Episode 28: Unpacking Autism Feeding and Eating Challenges

Di: 0:25

Welcome to another exciting episode of Body Haul Like With D. This is episode number 28. Body Haul Like With D is the podcast and show where we dive deep into the world of cutting edge and science-based well-being. I'm your host, dee Katz-Sahar, and today we have an incredibly special guest with us. Dr Pranali Hoyle is a board-certified behavior analyst at a doctoral level whose career has spanned across schools, clinics, group homes and residential placements. Her dedication to making a difference in the lives of individuals on the autism spectrum made a deep impression on me. Dr Hoyle's clients have ranged from as young as 12 months to as wise as 75 years, and she is driven by a passion to ensure that every individual receives evidence-based treatment to enhance their quality of life.

Di: 1:21

I must say my conversation today with Dr Pranali was nothing short of fascinating. It provided a wealth of knowledge about autism and its unique challenges. Specifically, we explored a topic that is often overlooked but of utmost importance feeding and eating challenges for children on the spectrum. Dr Pranali's insights to this complex area are not only eye-opening but also incredibly valuable for parents, caregivers and professionals in the field. So, without further ado, let's jump right into this truly enlightening discussion with Dr Pranali Hoyle. Get ready to expand your understanding of autism and gain valuable insights to the world of feeding and eating challenges. Stay tuned, dr Pranali Hoyle, thank you so much for joining me today. I am so excited to talk to you.

Dr. Hoyle: 2:22

Thank you, I'm super excited. Nice to see you again, even though we're not in person. It was nice to see you at the conference and now I'm getting to see you virtually.

Di: 2:31

Listen. I love technology these days and how it just brings us closer together. It's amazing, yeah. And then I get to have you on my podcast so people hear all the amazing things you have to say. So I actually want to start with you giving all of us a little bit of your background and what you specialize in, and then from there we're going to zoom in, because the topic of today's discussion is actually feeding and eating. Challenges, especially among children with autism, are on the spectrum. But before that, a little bit about yourself, please.

Dr. Hoyle: 3:20

Sure, absolutely so. I'm Dr Pranali Hoyle. I have been a behavior analyst for almost nearly 10 years at this point, but I've worked in the field of autism specifically for over 20 years. I started out at the age of 19. So now I'm going to date myself.

Dr. Hoyle: 3:41

Obviously. It's been over almost 22 years where I've serviced children and adults on the spectrum across public schools, private schools, clinics, residential group homes, and I've worked with clients with a range of severity with autism. So I have clients that are completely non vocal and then I have clients with a great level of very age appropriate conversation and other skills, but not the social deficits continue to exist and the treatment that we provide ranges from extremely intensive to just working on social skills and developing self management and self care in those areas. So that's really been my. Most of my experience is with children on the spectrum, but I've had a lot of other disabilities like and comorbidities like eating disorders, obsessive compulsive disorder. So it does. It ranges from anywhere from just the diagnosis of autism or diagnosis of autism with ADHD, learning disabilities, all, all range of different disorders.

Di: 5:04

So it's not specific. So when you talk about OCD and eating disorder, it's, it's in your expertise. It's coupled with autism.

Dr. Hoyle: 5:15

So what we find, especially because the diagnosis of autism, if you look at the DSM criteria and specific autism itself, has restricted and repetitive behaviors and that social deficit is a big component of autism.

Dr. Hoyle: 5:32

So, sometimes you'll see overlap of other conditions and a lot of times, especially when children are little, they're not being diagnosed with those secondary disorders until they get to like teenage years or even further into their life and then you'll see like a secondary disorder being diagnosed because it's difficult to really address that when you're so little. Essentially but I right most of what I see a lot of the times is autism coupled with ADHD, because there's such an overlap with those two disabilities.

Di: 6:07

Yeah, I can. Actually, that makes sense to me, the little I know. That does make sense to me. Yeah, and so, regarding the the topic of our conversation, how do feeding and eating challenges commonly manifest in children with autism and what do you think some of the key factors are that contribute to the challenges?

Dr. Hoyle: 6:34

Absolutely so.

