Interview between Speaker 1 (Meg) and Speaker 2 (Marsha Dunn Klein)
Episode 83
[Introductory music]
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify Autistic voices, and change the way we think about autism in life, and in our professional therapy practices. I’m Meg Ferrell, formerly Meg Proctor, from learnplaythrive.com broadcasting to you today from unceded Tsalagi territory.
Meg:
Before we get started, a quick note on language. On this podcast, you’ll hear me and many of my guests use identity-affirming language. That means we say ‘Autistic person’ rather than ‘person with autism’, because this is the preference of most Autistic adults. Being Autistic is a part of their identity that they don’t need to be separated from. Join us in embracing the word ‘Autistic’ to help reduce the stigma.
Welcome to Episode 82 with Marsha Dunn Klein, the creator of the Get Permission Approach to feeding and the author of ‘Anxious Eaters, Anxious Mealtimes: Practical and Compassionate Strategies for Mealtime Peace’. Y’all, Marsha is my kind of OT. She’s been in the field of pediatric feeding for over 50 years. She co-authored the pre-feeding skills book that I used to haul around in my trunk as a new grad early intervention OT. And she created the Get Permission Approach which is arguably one of the gentlest approaches out there. But after she created it, she kept listening and learning. Marsha reached out to me after Episodes 53 and 54 of the podcast with Naureen Hunani and Laura Hellfeld. She was listening, she was learning, and she was updating her own content that she teaches, and she wanted to learn more.
Since then, Marsha has taken Naureen’s full course on neurodiversity-affirming feeding practices. And she’s been interviewing Autistic folks who are also selective eaters. She attended last year’s Learn Play Thrive OT Summit. Marsha is one of those people who keeps changing and adapting her ideas as she learns more. And these are the people we need in our fields. So, Marsha reached out to me, we had a great talk about what it looks like to blend what we’re learning about the experiences of Autistic adults with our clinical practices in our work. It was a really sweet, practical, compassionate conversation. And from there, we decided to share what we talked about with all of you. I had such a nice time interviewing Marsha for the podcast and I know that you’ll love this interview, too. The conversations on feeding on the podcast have sparked more discussion than nearly any others. And we’re really excited to just keep this conversation going.
If you decide that you want to learn more about applying neurodiversity-affirming feeding principles to your work and to get continuing education credit for it, make sure that you register for the 2024 Continuing Education Summit where Naureen Hunani is one of the speakers. We have this registered for AOTA and ASHA CEU’s and we’ve applied for NASP and ASWB CEU’s and anticipate having those as well. You can grab your spot at learnplaythrive.com/summit. Here’s the interview with Marsha Dunn Klein.
Hi, Marsha. Welcome to the podcast.
Marsha:
Hi, Meg. It’s so exciting to be here. Thank you for inviting me.
Meg:
And thank you for reaching out to me. I am really, really thrilled to sit down and chat with you. And as we often do on the podcast, I want to start with a little bit of your story, Marsha. A lot of folks know who you are, and are probably excited to see your name here. But I want to track you from what we know of you to how you got to this place that you’re at now. I’ll tell you a little bit of my experience with coming across your work. When I was a new OT, I was in Durham, North Carolina. I was working in early intervention and there is a lot of behavioral-based feeding intervention happening in Durham, or at least there was then. I remember when I was on fieldwork in OT school, my fieldwork supervisor was doing force feeding, holding the kids hands down and feeding her, and I would literally step into the hallway of the apartment building and cry. It was just — it felt so wrong to me. So, I found your approach, the Getting Permission Approach, and even just the name of it was soothing to me because it was gentle and child-centered and nothing could be further from force feeding a child than getting permission. So, you’re a big name in the feeding world. You’ve been a therapist for quite some time. I want to hear about your journey and some of the big philosophical shifts you’ve made in your career.
Marsha:
Thanks for that question, Meg. You know, yes, I’ve been doing this for over 50 years, and I was around feeding when it kind of began as a field, when Suzanne Evans Morris and I wrote the pre-feeding skills book in 1986. There was a lot of evolution going on then. And we started with working with a lot of children with cerebral palsy and motor problems. And then, we learned more about developmental problems. And then, as a field, we learned more about lots of the babies with medical fragility, and had to really hone those skills. And then, we started learning more about how to pay attention to sensory. And there’s always been, as you said, that sort of behavioral component out there. And I knew when I put together the Get Permission Approach ideas, that behavioral wasn’t going to be the way that worked for me with babies, that we needed to be respectful, we needed to get that permission, we needed to have babies’ trust. So, when I talked about Get Permission ideas, it was always in that the baby needs to be comfortable. There cannot be crying. We cannot be forcing children. That has always, always been my mantra. And so, in the last 2, 3, 4 years, I’ve had to come to some sort of personal reckoning and realize that even within that framework of I want it to be kind, and I want it to be parent-centered and gentle, and I want children to have a good time, but the more we’re learning about brain science, the more we’re learning about neurodiversity, and just differently wired humans around food, people who are wired differently about their sensory systems relating to food really need some gentle tweaking of the approaches that, for me, felt gentle and loving in the past. And now I realize, oh, but I was trying to get them to try foods. Oh, but I was trying in a playful way to have them have a good time with food. And what I know now is that those techniques can work with lots of children. And for many of the more sensory diverse, for more of the children who have really complicated sensory processing issues, there can be masking, there can be a desire for these kiddos to just please.
