During the progression of a pilot nutrition intervention designed to teach cooking skills to young adults with autism spectrum disorder (ASD), one participant-Paul-fell in the parking lot. Prior to the accident, Paul had been making significant gains in the program and had communicated in a number of ways his enthusiasm. After his accident, which resulted in broken and dislocated bones in his ankle, his demeanor was dramatically altered, program gains were lost, and staff noted the appearance of many new challenging behaviors. This article analyzes Paul's behavior in reference to the pain response in autism. For some time, it was believed that many individuals with ASD did not experience pain based on anecdotal reports of how individuals responded to injury with seeming indifference. This view has given way of late to a more nuanced understanding of how atypical sensory processing and stimulus over-selectivity spill over into pain pathways and pain amplification mechanisms. The consequence is not a reduction in pain sensation, but a different expression of pain, determined by that individual's particular communicative, cognitive, or physiological challenges. From this perspective, many of the disruptive and harmful behaviors that emerged after Paul's accident can be seen as a delayed response to the incident. This article concludes by arguing that professionals across all domains of health care need to begin to see behavior as communicative for those with ASD. This is particularly true of changes in behavior, which can be significant indicators of health care problems rather than something to be dismissed as another manifestation of the condition.

No abstract

No abstract

The relationship between diet and a number of chronic health conditions has been well established. One of the most widely utilized tools for mediating this relationship is carbohydrate counting and dietary exchange systems. At the same time, nutrition and dietetics professionals have begun to stress the importance of cultural competency by encouraging all professionals to develop a comfort level with the ethnic, religious and contextual background of their patients. This paper is intended to support that movement by introducing nutrition professionals to the most common Jamaican foods as interpreted through the exchange list system. Across the entire Caribbean, trends have demonstrated increasing rates of type 2 diabetes mellitus (T2DM) accompanied by elevated rates of obesity. At present in Jamaica, T2DM is the second most common non-communicable chronic disease. Rates among immigrants and individuals of Jamaican heritage in the United States are unknown but are believed to mirror these trends. Understanding the food choices of this population will be vital to providing appropriate and meaningful nutrition treatment options. This paper addresses an important need and serves as a model for how to introduce other cultural traditions in cuisine to professionals in the fields of nutrition and dietetics.

No abstract