Dr. Hoyle: 6:36

I mean from what I, what I've seen, what I've experienced and other professional within the field, what we see is a lot of times children as little as 18 months to two years of age will begin having feeding challenges.

Dr. Hoyle: 6:49

So currently the clinics that I work with that provide services to children ages to and up, a lot of children that we assess come in with specific feeding challenges and they can range from mild to very severe. So we have students that just have food selectivity. So based on texture of the food, the smell of the food, the, the, even just when they chew the food, they like specific texture. Most of the children that I meet tend to like either really soft textures or really crunchy textures and then anything that's in between. You have to essentially desensitize and expose them. And then other children who have limited language especially, have difficulty expressing, like if they're eating a certain food, if their body is is having reaction to it. So typically if they have allergies to it, you kind of know right away, right, because they're going to have a reaction or some sort of flash, so you kind of identify those things right away.

Dr. Hoyle: 7:54

And a lot of children, especially now you you've seen the peanut allergy is very common, whereas in 30 years ago that was not the case. You know, we didn't really have that prevalence of peanut allergies in children or even sensitivity to gluten. So we see that a lot too with children on the spectrum, and then sometimes it was specifically with children on the spectrum, or because it's prevalent, it's also children, I think it's a combination of the two.

Dr. Hoyle: 8:25

So I think gluten, and specifically gluten and casein what we see is either they have a high sensitivity to it or you see like specific behavior changes happen if they have too much of that type of food.

Dr. Hoyle: 8:40

So a lot of times parents will do like gluten, casein, three diets because they just want to make sure that the kids are eating healthier options. But sometimes it could be as much as an allergy and sometimes it could be a lot more severe. So, like they've, there's research to show, like students who have a difficulty with chewing and swallowing, so that can be even more challenging. And then we have other professionals who need to be collaborated with when we're providing treatment to somebody who have internal challenges.

Di: 9:17

Physical internal challenges.

Dr. Hoyle: 9:19

Yeah, and especially if they can't tell you right. So if their food is not being swallowed properly through the, through the esophagus and all those areas, then it's difficult for a child who doesn't have language to be able to tell you that. So we've had parents who you know, put their kids in a high chair and try to feed them and a lot of times, you know, they end up choking or vomiting and things like that and gagging, and a lot of times it looks behavioral. But that's why we always try, we always tell parents first, rule out medical before we do any behavioral interventions. That's, you know, just ethically and clinically. That's always the best practice, obviously. So we always make sure there's not an underlying medical cause for the 100%.

Di: 10:07

So what I find really interesting from what you just said actually almost taken aback was that there are parents that will first come to you before they rule out. Wow.

Dr. Hoyle: 10:23

Absolutely yeah, because sometimes they just don't know, they think that their kid is just being picky. It's because that history of you know, and parents have other challenges along with just raising a child on the spectrum, which can be challenging on its own, just raising children alone, obviously, Right right absolutely yeah.

Dr. Hoyle: 10:45

So if you I mean even if you have a neurotypical child, there's challenges with that. So imagine when you have a child who's developmentally delayed, has limited language and parents just don't know. So a lot of times they will come to us first, especially when we're getting them at such a young age of two or three years old, where kids tend to be picky, naturally right. So it's hard to say whether there's a medical cause, especially like in a pediatrician's office. You're not assessing those things in detail. So it's really difficult for parents to really understand that medical versus the behavioral component, and we tend to usually send them out first to make sure there isn't a medical component before we provide intervention.

Di: 11:32

Wow, this is really, really fascinating when you so you teach classes on this specifically.

Dr. Hoyle: 11:43

Not specifically on feeding challenges. I mean, when I teach my grad courses, it's more encompassing, but what I have done is provide intervention specifically on feeding challenges. So when I've had clients that I've provided services to in-home and in a clinic, we're just working on a feeding intervention and getting them to be consuming and exposed to different types of food.

Dr. Hoyle: 12:09

I've had one client that I provided in-home services for and that was the only challenge she was experiencing, but that affected so many other factors of her life because she was unable to make healthy choices, first and then secondary. She was having such reaction to. Being in environments where different foods were present, like school cafeteria, was a huge challenge for her, which also limited her capability to have those social interactions.

