Education

Early Signs of Autism Spectrum Disorder (ASD) in infants

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Posted on by Freya Gardon

Small child laying in bed looking about mobile above

A common question new parents ask us at The Quirky Kid Clinic is ‘What do we need to look out for in relation to an Autism Spectrum Disorder (ASD)?’. The following article will discuss what ASD is, the diagnosis of ASD, and what to look out for if you have developmental concerns for your child.

What is ASD?

ASD is a developmental disability characterised by marked differences in social interactions, deficits in verbal and nonverbal communication skills, restricted and repetitive interests/behaviours, and sensory sensitivities. It appears in infancy and the symptoms and severity differ from individual to individual.

The severity of an ASD presentation can range from ‘Level 1 requiring support’, through to ‘Level 3 requiring very substantial support’. When ASD is diagnosed it includes the inclusion or exclusion or an accompanying intellectual disability (American Psychiatric Association, 2013, p. 52).

There is no known cure for ASD, and there is no current consensus amongst medical professionals on the precise cause of ASD. However what is clear is that quality individualised early intervention will support children to increase skill development, communication abilities and develop flexible adaptive behaviours (Dawson et al., 2010).

How is ASD diagnosed?

ASD has shown to be reliably diagnosed in a child as young as 18-24 months old (Charman et al., 2005). However, historically children have been more likely to have received a diagnosis closer to school age than during their toddler years (Mandell et al., 2005; Moore & Goodson, 2003).

Howlin & Moore (1997), who conducted a study of 1200 participants in the UK, reported that whilst the average age parents had any developmental concerns for their child was approximately 18 months old, for the majority of participants studied, the diagnosis did not actually occur until closer to the child turning 6 years old.

In response to ongoing research in the area of ASD diagnosis, in the United States, the American Academy of Pediatrics has now recommended that all children be screened for ASD at approximately 18-24 months old (Johnson & Myers, 2007).

In Australia, Williams et al. (2008) have concluded that currently, we have not matched initiatives occurring in other countries, such as the United States, in relation to early ASD diagnosis and early intervention support initiatives. However, the Autism CRC under the guidance of Professor Andrew Whitehouse and colleagues are currently developing a National ‘Best Practise’ Guideline document for the diagnosis of ASD within Australia. Whilst the document has not yet been finalised the draft submission cites the reliability of an ASD diagnosis for a child of 2 years old by a qualified professional. Although, it is still most common in Australia for children to receive a diagnosis between the ages of 3 and 5 years old (Whitehouse et al., 2017).

A reliable diagnostic process involves identifying the child’s strengths and weaknesses via a comprehensive formal assessment which includes a child observation, such as the Autism Diagnostic Observation Schedule (ADOS-2), a parent interview, such as the Autism Diagnostic Interview-Revised (ADI-R), and cognitive / developmental testing such as an IQ test or a general developmental assessment, completed by an experienced practitioner (Charman, 2010; Whitehouse et al., 2017).

Following diagnosis, access to individualised early intervention with the aim of increasing developmental deficits, and decreasing challenging behaviours can make a huge difference in your ASD child’s developmental pathway.

Early Signs to look out for in infants

Identifying characteristics of ASD in a child younger than two years old can be difficult. Concerns may arise due to the ‘absence’ of behaviours considered to be ‘normal’ development and the ‘presence’ of behaviours considered to be ‘abnormal’ development.

Developmental milestones occur across age ranges so your child may be ahead or behind their peers with respect to milestones such as crawling, walking, and early verbal and nonverbal language development.

