October 30, 2019
2 min read

Autism MEAL Plan offers multidisciplinary approach to address food selectivity

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PHILADELPHIA — Presenters at the Food & Nutrition Conference & Expo showcased a parent-mediated, group-based intervention called the Autism Managing Eating Aversions and Limited variety, or MEAL, Plan.

“Children with autism experience a high prevalence of feeding concern,” William Sharp, PhD, director of the Children’s Multidisciplinary Feeding Program at Children’s Healthcare of Atlanta, said during the presentation. “In 2013, we conducted a meta-analysis that revealed that about 95% of kids with autism have feeding problems.”

This high prevalence corresponds with a “huge unmet need” for the development of access to evidence-based care, according to Sharp. Although autism might not be quite as ubiquitous in the modern world as it seems because detecting methods have improved and definitions have become more broad, Sharp noted that about one in 59 children has autism and approximately 1 million children in the United States with autism have feeding problems.

“In the same meta-analysis, we found evidence that children with autism have a fivefold increase in food selectivity compared with children without autism,” Sharp said, highlighting selectivity as the primary feeding concern in this patient population.

Parents’ own diets are affected as well often from attempting to avoid negative outcomes of bringing disliked foods into the house that may upset the child, according to Sharp.

A main component of the MEAL Plan involves matching the intervention to the severity of food selectivity. Sharp and colleagues classified selectivity into three categories — severe, which includes a complete rejection of one or more food groups and accepting five or fewer total food items; moderate, which includes consuming two or fewer items in one or more food groups; and mild, which includes at least three or more items from each food group and daily acceptance of food from all five food groups.

The final take-away point of Sharp’s presentation focused on the availability of effective interventions for feeding disorders, including selectivity in autism, and the importance of intensive, multidisciplinary treatment.

Multidisciplinary treatment, especially for this patient population, can be coordinated between psychology, medicine, nutrition and speech-language pathology/occupational therapy, according to Rashelle Berry, MPH, MS, RDN, nutrition manager of the Children’s Multidisciplinary Feeding Program at Children’s Healthcare of Atlanta. The four pillars of the MEAL Plan are medicine, nutrition, skill and behavior, and the primary disorder it addresses is Avoidant/Restrictive Food Intake Disorder, or ARFID, according to Berry.

“MEAL Plan was really created as a health promotion program for children with autism and is designed to prevent ARFID A2, which is mild or moderate food selectivity,” Berry said.

Specifically, a dietitian evaluates a child’s growth measure and nutritional needs and helps select foods to expand food diversity. They also provide child-specific information to create a well-balanced diet that can help avoid nutritional deficiencies from food selectivity.

“We use behavior management strategies with nutrition so that can we establish this diet and make it work for each patient, and this is where dieticians merge with behavioral psychologists to work to change that child’s behavior,” Berry said. “I, as the dietitian, need to speak the same language the behavioral professional is speaking so parents don’t think we are going way off script.” – by Joe Gramigna


Berry R, Sharp W. The Autism MEAL Plan: Empowering Caregivers to Feed in Avoidant/Restrictive Food Intake Disorder. Presented at: Food & Nutrition Conference & Expo; Oct. 26-29, 2019; Philadelphia, Pennsylvania.

Disclosures: Berry reports working for Children’s Healthcare of Atlanta. Sharp reports working for Children’s Healthcare of Atlanta and Emory University, as well as research support from the Organization for Autism Research and an Emory Pilot Grant.