Q: My 38 months old granddaughter chews food and then spits it out - just lets it fall out of her mouth onto the table. She spits out any kind of food when she appears to be full. She has been diagnosed with delayed speech and goes to a disabled daycare run by the local school district. She is bright and knows more than many other four year olds, but does not communicate what she knows. I hear her talking to herself and naming shapes, colours, objects in books. I hear her talking to her dolls and having them interact, but she will not look us in the eyes, or answer questions except those that begin with what is, where is, etc. She always chooses the last item when you give her a choice. Other than the day school, she has no opportunities to interact with children or other people because her father is the day care provider and rarely takes her anywhere. My daughter-in-law is a loving person, but she is the sole provider (that was their choice) and works many hours and is frustrated. I have spoken to my son many at times, but he gets irritated. He says she will grow out of her problems. She is not even toilet trained. I cannot interfere for all the reasons familiar to you, but I am going to have her for a week at the end of the month and at least I can work on toilet training and her food habits. My questions to you are why does she chew and then spit out food, and what can we do to help change this behaviour?

A:From your description of your granddaughter, it seems that she might be an autistic child. Perhaps you could find out about autism from many websites, including www.doctorndtv.com As a first step, you could avoid the kind of foods that she spits out. There are good nutritional substitutes for them. Also do not overfeed her. When she says she has had enough, stop feeding her. If you can locate an expert in handling autistic children, you could get specific advice on handling the problems. Make a simple tool out of cardboard, with little squares of different textures and colours stuck on them. Let her indicate that she needs to use the toilet by pressing the specific square. For other things like hunger and thirst, specific squares should work. While teaching her and working with her, do not force her to look at you while talking to her. She may be more comfortable picking up the messages by merely glancing in your direction. All the best.