Impact of garden based nutrition education on cognitive skills of school going children with autism spectrum disorder

Abstract

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition of the brain that requires specialized attention due to its diverse manifestations. Studies show that its prevalence is increasing worldwide. ASD is characterized by core symptoms, including difficulties with communication and social interaction. In addition to these core features, individuals with ASD often experience comorbidities such as gastrointestinal issues and sensory sensitivities, which can make them more vulnerable to nutrition-related problems, including malnutrition. Along with these comorbidities, children with ASD also face challenges in cognitive skills. The cognitive capacity of each child with ASD varies, highlighting the importance of individualized care. Although ASD is a non-curable condition, early intervention can lead to improvements in the severity of symptoms. Horticultural therapy has emerged as one successful intervention. Similarly, school-based garden activities have proven to be an effective method for implementing nutrition education and improving cognitive outcomes in children. Garden based initiatives are educational activities in which children actively engage in learning about nutrition, food, and the environment through hands- on experiences, either in school settings or through outdoor gardens, farms, raised beds, greenhouses, containers, and micro-farms, which connect children with local fruits and vegetables. The present study aims to assess the impact of garden-based nutrition education (GBNE) on cognitive skills in children with ASD. The research was conducted across three distinct zones in Kerala— South, Central, and North. In each zone, three districts were randomly selected: Thiruvananthapuram, Thrissur, and Kozhikode. The Centre for Research and Development of Autistic Children (CRDAC) schools were chosen through purposive sampling, resulting in a sample of 210 school-age children with ASD, aged 7 to 15 years. Out of this group, 105 children were assigned to an experimental group that received the GBNE intervention, while the remaining 105 formed a control group. The study was structured in three phases. Phase I involved pre- intervention assessments of nutritional status, eating behaviors, and cognitive skills. Standardized assessment tools, including the Brief Autism Mealtime Behavior Inventory (BAMBI) and the Indian Scale for Assessment of Autism (ISAA), were employed for reliable data collection. This phase collected data on socio-economic and demographic profiles of families and individual characteristics of the children. The pre- intervention analysis revealed that a significant portion of parents of children with ASD were aged between 41 and 50 years, with varying levels of educational attainment. Among the children, an even age distribution was observed, with a notable predominance of males (73.30%). Growth patterns indicated that a substantial number of children exhibited abnormal growth metrics. Phase II focused on implementing the GBNE intervention, which consisted of three components: nutrition education for children through games, stories, and child-friendly garden videos; dietary counselling for parents, highlighting the importance of a specific diet for children with ASD; and the establishment of a nutrition garden involving the children. Phase III comprised post-intervention assessments to evaluate the outcomes of the intervention. Following the GBNE intervention, marked improvements were observed in the experimental group. The frequency of fruit and vegetable consumption increased significantly (fruit consumption pre to post: 20.10 ± 6.21 to 21.32 ± 6.18; green leafy vegetable: 2.14 ± 1.38 to 6.37 ± 4.24; roots & tubers: 21.29 ± 2.91 to 21.93 ± 3.19; other vegetables: 12.80 ± 3.93 to 15.22 ± 4.11). Additionally, the ISAA scores demonstrated significant enhancements in cognitive skills (34.24 ± 4.27 to 31.05 ± 5.19), particularly in areas related to memory, reasoning, and visual processing. In conclusion, the GBNE intervention proved to be an effective strategy for promoting healthier eating habits and enhancing cognitive development among children with ASD. This study emphasizes the importance of innovative, participatory approaches in addressing the complex needs of children with autism, potentially paving the way for similar interventions in other regions and populations. The findings advocate for continued research into garden-based educational methods as a means of supporting not only the nutritional health but also the cognitive development of children with ASD, thereby fostering a holistic approach to their care and education. By engaging children in gardening and nutrition education, we can cultivate not just healthier eating habits but also enrich their learning experiences, paving the way for improved developmental outcomes.