Marsha, you’re having such a good time when you’re so playful, and you’re such a cheerleader. And I look back at some of my case studies from those years that were playful and what I thought was gentle, and some of those kiddos didn’t carry over the great progress they made when we were playing together. And I didn’t quite understand it. And now through the lens of learning more about the nuances in brain wiring, the nuances in trauma, the nuances in neurodiversity, in sensory processing, I’m learning that when we push into that trauma and that worry, that disgust, and that differently — that person is responding to foods differently — they can either run away, or mask their true selves. So, the bottom line here, Meg, is that I’m having to teach this so differently and approach this so differently. But what I want to say, most importantly, is that every child we see is so unique. So, we have to look at each child in the moment, in their body, with their family, with their experiences. And it’s become harder and harder to generalize our strategies because they have to be so personalized.
Meg:
I love that. I know a lot of folks probably really resonate with that experience after listening to Episode 53 with Naureen Hunani, Episode 54 with Laura Hellfeld, where for a lot of us that’s the first time we’ve heard some of our feeding practices that felt affirming to us questioned through the lens of the neurodivergent child’s experience. And it’s lovely to hear about how you have also been listening, and learning, and shifting, and changing. I want to name the neurodiversity-affirming principles that you’re applying to your feeding practice. You and I chatted recently. And one thing I think we both agreed on — and this is something that Rachel Dorsey talks a lot about, is that neurodiversity isn’t a set of rules or neurodiversity-affirming practice isn’t a set of rules and guidelines, similar to culturally responsive practice. It’s a process.
Marsha:
Yes.
Meg:
And you were able to identify some of the principles that were maybe not influencing your work before that you’ve overlaid on to your work after learning more from Autistic folks. Can you talk a little bit more about what that looks like?
Marsha:
You’re right. I have spent a lot of time in the last couple of years trying to learn more, to read more, to learn more. There’s new research, there’s new brain science, and there are voices out there of neurodivergent people who are explaining to us about their experiences with eating. And we didn’t have as many of those voices in the past. So, I’m just trying to find them wherever I can find them and learn. And the thing that I realized is that I have to be careful when I teach that I don’t come up with principles that are the only way to do things. I’ve never been a protocol kind of gal, ever. However, you know, I will say things like, “Let’s think about mealtimes,” right? I’ll think about, “Let’s include children at mealtimes.” And, Meg, I have to say, I still think that’s a good idea for many of the children that we know, because all of the children and the adults we know, I mean, they’re not all neurodivergent. They all aren’t people who interact in any one particular way, even within a neurodivergent community, even within sensory individual differences. Every human is different. So, you can’t say this doesn’t work for any of these people and this all is the only way to do it. So, for example, yes, I believe for many of the children — and, you know, I mostly come from working with children — but for many of the children that I work with, it’s a great idea to have them at the mealtime. They can learn a lot from being around others, they learn about tools and about foods, they can meet foods they haven’t met yet and figure out what it is that they want to try when they’re ready. And I now also have to continue that sentence to say, “And mealtimes, together times with others isn’t the best way to eat for some people.” For some people, the chaos of the mealtime, the sensory overwhelm of the mealtime just doesn’t work. And as I listened to the voices of those people who can explain that to me as they are adults — I just was interviewing somebody yesterday who said, “I want to eat in front of my computer, with my familiar food, with my familiar videotapes every night, because I have school, I have work. And just navigating the world of social interactions during the day is so complicated for me that when I come home, I need to enjoy my food and be comfortable and not feel the stress that it causes me,” this friend, not feel the stress it causes him of trying to interact with people while eating.
So, what I realized now, and I’m hoping others are realizing is we don’t have to throw out a lot of the ideas that have worked for many children, many families through the years. And we have to also be aware that many of those ideas will not work with neurodivergent individuals who have very unique ways of interacting with mealtimes. I wanted to say that, you know, when I think about mealtimes, I think about it as a time to fuel up. I think about it as a time to fill up. And I want to make sure that parents understand when children come to the table, that should be our first line of thinking. What does my child, what does this individual, what does this human being need at their mealtime to meet their fuel needs, to meet their energy needs? And that might look like plain spaghetti for some children, and it might look like a whole variety of things for other children, for other people. But first and foremost, people need to be able to trust that they can fill up without judgement, without shame, and without enough food.
Secondly, I think of mealtimes in a little different way these days. I think of a meal as the food we eat whatever that is, for whatever individual. When I think of the time, that’s the time we’re eating that food. So, no longer can I say, and should we be saying, that all mealtimes need to look alike, all mealtimes should be together in a group, all mealtimes should be at some family table without the TV on. Those ideas may be appropriate suggestions for some children and people, and individuals. And they are not the ideas for others. So, what I want to say, Meg, is I don’t think I should be in a position to say ‘All mealtimes have to be together’. But I also think we’ve got to be careful that we don’t say ‘All mealtimes are bad for neurodivergent people’. Because it depends on the individual, right? So, we — so what we can’t say in 2023 is that there’s absolutes. It’s the individual person and their needs.