Di: 12:43

That's what I was just thinking, yeah.

Dr. Hoyle: 12:44

Yeah, so that you know. And then you know, when she would walk into a cafeteria she would immediately have like this gag reflex from smelling the different foods and being exposed to different foods that she initially was not consuming. It took us almost two years to get to the point where we can go out to a restaurant and have her there and she was able to tolerate and eat different foods and be around other people eating different foods.

Di: 13:15

So that's so interesting. It sounds like it does kind of. I mean again, I'm not a psychologist and I'm not, I'm not an expert in autism, but you know, for the layman it sounds like there definitely is some kind of overlap with OCD. Yeah, absolutely.

Dr. Hoyle: 13:38

Yes, and OCD in itself doesn't typically get diagnosed until more of the teenage years because you kind of have to have that, the compulsion and the obsessions, for such a repeated period of time. You know that. Yeah, so some of that, and because children on the autism show so many signs of OCD, it's really difficult to separate out one over the other.

Di: 14:03

Right, the. I want to ask so many questions right now because, like you're, you're you're just exposing me personally to a world that I just am unfamiliar with. Yeah, so the is there a specific link between feeding in general and autism, or is it that autism has different obsessions and you specifically deal with one of your expertise is dealing with the feeding and eating challenges, or is? Or does it always have to? Is there always something around food? That's my question. Is that typical?

Dr. Hoyle: 14:48

I mean, you know, based on research, there's almost 40 to 45% at this point children on the spectrum exhibit some sort of feeding selectivity.

Dr. Hoyle: 14:59

So most of the children that we get that I assess personally just within the last week I had several assessments I would say more than half of those students had some sort of feeding challenge. So it was either such rigidity to eating certain foods and it can even be, you know, let's say, they only eat French fries, let's say, for example, but then the French fries have to be from a certain place. So let's say you change the type of French fries, then they won't accept, like if they, if they're only eating French fries for McDonald's and you try to change it to Wendy's one day, that also just in itself be a challenge. So sometimes we have to start even as small as just generalizing to a variety of different types of French fries before we can even move to like exposure to different types of foods. So that sometimes can also be challenging for parents. You know I have parents tell me like I have to pack food everywhere I go and I have to have these specific things and you know, at long term that's almost unfeasible for any parent.

Di: 16:06

Right.

Dr. Hoyle: 16:07

So it really varies, honestly, but I would say more than half of the students that I assess currently tend to have some sort of food selectivity or feeding challenge that we have to incorporate within our treatment.

Di: 16:23

And my heart goes out to the parents, like because all the mom and dad what they want is just for the kid to get all the vitamins and minerals and, you know, be comfortable in life. And but also my heart goes out to the child. It's frustrating. I can only imagine how frustrating it is to see the frustration around you and being unable to overcome it. And then there's you who comes along and like saves the day, which is huge.

Dr. Hoyle: 17:00

And it's the problem. The biggest challenge, I find, is the is the time component right? So we can't as much as we can put in interventions in place and have so many different strategies, positive reinforcement and evidence based techniques that have been developed, you can't predict how quickly it's going to happen, sure, so that's just mentioned a two year, a two year intervention.

Dr. Hoyle: 17:27

Right and you know we systematically increased her exposure to different foods and into in different settings. We had to work on specifically how do we expose now the same intervention that we're doing in home? How do we generalize that to her school setting? How do we generalize it to a restaurant, to a party, for a day party? So, like that's another challenge within just the realm of autism and even, I think, children on the spectrum or in children, even some children that are neurotypical, you'll see them go to a birthday party and they won't consume food because it's not looking a certain way or pizza is not from a certain spot and it doesn't look the same as what they have typically.

Dr. Hoyle: 18:12

So I mean children on the spectrum, that's 10 folds of right. So you know, generalization is always a challenge for most children and I would say even more of a challenge when you are dealing with somebody with autism.

Di: 18:27

Absolutely, and I'm also thinking like autism in general. The social aspect of it is what is it the main aspect? Is it the communication?

