Adaptation of Smarter Lunchroom Design to the specific needs of children with intellectual and developmental disabilities: Formative research and community collaboration

The occurrence of secondary conditions such as obesity in children with intellectual/developmental disabilities (IDD) may undermine their ability to live independently, limit future opportunities for employment, and contribute to health disparities experienced as adults. Schools offer important opportunities for the prevention of obesity and other chronic diseases, and the school food environment offers a promising venue for focused efforts to improve child dietary intake. The field of behavior economics and principles of behavioral science guide recent efforts to “steer students to better choices by making low or no-cost changes to the cafeteria environment” – called the Smarter Lunchroom Initiative. Simple techniques including changing prompts by foodservice workers, slicing and peeling fruit to improve accessibility, and offering structured choices positively influence food choice and consumption in school-based interventions with typically developing children. No published research has addressed the extent to which these approaches can be adapted for children with IDD.

We sought to adapt Smarter Lunchroom Design for the specific needs of children with IDD enrolled in a residential school. Recommendations for adaptation strategies solicited through focus groups and key informant interviews with school staff included: communicating with social stories and food photographs, reducing auditory and visual distractions in the eating environment, and taste-testing activities. The Project Advisory Board, comprised of school program directors, parents, community members, and researchers functioning as the expert panel, refined and approved the final adaptation strategies. Engaging the school staff through focus groups and on the expert panel has “prepared the field” for the planned intervention.