Meg:
That’s so helpful. I love hearing you say that mealtime should be a time that a child can trust they can fuel up without judgement and without shame. Those are the kinds of words when you hear them, they feel really obvious. But maybe we’re not actually making that as important as we intend to. We lose sight of that for all the other things we’ve layered on. So, it’s nice to hear you talk about how feeding has evolved. Our considerations in supporting children to eat have evolved. At one point, we needed to add on sensory processing. And now, you’re adding on questions about Autistic masking, questions about the social demands of mealtime. And I love hearing you redefine or help us look more openly at what mealtimes can look at, especially considering that often there’s an Autistic parent, sometimes there’s a PDA parent, and we really want to be creating routines that work for families, not coming in and saying a bunch of ideas that don’t work and leaving. I want to talk about our role. I’ve said before on the podcast that I had a mentor early on who said — she was an educator by training and a parent of an Autistic child, and I was struggling to get a kid to meet a goal. And I was like, I just don’t know what else to do. And she said, she said very kindly, “The problem with you therapists is you think your job is to get a kid to meet a goal.” And she was like, that’s not your job. You can provide them opportunities to learn in a meaningful way the things they’re ready to learn. But your job isn’t to get them to do anything just because you wrote the goal. So, the way we see our role really impacts how we work. Can you define, or can you share how you define our role as providers in the realm of food when we work with families?
Marsha:
Yes. So, I agree with you completely that it is not our job to get children to eat, not our adult job or a therapist job. And our friend, Jenny McLaughlin is a speech-pathologist out of Texas. And she’s explained that to us that it’s not our job to get kids to eat. And it is our job, in fact, to give children opportunities to figure out what do you love, what foods work for you, what environment works for you. That’s our job. And our other job is to really help — because remember, I work with parents most of the time — really help parents be successful with their children. And that’s very different than what it might have looked like over the past five decades. Many therapists got out of school and believed it was their job to get kids to eat. Many of us believed that if we could just get kids to eat, then they would just do it at home. And that’s just plain not our job. And when we believe that, it could tip us into the realm of pressure, of pushing kids to do things they’re not ready for or they’re not comfortable with. It becomes an adult-directed goal.
When really, when I think about feeding, we need to think about feeding from an internally motivated place. What works for you, little person or big person? What do you love? What foods, what sensory properties, what environments work for you? And in feeding therapy these days, my feeding therapy looks a lot more like conversations with parents about thinking about the environment and how food is presented. It looks a lot more like it may have some food interactions. A food interaction, however, is not done to get kids to eat one bite of that food. A food interaction might be, you like pancakes, could we make pancakes together and see how it goes? And what we, the parents and we learn is, oh, well, your child doesn’t want to be in the kitchen. Oh, or they do like making the pancakes. Oh, you’re learning about something about that child as we go forward in the world of food. But it’s never any more, and it used to be, we would try to get kids to eat it. But it’s not that anymore because we know that doesn’t work for individual children.
And then, we know that it’s putting our role back into that externally motivated ‘we’re in charge and we want to get you to do it’. That’s not our role. And in my teaching, that is a large change in my teaching, to really make sure that nothing I say could be interpreted as ‘It’s our job to get’, ‘Our job to do to’, ‘Our job to make kids try’, right. That’s pushing into worry, trauma, and for many children in many therapeutic settings, that was creating negative memories that was contributing to the trauma or negative experiences the child had. And in fact, not helping the child move forward with good self-esteem and with enjoyment about eating.
Meg:
This really brings up a question about food exposures. So, we’ve had a number of Autistic folks on the podcast talk about the tendency of providers, I think this happens a lot with OT’s, to treat sensory sensitivities as if they are anxiety-based, not sensory-based, and try to systematically desensitize a child to them. I’ll never forget Dr. Damian Milton on Episode 2 of the podcast saying, “If you do that to me with parmesan cheese, that’s torture,” and I imagine the things that feel to my sensory system just torture, as in somebody writing a goal to systematically desensitize me to them. No, thank you. Especially if you experience it as pain. So, there’s this ask to move away from play-based systematic desensitization for sensory sensitivities, including food, including the ones that are fun and play-based, ‘and look how much fun we’re having, you can try it, too’. And we also know that kids only try new foods if they’re exposed to them. And that sometimes takes a lot of exposures before a child is interested in the food. I mean, I know this as a parent, right. Like if I, if a food falls off my radar for years, there’s no chance my child’s going to be interested in that. And sometimes, if it becomes available a lot, they surprise me. So, what’s the balance between exposing kids to new foods without taxing their sensory systems?