Dr. Hoyle: 18:42

I would say the social deficits. It's usually that first indicator. So like the lack of eye contact, lack of some joint attention skills, and what I mean by that is like when children first start to play, they always want somebody to kind of see what they're doing.

Dr. Hoyle: 19:01

So a lot of times they'll come over and have you look at what they're doing or even point to what they're doing, Whereas children on the spectrum they're very content with playing on their own. If they have some initial play skills, they tend to not want to share that essentially Right, very interesting.

Di: 19:23

And then the food being such a social thing in our lives, Right exactly. And so it's like actually sounds very lonely, yeah, yeah.

Dr. Hoyle: 19:34

Because you realize, like the communal act of eating is just, there's so much social interactions involved in there. I mean, when you go to a dinner, like you're interacting, you're watching the other person, so even like the sight of another person chewing could be difficult for somebody on this spectrum because they're chewing something that's not favorable to them. So, oh my gosh, all these aspects absolutely. And then just being in a new setting in general, so even if you don't have eating challenges, just being in a restaurant and being able to tolerate those smells, the noise, all of those components, the lights in the you know, all of those components go into play when we try to develop intervention. We think about all of these factors and how do we systematically expose so that the child can be successful in these settings?

Di: 20:27

Seriously, I'm like imagining you mapping things out, so you don't map.

Dr. Hoyle: 20:32

Yeah, basically of like how we're gonna do this and you know how we're gonna essentially maintain those skills, because a lot of times what happens is, once intervention is faded out, that maintaining that over time is gonna be crucial too right. Right. We have to also consider those factors when we're not there 30, 40 hours a week, when we're down to five hours a week how are? We making sure the parent is confident to really carry these things out into the food site, absolutely. Yeah.

Di: 21:05

Absolutely. Yeah, Wow, I. This is so fascinating to me. Getting into more research-based science, Can we, can you discuss a little bit the research-based strategies for assessing and identifying specific feeding and eating concerns, with children, of course on the spectrum and considering both behavioral and sensory aspects? Like getting into the more nitty gritty of the science.

Dr. Hoyle: 21:43

Yeah, absolutely so. I mean the feeding. There are so many different feeding clinics and one of the best ones that I can think of is obviously the Kennedy Krieger Clinic, and they do amazing research there. They're publishing such great resources for people in the field, which always blows my mind. How-.

Di: 22:04

Can you repeat?

Dr. Hoyle: 22:05

it, please the Kennedy Krieger Clinic in Maryland. So they're one of the top, I would say, leaders in this area for sure. So a lot of times there's Rutgers University now in New Jersey they also have a feeding clinic. There's several hospitals that have clinics and they use more of like that collaborative approach where they go in, A lot of times interview-based. For me personally, it's a lot of it's interview-based, where we initially do the assessment, we talk to the parents regarding skills across different domains and then feeding is always part of that. So how does your child consume foods? Are they able to use utensils independently, Do you? You know, we try to be absolutely culturally responsive with that is, some cultures don't use utensils, so for us to try to teach a child who might be consuming foods with their hands to try to use a fork or a spoon, because that's what we expect within this culture but, that might be the expectation.

Dr. Hoyle: 23:14

So you know all of those things. We make sure that we're using a very collaborative and culturally responsive approach when we're doing feeding as well. Beautiful the speech. Therapist, occupational therapist, depending on which setting you're in typically in a hospital setting and more of those clinics. They tend to have other professionals and medical professionals that rule out the medical concern first From a behavioral perspective, we do like parent interviews. Then we'll do some sort of assessment to see what are the most preferred foods, and that something like that is called a preference assessment. There's a variety of different ways of doing that as well. So we try to identify what does the kid like first before we move to what do they not like, and typically we get that information from parents and then we see when they're in settings where other might, other children might have those foods. We see what their emotional reaction to that is and make notes of that and then develop a comprehensive plan based on those results essentially.

