A Nova Scotia woman has created a meal-planning tool to help autistic children overcome fussy eating habits.

Jean Nicol, who has a degree in nutrition and has spent 25 years working with autistic children, developed The Eating Game (Get Awesome Meals Everyday) to help autistic children take an active role in planning their meals, with the aim of expanding their food choices for a healthier diet.

Children with autism develop motor, language, cognitive and social skills at different rates than others their age. For example, they may be very good at solving math problems but have difficulty speaking. An estimated 190,000 Canadian children have the condition, and recent studies suggest the prevalence is steadily rising.

While the symptoms vary between cases, some children will fixate on a few types of food and refuse to eat anything else, Nicol explained in an interview with CBC News, a tendency that frustrates and worries parents who want their children to eat healthy meals.

"Quite typically, they might choose to eat hotdogs, rice, pizza and mashed potatoes — and that's it," Nicol said. "Mom and dad will always have those four foods in the house, because that's all their child will eat. Over a period of time, they will change [their preferred foods], but they still limit themselves."

Nicol, from Little Harbour, N.S., developed the book last year while working with seven-year-old Ethan Hillier, from New Glasgow, N.S. When they met, Ethan would only eat two types of food.

She started by putting pictures of food from Canada's Food Guide in a three-ring binder, and then let Ethan choose his snacks and meals from the pictures; after he had done so, he would place the picture of his chosen food on a grid on the family fridge.

This meal-planning system turned into The Eating Game, with children choosing their foods and putting the Velcro-backed pictures on a colour-coded guide to ensure they're meeting food guide recommendations. For example, the green category is fruits and vegetables.

"They just have to match the colours," Nicol explains. "So you don't have to be verbal to do this. I know from experience that children with autism respond very favourably to visual support systems. Many of them think in pictures."

The method is based on Nicol's theory that it's not the food's taste or texture that makes autistic children fussy, but a need for routine.

Improvement 'huge,' mom says

"The kids, they like to be in control in their environment, but it's very difficult for children with autism to do that," Nicol said, adding that when she looked at the desire to eat the same foods for all meals, it seemed like "a choice of control kind of thing, where they themselves were creating that predictability around mealtime."

Ethan's mom, Shirley Hillier, said the improvement in her son has been "huge" since they started working with Nicol. She said that a lot of the credit for Ethan gaining weight, to 84 pounds, belongs to The Eating Game.

"He liked hot dogs and rice, and he would have eaten that breakfast, dinner, supper and snack," she said, explaining that now "I'd say he's eating over a hundred new foods."

Ethan agreed, adding, "I like all the foods in the whole wide world," citing his latest favourites as macaroni and garlic fingers.

The first edition of the book went on sale in November, and without a website or a single advertisement, Nicol received more than 100 orders. The book is popular among parents, school boards and adult group homes.

She has since launched her own business, EyeCan Creations, and contracted out the manufacturing to Sackville, N.S.-based Anchor Industries, where 40 mentally challenged employees cut out and assemble the books.

The second edition sells for $50 and features pictures of food drawn by a local artist.