Today’s post comes from Khushmol Dhaliwal. Khushmol is a graduate student in the Department of Pediatrics at the University of Alberta. She is also the current Recruitment Director of the OC-SNP National Executive.
Autism Spectrum Disorder (ASD) is among the most common developmental disorders, with a Canadian prevalence of 1 in 66 (1). ASD represents a complex set of neurological and developmental symptoms which occur on a continuum of severity (2,3). Children with ASD have been found to have higher rates of obesity than neurotypical children (4). Several factors may be contributing to this excessive weight gain in children with ASD such as idiosyncratic eating behaviors (5), reduced opportunities for physical and recreational activities (6), the use of medications (such as antipsychotics) to manage symptoms of ASD (7), and genetics (8).
Selective eating, which is described as picky eating and a limited acceptance of foods (5), is often reported among children with ASD, which may be due to factors such as abnormal oral sensory processing and consequent sensitivities to specific tastes and textures while eating (9). Frequently decreased opportunities for children with ASD to engage in recreational and physical activities with peers is reported (6). This may be due to factors such as social and behavioral challenges as children with ASD often show limits in social reciprocity skills such as turn taking (10). Furthermore, motor deficits are seen in children with ASD which may limit their ability to engage in sports (11). There are also many comorbid conditions, such as ADHD, which manifest alongside ASD (12). Psychotropics such as antipsychotics are typically prescribed to manage symptoms of ASD and comorbid conditions, which are also known to contribute to weight gain (13, 14).
So, what are the current treatments for childhood obesity? Current treatments generally involve a combination of: (15)
- non-pharmacological interventions,
- pharmacological interventions,
- surgical treatments
Typically, non-pharmacologic interventions involve behavioral treatments and weight-reducing diets (16). However, these may pose additional challenges for children with ASD who struggle with social and behavioral challenges, and potential lack of understanding on the consequences of obesity and associated diseases (17, 18). This also poses challenges for families of children with ASD to establish routines when working towards managing obesity. Pharmacologic interventions may also come with unique challenges for children with ASD who may already be on medication(s) to manage other symptoms adding to the burden of medications (19). The current rates of surgical intervention in childhood obesity is not completely understood but is often the last form of intervention and only for severe cases of obesity (15, 20). Thus, prevention of obesity and overweight remains the best approach which can begin by understanding the unique risk factors at play for children with ASD. This also highlights the need for more specifically tailored treatments and combination of techniques for children with ASD (18).
- Ofner, M.; Coles, A.; Decou, M.L.; Do, M.T.; Bienek, A.; Snider, J.; Ugnat, A.-M. Autism spectrum disorder among children and youth in Canada 2018: A report of the National Autism Spectrum Disorder Surveillance System. Available online: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/autism-spectrum-disorder-children-youth-canada-2018.html
- Karst JS, Van Hecke AV. Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation. Clinical Child And Family Psychology Review. 2012;15(3):247-277. doi:10.1007/s10567-012-0119-6
- Ousley O, Cermak T. Autism Spectrum Disorder: Defining Dimensions and Subgroups. Current Developmental Disorders Reports. 2014;1(1):20-28.
- Zheng, Z.; Zhang, L.; Li, S.; Zhao, F.; Wang, Y.; Huang, L.; Huang, J.; Zou, R.; Qu, Y.; Mu, D. Association among obesity, overweight and autism spectrum disorder: A systematic review and meta-analysis. Rep. 2017, 7, 11697.
- Bandini, L.; Curtin, C.; Phillips, S.; Anderson, S.E.; Maslin, M.; Must, A. Changes in food selectivity in children with autism spectrum disorder. Autism Dev. Disord. 2017, 47, 439–446.
- Bandini, L.G.; Gleason, J.; Curtin, C.; Lividini, K.; Anderson, S.E.; Cermak, S.A.; Maslin, M.; Must, A. Comparison of physical activity between children with autism spectrum disorders and typically developing children. Autism 2013, 17, 44–54.
- Park, S.Y.; Cervesi, C.; Galling, B.; Molteni, S.; Walyzada, F.; Ameis, S.H.; Gerhard, T.; Olfson, M.; Correll, C.U. Antipsychotic use trends in youth with autism spectrum disorder and/or intellectual disability: A meta-analysis. Am. Acad. Child. Adolesc. Psychiatry 2016, 55, 456–468.e4.
- Bachmann-Gagescu, R.; Mefford, H.C.; Cowan, C.; Glew, G.M.; Hing, A.V.; Wallace, S.; Bader, P.I.; Hamati, A.; Reitnauer, P.J.; Smith, R.; et al. Recurrent 200-kb deletions of 16p11.2 that include the SH2B1 gene are associated with developmental delay and obesity. Med. 2010, 12, 641–647
- Cermak, S.A.; Curtin, C.; Bandini, L.G. Food selectivity and sensory sensitivity in children with autism spectrum disorders. Am. Diet. Assoc. 2010, 110, 238–246.
- Leach D, LaRocque M. Increasing Social Reciprocity in Young Children With Autism. Intervention in School & Clinic. 2011;46(3):150-156. doi:10.1177/1053451209349531.
- McPhillips, M.; Finlay, J.; Bejerot, S.; Hanley, M. Motor deficits in children with autism spectrum disorder: A cross-syndrome study. Autism Res. 2014, 7, 664–676.
- Yael eLeitner. The Co- Occurrence of Autism and Attention Deficit Hyperactivity Disorder in children-what do we know? Frontiers in Human Neuroscience. 2014. doi:10.3389/fnhum.2014.00268.
- Fallah, M.S.; Shaikh, M.R.; Neupane, B.; Rusiecki, D.; Bennett, T.A.; Beyene, J. Atypical antipsychotics for irritability in pediatric autism: A systematic review and network meta-analysis. Child. Adolesc. Psychopharmacol. 2019, 29, 168–180.
- Nihalani, N.; Schwartz, T.L.; Siddiqui, U.A.; Megna, J.L. Weight gain, obesity, and psychotropic prescribing. Obes. 2011, 2011, 893629.
- Han, J.C.; Lawlor, D.A.; Kimm, S.Y.S. Childhood Obesity—2010: Progress and Challenges. Lancet 2010, 375, 1737–1748.
- Ash, T.; Agaronov, A.; Young, T.; Aftosmes-Tobio, A.; Davison, K.K. Family-based childhood obesity prevention interventions: A systematic review and quantitative content analysis. J. Behav. Nutr. Phys. Act. 2017, 14, 113.
- Leekam, S.R.; Nieto, C.; Libby, S.J.; Wing, L.; Gould, J. Describing the Sensory Abnormalities of Children and Adults with Autism. Autism Dev. Disord. 2007, 37, 894–910.
- Bennett, E.A.; Kolko, R.; Chia, L.; Elliott, J.P.; Kalarchian, M.A. Treatment of Obesity among Youth with Intellectual and Developmental Disabilities: An Emerging Role for Telenursing. J. Nurs. Res. 2017, 39, 1008–1027.
- Mohammed, M.A.; Moles, R.J.; Chen, T.F. Medication-related burden and patients’ lived experience with medicine: A systematic review and metasynthesis of qualitative studies. BMJ Open 2016, 6, e010035.
- Stylianos Roupakias, Paraskevi Mitsakou. Surgical morbidity in obese children. Asian Journal of Surgery. 2012;(3):99. doi:10.1016/j.asjsur.2012.06.008.