Dr. Hoyle: 24:23

Sometimes we also do something called a functional analysis. We try to figure out what is the function behind the fact that this child is avoiding certain foods. So is it because they just have a repeated history of getting access to foods that are so preferred and maybe not as healthy? So if a parent, especially if a parent is having so many challenging behaviors, like if a kid is hurting themselves, let's say and this happens a lot when they are being asked to consume foods that they don't typically like, you'll see challenging behaviors happen where they might be hitting their head or becoming aggressive or throwing tantrums that last long durations and that can be very challenging for a parent. So the solution would be to okay, you're gonna get the French fries you want, right that's what I was just gonna say, I mean, At some point the parent's gonna have that.

Dr. Hoyle: 25:23

They're gonna hit their essential point where they're like okay, I really don't know how to get you to calm down, so I'm gonna do what you need now. So there is that history that happens and it's unfortunate, but from a parent perspective being a parent myself I can completely understand there's, and especially when you're out in the community, you're not gonna have your child have this complete breakdown.

Di: 25:50

Wow, that's what you'll want to watch, so go ahead.

Dr. Hoyle: 25:57

What were you gonna say?

Di: 25:58

No, you, I mean, I'm just thinking like, so what do you do? I mean that's I guess you know that's from the assessment. Then, like, how do you actually intervene? Or even like, or, and you know, what do you see that actually works out in the field or in the literature, and maybe examples that I don't know, take home examples, or is it? Yeah, like I'm wondering, is this too delicate to even give take home examples?

Dr. Hoyle: 26:35

I think it depends on the severity of it. So if you have a child who's clearly choking and gagging when you are presenting certain foods, then that might not be an area where we tell the parent. No, you know, let's have more professionals before we move to where you're implementing that and we make sure that that parent training component is a huge part of it. So they're coming in and watching what we're doing before they try to do it at home. Now, if you just have a child who's selective, like they eat so I have children like this too, where they eat a variety of food but they might not eat any vegetables, but they'll eat a variety of fruits and other things, but they might not eat like or they might not eat foods that are certain colors. Now, if it's something as simple as that, then we'll start with a plan that you know systematic exposure.

Dr. Hoyle: 27:30

So we have so many different strategies within research that have been effective, like positive reinforcement. Something called this escape, extinction is used a lot in feeding research, where you continue to expose and not let them essentially gain access to what they want. We also ask parents like okay, if we're going to do a feeding intervention and we did a preference assessment. Let's say, for example, the child loves gummy bears, for example, we'll use something called a pre-mark principle and it's just. That's basically like grandma's rule, in more layman terms, like if you eat this, then you get access to them.

Di: 28:13

Okay.

Dr. Hoyle: 28:14

So if you take a small bite of a broccoli, for example, then you'll get two gummy bears, because we always try to keep that reinforcement very, very high until we get success where the child is.

Di: 28:26

Because the key is to just expose right now.

Dr. Hoyle: 28:30

Yes, exactly, the key is to expose and be consistent. So if you're going to do something, so it can't be one week I'm gonna try broccoli, next week I'll try cucumbers. It has to be like let's make broccoli successful before you move to a new food. So that is another area where we tell parents that, or what we'll do is we'll have single exposure, so we'll have like a non-preferred food on a spoon followed by a preferred food. So we'll have like a tiny piece of, let's say, a carrot followed by a big piece of a cookie, and then they have to first eat the carrot before they can get access to the cookie. So it's also like how you're presenting it too. It could look very different from child's talent. I'd have some children who can only tolerate single exposure and some children who can have multiple non-preferred things and one preferring thing, and there's research on really presenting it multiple different ways where it can be successful. But it's just biggest thing with behavior analysis is just that individualization.

Dr. Hoyle: 29:39

Making sure that success is individualized based on that child's preference and how they learn best, essentially, Right.

Di: 29:48

I imagine that from what you're saying, you're very sensitive to the individual and you probably study the child. Yeah it's not like yeah, it's not more.

Dr. Hoyle: 29:59

You know where group research kind of looks at like a group of individuals and how they perform. We look at every individual as its own and look at the intervention, how it's affecting that particular individual and how-.

Di: 30:13

I feel like that's the way to be effective.

Dr. Hoyle: 30:16

Right, it can be a lot more work, obviously, because every individual has their own intervention going on and even if two people are working on the same thing and it could look very different from person to person. Right yeah, so and that's one of the reasons why I love this field, because one of the only fields that I've found that really looks at a person.

