iPad® Video Prompting to Teach Cooking Tasks to Korean American Adolescents With Autism Spectrum Disorder

Abstract

In response to the growing necessity for considering the cultural and contextual needs of youth with disabilities in experimental studies, this study examines the effectiveness of an intervention package consisting of video prompting with a system of least prompts and reinforcement on Korean American adolescents with autism spectrum disorder. Through the replication of procedures used in a study by Mechling et al. (2008), the current study examined the effects of self-directed video prompting with a system of least prompts and verbal praise on completion of three preferred cooking tasks by three Korean American male adolescents with autism spectrum disorder. A single-case multiple probe design replicated across three cooking tasks was used. Results indicated the correct completion of multi-step cooking tasks increased with the intervention package and was maintained seven weeks following intervention across three participants. Discussion and implications for future research and practice are presented.

Keywords

adolescents autism spectrum disorder independent tasks Korean American video prompting

In recent research, various interventions have been applied to support self-management and development of daily living skills in individuals with autism spectrum disorders (ASDs). In particular, interventions for adolescents with ASD have focused on teaching specific independent living skills such as grooming (Lasater & Brady, 1995; Rayner, 2015), cleaning (Kellems & Morningstar, 2012), and job-related tasks (Bennett et al., 2013) to prepare students to become more independent in adulthood. Cooking, another essential daily skill, has also been studied frequently. Researchers have found several benefits to teaching cooking skills, including: (a) preparing meals at home as a more economical option than dining out (Schuster, 1988; see also Mechling et al., 2008); and (b) learning independent cooking skills because these skills are associated with healthier eating patterns (i.e., reduced consumption of fat, cholesterol, sodium, and carbohydrates; Archuleta et al., 2012) and higher diet quality (i.e., fruit and vegetable consumption; Chu et al., 2012). As the majority of individuals with ASD often have problems related to food consumption, such as gastrointestinal (GI) issues, eating disorders, obesity, and allergies (Goldschmidt & Song, 2015), teaching cooking skills may be beneficial in supporting physical well-being and health, including an opportunity to foster independence.

Diverse modalities have been adopted to examine the effects of teaching independent cooking tasks to individuals with ASD. Fiscus and colleagues (2002) used picture-based recipes to teach simple cooking tasks to four 8- to 12-year-old children with intellectual disability (ID). Auditory systems were also used in several research studies (Lancioni et al., 1995, 2001), such as Lancioni et al.’s (2001) use of audio cassette players to give cooking instructions for desserts and appetizers to three 19- to 22-year-old individuals with multiple disabilities. With the advent of more recent video technologies, researchers have examined various types of video-based instruction (VBI). In a study by Bidwell and Rehfeldt (2004), three adults with ID were taught to make coffee independently using video modeling procedures. Sigafoos et al. (2005) used video prompting (VP) to instruct the preparation of microwave popcorn to three adults with ID. VBI, in particular, is a versatile intervention that involves observational learning, is shown to promote the learning of novel skills, and is appropriate for individuals with ASD who learn effectively through the use of visualization (Bellini & Akullian, 2007; Bandura, 1977).

As a type of VBI, VP strategies have been distinguished from other VBIs in that it introduces a series of skills by presenting each step independently (Mechling et al., 2008). Following each videoclip, the student imitates the modeled action in chronological order, with the objective of completing the entire sequence. VP has been reported as a frequently used intervention to teach independent cooking tasks to individuals with various types of disabilities (e.g., Mechling et al., 2008, 2013). The National Autism Center (NAC, 2009) reported antecedent-based procedures and modeling through videos were effective and established intervention strategies for school-age children with ASD (3–18 years; Mechling et al., 2008; Wong et al., 2015).

In a study by Graves et al. (2005), a point-of-view VP was used to teach three adolescents with ID to cook recipes, such as ramen noodles and macaroni and cheese. VP was effective for all participants and their learned behaviors were maintained for two weeks after the intervention. Mechling et al. (2008) showed the use of a portable DVD player was successful in teaching cooking skills to adults with ID. Three 19- to 22-year-old participants watched videoclips on cooking hamburgers and making sandwiches and salads. If the participants performed a step incorrectly, a system of least prompts (SLPs) was used hierarchically to allow participants to self-correct independently with a verbal or gestural prompt. This study adapted a single-case multiple probe design across three cooking behaviors, and two sessions occurred every week for 10 weeks. All participants performed an average of 90% of the steps correctly, and the learned skills were maintained up to 7 weeks post-intervention. These findings suggest that the use of videos can be successful in teaching adolescents and adults with ID how to cook a wide range of foods.

In response to the increasing culturally and linguistically diverse (CLD) populations in the United States and criticism of the prevalence of White-centric issues in the field of intervention research (Artiles et al., 2010), greater attention is now being paid to the cultural responsiveness of evidence-based interventions. Particularly, recent studies reported that the proportion of students from CLD backgrounds in intervention research has risen dramatically (Aceves et al., 2015; Brown et al., 2018). For instance, Asian Americans are the second fastest growing ethnic minority in the United States (Vespa et al., 2018) and may therefore, contribute to the growing CLD student population. Thus, more research with CLD individuals, such as Asian Americans, is necessary for the development of more culturally responsive interventions. Unfortunately, there are no clear guidelines for establishing culturally responsive empirical or experimental studies to date. Sugai et al. (2012) asserted that although cultural adaptation is considered a core part of culturally responsive practice, there is still a lack of research on the theoretical and operational models of culturally responsive practices.

