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Ophir Y, Rosenberg H, Tikochinski R, Dalyot S, Lipshits-Braziler Y. Screen Time and Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2346775. [PMID: 38064216 PMCID: PMC10709772 DOI: 10.1001/jamanetworkopen.2023.46775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Contemporary studies raise concerns regarding the implications of excessive screen time on the development of autism spectrum disorder (ASD). However, the existing literature consists of mixed and unquantified findings. Objective To conduct a systematic review and meta-analyis of the association between screen time and ASD. Data Sources A search was conducted in the PubMed, PsycNET, and ProQuest Dissertation & Theses Global databases for studies published up to May 1, 2023. Study Selection The search was conducted independently by 2 authors. Included studies comprised empirical, peer-reviewed articles or dissertations published in English with statistics from which relevant effect sizes could be calculated. Discrepancies were resolved by consensus. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two authors independently coded all titles and abstracts, reviewed full-text articles against the inclusion and exclusion criteria, and resolved all discrepancies by consensus. Effect sizes were transformed into log odds ratios (ORs) and analyzed using a random-effects meta-analysis and mixed-effects meta-regression. Study quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Publication bias was tested via the Egger z test for funnel plot asymmetry. Data analysis was performed in June 2023. Main Outcomes and Measures The 2 main variables of interest in this study were screen time and ASD. Screen time was defined as hours of screen use per day or per week, and ASD was defined as an ASD clinical diagnosis (yes or no) or ASD symptoms. The meta-regression considered screen type (ie, general use of screens, television, video games, computers, smartphones, and social media), age group (children vs adults or heterogenous age groups), and type of ASD measure (clinical diagnosis vs ASD symptoms). Results Of the 4682 records identified, 46 studies with a total of 562 131 participants met the inclusion criteria. The studies were observational (5 were longitudinal and 41 were cross-sectional) and included 66 relevant effect sizes. The meta-analysis resulted in a positive summary effect size (log OR, 0.54 [95% CI, 0.34 to 0.74]). A trim-and-fill correction for a significant publication bias (Egger z = 2.15; P = .03) resulted in a substantially decreased and nonsignificant effect size (log OR, 0.22 [95% CI, -0.004 to 0.44]). The meta-regression results suggested that the positive summary effect size was only significant in studies targeting general screen use (β [SE] = 0.73 [0.34]; t58 = 2.10; P = .03). This effect size was most dominant in studies of children (log OR, 0.98 [95% CI, 0.66 to 1.29]). Interestingly, a negative summary effect size was observed in studies investigating associations between social media and ASD (log OR, -1.24 [95% CI, -1.51 to -0.96]). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that the proclaimed association between screen use and ASD is not sufficiently supported in the existing literature. Although excessive screen use may pose developmental risks, the mixed findings, the small effect sizes (especially when considering the observed publication bias), and the correlational nature of the available research require further scientific investigation. These findings also do not rule out the complementary hypothesis that children with ASD may prioritize screen activities to avoid social challenges.
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Affiliation(s)
- Yaakov Ophir
- Department of Education, Ariel University, Ariel, Israel
- Centre for Human Inspired Artificial Intelligence, University of Cambridge, Cambridge, United Kingdom
| | | | - Refael Tikochinski
- Faculty of Data and Decision Sciences, Technion–Israel Institute of Technology, Haifa, Israel
| | - Shani Dalyot
- Communications Department, Sapir Academic College, Hof Ashkelon, Israel
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Must A, Eliasziw M, Stanish H, Curtin C, Bandini LG, Bowling A. Passive and social screen time in children with autism and in association with obesity. Front Pediatr 2023; 11:1198033. [PMID: 37492602 PMCID: PMC10364473 DOI: 10.3389/fped.2023.1198033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023] Open
Abstract
Background Screen time has been identified as a risk factor for childhood obesity, but the media landscape has evolved rapidly. Children with autism tend to be heavy users of screens and have an elevated prevalence of obesity. We know little about screen use patterns among children with autism vs. typically developing (TD) peers and in association with obesity. Methods Baseline data from 10,842 participants in the Adolescent Brain Cognition Development Study was used to characterize time spent with child-reported passive screen use (television/movies/watching videos), playing video games, and using social media. Duration of screen time by autism status and gender was summarized as mean time per day; obesity was defined using CDC/WHO criteria. A propensity score analysis was used to create a matched dataset for analysis. Results Overall, 1.7% of children were was identified as having autism. Significant mean differences were observed by autism status and gender for both passive viewing and playing video games. Compared to TD children, boys with autism spent more time (2.9 vs. 2.3 h, p < 0.001) watching TV, movies or videos, as did girls (3.0 vs. 2.0 h, p = 0.002). Compared to TD peers, boys with autism reported more video game time (102.7 vs. 77.5 min, p = 0.001), as did girls with autism (64.4 vs. 37.9 min, p = 0.03); girls with autism also spent more time on social media sites or video chat (45.5 vs. 21.9 min, p = 0.04). Overall, obesity prevalence increased with increasing screen time duration, significantly for passive screen time (p-value = 0.002) and texting (p-value = 0.02). Associations between obesity and screen time duration did not differ by autism status. Discussion Children with autism spend more time playing video games and on passive and social screen activities than their TD peers, with some variations by gender. High rates of social media use among girls with autism and multiplayer video game use among both boys and girls with autism may challenge the notion that the high levels of screen time reflect social isolation in the group. Given potential positive aspects of screen time in children with autism movement to focus on content and context is appropriate.
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Affiliation(s)
- Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Heidi Stanish
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts-Boston, Boston, MA, United States
| | - Carol Curtin
- E.K. Shriver Center, UMASS Chan Medical School, Worcester, MA, United States
| | - Linda G. Bandini
- E.K. Shriver Center, UMASS Chan Medical School, Worcester, MA, United States
| | - April Bowling
- E.K. Shriver Center, UMASS Chan Medical School, Worcester, MA, United States
- Department of Nursing and Health Sciences, Merrimack College, Andover, MA, United States
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Özbaran NB, Erbasan Zİ, Balki HG, Gökşen Şimşek RD. Is Bariatric Surgery an Option for Obesity in Autism Spectrum Disorder?: A Case Report. J Nerv Ment Dis 2023; 211:407-410. [PMID: 37040143 DOI: 10.1097/nmd.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and interaction, stereotypical behaviors, and restricted interests or activities present during early periods of development. Obesity, which is an important public health problem, is also becoming a serious problem in individuals with ASD. In this case report, we aimed to represent the multidisciplinary medical and psychiatric treatment of a 16-year-old adolescent with ASD and obesity who was consulted for bariatric surgery.