Dr. Hoyle: 30:41

It's a very holistic approach, I feel, in a lot of ways, because you're looking at the whole person and not just okay, I'm gonna try this strategy because it works for somebody else, right, If it's not working for you, that means it's not the best strategy, and then you modify in how that person is learning.

Di: 31:01

And I'm also thinking of the fact that just autism in general is such a spectrum. Yes, absolutely, and just by definition that it's actually. I couldn't even imagine it before you and I started talking the complexity of it. But yeah, it's very, very complex. I now know.

Dr. Hoyle: 31:28

Yeah, and it's funny you bring that up, bring that up the spectrum part of it, because we had some of that distinction when we had more of those diagnosis. So we had, you know, it used to be ASD, pervasive developmental disorders, aspergers but now it's no longer diagnosed that way either. It's just autism and it's mild, moderate or severe, it's like based on levels of autism. So in a way, in some ways that's a good thing because you can kind of say like all right, this person is clearly exhibiting signs of autism based on these criteria. But you know, somebody with a sort of that PDD diagnosis or pervasive developmental disorder can have a lot of those similarities but have less challenges in some areas you know, so sometimes it's a good thing to put that distinction.

Dr. Hoyle: 32:28

Sometimes it's not. So. You know, I haven't found, and if you ask one person to another they'll say, yeah, it was better when we had those multiple diagnosis. I know this is so much better and I'm not a diagnostician as behavior analysts we're not allowed to diagnose with sometimes can be because we treat children on the spectrum all the time. Sometimes it can be a little challenging why we can't be the first people that see this kid coming in.

Di: 33:00

Yeah, it's kind of limiting Because, like you know, you are an expert in this.

Dr. Hoyle: 33:07

Right. So as of right now at least, we are not. But you know, if they come in with a diagnosis from a developmental pediatrician or neurodevelopmental physician, then within the reports you'll see levels of autism based on the assessments.

Di: 33:26

Yeah, it does sound like. Now that you explained how now it used to be separated and now it's it does, I could understand how it could complicate things, right? Yeah, and then.

Dr. Hoyle: 33:44

Sometimes have a challenge.

Di: 33:46

I'm sorry.

Dr. Hoyle: 33:47

Parents sometimes have a challenge. I mean just getting the diagnosis of autism.

Di: 33:52

For sure.

Dr. Hoyle: 33:53

Can be, you know, challenging for a parent to hear that, because that's a lot. You know there's no cure for autism. As we know, there's no applied behavior analysis, really the only evidence-based intervention that's shown to be effective, but there's so many other interventions, so there's the realm of information is unlimited, but what to do and what's best for your child once you get that diagnosis, that you know, that's a process that parents go through which I can imagine can be very challenging as well, and it's it probably changes also with age, Like one thing that used to work very well at, let's say, five years old might be very different for an eight year old, just because an eight year old is nothing like a five year old, I mean, it's just so.

Di: 34:43

It's kind of like always, you know, keeping your hand on the pulse, like your finger on the pulse and like just constantly being on top of things, which is a challenge, which is not easy.

Dr. Hoyle: 34:57

Absolutely yeah. So you know, within the realm of interventions based on the medical model, that's why we do assessments every six months. We make sure that every six months we're reassessing and developing a new treatment plan that meets the child where they are after six months of therapy. Within a school model, typically you have students with IEPs and that's usually you make changes and even in that realm, you know, a lot of parents don't know what to ask for.

Dr. Hoyle: 35:31

What are going to be the best services for my child. So really advocating for that and making sure that the placement is appropriate, because a lot of public schools now have programs, fortunately, especially in New Jersey, but that quality of that program is going to vary right Depending on your. So unfortunately, some of the social, economic, demographics and all those components really go into that too. Like, culturally speaking, like I have a lot of clients who are whose first language is also not English. They're Spanish speaking, they're coming into this country, they might have just moved and they have children and now their child has a diagnosis of autism. It's very challenging for parents and I mean luckily we live in a state where there is a lot of resources. I will say New Jersey is one of the best in that area.

