Shared with permission, identifying details changed
by Jo Cormack PhD
A few years back, I worked with the family of a ten-year-old girl with a very limited diet – let’s call her Amy. Amy is autistic and has quite a few sensory differences. She goes to a local school and is into video games and netball (volleyball).
When I asked Amy’s mother about mealtimes, she explained that Amy was only able to eat dinner alone in the living room, playing video games or watching TV. This raised two key questions for me and I thought it might be useful (and hopefully interesting) to explore them here.
- Amy is neurodivergent. Is it an appropriate goal to have her join the family table when she is clear that this doesn’t work for her?
- Why is Amy finding family meals hard? Maybe it’s all that sensory data… maybe the social aspects of mealtimes… maybe simply that she’s always eaten in the other room, and the change wouldn’t feel good. Or maybe she’s experienced pressure in the past, and needs to eat in a space where she knows her autonomy will be respected.
In fact, question two informs question one. I would argue that – neurodivergent or not – we need to understand WHY a child is finding something hard in order to decide whether and how to address it. I think we need to be cautious about making assumptions and unquestioned accommodations. Assuming children ‘can’t’ do something means we don’t dig deeper. This risks failing to see the individual and missing out on healing opportunities.
On the other hand, what am I trying to gain by exploring whether Amy can join the family table? Am I just imposing my cultural norms, that notion that ‘sitting at a table’ is the correct way to eat a meal? Do I want Amy to ‘act neurotypical’? What is genuinely in Amy’s best interest?
Then we have the issue of competing needs. What if Amy’s need for a separate space to eat is more important than the potential benefits of eating with her family (connection, opportunities to experience different foods, the benefit of modeling, etc.). If her felt safety is compromised, she won’t benefit from all of that anyway. In fact, aversive experiences would increase any existing negative associations with being at the table.
The order in which we approach question one and question two is key. If I begin with the first question and decide on whether sitting at the table is a goal BEFORE I’ve got a nuanced understanding of what is going on for Amy, then I’m imposing my agenda. However, if I can get an understanding first, then reflect on which goals may be appropriate, I’m able to understand Amy in context and view her as an individual. This is where the ‘whole child lens’ that RFT practitioners talk about comes in. A more rigid approach might begin from the assumption that sitting at the family table is a fundamental necessity and should be aspired to in every situation.
I had a chat with mum, who thought Amy needed the distraction of the screen while she ate. This seemed plausible. Then I had a chat with Amy, who laughed at me for not understanding why she didn’t want to be at the table.
“Well it’s obvious!” She said. It wasn’t. I asked her to tell me more. She looked at me quizzically, and said, “Why would I want to be at the table with cold toes”?
And this was the crux of it. The living room had a nice soft carpet. Amy couldn’t stand socks or slippers on her feet because of her sensory preferences, and – quite simply – the floor in the room where the family ate had cold tiles and she didn’t like how it made her toes feel. No one had asked her about this before, so she’d never shared it.
Guess what we did? Amy and Mum went rug shopping. And from that moment on, Amy happily joined the family at the table for the evening meal.
The takeaway here is not that tiled floors need rugs. Neither is it that autistic children should necessarily be encouraged to sit at the family table. The point is, we should neither decide what is right for a particular child (especially on the basis of a particular diagnosis alone) or what is going on for a child, without really diving deep into it first.
Epoché is a term used in some branches of qualitative research, to describe an attempt at bracketing off assumptions and a simultaneous acknowledgment that this is an impossible goal. The art of epoché involves first bringing into awareness what our assumptions are, before setting them aside as far as we can.
Note: your assumptions may contradict one another… actually, spotting these tensions can be helpful too.
My assumptions were:
- Sitting at the family table is an inherently good thing
- We shouldn’t aspire to autistic children socially conforming
- Amy probably didn’t want to be at the table because of sensory or social overwhelm
- Amy had probably been pressured to eat in the past and needed to avoid this
- Being at the table was too hard for Amy
By setting these assumptions aside, I was able to be open-minded about what was really going on. I also had huge help from Amy, who was happy to explain.
To reflect on this in relation to the assessment phase of a new case, I think a paradox comes into play. We need to gather information and perhaps begin the process of drawing conclusions, while keeping an open mind. It’s a delicate tightrope to walk, but being ready to be proved wrong is key!
I don’t get it right every time and I know I’m still guilty of making unhelpful assumptions in my work. But I try and keep two words in mind – especially when assessing and trying to get a sense of a case: humility and curiosity.
Next time you’re beginning work on a case, have a go at listing all your assumptions, maybe after you’ve had the pre-assessment paperwork back but before your first appointment. Then review them afterward. Were they correct? Were you able to set them aside? Did any of them reveal potential biases that you might need to work on? And did the practice of listing assumptions itself support your ability to approach the case with humility and curiosity?
Make the Most of Your Pre-Assessment Paperwork