10 Reasons My Son Won’t Eat His Dinner. An Exercise in Futility?

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You and Me Medical Magazine

 

“When is it going to be okay for me to treat James like Charlie the dog? I want to put down a bowl of Oatmeal Squares three times a day and let him eat it with his hands. It would save all of us a lot of trouble.”

Dr. Mom

Lynn W. Adams, Ph.D

When my son James was between the ages of two and four, he had a big problem with hand dryers. In most public restrooms the instructions read: 1) Press button, 2) Place hands under nozzle, 3) Rub hands briskly together. Occasionally, some wise guy has added: 4) Wipe hands on pants. James’ responses to hand dryers included: high-decibel screams, pants-wetting, crawling under stall doors, and wedging himself into the backseat like a molly screw. The apex of our hand dryer horrors took place in a roadside McDonald’s the summer James was four. We were returning to New Orleans from a hand-dryer-heavy trip to North Carolina and James was squirming around the booth after picking at his hamburger bun, his little thighs going squeak- squeak on the yellow molded plastic.Instead of gullibly asking if he had to pee-pee, I just said,“Honey, let’s go use the potty.” Our family of four crept toward the promisingly labeled Family Restroom, James clinging catlike to any obstacle in our path.

The closer we got, the louder he shouted. “No, I don’t have to
go! Please, please don’t make me go in there! No hand dryer! I really don’t have to go!” I smiled apologetically at a woman as I peeled his hand off of her purse strap, but she didn’t smile back.

Five minutes later, when we emerged disheveled and unrelieved from the restroom, James now desperately grabbing his crotch, my husband suggested we beat a hasty retreat in case someone had called the authorities. Indeed, all eyes were on us. We dumped our fries and split.

Before I was James’ mother, I worked as a child psychologist. I wanted to ease his suffering at the McDonald’s, but I was also embarrassed that I couldn’t manage my kid. At first, I had tried that old bachelor’s-level technique, avoidance. I avoided public restroom changing tables by performing clandestine diaper changes in the car seat , in the hatchback, behind a bush, and in the stroller. We got by until James was toilet trained. This new accomplishment came with, in addition to Bob the Builder underwear, a need to use public restrooms. There’s only so much pee-peeing in a bush that polite society can tolerate. When I think I’m having a hard time handling things, I just remember the day I helped one child poop very tidily in a bush with the other one strapped to my back. Twice.

This became my public restroom survival kit: a clutch of paper towels, a few blank post-it notes, and some post-it notes that read: “HAND DRYER OUT OF ORDER. PLEASE DO NOT USE.” Our routine went like this: 1) Enter restroom warily; 2) Post out-of-order signs on any and all hand dryers; 3) Place a post-it over the sensor for the automatic flush; 4) Take care of business; 5) Wipe hands on paper towels and collect supplies; 6) Move on. It worked well, but like most irrational fears, this one mushroomed each time we avoided it. At first, it was okay if we didn’t use the hand dryer. Next, no one in the restroom could use it. Eventually, going to a place that might have a hand dryer became too much to bear. I found myself living the pages of my Abnormal Psychology textbook.

A large portion of my psychological training came from proponents of Cognitive-Behavioral Therapy (CBT), a very tidy approach to problem-solving. You identify a problem and perhaps any mistaken assumption associated with it, and then change either what comes before (triggers) or what comes after (rewards or punishments). I first used CBT to train my cat, Walter, to use his scratching post. Instead of whacking him for scratching the sofa, I put a container of treats on top of his post and gave him one every time he scratched it. It was humane and effective. My textbook made the point that a mollusk could be trained to clap its shell on command. Wow, I thought at the time. What can’t CBT do?

Oblivious, I hunkered down. In an attempt to render the scary hand dryer more friendly, we studied up. We printed out pictures of various hand dryer models and posted them around the house. My sweet husband made several hand dryers from boxes, and mounted them in our bathrooms. I came to expect James’ soft, earnest “vvvvvvvvv” sound effect after the flush and the splashing. In Psychology Land, we call this Systematic Desensitization: exposing the child to closer and closer approximations of the feared object to build up tolerance. I stopped short of planting him under the hand dryer in my office building with a pile of M&Ms, but I kept up the campaign from August to November.

One would think that four months of earnest intervention from a psychologist / mother would suffice. When it ended, though, the success was clearly James’ alone. One day, James had to go to the hospital for a medical test. On the way there in the car, we talked about his reward. I had some suggestions: ice cream, a smoothie, the playground, the vacuum cleaner aisle at Lowe’s, the guitar store, a nearby construction site. James looked out the window for such a long time that I’d given up hope of an answer.

As we pulled into a parking space he said, still looking out the window,“No, Mommy, I think I’d like to go to the grocery store and use the hand dryer.”

About the Author: Lynn Adams lives in New Orleans with her husband, son, and daughter. After studying at the Yale Child Study Center and the University of North Carolina at Chapel Hill TEACCH program, she worked as a child psychologist specializing in Autism Spectrum Disorders. Being part-time psychologist, part-time homemaker seemed like the best of both worlds. It wasn’t, and now she is a full-time mom. She is a co-author of Autism: Understanding the Disorder and Understanding Asperger Syndrome and High Functioning Autism.