Listen to your ‘gut instinct’ as a parent. Consider seeking help from your Child Psychologist or Paediatrician if your 12-month-old infant is not demonstrating the following behaviours, either as an emerging skill that is continuing to progress, or once learnt, does not demonstrate these behaviours consistently across multiple environments (Boyd et al., 2010; Charman, 1998):

  • Responding to their name, or to the sound of a familiar voice, by turning their head and referencing the person who spoke or the direction from where the voice came from;
  • Referencing a familiar person with eye contact, such as smiling in reciprocation to being smiled at, at times such as feeding, and or when playing ‘peek a boo’ like games;
  • Demonstrating joint attention, such as referencing a favourite toy or food, then referencing a familiar person, then looking back towards the item of interest as if to say, “pass it to me”, or “can I have more”;
  • Babbling or making noises to get a familiar adults attention;
  • Developing an imitation repertoire such as waving and clapping, and or including the imitation of a familiar person’s facial expressions and movements;
  • Demonstrating reciprocal interest and enjoyment in play, such as tickles, ‘peek a boo’ like games and cause and effect toys, coordinating eye contact to indicate “more”;
  • Tracking objects or familiar people visually around the room and or following a familiar person’s gestures, such as pointing to an object;  
  • Coordinating gestures in order to communicate, such as pointing at an object to initiate a communication, or waving goodbye;
  • Positively responding to cuddling, and or reaching out to be picked up.

Remember that your child may, like all individuals, experience good days and bad days. Your child’s development will occur in spurts and patterns, and it is best to evaluate your child’s development by considering the consistency and frequency of these emerging skills.

If you feel a particular skill is lacking spend the time to practise the behaviour with your child, ensuring that you are providing attention and praise for your child’s attempts at demonstrating the behaviour. If the skill does not start to develop or your child responds negatively to your attempts to model and teach the skill then seek help from your Child Psychologist or Paediatrician.  

Seeking Intervention

Commence an individualised early intervention program as soon as possible. Whether your child has a formal diagnosis or not it is advisable to start intervention as soon as you suspect that your child’s development is not progressing at the level expected for their age rather than following a wait and see approach.

Here at The Quirky Kid Psychology Clinic, our experienced team of Psychologists are more than happy to meet with you to discuss any concerns you have in relation to your child’s development and behaviour.

We always start with a parent only consultation to ensure that we get a thorough understanding of your child’s developmental history and a sense of your families identity, history and cultural dynamics. From here we provide an individualised case plan dependent on your child and families needs. Please don’t hesitate to contact our friendly reception on (02) 9362 9297.

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References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Boyd, B. A., Odom, S. L., Humphreys, B. P., & Sam, A. M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention, 32, 75-98.

Charman, T. (1998). Specifying the nature and course of the joint attention impairment in autism in the preschool years: Implications for diagnosis and intervention. Autism, 2, 61-79.

Charman, T. (2010). Developmental approaches to understanding and treating autism. Folia Phoniatrica et Logopaedica, 62, 166-177.

Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J. A., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry, 46, 500-513.

Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., & Varley, J. (2010). Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23.

Howlin, P., & Moore, A. (1997). Diagnosis in autism: A survey of over 1200 patients in the UK. Autism, 1, 135-162.

Johnson, C., & Myers, S. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120, 1183–1215.

Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116, 1480-1486.

Moore, V., & Goodson, S. (2003). How well does early diagnosis of autism stand the test of time? Follow-up study of children assessed for autism at age 2 and development of an early diagnostic service. Autism, 7, 47-63.

Whitehouse, A.J.O., Evans, K., Eapen, V., Prior, M., & Wray, J. (2017). The diagnostic process for children, adolescents and adults, referred for assessment of autism spectrum disorder in Australia: A national guideline (Draft version for community consultation). Autism CRC Ltd.

Williams, K., MacDermott, S., Ridley, G., Glasson, E. J., & Wray, J. A. (2008). The prevalence of autism in Australia. Can it be established from existing data?. Journal of Paediatrics and Child Health, 44, 504-510.

 

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Building Social and Emotional Learning during the School Holidays

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Posted on by Leonardo Rocker (Quirky Kid Staff)

child inside a backpack. social and emotional skills for kids

The school holiday period can be a great time to reflect on the last term, prepare for upcoming changes and review skills that need to be improved.