Marsha:
Yes, yes. Great question. So, I’ve talked about exposures in the past. I’ve actually written a book about ‘Anxious Eaters, Anxious Mealtimes’ talking about the worry and the distress about mealtimes for so many families, so many children and adults. And I’m really thinking differently about exposures these days. I think the term ‘exposure’ has gotten a pretty negative connotation. So, I would like to suggest that we don’t use that term anymore. I think the negative connotation is in the name of exposures, therapists have made children smell it, or made them taste it, or made them take a bite, or in a way that might work for some kids. But there’s been so many where it’s been actually detrimental or worrisome for that individual. So, it’s a continuum. But it requires a really careful, critical thinking, and very careful observation of the child. The whole business about ‘It takes 10 exposures to try something new’. Well, who decided ten? And how does that relate to, you know, this particular child who’s in front of me at the moment?
I have this experience, Meg, where my grandmother used to come visit and she and my mom would make steak and kidney pie. They were from Scotland. And I could smell it from the bus stop. And I’m going to tell you, I will never put it in my mouth. I don’t care what you do to make me take a little smell, that’ll just make me gag. Make me touch it, I hate the texture. I will vomit with the flavor. It’s, I am disgusted with steak and kidney pie. So, don’t try to make me learn to like that. The comment in my brain now is there are so many foods out there to help children learn about. Why are we working on the ones that they have to be desensitized to in a strict, ‘it’s my idea’, externally motivated kind of way? All right, so we need to move away from that. However, we need, in my experience, I want to give children and adults the opportunity to be around foods they’ve never met. And that’s the terminology I use. If you only ever eat your kind of formula, and some crackers, and you never meet any other foods, you’re for sure not gonna like anything else. But the difference is, can we talk about those meeting of new foods as opportunities? Can we think of opportunities as — I have a little guy that I know and he really likes drinking his canned formula. And sometimes his mom will sit next to him while they’re reading a book and she might eat an apple. That, for him, he doesn’t mind it. That sound isn’t worrisome. But he’s getting to meet an apple while somebody else is eating it nearby. If that were offensive to him, well, then let’s think of something else. But we want him to make sure that he has the opportunity.
For a lot of children, having the opportunity to eat at a family meal does have them, allow them to meet new foods that they might want to reach over and try. So, I don’t want to eliminate that as a theory. And exposure is also carried over into, “I’m just going to put food on your plate, Meg, it’s going to have, you know, yes, I’ll put your waffle on it. But I’ll put three Brussels sprouts and four pieces of asparagus on it,” and the child will look at it and go, I can’t be at this table. I’m now not safe. I’m out of my regulation and comfort zone. I’m out of here. And so, in terms of exposures, I don’t think that’s the way to do it. I think that’s too direct. I think that can be too fearful for so many kids. Too sensory disgusting for so many kids, depending on what’s going on in their little or big bodies. These days, I suggest could we think about, maybe when children are a part of a group, could we have a buffet where children can put on their own plate what works for them. So, they put their own waffles, or mac and cheese, or chicken nuggets, or the foods that they’re most comfortable with. And there happens to be a bowl of salad there that other people can choose from but you don’t need to. Can we help children or adults learn that you’re in, you live in a world where some people eat different foods and you could meet them or not, try them or not, but it’s your choice what goes on your plate.
And this whole business where we somehow thought we were going to force kids to have things on their plate, I feel like went a little too far into the pushing into too much worry, too much stress, too much disgust, too much putting some of these kiddos in a place where the mealtime wasn’t even working for them anymore, because they couldn’t trust it, and there were those unwanted smells and that unwanted chaos. So, number one, could we do it as a buffet? Or could the child put on their own plate what they would like, what works for them. And when children have their — and adults — have their food, they get to decide where they’re going to eat it. Because sometimes that’s a spaghetti that one of my friends knows, and I can eat spaghetti here with you all today. Cool. There’s not big smells in the room. Fine. But other days, a friend of mine says, “You made clam chowder, Mom. It stinks. I’m going to eat my dinner in my room with my computer and be calm.” And we have to get to a place in the world where parents and therapists understand those are choices we want to support. And we want to help each individual tune into what’s working for their body today, in this moment, and support them in those choices, validate them in those choices, and have it not be that they’re disappointing somebody because they made those choices.
Meg:
That’s lovely and so intuitive. I think often, when we’ve made these suggestions of ‘Put everything on their plate’, I used to tell a family that they needed to pack non-preferred foods together with the preferred food in the child’s lunchbox. And the parent, like, just kind of blank-eyed nodded at me and never did it. Because they intuitively are like, no, this is not a good idea. I think about my own four- and six-year-old who are very picky. I’ve sent them — zero times have I sent them foods just to like expose them to that food in their school lunchbox. I mean, one, the extra effort of the parent, the extra work, the cost, the food waste, on top of the stress on the child and the parents’ just intuition that this isn’t going to be good for them. So, I love that shift.
Marsha:
You know, I’ve done the same thing, Meg. And I sometimes look back a little bit horrified at some of those recommendations. But you know, I like Maya Angelou’s quote, “When we know better, we can do better.” You know, it’s evolving, and we’re all evolving. But when we think about eating from a bigger, broader view, if the child has certain foods they like and they’re at school where there’s lots of stress and chaos in the lunchroom, that is not going to be the moment that that person is going to want to try something new probably, right. So, what are we doing and what are we telling parents to do? We’re telling parents to do things that their kids are going, “Mom, why did you do that for?” and we don’t want to mess with that close relationship and trust that they have.