Cultural adaptation is a response to diverse experiences and values (Bernal et al., 2009). In the field of special education, researchers have used the guidelines for culturally responsive intervention research established by Trainor and Bal (2014), which suggest considering cultural and geographical contexts as well as the goals and needs identified by participants and their families. In other words, culturally responsive intervention research can be initiated by evaluating the experiences and perspectives of the cultural group. Similarly, Butler and Titus (2015) specified two levels of cultural adaptation: (a) cultural adaptation of surface structures that modifies methodologies to consider individuals’ linguistic and ethnic backgrounds; and (b) cultural adaptation of deep structures that modifies content to reflect the diverse sociocultural and psychological aspects of the individuals, as well as their environment and history (Davenport et al., 2018). Previous researchers stated that meal preferences are critically affected by one’s cultural and ethnic backgrounds (Sealy, 2010) and found that families born outside of the United States cooked at home more frequently compared with families who were born in the United States (Virudachalam et al., 2014). Larson et al. (2006) found that demographic factors such as being female or Asian American or having a low socioeconomic status were related to greater involvement in purchasing ingredients and preparing meals in adolescence.

In this study, we applied these guidelines as we examined the effect of VP intervention packages for teaching multiple-chained cooking tasks to three Korean American (KA) adolescents with ASD. To date, there have been limited studies examining the cultural responsiveness of VBIs for culturally diverse students with ASD, and KAs have not yet been involved in research on VP intervention for cooking tasks. Taking into consideration the criteria for culturally responsive interventions (Butler & Titus, 2015), the current study adapted procedures for KA individuals with ASD by considering the participants’ preferred languages and eating habits (surface structures) as well as the home culture and microcultural groups’ values (deep structures). The growing Asian American population in the United States, which includes KAs (Vespa et al., 2018), calls for more research investigating culturally relevant intervention for KAs.

This study replicated the procedures of Mechling et al. (2008) by examining the effects of self-directed VP with an SLP and verbal praise on a Fixed Ratio–3 (FR-3) schedule of reinforcement upon completion of cooking three preferred foods by three KA male adolescents with ASD. Parents, as indirect stakeholders of the intervention, were asked to report their experiences and perceptions of the intervention via a postintervention questionnaire. The research questions were as follows:

Research Question 1: Is there a functional relation between the intervention package of VP with an SLP and verbal praise and completion of cooking preferred foods in three male adolescents with ASD and CLD backgrounds?

Research Question 2: How do KA stakeholders of the intervention (KA parents of male adolescents with ASD and CLD backgrounds) perceive the goals, procedures, and outcomes of the intervention package adopted for participants with ASD?

Method

Participants

Three KA adolescents diagnosed with ASD participated in this study. Before obtaining parental consent and written assent from the participants, researchers screened participants’ eligibility, using a screening form with seven criteria, including the participant: (a) was diagnosed with ASD; (b) was aged between 10 and 17 years; (c) watched videos using an iPad; (d) enjoyed watching videos; (e) was interested in learning how to cook; (f) could provide written assent; and (g) did not exhibit severe challenging behaviors, such as tantrums or self-injury. Participants were identified as interested in cooking and watching videos on portable devices (i.e., iPad), but had not learned to cook any foods or use kitchen appliances independently. All three participants had previous experience of cooking at home. Participants’ preferred languages were used for instructions in videoclips and sessions. All names used are pseudonyms.

Nick was a 17-year-old boy diagnosed with ASD. Nick had mild-to-moderate ASD (Childhood Autism Rating Scale–Second Edition [CARS-2]; Schopler et al., 2010) and speech language impairment. He was born in Korea and his family moved to the United States, for his father’s postsecondary education, when he was six months old. Nick wanted to become a chef after high school and enjoyed playing games on the iPad. His overall adaptive behavior was low (1%) on the Vineland Adaptive Behavior Scales–Third Edition (VABS-3; Sparrow et al., 2016). His communication skills (2%), daily living skills (<1%), and socialization skills (1%) were considered low. Considering Nick’s preferred mode of communication, as determined by the researchers’ direct observation and parents’ report on the screening form, all videoclips and sessions were completed in English.

Duri was a 13-year-old boy diagnosed with ASD. Duri was considered as having severe ASD (CARS-2). He was born in the United States after his family moved for his father’s education. His father was a technician, and his mother was a stay-at-home mom. Duri enjoyed looking at satellite maps and watching videos on the computer. Duri’s favorite foods were condiments, such as peanut butter and ketchup. His overall adaptive behavior, communication, daily living skills, and socialization skills scored low (<1%) on VABS-3. Based on the researchers’ direct observation and parents’ report on the screening form, Duri communicated using one to two English words. He understood Korean as his mother spoke Korean at home, but Duri communicated mostly in English; therefore, English was used in all videoclips and sessions.

Chris was a 14-year-old boy diagnosed with ASD. Chris had severe symptoms of ASD (CARS-2). He was born in the United States after his parents met during their postsecondary education and got married in the United States. Both parents were fluent in English and Korean and worked full-time. Chris enjoyed watching videos on the iPad and had a consistently high appetite. Chris’s overall adaptive behavior, communication, daily living skills, and social skills scored low (<1%) on VABS-3. Based on the parental report, the family communicated with Chris in English after Chris’s diagnostician advised using one language at home. Chris communicated with the researchers using short English phrases. Although he understood Korean, Chris verbally communicated in English, and thus, all sessions and videoclips were conducted in English.

