Autism MEAL Plan: Parent Training to Manage Eating Aversions & Limited Variety

The Autism Managing Eating Aversions and Limited variety (MEAL) Plan is a structured
parent-mediated, group-based intervention to reduce mealtime disruptive behavior, expand
dietary diversity and reduce parental stress associated with moderate food selectivity in
young children with Autism Spectrum Disorder (ASD).

Children ages 3-8 with a diagnosis of ASD who present with moderate food selectivity and
associated problem behavior will be screened for inclusion in the study. Following consent
and screening procedures, parents of eligible children will be assigned to a group-based
parent training (Autism MEAL plan) or group-based parent education. Each parent will receive
1.5 hours of intervention per week for 10 weeks by a masters or doctoral level clinician.

Data will be collected on parental compliance with the Autism MEAL plan and the food
acceptance of the child as well as nutritional intake, and refusal behaviors. Child
participants will also be included in parent-child dyad in-vivo feedback sessions. Parents
assigned to parent education will be able to cross-over to receive the Autism MEAL Plan
following completion of post-study measures.

The first aim of the study is to finalize the Autism MEAL Plan materials (e.g., role-play
activities, activity sheets and video examples). This includes standardizing therapist
scripts in line with the revised curriculum and creating new video examples that coincide
with practice worksheets. Home recording (e.g., personal camera phone) to document and
present home meal data will also be added to the curriculum.

The second aim is to evaluate the feasibility of the Autism MEAL Plan versus parent education
in 40 children (20 per treatment assignment) with ASD and moderate feeding problems.

The final study aim is to evaluate the preliminary efficacy of the Autism MEAL Plan in
expanding food diversity, decreasing disruptive behavior and reducing parental stress
compared to Parent Education. Methods of evaluating this aim include direct observation,
parent ratings of behavior, food intake and stress, as well as blinded clinician ratings,
height, weight and BMI.

Inclusion Criteria (for children):

- A diagnosis of autism spectrum disorder (ASD), supported by the Autism Diagnostic
Observation Schedule (ADOS) and the Social Communication Questionnaire (SCQ)-Lifetime

- Presents with a history of moderate food selectivity (a diet involving at least 6 food
items)

- Accepting at least one fruit or vegetable

- Fewer than two food items in one or more food categories (i.e., fruit, vegetable,
protein, starch) as measured by the Food Preference Inventory

- Exhibits disruptive refusal behaviors when presented with non-preferred foods (e.g.,
crying, active verbal protest, tantrums) often or during every meal as indicated by
item 7 on the Brief Autism Mealtime Behavior Inventory (BAMBI)

Inclusion Criteria (for parents or primary caregivers):

- Parent, or primary caregiver, endorses a feeding concern as one of the top two
problems on the Parent Target Problem

- Parent, or primary caregiver, agrees to participate and is deemed able to attend group
sessions

- Parent, or primary caregiver, is able to speak, understand, read and write in English

Exclusion Criteria (for children):

- Severe feeding problems (e.g., < 5 preferred foods as measure by the Food Preference
Inventory)

- Complex medical issues (e.g., gastrostomy tube or formula dependent) requiring
intensive treatment such as day treatment or hospital-based treatment