Returning to school is typically experienced with mixed emotions. For some parents, it is a welcome relief after what feels like a very long holiday. For others, the return to school signals the end of a carefree, relaxing break and there can be feelings of sadness and/or anxiety associated with the return to routine and the academic and social demands associated with the school.

Children and young people equally experience a range of feelings about the return to school. For some, there is great excitement about starting a new school, seeing friends or perhaps finding out who their new teacher will be. For others, there may be sadness about the end of the holidays or anxiety about a raft of possible concerns such as making friends in their new class or coping with the work/homework requirements.

A tried and test way to prepare for changes and transitions is by focusing on your child’s social and emotional adjustment.

Tips to Help Your Child Settle Into Term 3

Whilst a lot of focus is placed on the academic tasks associated with school, paying particular attention to a child’s social and emotional adjustment over the coming weeks/months is also critical. Below are 3 tips to get you started:

  • Make time to check in with your child about how they are feeling and coping with the school year so far. It’s important to really listen to what your child is saying. To do this, begin by just repeating back or paraphrasing what your child is telling you. Where your child is experiencing uncertainty try to normalise this and remind your child that it can take a few weeks to really settle in. It is not uncommon for children (and parents) to express disappointment about a new teacher they may have been assigned or about the discovery that they don’t have as many close friends in their class. Rather than jumping to solve the problem for your child, build resilience by encouraging your child to come up with some ideas about ways to help themselves cope in such a situation.
  • It can often be a good idea to make time to check in with your child’s teacher as soon as terms resume. Whilst you will, of course, wish to discuss their educational strengths/weaknesses, also address how your child is feeling about their progress and to highlight anything (e.g. camp, homework) that may be worrying your child.  Make sure you also discuss your child’s social skills with the teacher. If they are struggling with friends, ask your child’s teacher how the school can help in facilitating friendships. If your child has had any ongoing incidents of bullying/teasing it is critical to mention this again and ask how they can help to ensure that such incidents don’t occur again during the next terms. Equally, if your child has a history of seeking attention from others in a class by misbehaving, check on how this is been handled at school. Teachers will undoubtedly find your insights into what works and what doesn’t work at home very useful.
  • Encourage friendships and further consolidate social skills in by organising playdates or outings with any new classmates made throughout the term. Whilst children often request existing friends, it can be worthwhile trying to extend friendship networks by inviting new children over. This is not only good for your child but can also help to expand social support networks for you as a parent. In secondary school, it is equally important to encourage friendships by providing opportunities for your son/daughter to have friends over or by offering to drive them to a movie etc. This not only helps foster friendships but also gives parents valuable insights into the type of friendships that your child is building.

Why social-emotional learning is so important

The importance of focusing on the social and emotional well being of children is becoming increasingly acknowledged. In the current climate of increasing rates of mental illness in young people and concern over youth suicide rates, the NSW government has reportedly decided to tackle the problem more aggressively by proposing to adopt a more preventative approach in addressing such issues. The Government’s decision to begin at the grassroots level and start better-educating school-aged children (from Kindergarten) about mental health issues is welcome news to everyone here at Quirky Kid.

The changes to the Personal Development, Health, Physical Education (PDHPE) syllabus which are apparently due for implementation from 2020 include a more comprehensive effort to address social-emotional learning and mental health issues from primary school onwards. Beginning in Kindergarten, it is proposed that children will begin with simple social-emotional concepts such as feelings and building relationships with others, but as they progress to higher grades the aim will be to address important issues such as coping with success and failure, overcoming adversity, grief and death, coping with controlling behaviour in others, domestic violence, and substance abuse.

Helping Children to Build Important Social-Emotional Skills

Equipping children to cope with the social and emotional demands of school fosters increased coping and resilience skills. The evidence suggests that well developed social and emotional skills are both protective and helpful. Strong social and emotional skills in children not only predict fewer behavioural problems in the classroom but they are also related to positive academic outcomes and improved school performance  (Myles-Pallister, Hassan, Rooney, & Kane, 2014; January, Casey & Paulson, 2011; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011)

The government and other mental health agencies hope that by tackling such topics in school and by better-educating children about mental health, steps will be made to not only demystify such issues but will crucially equip children with a more effective toolkit for managing difficult feelings. It is further hoped that lessons learned at school will have a lasting impact as children become adults.