Meg:
The other thing I love that you said was why are we picking the foods that we have to desensitize them to? when I think about supporting therapists who are having trouble getting an Autistic client to meet a non-feeding goal, the question I always ask is, is it an emerging skill? And they’re like, no, not by a longshot. And I’m like, this isn’t the right goal, this isn’t something that the child is ready to learn. And I love the idea of looking at the foods that the child is ready to meet, rather than arbitrarily assigning all of these and going through the arduous steps of desensitizing. I was also thinking as you were talking about the invitation versus the pressure overlaid with the risk of masking. I know that I was trained to use the language of ‘You can smell it’, ‘You can touch it’. And intuitively, with my own children, I have never used that language. And I know that they are not people pleasing to me, they are not masking to me, they are pretty authentic. And I might say something like, when they show interest in a food at the table, they’re not used to I might say, “Do you want to smell it?” And often they say, “No.” And sometimes they’re like, “Yeah, I do.” And we try it. How do you feel about that distinction of just offering that, if we’re being thoughtful about the child’s propensity for people pleasing and masking?
Marsha:
Yes. ‘Do you want to’, rather than ‘You will’, or ‘You can’, or ‘You should’. What we know is, our kids, they know their adults wanted them to try something new. They’ve been sitting at the table and asked to try new things at home and in therapy for a long time. So, they know with our words, “Hey, you can do this,” can feel nice to my mouth to say that, but to the person who’s hearing it, it could be like pressure, pressure, pressure, they want me to do this, right. So, in the words, in the vocabulary of the Get Permission approach, we talk about offers, and we talk about invitations. So, what we know about lots of children when they’re learning how to eat, they touch it, and pick it up, and they play with it. And that can be a way to really learn about new foods. When I think about the sensory aspects of foods, I do still believe that if I like the smell, I’m more likely to be interested in that food, right. Because they think of smell as kind of a taste preview. I know that if I don’t want to touch it, or the kiddos that I meet that have their fingers splayed, and they just don’t like that food on their hands when they don’t like to touch it, why would they put that in their mouth, right? If you don’t like the flavor, why would you put it in your mouth? And if you hate the texture in your mouth, why would you do it? So, I do know that it is important to appreciate the sensory aspects of a food before you’re going to eat it. But I don’t believe it’s my job to make you do those things. And I used to help kids more directly to do those things. And I want to share that with therapists out there. This is a shift. And I’m wanting to role model that we can shift, right.
But I had a family say to me, “My child hates the smell of banana, how am I going to get him to eat banana?” And I want to say, if you already know, because bananas have been around, that they hate the smell of it, why are we picking that food? Why is that a goal food right now? There are so many foods out there, let’s expose your child, give your child the opportunity to be around a lot of different foods. And then, notice which ones are they kind of interested in. I spoke with an Autistic man yesterday that was telling me about his youth and his relationship with trying new foods. And he said, “Ms. Marsha, my mom was cooking something and it smelled so good. And it was corn on the cob. And I said, ‘Mom, what is that?’ And she said, ‘It’s corn on the cob. Do you want to try it?'” And he thought the smell was wonderful. And he was curious. And he went to the kitchen and looked to the corn and said, “No, not today.” So, the smell was attractive, which would be a food you could ask more questions about. But it still has to be that child, that sensory response of that individual in that moment. So, one of the things that I realized is when we when we give children the opportunity to be around other foods — I’m eating something or somebody’s naturally and authentically having a meal — and when the person shows some kind of interest in that, or when the adult shows an interest in that, that would be one to explore a little differently. But again, with guidance, but not with externally driven motivation and pressure. So, can I describe how I used to think about trying, and how I don’t think about it in that same way anymore?
Meg:
Yes.
Marsha:
Because I used to think, you know, somebody’s willingness to just smell a food could be a try, or they could just touch it could be a try. Maybe they could put in their mouth and spit it out could be a try. And I was trying to be so loving about all those choices. What I didn’t realize, I was kind of pushing some of the kiddos past their comfort level. And I was getting them to do that, right. What I think now is when you meet a new food you want to try, if you want some help with that, we can help you. And so, let me give you a story. There are two stories, Meg, that are so powerful, and I’m hoping that they resonate with your audience. I met an adult woman who was 40-years-old. And she said to me at some office event from my husband’s office, “Hey. I, you know, I’m a picky eater, and I want to try to like new foods. And I hear this is what you do.” And I said, well, I do it with kids, but we can talk about it. Clearly, she would have had an ARFID diagnosis but didn’t have it at that moment. She liked white rice, and bread, and potatoes. French fries, potato soup, mashed potatoes, and a few kind of crunchy things. That was it. So, I said, “Well, how do you try new foods?” And she said, “Well, I take a mouthful of it. And I put it in my mouth and I plugg my nose and I chug down water.” And as she described it to me, she had this grimacing face and I just looked at her and I said, “Is that working for you at all? Are you finding anything new that you like?” And she said, “No, never.” Okay. So, I helped her with the process of what food might you want to try. Well, her husband really likes salmon. I said, okay, if you want to like salmon, first of all, what do you think about the smell of it? Because honestly, in my brain, salmon’s kind of a big smell. And if she hates the smell, that’s not going to go anywhere for her problem. She said, “I like it. I go outside, my husband barbecues it outside.” I said, “Okay, if you like the smell, so it’s an okay place to start. What kind of food might you be eating with that salmon?” And she said, “Oh, bread, rice, potatoes.” So, I said, “What about if you took some bread, and you put a little tiny, tiny, tiny piece of salmon, whatever size you want, and then put another piece of bread over it, and you made like a little sandwich. Could your mouth try it in that way?” And she said, “Wow, I could do that.” And I said, you know, if you like that, you could do it again, you can do it a bunch of times, just once — it’s up to your mouth and you. But over time, you could make the pieces bigger and bigger and bigger. And gradually, if you’re liking it along the way, you could have a piece of salmon on a piece of bread, and then eventually not the bread. You could go with the pace your sensory system says it’s okay to go. She said, “Wow, I can do that.” I met her two weeks later at some other random event and she said, “Marsha, I have found eight new foods I like.”
