The Autism Managing Eating Aversions and Limited Variety Plan vs Parent Education: A Randomized Clinical Trial

• Type of Material: Article
• Authors: William Sharp, Emory University; Teresa Burrell, Emory University; Rashelle C. Berry, Marcus Autism Center; Kathryn Stubbs, Emory University; Courtney E. McCracken, Emory University; Scott E. Gillespie, Emory University; Lawrence Scahill, Emory University
• Language: English
• Date: 2019-08-01
• Publisher: Mosby-Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2019.03.046
• Title of Journal or Parent Work: Journal of Pediatrics
• Volume: 211
• Start Page: 185
• End Page: +
• Grant/Funding Information: Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development by grants to Emory University (MH081148; principal investigator: W.S.; Marcus Foundation and Children Health Care Trust).
• Keywords: Science & Technology; Mealtime behavior problems; feeding problems; Metaanalysis; Food selectivity; Pediatrics; Validation; Children; Life Sciences & Biomedicine; Intervention; Spectrum disorder
• Research Categories: Psychology, Developmental; Agriculture, Animal Culture and Nutrition; Psychology, Behavioral

Abstract

Objective: To assess the feasibility and initial efficacy of a structured parent training program for children with autism spectrum disorder (ASD) and moderate food selectivity. Study design: This 16-week randomized trial compared Managing Eating Aversions and Limited variety (MEAL) Plan to parent education. MEAL Plan (10 core and 3 booster sessions) provided parents with nutrition education and strategies to structure meals and expand the child’s diet. Parent education (10 sessions) provided information about autism without guidance on nutrition, meal structure or diet. In addition to feasibility outcomes, primary efficacy outcomes included the Clinical Global Impression - Improvement scale (CGI-I) and the Brief Autism Mealtime Behaviors Inventory (BAMBI). Grams consumed during a meal observation served as a secondary outcome. Results: Eligible children (N=38; 19 per group, 32 males. For MEAL Plan, attrition was <10% and attendance > 80%. Therapists achieved > 90% fidelity. At Week 16, positive response rates on the CGI-I were 47.4% for MEAL Plan; 5.3% for parent education (p < 0.05). The adjusted mean difference (SE) on BAMBI at Week 16 was 7.04 (2.71) points (p = 0.01) in favor of MEAL Plan. For grams consumed, the adjusted standard mean difference (SE) was 30.76 (6.75) also in favor of MEAL Plan (P = .001). Conclusions: MEAL Plan appears feasible, and preliminary efficacy results are encouraging. If further study replicates these results, MEAL Plan could expand treatment options for children with ASD and moderate food selectivity.