How Can Quirky Kid help develop your child’s social-emotional learning skills?

At The  Quirky Kid Clinic, we are strong advocates for prevention and early intervention when it comes to children’s mental health issues. Prevention, is, of course, the preferred approach. In our experience, providing intervention to children and families before problems become too entrenched can often be the key to success. Where issues have been developing for some time, it can be much harder to address problems and for both the child and family such situations can feel insurmountable.

The Best of Friends® gives children the knowledge skills and confidence to understand and manage emotions, set and achieve positive goals, develop and maintain friendships and make good decisions. Designed for children aged 7 to 11, the program teaches these critical skills to children in an age-appropriate and practical way.

So embrace this potentially challenging time with your son/daughter and remember children tend to take the lead from their parents. With this in mind, try to model calm, brave behaviour whilst at the same time keeping the doors of communication wide open. By adopting these strategies your child should feel a little braver about adapting to their new classroom, teacher and school expectations.

Term 3 Social and Emotional Learning Programs for Children

If you are looking for a more extensive approach to preparing your child for Term 3, book now for our The Best of Friends® holiday and Term 3 Programs.

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References:

Durlak, J.A., Weissberg, R.P., Dymnicki, A.B., Taylor, R.D., & Schellinger, K.B. (2011).  The Impact of Enhancing Students’ Social and Emotional Learning: A Meta Analysis of School-Based Universal Interventions.  Child Development, 82(1), 405-432

January, A.M., Casey, R.J., & Paulson, D. (2011). A Meta-Analysis of Classroom-Wide Interventions to Build Social Skills: Do They Work?.  School Psychology Review, 40(2), 242-256

Myles-Pallister, J.D., Hassan, S., Rooney, R.M. & Kane, R.T. (2014).  The efficacy of the enhanced Aussie Optimum Positive Thinking Skills Program in improving social and emotional learning in middle childhood.  Frontiers in Psychology, 5, 909.

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Surviving Long Trips with Kids

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Posted on by Dr. Kimberley O'Brien

Kids and parents traveling together in a car. Bubbles dogs, drawings. Article by Quirky Kid

Long distance travel is often intimidating for parents. The combination of energetic kids, and prolonged periods of time in a confined space seems like a recipe for disaster. However, by preparing in advance, being flexible to change and following these tips compiled by the Quirky Kid team, your long distance travel experience can be more positive, rewarding, and fun for children and parents.

Tip #1 Let Kids Play a Role in Planning the Itinerary

Make the trip more inclusive and enjoyable for kids by letting them have a say in the kind of places they would like to visit, sites they would like to see, and activities they would like to do along the way. Letting them take part in family decision-making teaches children valuable skills as they learn to advocate for what they want, listen to others’ wishes and make compromises. It also keeps them excited and interested and gives them specific things to look forward to. Furthermore,  acts as an incentive and a reward for sitting through the parts of the trip that less suit their preference.

It may not always be feasible, and children may not always come up with appropriate suggestions, but letting them select between a couple of alternatives that you deem acceptable and possible (e.g. stopping at a pool along the way, or, having a picnic at a roadside park/playground) is a great way to make the trip pleasant for all.

Tip #2 Avoid Relying on Screens to Keep Kids Busy

It is tempting to keep kids occupied with screens on long haul trips. Phones, Ipads, and laptops are easy time-fillers on the road. Dr. Kimberley O’Brien, principal Child Psychologist at the Quirky Kid Clinic, warns about the use of technology to keep kids preoccupied, particularly for long periods of time. While it may not always be avoidable, it is recommended to try all other entertainment avenues before turning on the screens, and ideally avoid using them at all when only travelling short distances.

