Feasibility of a virtual nutrition intervention for adolescents with autism spectrum disorder

Abstract

Adolescents with autism spectrum disorder are at increased risk of unhealthy eating behaviors and obesity. This study examined feasibility of a virtual implementation of Bringing Adolescent Learners with Autism Nutrition and Culinary Education, an 8-week nutrition intervention based on social cognitive theory that addresses autism spectrum disorder–specific eating behaviors and food environment challenges. The implementation process was measured with fidelity checklists, engagement records, and field notes. Feasibility of virtually assessing adolescents’ outcomes (food frequency questionnaire, psychosocial survey, height, and weight) was also evaluated. Adolescents with autism spectrum disorder aged 12–21 years were recruited through a local community partner. Six groups (n = 27; group size ranged 2–7) participated. Univariate data analyses were performed. Mean lesson attendance was 88%, participation was 3.5/4 (4 = Frequently), homework completion was 51.9%, fidelity was 98.9%, and technical difficulty prevalence was 0.4/2 (2 = Major technical difficulties). Assessment completion rate was 100% (98.9%–100%) at baseline and 92.6%–96.3% (99.5%–100%) at post-intervention. Data quality was high for 88% of food frequency questionnaires and 100% of psychosocial surveys. Findings suggest that a virtual implementation and evaluation of Bringing Adolescent Learners with Autism Nutrition and Culinary Education was feasible. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be implemented virtually to reach diverse populations of adolescents with autism spectrum disorder. Future research should examine the impact of the intervention on dietary behavior and obesity outcomes. Lay abstract Adolescents with autism spectrum disorder are at an increased risk of unhealthy eating behaviors and obesity compared to their typically developing peers. Many nutrition interventions for this population focus on improving autism spectrum disorder symptoms or managing weight rather than addressing participants’ healthy eating self-efficacy. The purpose of this study was to examine a virtual implementation of a new intervention for adolescents with autism spectrum disorder, Bringing Adolescent Learners with Autism Nutrition and Culinary Education. We used fidelity checklists, engagement records, and field notes to measure implementation. We also examined the feasibility of assessing outcome measures, including a food frequency questionnaire (FFQ), psychosocial survey, height, and weight. We recruited adolescents with autism spectrum disorder aged 12–21 years. Six groups of 2–7 adolescents (27 total) participated in the intervention and pre-/post-intervention measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education consisted of eight weekly lessons: exploring taste, flavor, and texture; mealtimes and rules; food groups and nutrients; moderation; beverages; cooking; well-being; sustaining healthy eating habits. The virtual implementation was feasible based on lesson attendance, participation, homework completion, fidelity, and prevalence of technical difficulties. Evaluation was also feasible based on response rate, completion, and data quality for the food frequency questionnaire, psychosocial survey, and height and weight measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be used in virtual settings to reach diverse populations of adolescents with autism spectrum disorder. Future research is needed to evaluate the impact of Bringing Adolescent Learners with Autism Nutrition and Culinary Education on dietary behavior and obesity outcomes.

Parent and Adolescent Attitudes Toward a Virtual Nutrition Intervention for Adolescents with Autism Spectrum Disorder

“…Although participants were not asked specifically about SCT constructs, adolescents and parents mentioned knowledge/awareness, behavioral strategies, self-efficacy, outcome expectations, and outcome expectancies. These qualitative findings confirmed the significant pre-/post-intervention mean differences detected for behavioral strategies ( p = 0.010), self-efficacy ( p < 0.001), and outcome expectations ( p = 0.009) in our quantitative assessment (Buro et al, 2021 ) and indicated that BALANCE shows promise at improving some psychosocial determinants of dietary intake. These results are also consistent with findings of the other recent virtual nutrition education intervention for adolescents with ASD; parents reported via close-ended survey responses that the intervention improved their children’s knowledge and eating habits (Shurack et al, 2021 ).…”

“…The conceptual framework for BALANCE (Buro et al, 2021 ) incorporates SCT constructs and ASD-specific challenges, including sensory differences (Hazen et al, 2014 ) and cognitive rigidity (Polfuss et al, 2016 ), to promote positive dietary behavior change. The virtual implementation included eight weekly 30–45-min lessons delivered via Microsoft Teams (exploring taste, flavor, and texture; mealtimes and rules; food groups and nutrients; moderation; beverages; cooking; well-being; and sustaining healthy eating habits), as well as weekly homework assignments, weekly parent email handouts, and three parent webinars.…”

“…The present study is part of a larger study on the feasibility and acceptability of an 8-week, Social Cognitive Theory (SCT)-based (Bandura, 1989 ) virtual nutrition intervention for adolescents with ASD, BALANCE (Bringing Adolescent Learners with Autism Nutrition and Culinary Education). The virtual implementation of the BALANCE intervention was feasible based on mean lesson attendance (88%), participation (3.5/4; 4 = frequently), homework completion (52%), fidelity (99%), and prevalence of technical difficulties (0.4/2; 2 = major technical difficulties) (Buro et al, 2021 ). Feasibility measures were assessed by fidelity checklists and engagement records that were completed by research team members who were not involved in intervention implementation based on intervention session recordings.…”

Recommended practices for virtual nutrition education interventions for adolescents with autism spectrum disorder: A reflection from two pilot interventions during the COVID-19 pandemic

“…The Teams intervention consisted of eight weekly lessons that were initiated within an in-person setting and adapted for virtual implementation via Microsoft Teams ( n = 27, with six groups of 2–7 adolescents aged 12–21 years) ( Buro et al, 2021 ). Sensory activities including food tasting and preparation and visual and verbal prompts in the form of lesson booklets to reference during and between lessons and printed activity cards were utilized to engage participants.…”

“…The current report describes the development, implementation, and evaluation of two novel virtual nutrition education interventions for adolescents with ASD ( Buro et al, 2021 ; Shurack et al, 2021 ). The authors of both studies documented the feasibility and acceptability of the two virtual pilot programs.…”