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The Outsider: On Siblings and Autism

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My children have shut me out of their closed relationship, and that’s a wonderful thing.

It began during a friend’s visit, in the playroom with my newborn daughter and two-year-old son. The friend had brought a blanket for Margot and a red pinwheel for James. James wasn’t able to blow yet, and I was concerned about it, and later I’d see it as an early sign of his Autism Spectrum Disorder. So he couldn’t work the pinwheel, even after we showed him. Dread was a familiar feeling by then.

My friend and I talked about the baby. Her delicate size, her tendency to sleep angelically all day and cry all evening, her mop of hair the same color as James’. I looked over at James just in time to see him inspecting the sharp end of the pinwheel’s stick. His gaze next moved to his baby sister’s fuzzy head, then back to the pinwheel. He reached out with the pinwheel and poked her. Their eyes locked, but what passed between them surprised me: a combination of thrill and interest as if they’d each just opened a surprise birthday gift and found the other inside.

This is it, I thought: the beginning of the older brother menacing the younger sister. I’d known it was coming, as that’s what I’d experienced with my own brother, four years older. My brother, now a perfectly respectable father of two, had dipped my face into a creek like a chicken nugget into mustard sauce. He’d given me “noogies” well into his thirties. He’d lure me into his room, turn off the light and close the door, and murmur, “When you least expected it… expect it.”

That evening, when I announced bath time, James shouted, “You can’t hear! Baby cry!” He reversed his pronouns, “I” for “you” and “you” for “I,” another early sign of autism that stoked my dread. But he was also using his new sister as a smokescreen. Could they be working as a team? Could James even do that if he had autism?

There are as many ways of having autism as there are people who have it, and James did eventually receive the diagnosis. Since before Margot’s birth, he had been attending developmental therapies to address his delays, and appointments with specialists to rule out other problems. His main challenges during those early years were language development, and ,relatedly, big-time tantrums. We also had to work hard to connect with him socially, to bring him out of his own head and into the world around him. Through the appointments and the tantrums, Margot tagged along.

At one year of age, Margot started each day by standing up in her crib and yelling, “Jay! Jay Jay!”

He’d hop in with her and they’d roughhouse for awhile.

One morning I heard James saying, “That’s right, Margot. Just pick up a leg and put it right there. Now pull with your arms. I’ll catch you, don’t be scared.” He was mimicking Ms. Sharon, his occupational therapist, almost word for word.

Bump! Margot hit the floor and they both exploded in giggles. From then on, Margot was out of her crib like a super ball every morning before 6:00, bouncing into James’ room.

The next year, James took Margot’s hand, led her into the bathroom, and closed the door. “Just a minute, Mommy,” he said over his shoulder. “I’m going to teach Margot how to use the potty.”

She was his little doll. Everything that was done to him, the instruction, the encouragement, he did to her.

Soon the shenanigans began. One would distract me with a lost toy or a spill, and the other would get into the forbidden fruit, whatever it was that day: my makeup, the toilet bowl, the cookie jar, the trashcan.

“I can’t bear it,” I said to my mother. “They’re the dynamic duo, working together to spread mayhem. How did you handle it when we were little?”

She paused, then said, “It was different with you two. Mostly your brother just menaced you and you tattled on him. Other than that, you didn’t interact all that much.”

Interaction. One of the main areas of impairment in autism, that’s what James and Margot did all day long. Starting with the curiosity of the pinwheel poke, moving through the brother-to-sister lessons on climbing out of the crib and using the potty, culminating now in the give-and-take of the hi-jinks, James and Margot already had a closer relationship than I’d had with my own brother. And neither of us had had autism. What was next? Empathy, that holy grail of social skills development?

Now, let me be clear. Close relationships are not always harmonious ones. James and Margot do their share of fighting, physically and otherwise. They’ve left longlasting marks on one another’s bodies that other people have noticed. But no scars. I continue to complain to my mother about the fisticuffs, the potty words at the table, the madcap dashing around the house.

I’d worried that Margot would have to take care of James, that she’d visit him in the group home, her kitten heels clack-clacking on the linoleum. And that was because of James’ autism. Even before he was diagnosed, though, I worried I’d have to protect her from the menace of her older brother. Like many a worry, these were misplaced.

One day last year after school, Margot got out of the car, sat down cross-legged on the sidewalk, and refused to move. We’d parked a few houses down from ours, so James and I set off down the block, figuring she’d get up and follow. Instead, she began to scream, “Mommy! Don’t leave me here! Don’t leave me all alone! Mommy!”

The girl just needed to get up and walk into our house. But she wasn’t going to go quietly. This had all started when I told Margot she couldn’t have a stick of gum. Of course, that wasn’t the whole story. It had been a long day. But she wasn’t the one with autism. Why couldn’t she just do as she was told?

How did I handle it? I didn’t. Because before I could get over my internal argument about comforting my distressed child versus giving in to a brat, James came to Margot’s rescue. He walked back down the block, hoisted her up, and carried her home, her little legs flapping against his shins. She rested her cheek on his shoulder and closed her eyes. He put her down on the front steps and kissed her.