And why I’m telling you this story is because this is an adult. She was, you know, she was a colleague of my husband’s. She’s a bright human. We’re bright humans, you know, we — yes, and she thought that trying a new food was that overwhelm that she was doing. She thought trying a new food meant put a plop of it in your mouth, plug your nose, and chug water. So, what I have learned through the years is that some of our little kids, and some of our adults, and everybody in between, sometimes people need to have some support in their strategies of trying new things so they’re not overwhelming themselves. So, an interview I did just recently with an Autistic adult: “So, I wanted to try a Caesar salad because I liked chicken, and I liked lettuce, and I liked croutons.” So, he asked his mom, “Please make me a Caesar salad like you made my brother.” And so, she brought the Caesar salad with parmesan on it and lots of dressing. And he said, “Oh, I just stared at it for two hours. I just couldn’t make myself try it.” Because he overwhelmed himself in the way he wanted to try it. So, I said, “In the future, if you want to try something like that, could you break it into smaller steps?” Because you were motivated to try it, but then, somehow the situation became too overwhelming. Could you take charge of some of the parts of that trying? And maybe say to your mom the next time, “I like my chicken, my lettuce, and my croutons in my salad. But can you put some dressing right there on the side? And I could try it if I want to.” I could take a little taste if I want to. And you could say to yourself that day, “Yes. Today I feel like trying a little bit of that dressing,” or, “No. I saw it, I smelled it. Nope, not today.” And give yourself the grace to know I wanted to try it. And I made it as easy for myself as possible. And it works for me today, or it didn’t.
So that we can rethink the whole concept of trying. So, we do, in our conversations with parents and with kiddos, tell parents, you know, you can role model how you can interact with the food. I mean, kids, we role model. How do you eat lobster, and how do you eat ice cream, and how do you eat corn on the cob? I mean, we learn from watching others. So, you could sometimes — I might say to somebody, you know, sometimes when I’m trying a new food I just a little tiny taste to see what I think about it. That’s not an ask. That’s not a demand. That’s just information. So, the child has, and the adult, has more information. Sometimes, I just smell it first. Because if I like the smell that makes me think that I, you know, I might want to go farther with it. But if I hate the smell, that’s usually one of those things that tells me this isn’t a food to try right now. So, we talk about that you could — or you just could rub your finger on that apple and get just the flavor because sometimes we know that flavor and texture together can be way too complicated for new food triers. So, we try to give strategies. The difference is, Meg, that these days in my life, it’s not, ‘You have to do this’. It’s a strategy for when you’re ready. Or if I teach that strategy with somebody who’s curious about new foods, I teach them to do that strategy on a food they already know about. So, they’ve learned the strategy, but not on a Brussels sprout or a steak and kidney pie.
Meg:
I want to really ground us all here in the interoceptive demands and abilities that sort of underlie this, right. Because for that person who just crammed the bite of food in their mouth, they’ve probably had a practice of trying not to feel what it feels like to be in their body for a long time. And there’s probably a lot of things that ask them to shut down their own experience in favor of whatever is expected of them. And this is a big shift to, like, you’re not saying, “Put it on the cracker and do it,” you’re saying, “Kind of put it on the cracker. Check in with yourself, see how that feels to you, see if you’re ready. Try it, and then check in with yourself again and see how you’re doing,” right?
Marsha:
Absolutely. Because if the person is not listening to their interoceptive self, they’re not going to find new things that they like, because their body is going to say ‘Stop it, this is not working for you’ right? So, you’re not going to find new things. You know, Meg, people who know me know that the grasshopper is my logo. And I embrace that as a logo because I was hearing people online talking to me about that as that grasshopper therapist. But it’s because I talk about the experience two of my children and I had went to Mexico to for a Spanish immersion program for a summer. And we were living with a local family and we had our room and board with them, and our local Señora made us amazing foods. And I remember saying to my children in the beginning, “We gotta be good guests though. So, we should try what, you know, whatever she’s making,” because that’s the kind of mom I was, am. And we had delicious food and amazing food and my kids just tried it and enjoyed everything. Yeah. The day before we were leaving, she went to the mercado and she said, “Tengo una suppressa,” that she had a surprise for us. And so, “Oh, what is it? What is it?” She didn’t speak English well, we didn’t, you know, we’re still learning our Spanish. She said, “Chapulines.” So, she couldn’t describe it and I had no idea what that was. And so, I looked it up on my little handy dandy dictionary and it said, okay, grasshoppers. Okay. So, but I wanted to be polite, because this was our Señora, she went to the mercado, she spent money on this, these grasshoppers for us. So, first of all, I mean, I did some of the things sort of naturally that I think a lot of our pickier eaters are, our more worried food approaches, right. I said, “Well, let’s see. What is it?” I looked at it and it was parts, it was grasshopper parts, Meg. There were leg parts, eye parts, body parts. So, okay.
