The BALANCE nutrition education intervention for adolescents with ASD: A formative study in a school setting

Background: Adolescents with autism spectrum disorder (ASD) may consume fewer types of foods overall and consume more processed foods than their typically developing peers. This study aimed to collect formative data to develop an eight-week school-based nutrition intervention for adolescents with ASD (Phase I) and to examine the feasibility and acceptability of the intervention in a school setting (Phase II). Method: Focus groups, interviews, surveys, and feasibility testing of outcome measures (dietary intake, psychosocial determinants, height, weight) were conducted. Eleven adolescents and nine parents participated in formative focus groups and interviews, and twelve adolescents partici-pated in a subsequent pilot intervention of BALANCE (Bringing Adolescent Learners with Autism Nutrition and Culinary Education). Lessons included group-based activities and tasting sessions and lasted 45-50-min. Descriptive statistics and thematic analysis were conducted. Results: Adolescents and parents discussed the importance of having social modeling, visual cues, and student-led initiatives in a nutrition intervention. BALANCE lessons were administered with 100 % adherence, high quality, and 100 % exposure. On average, 11 students attended the intervention lessons (ranged 10-12). Participants reported that the intervention was acceptable; sensory exposure was an important component. Conclusions: Instrument feasibility varied by age and social communication skill level, suggesting that measures should be carefully selected. The BALANCE intervention was feasible to implement and acceptable to adolescents with ASD.