Dr. Hoyle: 36:25

But in a lot of more rural states. Its treatment doesn't even exist right now, so it can be very challenging.

Di: 36:35

Yeah. So that's where you know public health promotion needs to come in and teach and yeah, yeah, that's. Yeah, it's like upsetting to hear this and unfortunately it's also kind of the expectation Some of the long-term or potential long-term outcomes or benefits of early intervention and strategies in improving feeding and eating behaviors on the autism spectrum. From your experience, could you maybe elaborate on that? I have to also just say, specifically with that question, the early intervention.

Di: 37:29

I've recently met a mother of a child who was diagnosed with autism at a very, very early age and I'm just sitting there listening to what she has to say and I'm thinking to myself how awesome are you to like get your kid what he needs Specifically it's a boy what he needs at such an early age, because it's like you even mentioned it yourself, it's kind of nerve wrecking even just going to get the diagnosis. It's like I don't want to hear it, I don't want to see it. This is like too scary. So there's that. There's also like just picking up on it because it's still a very, very young child. So, yeah, I'm curious. I just couldn't stop thinking when she was telling me like how amazing she is and so, yeah, from your professional perspective, what are the benefits and what interventions are there that really you see work for early intervention?

Dr. Hoyle: 38:37

Absolutely so. I mean within early intervention. So the model we have, especially in the US, is early intervention starts as early as 12 months. I mean if you feel that your child is really not meeting those developmental milestones, and then it's a state funded program. So you go through that system and early intervention will come in. They'll do their own assessments and typically they have occupational therapists, physical therapists, speech therapists that will come in and then they have what we call developmental interventionists. So those typically don't do 10. They tend to not be behavior analysts typically.

Dr. Hoyle: 39:19

So what happens is with early intervention it's more working on play skills, some receptive, initial receptive skills like following a direction, like if you tell a child, especially from a safety concern point, if you have a child who runs, you want them to be able to come back when you're asking them to come here. So we work on like those simple initial skills that are developmentally appropriate at that age. But then and then from that OT speech perspective, they're working on the fine motor, the oral motor, the language to communication, and then we typically as behavior analysts sometimes we don't get them till the age of two, sometimes even three, because early intervention mass till the age of three and then we go into the ABA model, so that intensive ABA model. Sometimes for some parents they they don't get contact to that till maybe two years of age, three years of age, and some parents don't get the diagnosis even till the age of three because a lot of times pediatrician will be like, okay, they're still young, right, they're.

Dr. Hoyle: 40:29

And I've heard this from so many parents like like wait it out wait it out, you know they might just be slowly develop, slower to develop communication skills, and that happens a lot too because there's specific indicators. But sometimes some children just develop at a later age. You know communication, especially with boys. We see this a lot where their communication skills are later developed rather than at the age as most developmental milestones are supposed to be. So that can also be challenging because it can manifest into further concerns if they're not getting that diagnosis. So luckily with early intervention you don't need a diagnosis, but they have that specific criteria and you have to meet certain deficits to get early intervention as well. Okay, so that always is very helpful, especially, you know, for like, let's say, if you have a child with feeding concerns, like OT will work on like some of those sensory processing areas.

Dr. Hoyle: 41:32

So, I've got occupational therapists. I won't speak too much on that, but they they want to look at feeding issues from like across all the five senses, and expose the child to different foods, like do they let them tolerate smelling the food, putting the food to their mouth, putting it to their lips, things like that. And then, from a speech perspective, they'll work on looking at like what are the functions in the oral motor that may you know? So, are they chewing correctly? You know they'll look at a lot of those functions, like are they gagging or are they? You know, when they're chewing in their mouth, are they moving it from side to side? All of those components. And then from a behavioral perspective, we'll look at like where's, where's the lack of selectivity? So is it just because they've gained access all their life to what they want? And you know, this has become a pattern?

Dr. Hoyle: 42:31

Or is it because the challenging behavior is so so much more interfering with their lives that their you know parents are just like? I'm just going to not address feeding at all because I don't want to see the challenging behavior. So in a way it's like some negative reinforcement on the part of the parent because he gets his hate not having to deal with that tantrum.