Meg:
Somehow parts is even just worse than whole grasshoppers to me right now.
Marsha:
Yeah, yeah, yeah. Yes. So, okay, there were parts. And then, so I’m worried but I’m trying to work through this. Okay. I smelled it. It smells like garlic. And well, you know, I like garlic stems. Okay. I touched it with my fingernail. And they were kind of body skeleton crispy, crunchy, kind of. So, that was a preview for me. I got an idea. So, when I put it in my mouth, it’s going to be kind of crunchy. So, I said to her, “How do you do this?” and she took a tortilla, she put guacamole on it. She took a handful of these parts — a handful! — and put them all over. It’s a delicacy. And she just folded it like a taco and put it in her mouth. And okay, I knew I couldn’t do that. So, what I did was — and my kids are looking at me like, you know, you go first Mom, because put your mouth where your mouth is, right. So, tortilla, I put a lot of guacamole on it, just a lot. And then, I took a little pinch of a part and put it in the center and then I ate it. And there was just a little crunch in the middle. And okay, I like guacamole and tortilla. So, I lived through it. But through the course of the meal, because this was the only meal we were having, I put more, and more, and more, and more parts until I had, you know, a medium-sized cluster of parts. And it wasn’t — it was okay. I mean, it really was okay for me because it just made crunch from my avocado and tortilla.
But I thought about it from the perspective of some of the more sensitive eaters that we know. And that is, I first of all checked it out, like, how do other people do this? Can I tolerate this smell in any way or the crunch? Again, I gave myself a preview of the sensory properties, just checked it out. I watched what she did, and I paired my taste with something I already knew. So, that was the tortilla and the guacamole. And I didn’t overwhelm myself. I tried the tiniest amount. So, I started in something I already knew about so I could dilute the newness of that grasshopper in my mouth and I could dilute some of the properties that were making me kind of nervous. And then, I went at my own pace. Because, really, Meg, one of the things I tell parents is, we’re the only ones that know what our body needs. The individual with sensory differences is the only one that knows what’s good for their body today in this moment. And so, I got to go at my pace and add more, and more, and more. But honestly, if you had found a therapist and said to me, “Put your hands down, I’m going to give you a mouthful of grasshoppers. And then, afterwards, you can play with this toy,” I would have had to gag or vomit, because I just couldn’t face my interpretation of the intensity of that grasshopper taste all by itself without some camouflage, right. So, that situation, and then the story with my friend with the salmon, and then meeting a number of parents who kept saying that their kids just try it by plopping things in their mouth, I realized we do, as a profession, need to think about kinder, gentler, sensitive ways a person could try a new food when they meet a food they’re ready to try.
Meg:
One thing I noticed about your grasshopper story is you didn’t talk about your, like, sensory aversion to it, you talked about your fear, and you were helping yourself move through fear through this process. But I also found myself thinking in that situation, would you say you tried it more because of the social pressure than because of an internal desire to try grasshopper?
Marsha:
So, yes. In this situation, it was I was trying to be socially appropriate. But I wanted to be. And also, I think about the sensory properties and fear in a continuum or as overlap, because my, you could say, the sensory properties were sort of worrisome to me. But you also could say, I was fearful that I would just plain gag or throw up. So, fearful of the consequences it might have in my body could be creating worry for me, or fear. So, the sensory and the worry, or the fear, or the discomfort can, it’s a little hard sometimes for me to think about where one starts and when the other ends, you know. There’s, it’s a continuum of emotion, I do believe. And I’m hearing from some of my neurodivergent voices that are talking to me in there. And so, they do talk about being worried or anxious, but sometimes that’s because of what their body might do about it in a sensory or interoceptive overload kind of way, right. So, I do have a book called ‘Anxious Eaters, Anxious Mealtimes’. And it’s going in for revision because just, oh, my gosh, the changes that my brain has made in the last few years. But also, I think there is a worry about how your body’s going to react to that sensory-unique way that your body is reacting to that particular food, I think there’s a relationship between both, if that makes sense.
Meg:
Which makes it make sense with how you said, okay, let me try a little bit. And then, if I do have a response, which I don’t know if I’m going to, it’ll be small enough and I can manage it, and then decide about how to move forward from there. Yes, that makes a lot of sense. Also, yeah, you’re very brave to write a book. I’m always glad that everything I have online is online and not in paper, so I can make changes to it more frequently. It’s such a process.
