Project Leapp(Learning to Eat App): Developing an Ipad-Based Video Modelling Intervention to Increase Food Variety in Children with Autism Spectrum Disorder.

Background: Feeding difficulties (FD) are identified in up to 89% of children with ASD¹. FD can lead to challenges such as disruptive mealtime behaviors, strained parent-child interactions and adverse health effects for the child^2-3. A multidisciplinary team approach is recommended to address FD in ASD. However, barriers include access and availability of feeding specialist team, cost, and time. Early intervention programs geared at preventing and/or addressing FD in ASD in preschoolers is lacking. Video modeling intervention (VMI) is a novel and promising approach where a child is expected to imitate the behaviours of interest after viewing a recording of it^4-6. VMI has been successful in teaching play and communication skills to children with ASD, but to our knowledge has not been attempted as a strategy targeting feeding behaviours in ASD. We intend to create a novel VMI with an animated model to deliver an early intervention program to address FD in ASD.

Objectives: To develop and pilot an animated VMI, Learning to Eat Application (LEApp) that provides auditory and visual feedback along with positive reinforcement to increase food variety in children with ASD. We hypothesize that an animated VMI can be designed for use by preschoolers with ASD and their parents to be implemented in a naturalistic environment.

Methods: Our methodology combines the principles of participatory design⁷ and interaction design ⁸ . Three focus groups (i) an inter-disciplinary panel (comprising of speech and language pathologist, occupational therapist, family leader, game programmer, illustrator, behavioural therapist and developmental paediatricians), ii) parents of children with ASD, and ii) community clinicians) were recruited to address the design and content of LEApp ( n=13). A descriptive thematic analysis was applied to the focus group data ⁹. Focus groups occurred in an iterative manner to inform the development of the LEApp prototype.

Results: A final LEApp prototype was created through analysis of focus group data. Themes that emerged reflected common areas of content and design: (1) feeding expectations; (2) feeding strategies; (3) application specific recommendations. Overarching themes relating to (1) challenges and (2) parent education aided the formulation of the information content of the application.

Conclusions: Project LEApp represents the first step in the creation and exploration of a novel tool that has the potential to impact an essential skill early in the lives of children with ASD. By involving children, their parents and multidisciplinary specialists throughout the process, LEApp has the potential not only to impact feeding outcomes, but can also be shared and utilized universally by families in any setting, thus filling a need in existing feeding intervention. LEApp also provides an educational platform for families to learn about strategies to address FD within their home setting and at their own pace.

Tech demo description: We would like to demonstrate LEApp’s functionality by displaying the parent-child interface of the application. The application features an animated character, Nibbles, who takes the parent and child through three different video modeling sequences that highlight five stages of feeding (i.e., touch, smell, lick, taste, eat).