Prescreening and Assignment of Recipes: Procedures of Cultural Adaptations

Before the intervention, interviews were conducted with each participant in their preferred language (i.e., English) and with their parents in their preferred language (i.e., Korean) to obtain a list of five foods preferred by participants. Then, researchers conducted an informal observation of the participants consuming each food two to three times and asked the participants whether they liked the food to confirm preferences. The participants provided a verbal (e.g., “yes”) or nonverbal response (e.g., nod or smile) to the foods that were selected. Finally, researchers and parents identified three recipes out of the five preferred foods by considering the level of difficulty to prepare each recipe (e.g., number of steps), types and numbers of ingredients, and the cooking modalities (e.g., use of a microwave or stove). During this process, parents also discussed and considered the importance of the nutritional benefits and balance in the selected foods. For example, all parents explained that the preparation and consumption of yogurt was a healthy habit for their children’s GI conditions.

After observations and interviews, three types of foods that required a variety of cooking methods were assigned to each participant. Nick prepared (a) fruit and yogurt salad that required simple arrangement of ingredients (e.g., retrieving, washing, and putting ingredients together); (b) Gay-Rahn-Chim (Korean egg pudding with chopped vegetables) using a microwave; and (c) stir-fried vegetables using a stove. Chris prepared (a) peanut butter and jelly sandwich using a butter knife, with consideration for his parents’ request to practice knife safety rules; (b) pasta using a microwave; and (c) fruit and yogurt salad. Duri prepared (a) chicken nuggets using an oven, (b) Bibimbap (Korean rice bowl) using a microwave, and (c) fruit and yogurt salad.

The first and second authors completed a task analysis of the three cooking behaviors for each participant, and the steps for each recipe were confirmed by the parents. Based on the nature and feasibility of the tasks, and the participants’ basic cognitive and motor abilities, two to three simple behaviors were clustered in one step (e.g., opening the microwave, putting the bowl in the microwave, closing the microwave). All participants learned to prepare the fruit and yogurt salad because of the parents’ desire to promote participants’ consumption of yogurt to address bowel-related issues, as well as the participants’ preferences for preparing and consuming yogurt salad. The number of steps and ingredients for the fruit and yogurt salad varied across participants depending on their preferences and levels of performance. Table 1 displays the task analyses for the three cooking tasks selected for Nick. The number of steps in one cooking task ranged from 20 to 30 for Nick, 10 for Duri, and 10 to 13 for Chris.

Table 1.

Task Analysis for Nick’s Cooking Behaviors.

Cooking task
Egg pudding	Stir-fried vegetables	Fruit yogurt salad
1. Get a bowl and lid and put them on the counter. 2. Get a tablespoon and a teaspoon and put them on the counter. 3. Get a small cup and put it on the counter. 4. Get salt and put it on the counter. 5. Get garlic powder and put it on the counter. 6. Get a bag of chopped carrots, corns, and peas from the freezer and put it on the counter. 7. Open the bag of carrots and put one tablespoon of carrot in the bowl. 8. Open the bag of corns and put one tablespoon of corns in the bowl. 9. Open the bag of peas and put one tablespoon of peas in the bowl. 10. Get three eggs from the refrigerator. 11. Crack the eggs and put in the bowl. 12. Get milk from the refrigerator and pour half cup of milk in the bowl. 13. Get half cup of water from the water purifier and pour it in the bowl. 14. Put one teaspoon of salt in the bowl. 15. Sprinkle the garlic powder in the bowl two times. 16. Stir the mixture 15 times and place the spoon on the counter. 17. Put the lid on the bowl. 18. Open the microwave, put the bowl in the microwave, and close the door. 19. Press 2, 3, and 0 (to set 2 min and 30 s). 20. Press “Start.” 21. Wait for 2 min and 30 s for microwave to “ding.” 22. Open the microwave and take out the bowl and put it on the counter. 23. Open the lid and get the spoon. 24. Stir the mixture 15 times and put the spoon on the counter. 25. Put the lid on the bowl. 26. Open the microwave, put the bowl in the microwave, and close the door. 27. Press 1, 3, and 0 (to set 1:30 min). 28. Press “Start.” 29. Wait 1 min and 30 s for microwave to “ding.” 30. Open the microwave and take out the bowl and put it on the counter.	1. Get the pan and put it on the stove. 2. Get the oil and place it on the counter. 3. Get the spatula and spoon and put them on the counter. 4. Get corn, carrots, and shrimp from the freezer and put them on the counter. 5. Get salt and sesame seeds and put them on the counter. 6. Put three tablespoons of corn on the pan. 7. Put three tablespoons of carrots on the pan. 8. Put three tablespoons of shrimp on the pan. 9. Put one tablespoon of oil on the pan. 10. Turn on the stove to “high.” 11. Get kitchen timer and press M two times and then press “start” (to set 2 min). 12. Stir the mixture on the pan for 2 min until the timer sounds. 13. Sprinkle salt one time on the pan. 14. Sprinkle garlic powder one time on the pan. 15. Set the kitchen timer to 2 min. 16. Stir the mixture on the pan for 2 min until the timer sounds. 17. Turn off the stove. 18. Open the sesame seed container and sprinkle sesame seeds one time on the pan. 19. Move the fried mixture on the plate using a spatula. 20. Put the pan and spatula in the sink.	1. Get a glass cup and put it on the counter. 2. Get a colander and put it in the sink. 3. Get one tablespoon and put it on the counter. 4. Get a knife and cutting board and put them on the counter. 5. Get a box of blueberries from the refrigerator and put it on the counter. 6. Get banana and put it on the counter. 7. Get yogurt from the refrigerator and put it on the counter. 8. Get cereal and put it on the counter. 9. Get honey and put it on the counter. 10. Open yogurt and put it in a cup. 11. Open the box of blueberries, take out 10 blueberries, and put them in the colander. 12. Turn on the sink, place the colander under water for 10 s, and turn off the water. 13. Put the blueberries in a cup. 14. Peel the banana and put it on the cutting board. 15. Cut the banana into five pieces. 16. Put the banana in the cup. 17. Open the cereal box, put 1 tablespoon of cereal in the cup, and put the spoon on the counter. 18. Put one squirt of honey in the cup and put the honey on the counter. 19. Put the colander, spoon, knife, and cutting board in the sink. 20. Put the left over blueberries inside the refrigerator.