An alternative strategy Dr. Kimberley suggests is planning for the trip well in advance, and packing a “kid-box” to keep kids entertained throughout the journey. The box can be filled with resources that are specific to each child, by asking them before you take to the road to “imagine they are on a long trip, and to think about the kind of things they would like to do”.

Here are some suggestions of fun activities for your long trip with kids:

  • Activity books (such as, colouring-in or dot-to-dot books) and story books/audiobooks
  • A great creative resource is the Tell Me A Story cards. These cards encourage kids to recall and retell some of their most extreme moments (“Bravest!” “Fastest!” “Highest!”), while uncovering a sense of pride in their past achievements and skills. Kids love hearing and telling stories, especially true stories, and it is an engaging and interactive way to pass the time together.
  • If you want to get more creative on the road, a few erasable whiteboard markers can turn the car windows into works of art, or a simple cooking tray can be turned into a magnetic play table using assorted fridge magnets (e.g. letters and numbers) or with a magnetic puzzle to keep all the pieces stuck in one place.

Tip #3 Take Frequent Breaks

A recent study (Morris & Guerra, 2015) examined 22 000 frequent travellers’ responses, in order to explore the link between trip duration and mood during travel. Not surprisingly, trip duration was found to negatively influence mood, primarily due to rising levels of stress and fatigue over the course of the journey. To combat this, consider frequent breaks where possible. Children have shorter attention spans than adults (Cowan, Fristoe, Elliott, Brunner, & Saults, 2006) and have not yet fully developed impulse control (Tarullo, Obradovic, & Gunnar, 2009). This means they will quickly become restless, fidgety, and uncomfortable if not given the opportunity to change environments and ideally, move around.

Taking breaks on family trips with kids where possible is important for drivers and passengers, both for safety and sanity. For kids, the opportunity to get out of the car should also involve some form of physical activity to let them burn off some steam. While this may mean allowing extra travel time to reach your destination, it makes the trip more bearable for all.

Tip #4 Plan Your Snacks (and take plenty of them)

Nutritionists admit that on the road with family it is often convenient to fall back on take-away foods and processed snacks from roadside stops. Sugary and highly-processed foods are not ideal and giving kids more energy that they are not likely to use up in the car is likely to backfire. Additionally, unhealthy snack options can deplete energy levels and leave you feeling drained over the course of a long drive. Nutritious treats can be prepared at home for easy on-the-go snacking and keep everyone feeling happy and healthy over the journey. Additionally, having access to plenty of snacks while travelling, giving kids a choice as to what they want to eat, sharing and divvying up snacks as the trip goes, is often a welcome distraction.

Tip #5 Use travel as a teaching/learning opportunity (for yourself & the kids)

Sometimes a change of mindset is needed. We often view travelling with kids as something impossible and difficult, or as the kind of trip you suffer through to get to your destination. In reality, travelling is a wonderful opportunity to share exciting, new experiences as a family and learn about other places, cultures, and ways-of-life. In fact, a study (2006) conducted by researchers at Clemson University (U.S.), used data compiled from the U.S. Department of Education, and found that kids who travel over their vacation/holiday period (no matter their destination) tended to perform better academically at school (indicated by better performance on standardised tests of reading, maths and general knowledge) than peers who didn’t travel.

To make the most of this learning opportunity, Quirky Kid recommends encouraging children to hit the books/computers to do some research and learn more about the trip and destination before you go, and encouraging kids to keep a travel journal. This could be in the form of drawings, photos, hand-written pieces, blogs, or whatever strikes their fancy. Not only does it keep them busy and help them remember the experience, it can be shared and enjoyed with friends and family on your return. The kids will love to show it off and tell everyone about how much fun they had on their family trip.