Marsha:
Meg, I’ve taught Get Permission courses for years. And we now are saying to people, if you’ve gone to one earlier than two and a half years ago, please come, please come for, you know, basically nothing, you know, a very, very deep discount. I want people to hear the evolution. Because I also think, as a person who’s been in this field for 54 years, Meg, I would like to role model that things have to be fluid, and we need to change. And as we know more, we need to change. And it’s been, in our field, there’s been some — people have been in different bubbles, because a lot of people, when they get out of school, they don’t know enough about feeding to do feeding. So, people go and learn this technique. They learn this sensory technique or this behavioral technique or this, or a motor technique, or this NICU technique. People have learned techniques and we’ve gotten ourselves in sort of bubbles, where my way is the right way, right. And I think what we should know is that there’s so much to learn from so much that’s out there, that being eclectic is maybe the main way, and that there is so much to learn. And as we’re learning more about neuroscience today, as we’re learning more about trauma, neurodiversity, as we’re learning more about the research that’s coming out now that wasn’t out there 20 years ago, there is so much more to learn. And as we learn it, we kind of need to change and see where we can take that newer information and tweak what we’re doing. It doesn’t mean we have to throw everything out that we used to do. It doesn’t mean that everybody that does this kind of approach is terrible. It means we have to tweak. And that’s where I feel like I am in this field where I want to say to people, when you learn something new, just incorporate that, and just help the next family a little bit better.
Meg:
I love that. And I think that you’re really speaking to your people here. The people who are listening to the podcast are the ones who are saying, “Oh, that’s different than I’ve been doing. Thank you. I’m excited to try that, that aligns with my values.” It’s very encouraging to me to watch what happens in this space. Anytime I get to see how people reflect on podcasts, episodes, courses, any of this content, listening to Autistic people with a real openness and enthusiasm to change, it makes me really hopeful for our profession, because I think our core values are genuinely that we care about the deep, authentic well-being of our clients. And I’ve seen that as true with OT’s, SLP’s, social workers, PT’s are like knocking down our door going, “Hey, we care about this, too. What should we be doing?” So, it gives me a lot of hope. And I appreciate how beautifully you model that in your work. Before we wrap up, is there anything you want to add or bring us back to?
Marsha:
Well, I want to say thank you to you for creating this space where there’s so much richness and wealth of information that you’re sharing voices of people who have lived experiences, where you have such a loving and compassionate but also knowledgeable base from which we can rethink how we learn. And because you make this environment that loving place to learn, it’s not so hard to make changes, because you’re not — I don’t feel like you’re beating us over the head with it. I feel like you’re really saying, “Hey, guys, you know, you did what you did, you cared about people. And we know differently now. So, we need to start moving in a different direction.” So, thank you, Meg, for what you’re doing out there in this space.
Meg:
And you made me tearful again, Marsha, you did this last time we spoke as well. It really, genuinely is a privilege to get to sit here and listen to and learn from so many people and share it with folks who are on the ground doing the actual hard work of applying it to their practice.
Marsha:
I have one more thing. I want to say that lately, I’ve co-founded the Get Permission Institute with Karen Dilfer and Stephanie Cohen, and we are providing online feeding classes for people that are interested in this get permission and responsive feeding kinds of concepts. And they’re constantly changing. They are in this newer mindset. And we are bringing in other voices of other people that can also contribute to this and complement to these concepts. And we’re starting a new series about people with feeding — with voices that want to share their lived experiences. And we’re starting a series of interviews with people who have lived experiences. Some of those people are Autistic adults, some of those people are parents through the years who’ve experienced feeding and different strategies in different ways. So, I’m learning from people like you, Meg, that we want to hear from people with lived experiences. And we’re really trying to seek those people out so that the feeding community that hears us and comes to our platform can learn more in those areas. Because I can only share as a therapist in this field where I’m learning and growing. But I am not a picky eater. I don’t have the sensory challenges, personally, that many of our children do. And so, I do think we want to make sure to hear from people that can share their experiences. But I also think it would be unethical when I teach to not say, and there’s trauma-informed care, and there’s neurodiversity-affirming care, and there are live voices. So, I want to make sure that I begin tweak people’s interests, and tell them where they can go to find more information about it. And yours is one of those places.
Meg:
Thank you, Marsha. Where can we find you and your work online?
Marsha:
So, it’s www.getpermissioninstitute.com. That’s the main place I am. But I also have a non-profit that supports families who’ve children with feeding challenges in Tucson, Arizona, and I think we’ll give you that link. That’s the main place you’ll find me. And then, I’m doing speaking nationally and internationally and getting to talk about these principles in other places that are really embracing these ideas, and it’s very exciting.
Meg:
It is so exciting. We’ll link to you and your resources in the show notes. Thank you so much for your work and for your time today, Marsha.
Marsha:
Thanks, Meg, for having me.
[Ending music]
Thanks for listening to the Two Sides of the Spectrum podcast. Visit learnplaythrive.com/podcast for show notes, a transcript of the episode, and more. And if you learned something today, please share the episode with a friend or post it on your social media pages. Join me next time, where we will keep diving deep into autism.