Settings and Materials

A 12.9-inch-iPad Pro in a waterproof case was used to record and present the videoclips. The Camera app was used to record the videoclips. The second author (interventionist) was the model in the videos and used materials found in the participants’ home kitchens. The interventionist completed the steps following a total task chaining procedure, and each step was recorded as an independent videoclip in the point-of-view VP format. A verbal description (i.e., “I get a bowl and put it on the counter”) was provided in each videoclip. For example, cooking Gay-Rahn-Chim (egg pudding) involved 30 steps; therefore, 30 videoclips were created. The Photos app was used to present the videoclips to participants. The volume and brightness were set at the maximum level. Touching the play button at the center of the screen started the videoclip, and each clip stopped automatically at the end. Pausing videoclips was not used for this study. To play the next clip, participants swiped left on the screen and touched the play button at the center of the screen again. All sessions took place in the participants’ home kitchens.

Experimental Design and Procedures

A single-case multiple probe design (conditions) across three cooking tasks (Gast et al., 2018) was used to measure the effectiveness of the intervention package that included self-directed VP with an SLP and reinforcement for the three KA participants with ASD. Using this research design, researchers achieved experimental control as changes in participants’ behaviors were observed immediately after the introduction of the independent variable (i.e., VP intervention package). In this design, at least five baseline data points were collected for each participant (Kratochwill et al., 2013). The criterion to move from the baseline to intervention phase was at least three consecutive, stable baseline data points that showed the participants did not present the targeted skills measured during intervention (i.e., at 0% or consistently low levels). The criterion to move from the intervention to maintenance phase, or the mastery criterion for a cooking task, was performing all steps of the task correctly (100%) for two consecutive sessions. After baseline data were collected across the tiers, the researchers introduced the intervention for Tier 1. Once participants met the criterion for Tier 1, maintenance of the learned task was assessed for Tier 1 and baseline data were collected for the subsequent tiers. This sequence of baseline, intervention, and maintenance conditions was staggered across the three tiers for all three participants. Visual analysis of graphed data was conducted to report the effect of the intervention package on the correct completion of cooking tasks across the three participants. Sessions across all conditions (i.e., baseline, intervention, maintenance) occurred 2 to 3 days every week for approximately 2 to 3 months.

Dependent Measure

The definitions of the dependent variables were adapted from Mechling et al. (2008) and differed across conditions. For the baseline and maintenance conditions, correct completion of a cooking step was defined as the initiation of a step within 3 s after the discriminative stimulus (S^D; that is, task direction or completion of previous step) followed by the correct completion of the step within 1 min. Incorrect completion of a cooking step was defined as (a) initiation of the step within 3 s after the S^D, followed by an incorrect or incomplete performance within 1 min, or (b) no initiation of the step within 3 s after the S^D.

During intervention, correct completion of a cooking step was defined as playing the videoclip on the iPad, initiating the modeled step within 3 s of the end of the videoclip, and completing the step correctly within 1 min. Incorrect completion of a cooking step was defined as: (a) no attempt to swipe left on the screen and play the next videoclip within 3 s after completion of a previous step; (b) playing the videoclip within 3 s after completing the previous step, initiating the modeled step within 3 s of the videoclip stopping, but completing the modeled step incorrectly or incompletely within 1 min; or (c) no initiation of the modeled step within 3 s of the videoclip stopping.

An SLP was used after an incorrect step during intervention. A 3 s response interval was used to move from one prompt to another in the order of least to most supportive (i.e., self-, verbal-, verbal-and-gestural prompt) to replay the videoclip and reattempt the cooking step. Replaying the videoclip independently within 3 s after completing a step incorrectly was considered a self-correction. If the participant did not self-correct, the researcher provided a verbal prompt, “Watch again.” If the participant did not replay the videoclip within 3 s after the verbal prompt, the researcher provided a verbal and gestural prompt by saying “Watch again” and pointing to the screen. If the participant replayed the videoclip within 3 s after a prompt and completed the step correctly, the participant was expected to swipe left to the next videoclip to perform the next step within 3 s. If the participant replayed the videoclip within 3 s after a prompt but completed the step incorrectly again, the researcher completed the step out of the participant’s sight, and the participant was expected to swipe left and play the next videoclip within 3 s.

Pretraining

Participants practiced operating the iPad prior to the baseline sessions by practicing playing and replaying a videoclip and swiping to the next clip. For training purposes, researchers chose the example of handwashing because it takes place in the kitchen, is related to cooking, and is a mastered skill for all participants. The selection of a mastered skill allowed participants to focus only on learning the video function of the iPad. The format of the pretraining videoclips was identical to the intervention videoclips. Researchers completed a task analysis of handwashing and recorded it while the second author performed the steps in the participants’ kitchens. There were six steps: turning on water, rubbing hands under water, getting soap, rubbing hands under water, turning off water, and drying hands. An SLP was used until participants completed all steps with 100% accuracy independently for one session. After the pretraining, the researchers confirmed that the verbal and gestural prompt served as the controlling prompt for all participants.