References

Butler, N (2016, June 3) Eight Kid-Pleasing, Healthy Road Trip Snacks. Retrieved from https://www.healthline.com/health-slideshow/healthy-road-trip-snacks

Cowan, N., Fristoe, N. M., Elliott, E. M., Brunner, R. P., & Saults, J. S. (2006). Scope of Attention, Control of Attention, and Intelligence in Children and Adults. Memory & cognition, 34(8), 1754-1768

Denny, S. (2014, January 5). 25 healthy snacks for kids. Retrieved from http://www.eatright.org/resource/food/planning-and-prep/snack-and-meal-ideas/25-healthy-snacks-for-kids

Morris, E. A., & Guerra, E. (2015). Are we there yet? Trip duration and mood during travel. Transportation Research Part F: Traffic Psychology and Behaviour, 33(Supplement C), 38-47. doi:https://doi.org/10.1016/j.trf.2015.06.003

O’Brien, Dr. K(Producer). (2017, August 31). Children and Technology (Audio Podcast). Retrieved from: https://childpsychologist.com.au/podcast-children-and-technology/

Pantley, E (2003). Taking a Road Trip with Your Babe. Retrieved from: https://childdevelopmentinfo.com/ages-stages/baby-infant-development-parenting/road-trip-with-babies/#.WcG_I9Og-8U

Parker, J. L. (2006). The Relationship of Family Summer Vacation Trips an Academic Achievement Among First Graders: A National Study.

Shellenbarger, S.(2017, May 17). Dare to let the Children Plan Your Vacation. The Wall Street Journal. Retrieved from: https://www.wsj.com/articles/dare-to-let-the-children-plan-your-vacation-1494947476

Tarullo, A. R., Obradovic, J., & Gunnar, M. R. (2009). Self-control and the developing brain. Zero to three, 29(3), 31. Retreived from: https://web.stanford.edu/group/sparklab/pdf/Tarullo,%20Obradovic,%20Gunnar%20(2009,%200-3)%20Self-Control%20and%20the%20Developing%20Brain.pdf

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5 Tips on Preparing Young People for Greatness

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Posted on by Dr. Kimberley O'Brien

Greatness comes in many forms and is quite subjective depending on an individual’s age and abilities. For a child overcoming anxiety, greatness may be winning a public speaking competition or finding the courage to confront a new fear. For others, greatness may reveal itself through academic or sporting achievements, kindness, creativity or thoughtful leadership. In any case, discovering one’s unique strengths or passions is easier with the help of a caring coach, an attentive teacher, or a dedicated parent.

According to a recent survey of Australian students in Year 4 to 12, parents and teachers are the greatest influencers of a student’s sense of satisfaction and fulfillment (State of Victoria, Dept of Education and Training, 2017). Therefore, it is essential for parents and teachers to give sound advice on the subject of achieving greatness as defined by the child.

Leadership expert, Robert Kaplan (2013), developed a roadmap for reaching potential. In brief, he suggests greatness is achieved when we know our strengths, take the initiative and connect our daily actions to a clearly defined goal. For most children, defining a goal is easy but taking the initiative to make it happen is usually dependent on the adults around them. That’s where we come in!

Here’s what you can do:

  1. Foster their self-belief. For example, if you know a child who aspires to be a professional soccer player, help them find a great coach or coaching clinic. For those with more left-of-centre skills outside the areas of sporting or academia, keep an open mind to the activities available that might help push their strengths to new levels. Show them that you believe in them and make it happen!

  2. Research together. Show young people how to take the initiative by helping them to research and connect with experts in their field of interest. A child with a passion for making robots would be forever empowered if you showed them how to contact the Head Inventor at Battlebots. Imagine if they said yes to a Skype call?

  3. Use a wide-angle lens. Think broadly when it comes to inspiring young people. Be proactive and organise a range of guests to visit your school to spark an interest in every child. These could include artists, refugees, adventurers or someone with a “diffability” who is pursuing a passion. You never know when inspiration will strike!

  4. Set an example. Take on a challenge of your own and you will inspire others to do the same. Show some initiative and take steps on a daily basis to reach your goal. Share your journey’s highs and lows with the young people around you and make haste towards your destination.