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Affiliation(s)
| | | | - Hanife Gül Balki
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, İzmir, Turkey
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Ketcheson L, Staples K, Pitchford EA, Loetzner F. Promoting Positive Health Outcomes in an Urban Community-Based Physical Activity Intervention for Preschool Aged Children on the Autism Spectrum. J Autism Dev Disord 2023; 53:633-647. [PMID: 33459918 PMCID: PMC7812710 DOI: 10.1007/s10803-021-04871-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 12/18/2022]
Abstract
While there is wide consensus regarding the importance of early intervention, health is rarely considered within priorities. Twenty-five children on the autism spectrum (Mage = 4.67, SD = 0.82) participated in a 12-week physical activity intervention. Primary objective was to examine impact of a physical activity intervention on physical activity, fitness and motor competence. Secondary objective was to examine associations between motor behavior and ASD symptoms. Ball skills (p < .001) and isometric push-up performance (p = .02) improved. Autism symptoms were associated with motor skills (r > - .49, p < .05). Study outcomes provide new knowledge regarding design, delivery, and measures for early interventions targeting health disparities in young children on the autism spectrum.
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Affiliation(s)
- Leah Ketcheson
- Department of Kinesiology, Health and Sport Studies, Wayne State University, 5101 John C Lodge Fwy, 257 Matthaei, Detroit, MI, 48202, USA.
| | - Kerri Staples
- School of Kinesiology, Center On Physical Activity & Health in Pediatric Disabilities, University of Michigan, 1402 Washington Hts, Ann Arbor, MI 48109 USA
| | - Edward Andrew Pitchford
- Department of Kinesiology, Iowa State University, 534 Wallace Road, 103n Forker, Ames, IA 50011 USA
| | - Franziska Loetzner
- Department of Kinesiology, Health and Sport Studies, Wayne State University, 5101 John C Lodge Fwy, 257 Matthaei, Detroit, MI 48202 USA
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Ahlberg R, Garcia-Argibay M, Hirvikoski T, Boman M, Chen Q, Taylor MJ, Frans E, Bölte S, Larsson H. Shared familial risk factors between autism spectrum disorder and obesity - a register-based familial coaggregation cohort study. J Child Psychol Psychiatry 2022; 63:890-899. [PMID: 34881437 DOI: 10.1111/jcpp.13538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Meta-analyses suggest an association between autism spectrum disorder (ASD) and obesity, but the factors underlying this association remain unclear. This study investigated the association between ASD and obesity stratified on intellectual disability (ID). In addition, in order to gain insight into possible shared etiological factors, the potential role of shared familial liability was examined. METHOD We studied a cohort of 3,141,696 individuals by linking several Swedish nationwide registers. We identified 35,461 individuals with ASD and 61,784 individuals with obesity. Logistic regression models were used to estimate the association between ASD and obesity separately by ID and sex and by adjusting for parental education, psychiatric comorbidity, and psychotropic medication. Potential shared familial etiologic factors were examined by comparing the risk of obesity in full siblings, maternal and paternal half-siblings, and full- and half-cousins of individuals with ASD to the risk of obesity in relatives of individuals without ASD. RESULTS Individuals with ASD + ID (OR = 3.76 [95% CI, 3.38-4.19]) and ASD-ID (OR = 3.40 [95% CI, 3.23-3.58]) had an increased risk for obesity compared with individuals without ASD. The associations remained statistically significant when adjusting for parental education, psychiatric comorbidity, and medication. Sex-stratified analyses indicated a higher relative risk for males compared with females, with statistically significant interaction effects for ASD-ID, but not for ASD+ID in the fully adjusted model. First-degree relatives of individuals with ASD+ID and ASD-ID had an increased risk of obesity compared with first-degree relatives of individuals without ASD. The obesity risk was similar in second-degree relatives of individuals with ASD+ID but was lower for and ASD-ID. Full cousins of individuals with ASD+ID had a higher risk compared with half-cousins of individuals with ASD+ID). A similar difference in the obesity risk between full cousins and half-cousins was observed for ASD-ID. CONCLUSIONS Individuals with ASD and their relatives are at increased risk for obesity. The risk might be somewhat higher for males than females. This warrants further studies examining potential common pleiotropic genetic factors and shared family-wide environmental factors for ASD and obesity. Such research might aid in identifying specific risks and underlying mechanisms in common between ASD and obesity.
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Affiliation(s)
- Richard Ahlberg
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Tatja Hirvikoski
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet & Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Habilitation & Health, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Marcus Boman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven Bölte
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet & Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Comparison of Physical Activity Between Children With and Without Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Adapt Phys Activ Q 2022; 39:456-481. [PMID: 35405634 DOI: 10.1123/apaq.2021-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Lower levels of physical activity (PA) are often observed among children with autism spectrum disorder (ASD) compared to children without ASD; however, some studies have demonstrated few to no PA differences between the two groups. The purpose of this systematic review with meta-analysis was to compare the differences in PA between children (2-18 years) with and without ASD. An exhaustive search of five online databases was completed, and 31 studies met the inclusion criteria. A pooled random-effects Hedges's g model was used to determine differences in PA between children with and without ASD. Children with ASD were found to be significantly less physically active than children without ASD (Δ = -0.62, p < .001). Subgroup analyses revealed significant moderate to large differences in PA by intensity level, age, setting, and measurement methods. Future studies are needed to further explore the underlying mechanisms associated with lower levels of PA among children with ASD.
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Manzanarez B, Garcia S, Iverson E, Lipton-Inga MR, Blaine K. Lessons in Adapting a Family-Based Nutrition Program for Children With Autism. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1038-1047. [PMID: 34895557 DOI: 10.1016/j.jneb.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the adaptation and implementation of an existing, evidence-based nutrition program for children with autism and their parents. METHODS Children aged 7-12 years with autism and their parent participated in 6 weekly sessions. Recruitment, intervention, and data collection took place in a community health center in an urban area. RESULTS Of the 50 referred participants, 38% attended the first classes, and 26% completed the program. Families and staff expressed satisfaction; parents reported increased physical activity, fruit, and vegetable intake in their children. Parents also desired continued learning and individualized recommendations. CONCLUSIONS AND IMPLICATIONS Adapting family-centered nutrition programs can positively influence diet behaviors in children with autism. As many children with autism battle with obesity, the findings from this pilot provide important insight into supporting these families and can further inform the development of evidence-based practices currently lacking for children with autism and their families.
