s books about food and eating (see Reference List)

Play with plastic foods. Sort by food groups, create pretend balanced meals

Paint with food. Make potato or melon stamps to use with paint

Use carrot, celery and other foods to paint with condiments

Avocado (or banana) can be cut up peeled and squished to use as finger paint or “shaving cream”

Load and dump toy trucks with various crackers, nuts. Talk about textures, colors, smells

Create a picture by gluing dry foods on paper (crackers, dry roasted soy nuts, dried fruit, freeze dried fruit)

Make necklaces of diced, pierced fresh, or dried fruits and veggies

Look at and experience foods in various forms: whole carrot with greens, peel the carrot, shred it, dice it, cook it, carrot juice, freeze dried carrots (can do with apples, peaches)

Professional Help
Quite often parents need to seek out professional help for their children. When pursuing an evaluation and treatment, it is important to find a feeding specialist who has experience with problem eaters. Speech or Occupational Therapists often seek out specialization in this area. Ask to have a phone consult with a therapist to gain information about the approach they use. While the use of one-to-one reinforcement for eating a new food (for example a bite of non-preferred saltine cracker earns a bite of preferred fish cracker) can be acceptable, forcing a child to eat is never acceptable. These therapy services can be expensive and it is reasonable to ask a therapist about their approach, training, and experience with problem eaters.