Baseline

Participants’ behaviors prior to the implementation of the intervention were observed for each of the three cooking tasks. First, the researchers verified that all ingredients and materials were positioned in the designated area. Then, the interventionist (second author) provided the direction, “Prepare the ______.” The order of the cooking steps was determined through the task analyses conducted by the researchers and parents. If the participant initiated a step within 3 s after the initial verbal direction (“Prepare the _____”) and completed the step correctly within 1 min, no feedback was provided by the researchers or parent. After the completion of a step, the participant was expected to initiate the next step within 3 s and complete the step correctly within 1 min to be considered as a correct response. At any point, if there was no response (no initiation within 3 s) or an incorrect completion (incorrect step performed or a correct step performed past the 1 min mark), the interventionist completed the step out of the participant’s sight. The researchers and parents did not provide any instructions or prompts. Descriptive verbal praises that refer to a cooking step (e.g., “Great job putting the bowl on the counter”) were not provided.

Intervention

The iPad was placed on the countertop, and the screen displayed the videoclip of the first step of the task. A verbal direction, “Prepare ____ using the iPad,” was delivered. Participants played and watched the videoclip, then performed the modeled step. This sequence was repeated until the last step of the task. After an incorrect completion, an SLP was provided to rewatch and reattempt the step. No additional directions or prompts were provided. Participants received descriptive verbal praises (e.g., “I like how you got the yogurt from the refrigerator and put it on the counter”) on an FR-3 schedule, once for every three correct responses. At the end of each session, participants were also naturally reinforced by consuming the food if they desired.

The authors replicated the main intervention procedures by Mechling et al. (2008), with the following exceptions. First, an iPad was used for the video presentation instead of a Personal Digital Assistant. Using the iPad, the videoclips were recorded for each step, and each clip paused automatically at the end. As a result, participants were not required to pause manually; however, participants had to swipe left on the screen to play the next videoclip. Second, although participants mastered the use of the iPad during pretraining, not attempting to swipe left on the screen and play the next videoclip within 3 s after completing a previous step was added to the definition of incorrect completion to distinguish the various modes of incorrect responses. This type of incorrect completion occurred several times across participants during the intervention.

Maintenance

Once the criterion was met in one tier for a specific cooking task, the intervention was withdrawn and maintenance data were collected. For the first task, three maintenance sessions were conducted; for the second task, two maintenance sessions were conducted; and, for the third task, one maintenance session was conducted. Materials and procedures were identical to the baseline phase. As a single-case concurrent multiple probe design was adopted, the maintenance of learned tasks was measured from 1 week after the intervention to 7 weeks across the three tiers.

Interobserver Agreement (IOA)

The first author was the primary coder and the second author (interventionist) scored over 42.2% of all sessions and over 34% of the sessions in each phase for Duri (M = 53.3%, range = 33.3%–64.7%), for Chris (M = 47.2%, range = 33.3%–73.3%), and for Nick (M = 98%, range = 94.1%–100%) by reviewing the video-recorded sessions. The first author trained the second author for IOA with practice videos until they reached 80% agreement, which is the minimum standard for IOA (Horner et al., 2005). Reliability was measured by calculating the rate of agreement on each step of the task for all sessions (i.e., total number of agreements divided by the sum of the total number of agreements and disagreements). IOA data were collected for Nick (M = 99.3%, range = 85.71%–100%), for Duri (M = 100%), and for Chris (M = 98.39%, range = 88.89%–100%).

Treatment Integrity

The first author observed all sessions in person and completed a checklist to evaluate the fidelity of implementation for baseline, intervention, and maintenance phases. During baseline and maintenance phases, the interventionist (second author) behaviors were assessed using the following criteria: (a) provided the task direction “Prepare _____,” (b) verified that materials were in the designated positions, (c) completed the steps out of participants’ sight during error correction, and (d) provided no prompts or reinforcement (e.g., verbal praise). During intervention, the interventionist’s implementation of the intervention was evaluated using the following criteria: (a) checked that the iPad functioned correctly (e.g., brightness and volume), (b) presented the first videoclip on the screen, (c) provided the task direction “Prepare _____ using the iPad,” (d) verified that ingredients and materials were in the designated positions, (e) provided an SLP with a 3 s response interval to replay the videoclips, (f) completed the steps out of participants’ sight during error correction, and (g) provided verbal praise on a FR-3 schedule after a correct response. The fidelity of implementation was calculated by dividing the number of observed behaviors by the expected behaviors. The fidelity scores were collected during baseline (M = 100%), intervention (M = 99.18%, range = 87.5%–100%), and maintenance (M = 100%).

Social Validity

Social validity of the intervention was measured using a questionnaire developed by Kazdin (1980) and Kennedy (1994, 2004) to assess the indirect stakeholders’ perspectives on goals, procedures, and results of the intervention. For the current study, the questionnaire was completed by parents after the last maintenance session at the family’s home. The questionnaire included six questions: (a) How acceptable was the intervention in addressing your child’s target behavior?; (b) How was the researcher’s interaction with your child?; (c) How willing are you to implement this intervention in the future?; (d) How satisfied are you with the intervention procedures?; (e) What expectations do you have that the intervention will have long-term effects on your child?; and (f) Do you expect the intervention to have side effects for your child? The six items were rated on a 5-point Likert-type scale. A higher score represented higher social validity. An open-ended question was asked to give parents the opportunity to share additional comments about the intervention or its implementation.