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Affiliation(s)
- Brenda Manzanarez
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Samantha Garcia
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ellen Iverson
- The Diabetes and Obesity Program and Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Megan R Lipton-Inga
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kevin Blaine
- California-based Nurse-led Discharge Learning (CANDLE) Collaborative, Institute for Nursing and Interprofessional Research, Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA
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Correlates of obesity in adolescents with and without autism spectrum disorder: The 2017-2018 National Survey of Children's Health. Disabil Health J 2021; 15:101221. [PMID: 34654677 DOI: 10.1016/j.dhjo.2021.101221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence of autism spectrum disorder (ASD) and childhood obesity are increasing, and youth with ASD are at an increased risk of obesity compared to typically developing youth. Specific obesity risk factors in adolescents with ASD remain poorly understood. OBJECTIVE This study examined correlates of obesity among adolescents with and without ASD using extant 2017-2018 National Survey of Children's Health (NSCH) data. METHODS This cross-sectional study examined the co-occurrence of obesity among US adolescents with ASD aged 10-17 years compared to those without ASD, adjusting for sociodemographic characteristics, co-occurring conditions, and relevant covariates, using 2017-2018 NSCH data. Multiple logistic regression was used to compare the odds of obesity among children with mild ASD, moderate/severe ASD, and without ASD. RESULTS Odds of obesity were higher in adolescents with ASD compared to adolescents without ASD (cOR 1.9, CI 1.3-2.7). In the adjusted model, the odds of obesity were not significantly higher in those with mild or moderate/severe ASD compared to those without ASD. Odds of obesity were higher for all adolescents who were Hispanic or Black, as well as those with lower household income or with one or more co-occurring conditions. CONCLUSIONS The association between obesity and ASD in this study highlights the need for greater attention to nutrition, physical activity, and co-occurring conditions among adolescents with ASD. Effective interventions to curtail the risks among racial/ethnic minority adolescents and adolescents with lower household income are needed. Further research is needed to examine additional factors associated with obesity in adolescents with ASD, including family, community, organizational, and policy factors.
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Shurack RH, Garcia JM, Brazendale K, Lee E. Brief Report: Feasibility and Acceptability of a Remote-Based Nutrition Education Program for Adolescents with Autism Spectrum Disorder: A COVID-19 Pilot Study. J Autism Dev Disord 2021; 52:4568-4574. [PMID: 34611836 PMCID: PMC8491746 DOI: 10.1007/s10803-021-05301-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
To examine the feasibility and acceptability of a remote-based nutrition education program during COVID-19 for adolescents with autism spectrum disorder (ASD). Ten adolescents with ASD participated in a 4-week nutrition education program utilizing Zoom software during COVID-19. Topics included shopping for healthy food, and food preparation safety measures. Attendance was collected for each session. Participants, parents, and the classroom teacher completed post-program surveys and interviews. The course attendance rate was 97%. Every adolescent reported they would participate in similar future programs, and the teacher/parents felt the program was a positive experience for the participants. The remote-based nutrition education program appeared to be feasible and acceptable to participants. Future research should focus on program efficacy.
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Affiliation(s)
- Riley H Shurack
- College of Health Professions & Sciences, University of Central Florida, 12805 Pegasus Drive, Orlando, FL, 32816, USA
| | - Jeanette M Garcia
- College of Health Professions & Sciences, University of Central Florida, 12805 Pegasus Drive, Orlando, FL, 32816, USA.
| | - Keith Brazendale
- College of Health Professions & Sciences, University of Central Florida, 12805 Pegasus Drive, Orlando, FL, 32816, USA
| | - Eunkyung Lee
- College of Health Professions & Sciences, University of Central Florida, 12805 Pegasus Drive, Orlando, FL, 32816, USA
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Parental Feeding Practices and Child-Related Factors are Associated with Overweight and Obesity in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:3655-3667. [PMID: 34453670 DOI: 10.1007/s10803-021-05247-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Atypical eating behaviors displayed by children with autism spectrum disorder (ASD) predispose them to unhealthy weight gain. We determined the factors associated with body weight status among 261 children with ASD (3-18 years) at nine autism intervention centers. Their mothers completed a self-administered questionnaire on sociodemographic background, parenting style, parental feeding practices, parenting stress, sleep habits, eating behaviors, and autism severity. Children with older age, non-full term gestational age, high maternal perceived weight, high maternal concern about child weight, and low pressure to eat were more likely to be overweight and obese. Obesity is a major concern among children with ASD. Healthy weight management programs for parents should incorporate appropriate feeding practices and a healthy perception of body weight.
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Köse S, Yılmaz Kafalı H, Erkan İdris ZG, Şentürk Pilan B, Özbaran B, Erermiş S. The prevalence and risk factors for overweight/obesity among Turkish children with neurodevelopmental disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 114:103992. [PMID: 34049231 DOI: 10.1016/j.ridd.2021.103992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/24/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the prevalence and correlates of overweight (OW) and obesity (OB) between autism spectrum disorder (ASD), intellectual disability (ID), and attention deficit-hyperactivity disorder (ADHD) and to investigate which variables significantly contribute to OW/OB in each group. METHODS Of 267 cases (96 with ASD, 80 with ID, and 91 with ADHD) aged 2-18 years, body mass index (BMI) percentiles, birth weight, food reward usage, weekly screen and physical activity time, and psychotropics used were recorded. RESULTS OB (OB + OW) prevalence was 22.9 % (36.4 %) in ASD; 22.5 % (40 %) in ID; and 17.6 % (27.5 %) in ADHD. Although the ADHD group had the highest rate of stimulant usage (χ2 = 69.605, p < 0.001), physical activity attendance (χ2 = 49.751, p < 0.001), and the lowest anti-psychotic (χ2 = 69.142, p < 0.001), and anti-depressant usage (χ2 = 7.219, p < 0.001) than ID/DD or ASD, BMI percentile of the participants did not differ between the groups (H(2) = 1.652, p = 0.43). In hierarchical logistic regression analysis, in ASD, food reward (OR = 4.65, 95 %Cl = 1.25-17.19) and the number of psychotropics used (OR = 2.168, 95 %Cl = 1.07-4.36) were significantly related to the risk of OW/OB. In ADHD, each drugs administered and a 1-kilogram elevation in birth weight was associated with a 4.09 and 2.82 increased risk for OW/OB. CONCLUSION OW/OB is prevalent in children with neurodevelopmental disorders regardless of their diagnosis. Our findings showed that food rewards put a higher risk for OW/OB in ASD than administering a psychotropic. It could be better to use other positive reinforcements other than edible ones to prevent OW/OB in these children.
