(PS2-74) The BUFFET-Snack Program: Leveraging Single Session Interventions to Develop a Brief Treatment for Food Selectivity in Autistic Youth

Food selectivity is a well-documented and common concern for autistic youth. Despite daily impact, risk for poor health outcomes, and threats to quality of life, there is a limited range of evidence-based food selectivity treatments. The Building Up Food Flexibility and Exposure Treatment (BUFFET) program began to fill this gap as a multi-family cognitive behavioral treatment (CBT) for food selectivity in autistic youth (8-12 years) that uniquely targets developmentally-relevant and emerging cognitive skills and self-determination. However, as a 14-week, clinic-based group therapy model, implementation feasibility and scalability for BUFFET is low. With an eye toward the benefit of a stepped care framework for autistic people (Lord et al., 2022), there is a particular need to expand the availability of interventions to support short-term and specific treatment gains. Key components of BUFFET (anxiety as a treatment target, exposure therapy, reducing parental accommodation of child avoidance behavior, school-age developmental window) align with effective single session treatment protocols, making a compelling case for a brief model of BUFFET that parallels a package of single session treatments tailored for food selectivity.

To address this need and develop BUFFET-Snack, a brief, low intensity treatment model of BUFFET, key informant interviews (N= 13) were conducted with individuals with lived experience and vested interest: autistic adults, caregivers, institutional partners (clinicians, practice administrators), and content experts (single session interventionists, food selectivity researcher, implementation scientist). Interviews (1) reviewed the BUFFET model, (2) examined relevant treatment components from single session interventions that could guide adaptation, and (3) explored billing and insurance coverage feasibility for BUFFET-Snack.

Key informant data converged on a brief treatment model of 3 to 5 sessions rather than a single longer exposure session (“Hard pass on the 3-hour session”). Informants emphasized the need to retain parent involvement (“There is a real need for this treatment and families would want to be involved”) and to continue including both cognitive and exposure components, though there was some variability in perspectives on sequence (“It can be hard to not want to jump right into the exposure part”; “The exposure stimulates the cognition”). Implementation and uptake considerations were highlighted related to the utility of 1-hr (rather than 90 min) sessions for community clinic models and optimal billing, as well as training needs based on provider background.

Based on key informant community feedback, BUFFET-Snack was designed to include cognitive restructuring with food flexibility scripts and food exposure for children, as well as cognitive behavior training for parents (focused on parental protection and the anxiety cycle). For BUFFET-Snack, treatment was consolidated into five weeks of sessions (five 1-hour parent-child, two 30-min parent-only). In this first phase of treatment adaptation, key informant feedback revealed support for BUFFET-Snack as a brief treatment for food selectivity in autistic youth. A pilot feasibility and acceptability trial is now underway.