Results

All three participants showed low, stable levels of correct completion of the cooking steps (0%–20%) during the baseline phase. After introducing the intervention, there was an immediate change in the percentage of correct completion of the cooking steps. During intervention, participants presented an accelerating trend in their correct cooking steps for all three recipes. The participants required six to eight intervention sessions to reach the mastery criteria of performing 100% of the cooking steps correctly for two consecutive sessions. During maintenance, high levels of correct completion of the cooking steps were maintained for 1 to 7 weeks.

Nick

The effects of the intervention package on Nick’s correct completion of the steps are presented in Figure 1. For the first recipe (fruit and yogurt salad), Nick received five baseline sessions before the intervention at a very low level (M = 2 %) with low variability. He demonstrated an accelerating trend from baseline to intervention and an immediate improvement in correct completion of cooking steps with an accelerating trend and low variability during intervention (M = 84.16%). The mastery criterion (100% correct completion in two consecutive sessions) was met during the sixth intervention session. His improved ability to complete the cooking steps was maintained during maintenance at a high level (M = 96.69%).

Figure 1.

Percentage of tasks completed correctly by Nick across three recipes.

For the second recipe (egg pudding), he also received five baseline sessions and demonstrated a stable and low level of performance with low variability (M = 13.57%). During intervention, he showed an immediate improvement in correct completion of the cooking steps with an accelerating trend and low variability (M = 86.31%). He reached mastery criterion in the sixth session. His improved ability to complete the cooking steps was maintained during maintenance (M = 100%).

For the third recipe (stir-fried vegetables), he received seven baseline sessions and demonstrated a low level of performance with a zero-accelerating trend and low variability (M = 0.71%). Upon intervention, he demonstrated an immediate increase in correct completion of the cooking steps and reached mastery criterion in the sixth intervention session (M = 94.17%). He completed the third recipe at a high level (95%) without intervention during maintenance. There were no overlapping data between baseline and intervention across the three tiers. When the intervention was introduced, an immediate and abrupt change in the levels of Nick’s correct completion of cooking steps was consistently observed, and the acquired behaviors were maintained at high levels for all three tiers consistently, supporting a functional relation between the intervention package and Nick’s completion of the cooking tasks.

Duri

Figure 2 depicts the percentage of Duri’s completion of cooking steps across three recipes. For the first recipe (fruit and yogurt salad), Duri did not perform any cooking tasks during baseline sessions (M = 0%). Upon intervention, his rate of correct completion of cooking steps increased, with an accelerating trend and low variability (M = 85%). He met mastery criterion at the eighth intervention session. After the intervention, the percentage of correct completion of the cooking steps slightly decreased but was maintained at a high level (M = 83.33%) compared with the baseline sessions.

Figure 2.

Percentage of tasks completed correctly by Duri across three recipes.

For the second recipe (chicken nuggets), six baseline sessions were recorded. Completion of the steps remained at zero during baseline sessions (M = 0%). During intervention, Duri’s completion of the second task showed an immediate increase in the rate of completion, with a clear accelerating trend with low variability (M = 82.56%). He met mastery criterion in the seventh intervention session. After the intervention, the percentage of correct completion of the cooking steps was maintained at a high level during the two maintenance sessions (M = 90%).

Prior to intervention for the third recipe (bibimbap), Duri’s completion of the task remained at a stable and low level, with a low variability during the baseline sessions (M = 3.33%). During intervention, he demonstrated an immediate improvement in the rate of correct completion with an accelerating trend and a low variability (M = 93.33%). He reached mastery criterion in the sixth intervention session. His improved ability to complete the cooking tasks was maintained at a high level during maintenance (90%). There were no overlapping data between baseline and intervention. When the intervention package was introduced to Duri, his level of correct completion of cooking steps immediately increased and was maintained at high levels across the three tiers consistently. This pattern supported a functional relation between the intervention and Duri’s completion of the three cooking tasks.

Chris

Chris’s data are presented in Figure 3. For the first recipe (peanut butter sandwich), Chris demonstrated a low level of correct completion of cooking steps (M = 4%) during the baseline sessions (n = 5). Upon intervention, Chris showed an immediate change in the level of correct completion of cooking steps with a relatively accelerating trend (M = 88.33%). Chris reached mastery criterion in the sixth intervention session. During the maintenance session, the mastered skills were maintained at high levels (M = 96.67%).

Figure 3.

Percentage of tasks completed correctly by Chris across three recipes.

For his second recipe (pasta), Chris also demonstrated a low rate of correct completion of cooking steps (M = 1.53%) during the baseline sessions (n = 5). Chris demonstrated an accelerating trend from baseline to intervention. With intervention, Chris exhibited an immediate improvement in the level of correct completion of cooking steps with low variability (M = 93.59%). He met mastery criterion in the sixth intervention session. Chris’ improved ability to complete the cooking tasks was maintained at a high level after the intervention (M = 96.15%).

Prior to intervention for the third recipe (fruit and yogurt salad), Chris’ rate of task completion was at zero (n = 5 baseline sessions). Upon entering intervention, Chris demonstrated an immediate change in level of correct completion of the cooking steps, with a slightly accelerating trend and relatively higher variability compared with the other two recipes (M = 88.57%). Chris reached the mastery criterion in the seventh intervention session. During the maintenance session, he continued to demonstrate an improved ability to complete the cooking tasks (80%). There were no overlapping data between the baseline and intervention conditions across the three tiers. Upon the introduction of the intervention, Chris’s correct completion of the cooking steps presented an immediate change in trend and level across all tiers consistently. During maintenance, Chris’s completion of the cooking steps were stable and at high levels for the three tiers, which, taken together, demonstrated a functional relation between the intervention and Chris’s ability to complete the cooking tasks.