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Affiliation(s)
- Sezen Köse
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
| | - Helin Yılmaz Kafalı
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
| | | | - Birsen Şentürk Pilan
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
| | - Burcu Özbaran
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
| | - Serpil Erermiş
- Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
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Ketcheson LR, Pitchford EA. Promoting physical activity participation and nutrition education through a telehealth intervention for children on the autism spectrum and their caregivers. Contemp Clin Trials 2021; 107:106496. [PMID: 34216816 DOI: 10.1016/j.cct.2021.106496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/14/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
There is growing empirical support which suggests children on the autism spectrum, as well as their caregivers experience significant health disparities. The global COVID-19 pandemic has only magnified the need to address health among vulnerable populations. While there has been a growing trend in the delivery of telehealth interventions, the delivery of such methods for children on the autism spectrum, and their caregivers remains relatively under examined. The primary goal of PLANE (Physical Literacy And Nutrition Education) is to promote positive trajectories of health for children on the autism spectrum and their primary caregivers through the delivery of a telehealth physical activity and nutrition education program. The study is a pre-experimental analysis of PLANE across 12 months. All activities will be delivered virtually through weekly synchronous and asynchronous programming. A total of 180 participants will be enrolled in this intervention, including children on the autism spectrum and caregivers. Each week a new physical activity skill along with opportunities for recipe assembly will be delivered remotely. Supplemental material will be disseminated online including; step by step directions outlining behavioral skill methodology, opportunities for additional skill practice, and reading material that support weekly topics. Study outcomes will be examined in the parent-child dyad and include rates of overweight/obesity, physical activity, nutrition and quality of life. Finally, feasibility of the telehealth intervention will also be measured. Justification for the conceptualization and delivery of PLANE is well warranted, and PLANE represents a promising intervention which is scalable, sustainable, and replicable.
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Affiliation(s)
| | - E Andrew Pitchford
- Iowa State University, 111D Forker, 534 Wallace Rd, Ames, IA 50011, United States of America.
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Howard PL, Sedgewick F. 'Anything but the phone!': Communication mode preferences in the autism community. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2265-2278. [PMID: 34169750 DOI: 10.1177/13623613211014995] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT What is already known about the topic?There has been a lot of research into things like how autistic people's communication styles are different to those of non-autistic people, especially among children. This has tended to focus on parent reports and experiments, rather than asking autistic people about their own experiences and preferences regarding communication.What does this article add?This article is the first to ask autistic adults how they prefer to communicate in different scenarios. We asked whether they preferred to use a range of methods, such email, phone calls, letters and live messaging, in scenarios from education to customer services to friends and family. When contacting unknown people or organisations, we found that generally email was preferred, and phone calls were very unpopular. However, for friends, family and people they felt comfortable with, they preferred both face-to-face and written forms of communication (e.g. email and text message).Implications for practice, research or policyThe findings suggest that services should move away from a reliance on phone calls for communication. They should make sure that access to support is not dependent on the phone, and instead offer written options such as email and live messaging which are more accessible. Future research should investigate the impact of COVID-19 on autistic people's communication preferences, as video calling has become much more commonly used and potentially combines benefits and challenges of other modes discussed in this article.
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Killian HJ, Pallotto IK, Sweeney BR, Dreyer Gillette ML. Weight Management Outcomes of Youth with Autism Spectrum Disorder Seeking Treatment from a Multidisciplinary Team. J Autism Dev Disord 2021; 52:791-799. [PMID: 33791886 PMCID: PMC8011772 DOI: 10.1007/s10803-021-04982-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/02/2022]
Abstract
Youth with Autism Spectrum Disorder (ASD) are at an increased risk for developing obesity when compared to their typically developing peers. Given higher prevalence of obesity in youth with ASD, understanding factors relating to success in obesity treatment provides insight into implementing efficacious treatments for youth. The current study examines age, sleep, and metabolic factors potentially affecting success in 74 youth (Mage = 11.66) attending a multidisciplinary weight management treatment program over a year. Multilevel modeling indicated that higher baseline BMI class category, medications at baseline, and absence of sleep difficulties predicted greater reduction in BMI after a year of treatment.
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Affiliation(s)
- Haley J Killian
- Department of Psychology, The University of Missouri - Kansas City, 5030 Cherry St, Kansas City, MO, 64110, USA
| | - Isabella K Pallotto
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Brooke R Sweeney
- Department of Pediatrics, Weight Management and Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City/University of Missouri Kansas City School of Medicine, 2401 Gillham Rd., Kansas City, MO, 64108, USA
| | - Meredith L Dreyer Gillette
- Department of Pediatrics, Developmental and Behavioral Health and Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City/University of Missouri Kansas City School of Medicine, 2401 Gillham Rd., Kansas City, MO, 64108, USA.
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15
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Pan CY, Tsai CL, Chen FC, Chow BC, Chen CC, Chu CH. Physical and Sedentary Activity Patterns in Youths with Autism Spectrum Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041739. [PMID: 33670129 PMCID: PMC7916824 DOI: 10.3390/ijerph18041739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022]
Abstract
Little is known about the patterns of sedentary behavior and physical activity (PA) within different school levels (i.e., primary school and secondary school) and on different day types (i.e., weekdays and weekend days) among youths with autism spectrum disorder (ASD). The sample was recruited from one city in Taiwan. A total of 68 male youths with ASD, aged 6–17 years, participated in the study. PA was assessed using an ActiGraph accelerometer, and sedentary behaviors (i.e., TV viewing, computer use, and reading time) were determined using a self-report log. The main findings were that (a) primary school youths with ASD were more active than secondary school youths with ASD on both weekdays and weekend days, but primary school youths with ASD also had more sedentary time than did secondary school youths with ASD on both weekdays and weekend days; (b) secondary school youths with ASD were more active but also more sedentary on weekdays compared with weekend days, but they had more screen use on weekend days compared with on weekdays. Future interventions are required to decrease sedentary behavior and increase PA to improve the health of these youths according to school level and day of the week.
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Affiliation(s)
- Chien-Yu Pan
- Department of Physical Education, National Kaohsiung Normal University, No.116, He-Ping First Road, Kaohsiung 802, Taiwan; (C.-Y.P.); (F.-C.C.)
| | - Chia-Liang Tsai
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan 701, Taiwan;
| | - Fu-Chen Chen
- Department of Physical Education, National Kaohsiung Normal University, No.116, He-Ping First Road, Kaohsiung 802, Taiwan; (C.-Y.P.); (F.-C.C.)
| | - Bik C. Chow
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China;
| | - Chih-Chia Chen
- Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA;
| | - Chia-Hua Chu
- Department of Physical Education, National Kaohsiung Normal University, No.116, He-Ping First Road, Kaohsiung 802, Taiwan; (C.-Y.P.); (F.-C.C.)
