LAUSR

Background Adolescents with ASD exhibit an increased prevalence of problematic eating behaviors, such as food selectivity, or consuming a narrow range of foods, and consume more energy-dense foods and fewer fruits and vegetables than typically developing children. Objective The purpose of this study was to examine the acceptability, perceived benefits, and unintended consequences of a virtual implementation of BALANCE (Bringing Adolescent Learners with Autism Nutrition and Culinary Education), an 8-week theory-driven nutrition intervention for adolescents with ASD. Study Design, Setting, Participants A qualitative study design was used. Twenty-seven adolescents aged 12-20 years who attended the BALANCE intervention and their parents participated in the study. Twenty-one parents participated in an interview. Six focus groups with 1 to 5 adolescents in each group were conducted. Data were collected virtually via Microsoft Teams. Measurable Outcome/Analysis Focus groups and interviews were audio-recorded and transcribed. Data were analyzed for a priori and emergent themes regarding intervention acceptability (likes, dislikes, satisfaction, and suggestions for improvement), perceived benefits, and unintended consequences. Results The intervention was generally acceptable to participants. Parents described, “I was so impressed,” “I feel like [he] was so happy,” and “he is more open to try new things.” Themes for acceptability included “virtual format,” “group setting,” “autonomy/independence,” “sensory components,” “interaction,” “reinforcement,” and “parent component.” Themes for perceived benefits included “diet changes,” “healthy weight,” “knowledge/awareness,” “behavioral skills,” “self-efficacy,” “outcome expectations,” “outcome expectancies,” and “other lifestyle changes.” “Anxiety/discomfort” during intervention lessons was an emergent theme regarding unintended consequences. Conclusion Our findings suggest that a virtual implementation of BALANCE was acceptable according to adolescents with ASD and their parents based on their reported perceptions and feelings about the intervention. Based on participant feedback, many adolescents with ASD may benefit from small group interventions, and virtual interventions are a convenient option for some adolescents and parents.