Social Validity

Six parents completed the post-intervention questionnaire. The average score was 4.78 out of 5. A higher score represented greater social validity, or greater acceptance and positivity. In response to the open-ended question, one parent reported greater positive effects of the intervention than expected and another parent requested an additional component of training regarding safety rules with kitchen equipment. Anecdotally, one mother explained that teaching cooking skills to her child was valuable in promoting independence prior to his transition to adulthood. She also pointed out that in Korean culture women are often responsible for cooking at home, so cooking will be an important skill for her child to learn and practice considering the uncertainty of whether her child would get married and have a family in adulthood. Finally, for one of the participants, cooking was described and observed as a highly preferred activity.

Discussion

The purpose of this study was to examine the effects of the intervention package consisting of a self-directed VP, an SLP, and reinforcement to teach cooking tasks to three KA adolescents with ASD. The results indicated a functional relation between the intervention package and the participants’ completion of cooking preferred foods. All three participants showed an immediate improvement in their cooking behaviors after the introduction of the intervention package across three cooking tasks, and these behaviors were maintained at high levels. On average, participants needed six intervention sessions to correctly complete all steps of a cooking task. Parents also indicated a high satisfaction with the procedures and outcomes of the intervention.

The current study expanded on the exploration of VP with an SLP (Mechling et al., 2008). Similar to Mechling et al. (2008), there was an immediate improvement in the participants’ cooking skills after the introduction of the intervention package, and the learned cooking skills were maintained afterward without the presence of the intervention package. Despite similarities, there were some differences in the pattern of results. First, the participants in Mechling et al. (2008) reached 100% accuracy in independent completion of tasks earlier than the participants in the current study. The difference in the findings may be due to the younger age (M = 14.67, range = 13–17) or lower levels of communication and daily living skills (at or below two percentile rank) of the current sample. Second, the current study’s participants presented a steeper accelerating trend in their cooking skills during intervention and a slight decrease in level (although still maintaining an accuracy of 80% or higher) during maintenance. In contrast, participants in Mechling et al. (2008) displayed a consistently zero-accelerating trend of cooking skills from the first intervention session to maintenance. The differences in the data pattern may be due to differences in participants’ initial skills during the baseline phase. Participants in the current study completed fewer steps (M = 2.53 %) during baseline compared with the participants in Mechling et al.’s (2008) study (above 20%). In addition, the cooking steps in the current study were more complex (e.g., washing, peeling, or cutting fruits; sprinkling salt; cracking eggs). The current participants also retrieved more than one object, such as a bowl and a lid, in one step. The complexity of the steps allows for the exploration of various modalities of cooking and the practice of following multistep directions.

The high comorbidity rate between ASD and various health conditions related to dietary patterns calls for effective interventions that teach meal-related tasks to individuals with ASD (Goldschmidt & Song, 2015). The current study suggests that the instruction of cooking tasks using a self-directed VP on an iPad with an SLP and reinforcement may be an effective intervention for improving the cooking skills of KA adolescents with ASD. To strengthen the social validity of the VP intervention, the researchers took into consideration the food types and cooking methods preferred by the participants and their parents. The recipes, the number of steps and ingredients, and the cooking methods were then selected after considering the nutritional benefits and balance across recipes, as well as participants’ abilities and needs. For example, all three participants made fruit and yogurt salad to address parental concerns regarding the participants’ GI conditions. However, the types and numbers of ingredients and the numbers of steps involved in making the salad differed for each participant, depending on their preferences and abilities. As learning how to cook is associated with healthy eating habits (Archuleta et al., 2012; Chu et al., 2012), cooking interventions that acknowledge students’ health conditions and abilities may teach practical skills needed for independence and benefit their physical health at the same time.

This study also intended to include individuals with CLD backgrounds in particular, and incorporate their values and preferences, as culture and ethnicity influence one’s food preferences and cooking habits (Sealy, 2010). According to Chung and colleagues (2016), Koreans place meaning, such as power, treatment, affection, and hope on their foods. For example, traditional ingredients and cooking modalities symbolize Korean history and agricultural backgrounds (Chung, 2015). With these cultural values, many Korean families practice “spoon culture,” where the family shares one large pot of soup and multiple side dishes, instead of having an individual dish for each person (Kwon et al., 2015). This cultural practice is reflected in the Korean word for family, “shikgu,” which has the meaning of “people who eat together.” Thus, the current study might provide a culturally responsive learning opportunity through the existing evidence-based practices by introducing skills for cooking foods preferred and frequently consumed by Korean families to acknowledge and preserve their cultural values of cooking and eating together.

In addition to this cultural aspect, Korean culture is also rooted in Confucian tradition in which women perform most of the cooking, cleaning, and raising of children at home (Chung, 2013). As this gender role is observed often in both Korean and KA culture, Korean immigrant mothers in the United States reported burdens related to their responsibilities at home (Kim & Kim, 2017). Considering these cultural practices, teaching domestic skills, such as cooking, to KA male adolescents could address mothers’ concerns regarding the distribution of housework across all family members. The findings from this study potentially show the benefits of teaching such skills to KA adolescents with disabilities with regard to promoting independence of both the adolescents (results from the visual analysis) and their caregivers (results from the social validity questionnaire).