- Correspondence: ; Tel.: +886-7-7172-930 (ext. 3533); Fax: +886-7-7114-633
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16
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Eliasziw M, Kral TV, Segal M, Sikich L, Phillips S, Tybor DJ, Bandini LG, Curtin C, Must A. Healthy-Weight Kindergarten Children with Autism Spectrum Disorder May Become Overweight and Obese during the First Few Years of Elementary School. THE JOURNAL OF PEDIATRICS: X 2021. [DOI: 10.1016/j.ympdx.2021.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Li YJ, Xie XN, Lei X, Li YM, Lei X. Global prevalence of obesity, overweight and underweight in children, adolescents and adults with autism spectrum disorder, attention-deficit hyperactivity disorder: A systematic review and meta-analysis. Obes Rev 2020; 21:e13123. [PMID: 32783349 DOI: 10.1111/obr.13123] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022]
Abstract
Individuals with autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD) may have unhealthy bodyweight. This meta-analysis was performed to understand the weight status in individuals with ASD or ADHD. PubMed, Embase, Cochrane and ISI Web of Science databases were searched from inception until June 2020 to identify relevant studies. Prevalence estimates and their 95% confidence intervals (CIs) of obesity, overweight and underweight were separately pooled using random-effects models. A total of 95 studies were included in the meta-analysis. The pooled estimates of the prevalence of obesity, overweight and underweight were 21.8%, 19.8% and 6.4% in individuals with ASD and 14.7%, 20.9% and 4.0% in individuals with ADHD. In subgroup analyses, an increasing trend in the prevalence of unhealthy weight was observed from children aged 2 to 5 years to adults with ASD (obesity: from 16.7% to 31.3%, overweight: from 16.2% to 27.2%, underweight from 5.3% to 8.6%) and from children aged 6 to 12 years to adults with ADHD (obesity: from 13.5% to 19.3%, overweight: from 18.8% to 31.2%). The worrisome epidemic of obesity and overweight in individuals with ASD, ADHD highlighted the need for weight management.
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Affiliation(s)
- Yong-Jiang Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xue-Ni Xie
- Shuda College, Hunan Normal University, Changsha, China
| | - Xue Lei
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Ya-Min Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianyang Lei
- Office of the President, Central South University, Changsha, China
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18
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Healy S, Brewer B, Garcia J, Daly J, Patterson F. Sweat, Sit, Sleep: A Compositional Analysis of 24-hr Movement Behaviors and Body Mass Index among Children with Autism Spectrum Disorder. Autism Res 2020; 14:545-550. [PMID: 33186491 DOI: 10.1002/aur.2434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022]
Abstract
This study (a) examined the daily composition of 24-hr movement behaviors in children with ASD using objective measures, and (b) applied compositional analysis to examine the associations of the time spent in moderate-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior (SB), and sleep duration (SD) with body mass index (BMI), relative to the time spent in the other movement behaviors in a sample of children (aged 7-19 years) with ASD. Time spent in MVPA, LPA, SB, and SD were measured using accelerometers over a 7-day period. BMI was calculated from measured height and weight. Participants (n = 46) spent 40% of time in LPA (M = 9.6 hr), 30.6% (M = 7.34 hr) in SB, 24.9% (M = 5.98 hr) asleep, and 4.5% (M = 64.8 min) in MVPA. Reallocating 30 min from LPA to SD decreased BMI by 0.471 kg/m2 (P = 0.003). Reallocating 30 min from MVPA to SD decreased BMI by 0.658 kg/m2 (P = 0.051). Reallocation of 60 min in equal proportions from SB, MVPA, and SD to LPA increased BMI by 0.418 kg/m2 (P = 0.021), and reallocation of 60 min in equal proportions from LPA, MVPA, and SD to SB increased BMI by 0.295 kg/m2 (P = 0.052). Finally, reallocation of 60 min in equal proportions from SB, LPA, and MVPA to SD decreased BMI by -0.845 kg/m2 (P = 0.001). LAY SUMMARY: Data was collected on time spent in light physical activity (LPA), moderate-vigorous physical activity (MVPA), sedentary behavior (SB), and sleep in 46 children with autism. The sample had insufficient sleep (a mean of 6 hr/night). We showed that replacing 30 min of LPA or MVPA with sleep decreased BMI. Also, moving 60 min to LPA or SB from the remaining movement behaviors (i.e., 20 min from each) increased BMI, and moving 60 min to sleep from the remaining behaviors decreased BMI.
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Affiliation(s)
- Sean Healy
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Benjamin Brewer
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Jeanette Garcia
- College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | | | - Freda Patterson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
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19
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Developmental-Behavioral Pediatricians' Diagnosis and Coding of Overweight and Obesity in Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2020; 41:258-264. [PMID: 32040046 DOI: 10.1097/dbp.0000000000000783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The prevalence of obesity in autism spectrum disorder (ASD) is high, and managing obesity in children with ASD can be challenging. The study's objective was to examine developmental-behavioral pediatricians' (DBPs) coding practices for overweight/obesity in children with ASD and patient characteristics associated with coding. METHODS We analyzed the clinical data on children with ASD with at least 1 visit at one of 3 developmental-behavioral pediatrics network sites between January 2010 and December 2011. Weight status was calculated using body mass index z-scores. For children meeting the criteria for overweight/obesity, we assessed the frequency of weight-related ICD-9 diagnosis codes at DBP visits, used multivariable logistic regression to determine characteristics associated with the presence of these codes, and examined the prevalence of weight-related codes relative to other diagnosis codes. RESULTS The sample included 4542 children, ages 2 to 19 years. 15.5% of children met the criteria for overweight, 14.7% for obesity, and 6.3% for severe obesity. Of children meeting the criteria for overweight/obesity/severe obesity, 7.5% had a weight-related code documented at their visits. Children with obesity or severe obesity and older children had higher odds of having a weight-related code. Compared with not being on medications, atypical antipsychotics use was significantly associated with increased odds of having a weight-related code. Of 3802 unique ICD-9 diagnosis codes documented at any visit during the study period, only 4% were related to weight. CONCLUSION Few children meeting the criteria for overweight/obesity had documented weight-related codes. Weight-related coding was more likely for children with obesity, who were older, and those taking atypical antipsychotics.
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20
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Curtin C, Hyman SL, Boas DD, Hassink S, Broder-Fingert S, Ptomey LT, Gillette MD, Fleming RK, Must A, Bandini LG. Weight Management in Primary Care for Children With Autism: Expert Recommendations. Pediatrics 2020; 145:S126-S139. [PMID: 32238539 DOI: 10.1542/peds.2019-1895p] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP's 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be noted that these recommendations do not reflect official AAP policy. Many of the AAP recommendations remain appropriate for primary care practitioners to implement with their patients with ASD; however, the significant challenges experienced by this population in both dietary and physical activity domains, as well as the stress experienced by their families, require adaptations and modifications for both preventive and intervention efforts. These recommendations can assist pediatric providers in providing tailored guidance on weight management to children with ASD and their families.
