Page 22 - Delaware Medical Journal - November 2016
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THE GOOD NUTRITION GAME:
Extending the Good Behavior Game to Promote Fruit and Vegetable Intake
Heather J. Cassey, M.Ed; Yukiko Washio, PhD; Donald A. Hantula, PhD
Background: Consumption of diverse and nutritious food is challenging for children diagnosed with Autism Spectrum Disorder.
Objective: We created the Good Nutrition Game and implemented the intervention among students diagnosed with Autism Spectrum Disorder at a therapeutic after-school socialization program. Method: We divided students into two teams in each session. The team earned one point per bite of fruit or vegetables by a teammate. The winning team congratulated each other for winning and was given the privilege to choose a small prize item as reinforcement.
Lessons Learned: The approach showed promising findings to increase fruit and vegetable consumption among students diagnosed with Autism Spectrum Disorder in a classroom setting. While the approach needs to be implemented with more students in a longer term trial, other challenges include objectively measuring the number of bites instead of self-report by team members and addressing different eating habits among students.
Keywords: Good Behavior Game, Nutrition, Fruits and Vegetables, Autism Spectrum Disorder, Special Education School
Abstract
IntroductionChildhood obesity continues to rise in the United States.
More than one third of children and adolescents in the United States are overweight or obese.1 Poor eating habits may be partially responsible. According to CDC,1 schools are in a unique position to promote good eating habits. As a result, there has been an upsurge in school nutrition programs such as, “High 2 3 4 5 and 6 While experts commonly recommend vegetables, average consumption for most children is far lower.7
Consumption of diverse and nutritious food is a challenge for children diagnosed with Autism Spectrum Disorders (ASD),8 and the likelihood of a child with ASD being overweight or obese
is consistent with national averages, if not higher.9 This may be partially due to some of the unique challenges faced by children with ASD including food selectivity, food refusal, feeding problems, and problems with oral/motor coordination. Learning to make healthy food choices is an important life skill for students with ASD, especially if they expect to live somewhat independently.
Previous research on increasing diverse and nutritious food intake of children with ASD has targeted individual behavior using individualized reinforcement contingencies yielding inconclusive results.10 These individualized interventions are time-consuming to develop and implement, requiring the one-on-one time and attention of dedicated and well-trained staff. Additionally, they have limited generalizability, and do not capitalize on all of the reinforcement available in the classroom.
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Del Med J | November 2016 | Vol. 88 | No. 11