The current study was the first to examine an intervention package consisting of a self-directed VP of cooking skills with an SLP and reinforcement for KA adolescents with ASD. By using their preferred language and foods, the study was responsive to the CLD backgrounds of the participants. For example, based on the parental report, Chris, as the only participant with a full-time working mother, spent less time at home or consuming Korean dishes compared with the other two participants. As a result, Chris was more exposed to, and therefore preferred, American foods. Therefore, each participant’s preference was studied and incorporated into the intervention for contextual fit and to provide an individualized natural reinforcer to each participant. Such culturally responsive procedures might affect participants’ motivation and, consequently, facilitate the process of acquisition and mastery of the introduced skills using the self-directed VP intervention package. In addition, it was important to consider the families’ involvement in and satisfaction with the intervention. Parents believed that the intervention was beneficial and expressed a strong interest in training for other independent living skills using VP. Specifically, considering the gender roles practiced in Korean families (Chung, 2013) as well as the mothers’ anecdotal concerns regarding their children’s independent living skills, the mothers sought and appreciated opportunities for their children to learn how to cook. The mothers believed that teaching such daily living skills to their children with ASD would facilitate a more balanced distribution of responsibilities at home and prepare their children for adulthood.

Limitations

There are several limitations to the study. First, although data collection was completed after ensuring reliability between two observers through training that required at least 80% agreement, there may have been a threat to internal validity, specifically regarding researcher bias, because the data were collected by the first and second authors. Second, the three participants with ASD preferred not to touch the iPad after completing some cooking steps (e.g., cracking eggs, cutting bananas, and washing fruits), which occasionally affected their behaviors during intervention. For instance, the participants were observed wiping their fingers or waving their hands in the air instead of swiping the iPad screen for the next videoclip. When the participants did not play the videoclip within 3 s after the completion of a previous step, their behavior was considered as an incorrect completion, which affected the percentage of correct completion of the cooking steps As a result, it took longer than needed for the participants to reach the mastery criterion. Third, the current study examined the independent skill to watch videoclips and complete cooking steps. Therefore, the operational definition of a “correct” completion of a step was watching the videoclip and then initiating the modeled step within 3 s. However, with the repeated exposure to the videoclips throughout the intervention phase, the participants sometimes attempted to complete a cooking step without watching the videoclip. The study procedures were limited in that this behavior was considered “incorrect” even when the participants completed the step correctly. Fourth, the researchers did not use the systematic fading procedures. However, they observed that participants needed almost no prompts to perform the steps correctly after multiple intervention sessions. Finally, the long-term sustainability and generalization of learned skills were not measured in this study.

Implications for Future Research

This study examined the implementation of a self-directed VP with an SLP and reinforcement in male adolescents with ASD and CLD backgrounds, whereas previous studies explored the effects of the intervention in both male and female participants (Mechling et al., 2008). Particularly, due to the relatively small percentage of KA adolescents with ASD in the United States and the higher male-to-female ratio in ASD diagnosis (Centers for Disease Control and Prevention, 2018), the identification of female KA adolescents with ASD was challenging. Thus, future research on interventions for CLD individuals could include both male and female adolescents to represent and understand the diverse patterns and outcomes of learning based on the participants’ different demographic characteristics. Moreover, research involving the use of tablets or mobile devices must consider the needs of participants with unique sensory processing to engage in appropriate behaviors to reorient themselves in the intervention procedures. Future research on VP should also carefully examine the criteria for correct and incorrect completion of a step to determine whether to accept the completion of steps without watching the videoclip as correct responses. Finally, as the learning of food-related independent tasks not only benefits one’s health, but also one’s ability to engage in vocational opportunities (Goldschmidt & Song, 2015), evaluating whether improvement in cooking behaviors is generalizable to novel materials and settings over time may inform researchers, practitioners, and families about the practical applications of self-directed VP for developing independence in various educational and professional contexts. As mentioned previously, the growing Asian American population in the United States, which includes KAs (Vespa et al., 2018), calls for more research investigating culturally relevant intervention for KAs. The findings from this study could add valuable information to the literature for practitioners who work with the growing CLD population. Furthermore, this study could provide preliminary evidence on ways to better understand efficient methods of cultural adaptation and accommodations for VP interventions.

Implications for Practice

The findings also provide several implications for practice. First, the cultural adaptation of deep structures (Butler & Titus, 2015) may increase students’ motivation and likelihood of utilizing the learned skills in their community. Also, this consideration may increase families’ satisfaction with and adherence to the intervention. Therefore, designing or modifying interventions that mirror the students’ experiences in their community (e.g., home, cultural group) would increase the level of familiarity and convenience when participating in intervention. Second, the cultural adaptation of surface structures (Butler & Titus, 2015) such as the families’ preferred languages may advance communication and collaboration between practitioners and families. In summary, understanding and applying diverse cultural perspectives, experiences, and backgrounds in the development and implementation of intervention may better serve CLD families and their needs (Trainor & Bal, 2014).

An implication specifically for the practice of using self-directed VP is to identify and address students’ individual needs to adapt or modify the VP intervention. In the current study, the number of intervention sessions needed to meet the mastery criterion ranged from six to eight. One participant needed a greater number of intervention sessions (eight) due to his self-stimulatory behaviors, especially when his excitement increased after watching videoclips of particular cooking steps he preferred (e.g., getting ketchup and squeezing ketchup on the plate). When the participant engaged in self-stimulatory behaviors (i.e., spinning around) and then initiated and completed the modeled step correctly, the response was considered incorrect because the initiation of the modeled step took longer than 3 s after the video’s end. When VP is applied in practice for students with self-stimulatory behaviors, it may be used with an additional component to address such behaviors (e.g., behavioral modification or modeling; NAC, 2009).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Sunyoung Kim

Veronica Y. Kang

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