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Affiliation(s)
- Carol Curtin
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts; .,Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Susan L Hyman
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Rochester Medical Center, Rochester, New York
| | - Diane D Boas
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,The Barbara Bush Children's Hospital, Maine Medical Center, Portland, Maine
| | - Sandra Hassink
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, Illinois
| | - Sarabeth Broder-Fingert
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Boston Medical Center and School of Medicine, Boston University, Boston, Massachusetts
| | - Lauren T Ptomey
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Kansas Medical Center, Kansas City, Kansas
| | - Meredith Dreyer Gillette
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Richard K Fleming
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Massachusetts Boston, Boston, Massachusetts
| | - Aviva Must
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,School of Medicine, Tufts University, Boston, Massachusetts; and
| | - Linda G Bandini
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, Massachusetts.,Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
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21
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The Association Between Somatic Health, Autism Spectrum Disorder, and Autistic Traits. Behav Genet 2019; 50:233-246. [PMID: 31811521 PMCID: PMC7355269 DOI: 10.1007/s10519-019-09986-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023]
Abstract
This study used a twin cohort to investigate the association of autism spectrum disorder (ASD) and autistic traits with somatic health. A total of 344 twins (172 pairs; mean age 15.56 ± 5.62 years) enriched for ASD and other neurodevelopmental conditions were examined. Medical history and current physical problems were collected with a validated questionnaire to determine twin’s somatic health. The Social Responsiveness Scale (SRS-2) was used to measure the participant’s severity of autistic traits. Identified somatic health issues with significant within-twin pair differences were tested in relation to both ASD diagnosis and autistic traits in a co-twin control model. Twins with ASD exhibited more neurological and immunological health problems compared to those without ASD (p = 0.005 and p = 0.004, respectively). The intra-pair differences of neurological conditions and SRS-2 score were significantly correlated in monozygotic twins differing for autism traits (r = 0.40, p = 0.001), while the correlation was not found for immunological problems. In addition, a conditional model for analysis of within-twin pair effects revealed an association between neurological problems and clinical ASD diagnosis (Odds ratio per neurological problem 3.15, p = 0.02), as well as autistic traits (β = 10.44, p = 0.006), after adjusting for possible effects of co-existing attention deficit hyperactivity disorder and general intellectual abilities. Our findings suggest that neurological problems are associated with autism, and that non-shared environmental factors contribute to the overlap for both clinical ASD and autistic traits. Further population-based twin studies are warranted to validate our results and examine in detailed the shared genetic and environmental contributions of neurological problems and ASD.
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22
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McCoy SM, Morgan K. Obesity, physical activity, and sedentary behaviors in adolescents with autism spectrum disorder compared with typically developing peers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:387-399. [PMID: 31364386 DOI: 10.1177/1362361319861579] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Decreased engagement in beneficial physical activity and increased levels of sedentary behavior and unhealthy weight are a continued public health concern in adolescents. Adolescents with autism spectrum disorder may be at an increased risk compared with their typically developing peers. Weekly physical activity, sedentary behavior, and body mass index classification were compared among adolescents with and without autism spectrum disorder. Analyses included 33,865 adolescents (autism spectrum disorder, n = 1036) from the 2016-2017 National Survey of Children's Health (United States). After adjustment for covariates, adolescents with autism spectrum disorder were found to engage in less physical activity and were more likely to be overweight and obese compared with their typically developing peers (p's < 0.05). As parent-reported autism spectrum disorder severity increased, the adjusted odds of being overweight and obese significantly increased and physical activity participation decreased (p-for-trends < 0.001). The findings suggest there is a need for targeted programs to decrease unhealthy weight status and support physical activity opportunities for adolescents with autism spectrum disorder across the severity spectrum.
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23
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Liang S, Li Z, Wang Y, Li X, Yang X, Zhan X, Huang Y, Gao Z, Zhang M, Sun C, Zhang Y, Wu L. Genome-Wide DNA Methylation Analysis Reveals Epigenetic Pattern of SH2B1 in Chinese Monozygotic Twins Discordant for Autism Spectrum Disorder. Front Neurosci 2019; 13:712. [PMID: 31379474 PMCID: PMC6660254 DOI: 10.3389/fnins.2019.00712] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/24/2019] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Aberrant DNA methylation has been observed in ASD but the mechanisms remain largely unknown. Here, we employed discordant monozygotic twins to investigate the contribution of DNA methylation to ASD etiology. Genome-wide DNA methylation analysis was performed using samples obtained from five pairs of ASD-discordant monozygotic twins, which revealed a total of 2,397 differentially methylated genes. Further, such gene list was annotated with Kyoto Encyclopedia of Genes and Genomes and demonstrated predominant activation of neurotrophin signaling pathway in ASD-discordant monozygotic twins. The methylation of SH2B1 gene was further confirmed in the ASD-discordant, ASD-concordant monozygotic twins, and a set of 30 pairs of sporadic case-control by bisulfite-pyrosequencing. The results showed that there was a greater DNA methylation difference in ASD-discordant monozygotic twins than ASD-concordant monozygotic twins. Further, verification of the Chr.16:28856743 of SH2B1 showed significant differences in DNA methylation between case and control. These results suggest abnormal methylation of SH2B1 is associated with ASD etiology. Our data suggest that it might be worthwhile to further explore the functions of SH2B1 and related genes of neurotrophin signaling pathway in ASD.
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Affiliation(s)
- Shuang Liang
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
| | - Zhenzhi Li
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC, United States
| | - Yihan Wang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Xiaodan Li
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
| | - Xiaolei Yang
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
| | - Xiaolei Zhan
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
| | - Yan Huang
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
| | - Zhaomin Gao
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
| | - Min Zhang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Caihong Sun
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
| | - Yan Zhang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Lijie Wu
- Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, China
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24
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Digital Media and Autism Spectrum Disorders: Review of Evidence, Theoretical Concerns, and Opportunities for Intervention. J Dev Behav Pediatr 2019; 40:364-368. [PMID: 30973425 PMCID: PMC6579611 DOI: 10.1097/dbp.0000000000000664] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the digital media landscape becomes more complex, individualized, and interactive, pediatric providers often find themselves asked to be the source of guidance for children with developmental and behavioral conditions such as autism spectrum disorder (ASD). In this brief report, we review the current literature that exists regarding the use of traditional media (e.g., TV, video games) in children with ASD. We then outline a conceptual framework to describe the interaction between ASD-specific developmental and behavioral vulnerabilities and the aspects of new media (e.g., mobile devices, interactive apps, streaming video services) that could lead to problematic media use. This conceptual framework is then applied to clinical implications for how to prevent and manage problematic media usage in ASD and how to use modern media as tools to support optimal development.
