Dear Dr. Barb,
My 27-year-old son had to leave his supported living situation and move back home. He really enjoys eating and it seems that food has become his main focus. We have a family history of diabetes and heart disease. I feel that as his guardian I have to help him make healthy food choices, but we seem to be making little progress. How can I convince him to make healthier choices?
-Helping Him Be Healthy
I know from both professional and personal experience that this is a difficult problem for many families. Several characteristics of ASD contribute to the problem. Often those with ASD have relatively few sources of positive reinforcement and use food as a primary source of both sensory pleasure and self-reward. Many of us without ASD also do this; however, those with ASD have more difficulty changing habits and more importantly may have difficulty connecting their behavior now with future consequences. The threat of heart disease is far away and it is hard for many to use it as a motivator for not eating ice cream right now.
The individual who has a greater language impairment also may have a difficult time making sense of the nutrition information he/she is being given if it is verbal and somewhat abstract. Finally, what motivates many of us to develop healthy habits, even if we don’t admit it, is social reinforcement. The individual with ASD may not really understand or care how his/her appearance affects how others react.
The first issue that needs to be addressed is motivation. We all repeat behaviors that make us feel good. Right now the reward coming from food is stronger than anything else. It will help to find some other concrete reinforcement that can be used to reinforce healthier choices. This may be social reinforcement in terms of praise, but it also may be some form of reminding the individual that he/she is moving toward a chosen goal, such as being a better runner or being able to find prettier clothes. Remember that change is nearly impossible if the individual doesn't buy in, so you need to help him/her find a motivation.
It often will help to use concrete visual supports to provide information, both about what healthy choices are and how they relate to the goal. Visuals might include a strip with symbols for the number of “treats” allowed each day so the individual can see how many are available and remove one each time a treat is eaten. Charts showing unlimited foods, weekly foods, and monthly treats also may help. Terms like “special occasion” may have little meaning to the individual with concrete language, “once a month” or “on holidays” is much more concrete.
Some individuals respond well to concrete reward systems such as sticker charts. Let the individual keep track of every positive choice they make on a chart with a clear visual of the goal they are working toward. Having specific visuals for choices such as a snack menu that shows only a limited number of choices, all of which are healthy, may be useful.
Finally it often is helpful to eliminate some of the need for choice by not having a lot of unhealthy food easily available. This may mean that others in the family also will have to change their habits.