Dr. Hoyle: 42:55

Essentially that occurs. So there's so many different ways and there's there is a lot of research from all different areas too, and that can be challenging for a parent to figure out like, okay, what's going to be the best approach for my child.

Di: 43:09

Right and so like seek out a professional that you trust and, and you know, even if it takes a few visits, you know I've heard things like, just specifically in the sports field, I didn't go to physical therapists and I'm like okay, but there are some that are amazing. Yeah, you know, I would like go and because if you need help, absolutely go, get help and find the right person for you, yeah, and for your child in this case. And and so you would say the earlier the better, absolutely, the earlier the better you know, and some of these feeding challenges, funny, can be indicators too.

Dr. Hoyle: 43:55

So your child, you know most, most children, like I've had students at the age of three that are still drinking out of baby bottles because they refuse to let that go. So I've had parents just asked me to work on that, just getting them to drink from a regular cup and that could be part of our feeding intervention even. Just exposure to different types of cups and removing the baby bottle, because you know, with the baby bottle we, as we all know that can affect oral motor development Absolutely the longer you drink out of those.

Di: 44:31

Right, because of the way the nipple presses against the teeth. Yeah, yeah, exactly. Even the pacifier, you know parents have real difficulty removing that.

Dr. Hoyle: 44:39

So if a child has a pacifier and a motor, if a child has a pacifier and in most I think in most pediatric research from what I've seen at the age of two they really shouldn't be having a pacifier because it really affects your oral motor development as well. So if a child has it till the age of three, four, because parent is just not able to remove that due to the increased problem behaviors that happen, that can create feeding challenges in the future too.

Dr. Hoyle: 45:12

So it could be as simple as working on that in exposure to different types of drinking out of bottles, removing the pacifier, like those types of things too. It could just be as simple as that to increase some of the feeding.

Di: 45:28

And so I'm as a parent as well.

Di: 45:31

I'm thinking of how much anxiety it can trigger for some of the parents, and it goes back to what I was saying a second ago like again, as someone who's not an expert.

Di: 45:44

For me, it sounds like it is so crucial to seek out the professional that will support the parent and the child as best as possible, because even I mean I'm thinking of different situations that I'm aware of and the child's behavior and tantrum behavior can actually be very triggering for the parent and literally too much for the parent to handle, and so absolutely go out and seek professional help so that you can also feel supported as the parent and get your child the best care that he or she needs. Yeah, so is it possible? Because people not specifically from New Jersey are going to be listening to this, and if anybody does have any specific questions, then I'm sure you and I are going to talk again and I'm going to get you back on here because you're really a wealth of information. So I'm wondering is there a way to reach out to you that is comfortable for you, whether it's social media or website, and I'm, of course, going to link everything.

Dr. Hoyle: 47:00

Yeah, so I have a very small company. Right now I just provide consultations for schools, currently through the company. Eventually I will go into the insurance-based market. I have not approached that as of yet just because of the time component and what it takes, but the company is called Neurodiversity of Northeast. I'll put it in the chat as well and my email is on there. The website has a link to get your first consultation for free. So I'll put this all in the chat as well and I'll send you a follow-up email with all the resources, and so I have created a list of resources for you research articles that specifically Amazing, you think.

Dr. Hoyle: 47:48

So I'll email you those components.

Di: 47:50

Amazing.

Dr. Hoyle: 47:51

Yes, absolutely. I'm happy to answer questions Now. I may not have answers to all the questions, but I'm going to do my best and guide you to the professionals who may be even more knowledgeable.

Di: 48:03

Right, because I'll tell you what I think that saying goodbye to you now and someone listening might be like wait. I have to talk to this person and I need more information because, really, the information you provided here today is so, so important and I'm so grateful that you came onto the podcast and you're getting the awareness to rise. So, thank you. Thank you, dr Hoyle. Thank you.

Dr. Hoyle: 48:39

Thank you for having me. This was amazing and you're a great interviewer.

Di: 48:44

I will say Thank you very much. It's just that you're really really fun and fascinating to talk to. Thank you very much.