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25
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Healy S, Aigner CJ, Haegele JA, Patterson F. Meeting the 24-hr movement guidelines: An update on US youth with autism spectrum disorder from the 2016 National Survey of Children's Health. Autism Res 2019; 12:941-951. [PMID: 30892834 PMCID: PMC6867706 DOI: 10.1002/aur.2095] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/04/2019] [Accepted: 02/28/2019] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to examine how adherence to the physical activity (PA), screen-time (ST), and sleep duration guidelines differ between youth with autism spectrum disorder (ASD) and youth with typical development (TD). A secondary objective was to assess how PA, ST, and sleep duration varied among youth with ASD by age and ASD severity. Utilizing the 2016 National Survey of Children's Health data, parental reports of time spent by youth in PA, ST, and sleep were used to determine adherence to the 24-hr movement guidelines for 1008 youth with ASD and 34 489 youth with TD. Multivariate logistic regression analyses determined that children with ASD were less likely to meet the guidelines for PA, ST, and sleep duration, and adolescents with ASD were less likely to meet the guidelines for PA and ST than participants with TD. Furthermore, logistic regression analyses determined adolescents with severe ASD to be less likely to meet the sleep guideline compared to adolescents with mild ASD. Overall, youth with ASD were significantly less likely to adhere to all three guidelines. The findings highlight the breadth of health behaviors that require intervention to counteract the poorer health status among youth with ASD. Autism Res 2019, 12: 941-951. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: New health recommendations suggest children and adolescents should have at least 1 hr of physical activity, no more than 2 hr of screen-time (e.g., television), and 9-11 hr of sleep (or 8-10 hr for children aged 14 or older) every day. This article looked at how children and adolescents with autism meet these new guidelines. The two main results were that: (a) children with autism were less likely to meet all three guidelines compared to children without autism, and (b) adolescents with autism were less likely to meet the guidelines for physical activity and screen-time.
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Affiliation(s)
- Seán Healy
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware
| | - Carrie J Aigner
- Department of Psychology, Humboldt State University, Arcata, California
| | - Justin A Haegele
- Department of Human Movement Sciences, Old Dominion University, Norfolk, Virginia
| | - Freda Patterson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware
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26
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Slobodin O, Heffler KF, Davidovitch M. Screen Media and Autism Spectrum Disorder: A Systematic Literature Review. J Dev Behav Pediatr 2019; 40:303-311. [PMID: 30908423 DOI: 10.1097/dbp.0000000000000654] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous studies suggest that psychiatric disorders are associated with problematic use of screen media. This article systematically reviews the literature on the associations between screen media and autism spectrum disorder (ASD). The review uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHOD Electronic databases were searched from inception to April 2018, using the term "ASD/autism" along with one of the following terms: "screen time"/"media"/"computer"/"phone"/"television"/"video game." RESULTS A total of 16 studies met the inclusion criteria. The studies support the view that children and adolescents with ASD are exposed to more screen time than their typically developing peers or other clinical groups and that the exposure starts at a younger age. The content and context of screen use (e.g., with parents vs alone) may affect the behaviors associated with media exposure. Correlates and long-term consequences of early screen exposure (before the age of 3 years) remain largely unexamined. CONCLUSION The current review provides important information about how ASD is associated with screen use and exposure. Future longitudinal research should examine the impact of early screen exposure on child development while accounting for potential moderating environmental factors (e.g., socioeconomic status, parent-child relationship). This will help determine whether-and if so, how much-exposure is detrimental and allow appropriate recommendations and interventions related to screen time among children with ASD.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Israel
| | - Karen Frankel Heffler
- Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA
| | - Michael Davidovitch
- Medical Department and Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
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27
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Tybor DJ, Eliasziw M, Kral TV, Segal M, Sherwood NE, Sikich L, Stanish H, Bandini L, Curtin C, Must A. Parental concern regarding obesity in children with autism spectrum disorder in the United States: National Survey of Children's Health 2016. Disabil Health J 2019; 12:126-130. [DOI: 10.1016/j.dhjo.2018.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/01/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022]
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28
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S. Padmanabhan P, Shroff H. The relationship between sensory integration challenges and the dietary intake and nutritional status of children with Autism Spectrum Disorders in Mumbai, India. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2018; 66:142-152. [PMID: 34141376 PMCID: PMC8132926 DOI: 10.1080/20473869.2018.1522816] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/02/2018] [Accepted: 09/02/2018] [Indexed: 05/26/2023]
Abstract
Objective: This study was conducted to assess the dietary intake, food refusal, and nutritional status of younger and older children with Autism Spectrum Disorders (ASD) in Mumbai, India, and to understand the relationships between these variables and mealtime behaviors and sensory integration. Methods: This was an observational cross-sectional study. Convenience and snowball sampling was used. Data were collected from 146 mother-children pairs, where children belonged to two age groups (3-6 years and 7-11 years). Caregivers completed scales on mealtime behaviors, sensory integration, and the dietary intake of their children. Nutritional status of the children was assessed by measuring their height and weight. Based on BMI 'z' scores, children were classified as 'Underweight', 'Mild Underweight', 'Normal BMI', 'Overweight', or 'Obese'. Results: There was no significant difference in mealtime behavior and sensory integration scores between the two age groups. There was a significant inverse relationship between the mealtime behavior and sensory integration scores. There was no relationship between these two variables and the dietary intake of children. However, there was a significant relationship between these two variables and the number of food groups refused by children with ASD. Only 39.7% children had a normal BMI. There was a significant positive relationship between dietary intake and nutritional status of children. Conclusion: Difficulties in sensory integration may contribute to mealtime behavioral problems and inadequate dietary intake in these children. At the same time, higher dietary intake (which may be poor in diversity) may be related with a higher likelihood of being overweight.