“Thanks, James,” I said.

He kissed her again, not even seeming to hear me.

Reading All the Parenting Books Just Made me Feel Like a Failure

Early parenthood is hard. Instead of needing to solve every problem, how about just coping?

I’ve always been uptight, and it just got worse when I had kids. So I’ve been working on it, starting with Mardi Gras. One stifling Lenten morning by the sandpit, a woman hiked up her maternity shorts and said, “You can either have a tidy house or happy, healthy children.” 

I felt a surge of love for her. People said things like that when my first child was a newborn, but I wrote them all off as slackers. 

“Yes, indeed,” I said. “At our house the Mardi Gras bead situation is out of control, and I just turn my head and look the other way.” I learned this from a friend whose husband leaves the Christmas tree up until Easter. 

A wispy-haired dad busted in, “You know, you have to watch those Mardi Gras beads because they’re from China. A lot of things from China have lead in them.” He patted his son’s wispy hair.

What is with these buzzkillers? First they try to peddle me the nonsense that is “nipple confusion,” and now they’re trying to take away my kids’ Mardi Gras? 

My kids had spent the previous Fat Tuesday up in a ladder together, both with drawn-on mustaches but one dressed as U2’s The Edge and the other as a ballerina. That year, Margot woke us up on Mardi Gras day by hollering from her crib, “Hey, Mister! Throw me something!” Our kids were a couple of maniacs, and thank goodness because that’s a pre-requisite for being a native New Orleanian. Now I was supposed to worry about poisoning them by letting them play with beads their customary three months after the holiday? They were standing in cardboard boxes and throwing them over the side, not eating them.

By sandpit day the kids were two and four, and I’d learned how to ignore buzzkillers. I had every right to complain about them, too, having been one myself. 

Breastfeeding was my first buzz-kill. There are tons of books on the subject, and tons of time to read while doing it. 

When James was a week old, the grandfatherly head of the pediatric practice called one morning just to check in. I could hardly hear him over the screams. “Have you tried a pacifier?” he enunciated. 

“Oh, no,” I shouted. “I’m breastfeeding.” 

“So?” he roared. 

“So, I don’t want him to get nipple confusion,” I said shrilly. The books said not to offer a pacifier or any nipple other than my own for the baby’s first two weeks. Otherwise, the child could possibly prefer the inferior nipple substitute and the whole thing was doomed. 

There was a faint thumping and a muffled moan. “In my 40 years of practice, I have yet to encounter a single case of this ‘nipple confusion’ of which you speak. Now, while I’m on the phone, I want you to get a pacifier and put it in that baby’s mouth.”

I wish I could say it was smooth sailing from there, but it wasn’t. For me, it was natural to continue in early motherhood doing what I’d always done, which was looking for answers in books. For James, it was natural to scream the house down.

After James and I mastered breastfeeding, I read about screaming. There were lots of reasonable techniques in The Happiest Baby on the Block that helped a tiny bit with James, and later a lot with Margot (another screamer). I had high hopes for a book called Secrets of the Baby Whisperer, and read it like the Bible. It told me how, from the very beginning, I could “start as I meant to go on.” I could establish a routine during James’ first days and use that routine to increase sleep periods and decrease fussiness: Eat, Activity, Sleep, then Time for You. The acronym was EASY, but my baby wasn’t easy. 

When the baby-care books failed, or, more precisely, made me feel like I’d failed, I went straight to the experts. We visited two pediatric gastroenterologists. The first advised me to go on a starvation diet, and later to stop breastfeeding and start soy formula. The second said that was a bunch of bunk and prescribed an antacid for James. He also said that it was possible I just had one of those fussy babies. 

After living through nine months of fussiness with James, I came to a conclusion. Being a baby is uncomfortable, some babies are more sensitive to this than others, and some babies are harder to soothe than others. 

I didn’t need a book to learn that time was the solution, and the choice was not what to do, but how to cope while waiting for the problem to vanish, or at least morph into another problem.

A mantra, perhaps, “Suck It Up,” would have done the job. Or, better yet, a mental image.

In the 70’s there was a soap commercial with the tagline, “Calgon, take me away!” The heroine was an embattled homemaker who relaxes in a frothy bubble bath and floats up into the clouds in a bubble tinged with pink. 

In my version, it’s a gleaming white clawfoot tub and my skin is dewy because of both the bubbles and my serenity. As my bubble rises toward the playroom ceiling, I extend a soapy arm over the side of the tub. I gaze down at the children.

Below me, James is lying on his back, clutching a posterboard guitar that is ripped in two, yelling, “Right now, right now, right now you have to put it back together!” He spins clockwise, powered by his stiff little legs. 

Just a few feet away, Margot is an island in a puddle of pee, looking down at her shoes quizzically. She looks up and says, “Oh, Mommy, look what happened.” 

The doorbell and the phone ring at the same time.  

I hear only the wet smack of the popping bubbles, smell only their lavender perfume. My skin is warm. How it glows.

I can only describe this feeling as a buzz.