  5. Work together. Challenges aren’t meant to be simple, but staying focused on the task at hand is easier when those around you are doing the same. Achieve greatness among your classmates, family or friends and your success will be even sweeter!

Power Up:

Our online Performance Psychology program Power Up! has been specially created for kids who want to push their performance skills to the next level. Power Up! gives them the power to: build self-confidence, cope with the pressures of competition, overcome self-doubt and negative self-talk, set goals and make plans to achieve them and maximise performance in any chosen field.

References:

  1. Kaplan, R.S. (2013) What You’re Really Meant to Do: A Roadmap for Reaching your Unique Potential.Ebook. HBR.
  2. Right School-Right Place (2017) State of Victoria. Department of Education and Training (Vic).
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Parent Tips for Fussy Eaters and Toddlers

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Posted on by Leonardo Rocker (Quirky Kid Staff)

For some families, dinner time can be the most challenging time of the day, kids and adults are exhausted and just need some space to relax. Dinnertime can quickly spiral out of control, deteriorating towards a full-on disaster zone. Navigating the ‘terrible twos’ at dinnertime can be emotionally challenging and downright exhausting.

Let’s set the scene – you and your little one have had a fabulous day at the park, you’re on top of the household chores, and you’ve just booked the next visit to the grandparents. You head home to start the evening routine, and dinner is next on the agenda.

Tonight’s menu is deliciously grilled chicken pieces, steamed broccoli, carrot sticks, and sweet potato mash. You serve your little one your ‘MasterChef’ quality meal and…cue whining, food smearing, flying carrot sticks, and ultimately tears, most likely from both of you. If you’re lucky, your little one will spend the meal smearing mash over their face, body and high chair while dropping carrot sticks on the cat. However, if your little one enjoys a tantrum or two, the mere sight of a vegetable will bring on an emotional outburst similar to a tropical thunderstorm.

The following recommendations have been revised from a previous Quirky Kid Fussy Eaters article and updated to support you through this tricky age and stage.

Managing Your Emotions

Sometimes it can be really hard to manage your own emotional responses when your child is demonstrating an escalation in their behaviour. Consider these tips for Parental Self-Regulation:

  • As hard as it sounds, try to remain calm – when you feel your emotional responses begin (anger, frustration, resentment), remind yourself to breathe, long, slow, deep breaths.
  • Remind yourself ‘It’s only a phase, this is normal behaviour, this is my little one testing the boundaries, the behaviour is their means of communication at this age’.
  • As a parent, modelling calm behaviour, as well as being willing to accept your child’s emotional responses, will in the long run support your child’s emotional regulation (Ramsden & Hubbard, 2002).

Understanding and Responding to Behaviour

When your child’s behaviour is beginning to escalate, as long as they are not in any immediate danger, it is important to evaluate their behaviour before you respond:

  • Ask yourself ‘What is my child’s behaviour trying to tell me?”
    • are they trying to avoid a food due to its taste?
    • are they trying to avoid a food due to its smell, texture and/or visual aversion?
    • are they already full because of late snacks at daycare?
    • are they seeking my attention because I am busy cooking?
    • can they see their favourite toy, which is just out of reach?
  • When you take a moment to try and understand what your child is trying to ‘say’ with their behaviour, then – and only when your child is calm – can you model an appropriate replacement behaviour, e.g. ‘Mummy, more chips please’ or ‘Finished, Mum’.

Positive Behaviour Strategies

Ongoing negative behaviour at dinnertime can be really challenging for everyone, so alongside the tips and strategies above, the following positive behaviour management strategies may be beneficial to support calmer, happier, more productive dinner times:

  • Tantrums may be unpleasant and noisy but they are also a great opportunity for parents to demonstrate to their child how to regulate their emotions. Parents can  show their child that they are providing loving support within appropriate boundaries. Providing ‘loving, sensitive guiding, and firm’ practices, as opposed to overly firm or overly flexible practices, supports your child’s emotional development (Coyne & Murrell, 2009).
  • Consistency is the key – always follow through with the contingency you have set up beforehand. You set your child up for success when you explain your expectations clearly before the meal, such as ‘‘Let’s explore lettuce and cauliflower tonight”. Then provide a contingency and/or choices based on whether your expectations have been met: “After we explore the new foods, you can have your sweet potato mash” (the most preferred item on offer), or “Do you want yoghurt or strawberries after we explore the new foods?” Present the new items alongside foods your child enjoys, withholding the most highly preferred food as reinforcement for meeting your expectations. Reinforcing appropriate behaviour will increase the likelihood that this behaviour will be demonstrated again in the future (Whittingham, 2015).
  • Ensure the focus of the meal is about curiosity to try new foods, with achievement measured in small steps, rather than expecting your child to finish a portion of less preferred foods in one sitting. Shaping your child’s food preferences means that you are providing reinforcement based on successful target behaviour and repeated exposure to new and interesting foods (Whittingham, 2015).
  • Trying new foods may include talking about the colour, the shape, the texture, what it does to fuel your body, how it feels, how it smells and lastly how it tastes. Encourage a pathway of touch, smell, lick, bite and allow the child to work their way along the pathway at their own pace. Repeated exposure to non-preferred foods in a non-punitive way will support increased likelihood of the child’s willingness to try the foods in the future (Wardle, et al., 2003).
  • Remember, your child’s energy intake and hunger may not be aligned with ‘mealtimes’ just yet and so it is important to meet their needs with healthy snacks  and food choices across the day (Allen & Myers, 2006).

Prevention and Planning Strategies

It is important to set your child up early with healthy eating behaviours, to provide ongoing information about food and health, and to provide opportunities to explore new foods and textures. Outside of mealtimes, the following tips can be helpful in supporting a child’s positive eating behaviour:

  • Depending on your child’s age, incorporate foods into other learning concepts, such as using foods to teach shapes, colours and textures.
  • You can incorporate different vegetables and foods in art and craft play, and use this as a time to talk about the foods’ nutritional value.
  • Make sure you keep healthy foods accessible to your child – you can keep  pre-cut vegetables in the fridge or on the table. When children are hungry, they may be inclined to eat the foods that they wouldn’t normally choose.
  • Pair non-preferred foods with highly preferred foods, such as salad dressing or sauce for dipping, this will help your child tolerate new tastes and textures and the sauce can be faded out slowly.
  • Encourage your child to participate in the grocery shopping. Let them choose new fruits and vegetables based on fun colours and textures and involve them in meal preparations. Giving your child some choice over their food (within limits) will support them to become more willing to eat the meals you have prepared.

While the information above is intended to support difficult eating behaviours in children at the toddler stage, it is important to note that some children experience more complex negative eating behaviours. In cases of severe food avoidance or associated conditions, families may benefit from individualised consultations. For a child who demonstrates severe food refusal and/or avoidance of particular tastes and textures, a consultation with both a Psychologist and a Nutritionist may be a consideration. Please contact us to schedule an appointment.

References

  1. Allen, R.E., & Myers, A.L. (2006). Nutrition in toddlers. Am Fam Physician, 74.9, 1527-1532.
  2. Coyne, L., & Murrell, A. (2009). The Joy of Parenting: An acceptance and commitment therapy guide to effective parenting in the early years. New Harbinger Publications, Oakland, CA
  3. Ramsden, S. R., & Hubbard, J. A. (2002). Family expressiveness and parental emotion coaching: Their role in children’s emotion regulation and aggression. Journal of Abnormal Child Psychology, 30(6), 657-667.
  4. Wardle, J., Herrara M.L., Cooke, L. & Gibson, E.L. (2003). Modifying children’s food preferences: The effects of exposure and reward on acceptance of an unfamiliar vegetable. European Journal of Clinical Nutrition, 57, 341–348.
  5. Whittingham, K. (2015). Connect and shape: A parenting meta-strategy. Journal of Contextual Behavioral Science, 4(2), 103-106.
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