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Affiliation(s)
| | - Hemal Shroff
- Centre for Health & Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
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Jachyra P, Anagnostou E, Knibbe TJ, Petta C, Cosgrove S, Chen L, Capano L, Moltisanti L, McPherson AC. Weighty Conversations: Caregivers', Children's, and Clinicians' Perspectives and Experiences of Discussing Weight-Related Topics in Healthcare Consultations. Autism Res 2018; 11:1500-1510. [DOI: 10.1002/aur.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/24/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Patrick Jachyra
- Bloorview Research Institute; Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
- Rehabilitation Sciences Institute; University of Toronto; Toronto Ontario
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics; University of Toronto; Toronto Ontario
| | | | - Catharine Petta
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | - Susan Cosgrove
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | - Lorry Chen
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | - Lucia Capano
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | | | - Amy C. McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Dalla Lana School of Public Health, University of Toronto, Rehabilitation Sciences Institute, University of Toronto; Toronto Ontario
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30
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Healy S, Aigner CJ, Haegele JA. Prevalence of overweight and obesity among US youth with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1046-1050. [DOI: 10.1177/1362361318791817] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to examine current overweight and obesity prevalence rates among US youth (aged 10–17 years) with and without autism spectrum disorder, based on the 2016 National Survey of Children’s Health. Analyses of weight status, derived from parent-reported height and weight measures, were conducted for a weighted sample of 875,963 youth with autism spectrum disorder and 31,913,657 typically developing youth. Controlling for age, race/ethnicity, income, and sex, youth with autism spectrum disorder had significantly higher odds of overweight (odds ratio = 1.48, p = 0.04) and obesity (odds ratio = 1.49, p = 0.02) compared to typically developing youth. Among youth with autism spectrum disorder, 19.4% were overweight and 23.05% were obese. Among typically developing youth, 14.9% were overweight and 15.91% were obese. Higher odds of obesity were reported for youth with severe autism spectrum disorder (odds ratio = 3.35, p < 0.01), compared to those with mild autism spectrum disorder.
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31
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Associations Between Family Member BMI and Obesity Status of Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2018; 38:690-696. [PMID: 28834788 DOI: 10.1097/dbp.0000000000000491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether there is an association between parent and sibling obesity status and obesity status in children with autism spectrum disorder (ASD). METHODS We examined predictors of obesity in children with ASD with body mass index data for the proband, 1 sibling, and 2 parents using data from the multisite Simons Simplex Collection. RESULTS In a stepwise logistic regression model, proband obesity status was associated with obesity status of the sibling (odds ratio [OR] 2.66; 95% confidence interval [CI], 1.92-3.70), mother (OR 2.10; 95% CI, 1.59-2.77), and father (OR 1.51; 95% CI, 1.15-1.98). Proband obesity was also related to somatic complaints (OR 1.60; 95% CI, 1.006-2.53), mood stabilizers (OR 1.80; 95% CI, 1.19-2.72), internalizing problems (OR 1.60; 95% CI, 1.14-2.30), age (OR 1.01; 95% CI, 1.00-1.01), and some adaptive functioning domains (OR 0.987; 95% CI, 0.977-0.997). Race, ethnicity, income, sex, and maternal education were not significant predictors. CONCLUSION Familial factors were generally the strongest predictors of obesity rather than medication use, demographics, or psychological characteristics. Results support a family-centered approach to treatment of obesity in children with ASD.
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Criado KK, Sharp WG, McCracken CE, De Vinck-Baroody O, Dong L, Aman MG, McDougle CJ, McCracken JT, Arnold LE, Weitzman C, Leventhal JM, Vitiello B, Scahill L. Overweight and obese status in children with autism spectrum disorder and disruptive behavior. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:450-459. [PMID: 28325061 PMCID: PMC5581311 DOI: 10.1177/1362361316683888] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Overweight and obesity are common in pediatric populations. Children with autism spectrum disorder and disruptive behavior may be at higher risk. This study examined whether children with autism spectrum disorder and disruptive behavior are more likely to be overweight or obese than matched controls. Baseline data from medication-free children with autism spectrum disorder who participated in trials conducted by the Research Units on Pediatric Psychopharmacology Autism Network (N = 276) were compared to 544 control children from the National Health and Nutrition Examination Survey database matched on age, sex, race, parent education, and era of data collection. The mean age of the children with autism spectrum disorder was 7.9 ± 2.6 years; 84.4% were males. In the autism spectrum disorder group, the prevalence was 42.4% for overweight and 21.4% for obesity compared to 26.1% for overweight and 12.0% for obesity among controls (p < 0.001 for each contrast). Within the autism spectrum disorder sample, obesity was associated with minority status and lower daily living skills. These findings suggest that children with autism spectrum disorder and disruptive behavior are at increased risk for obesity and underscore the need for weight management interventions in this population.
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Affiliation(s)
- Kristen K Criado
- Department of Pediatrics, Emory University School of Medicine, USA
- Marcus Autism Center, USA
| | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, USA
- Marcus Autism Center, USA
| | | | | | - Liansai Dong
- Rollins School of Public Health, Emory University, USA
| | | | - Christopher J McDougle
- Lurie Center for Autism, Massachusetts General Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - James T McCracken
- Division of Child Psychiatry, University of California at Los Angeles, USA
| | | | | | | | | | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, USA
- Marcus Autism Center, USA
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Healy S, Nacario A, Braithwaite RE, Hopper C. The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis. Autism Res 2018; 11:818-833. [DOI: 10.1002/aur.1955] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 02/06/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Sean Healy
- Department of Behavioral Health and Nutrition; University of Delaware; Newark Delaware
| | - Adam Nacario
- Department of Kinesiology and Recreation Administration; Humboldt State University; Arcata California
| | - Rock E. Braithwaite
- Department of Kinesiology and Recreation Administration; Humboldt State University; Arcata California
| | - Chris Hopper
- Department of Kinesiology and Recreation Administration; Humboldt State University; Arcata California
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34
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Stiller A, Mößle T. Media Use Among Children and Adolescents with Autism Spectrum Disorder: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0135-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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35
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Genetic analysis of very obese children with autism spectrum disorder. Mol Genet Genomics 2018; 293:725-736. [PMID: 29327328 DOI: 10.1007/s00438-018-1418-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/06/2018] [Indexed: 12/31/2022]
Abstract
Autism spectrum disorder (ASD) is defined by the triad of deficits in social interactions, deficits in communication, and repetitive behaviors. Common co-morbidities in syndromic forms of ASD include intellectual disability, seizures, and obesity. We asked whether very obese children with ASD had different behavioral, physical and genetic characteristics compared to children with ASD who were not obese. We found that very obese children with ASD had significantly poorer scores on standardized behavioral tests. Very obese boys with ASD had lower full scale IQ and increased impairments with respect to stereotypies, communication and social skills. Very obese girls with ASD had increased impairments with respect to irritability and oppositional defiant behavior. We identified genetic lesions in a subset of the children with ASD and obesity and attempted to identify enriched biological pathways. Our study demonstrates the value of identifying co-morbidities in children with ASD as we move forward towards understanding the biological processes that contribute to this complex disorder and prepare to design customized treatments that target the diverse genetic lesions present in individuals with ASD.
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36
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Bandini LG, Curtin C, Phillips S, Anderson SE, Maslin M, Must A. Changes in Food Selectivity in Children with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:439-446. [PMID: 27866350 DOI: 10.1007/s10803-016-2963-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Food selectivity is a common problem in children with autism spectrum disorder (ASD) and has an adverse impact on nutrient adequacy and family mealtimes. Despite recent research in this area, few studies have addressed whether food selectivity present in children with ASD persists into adolescence. In this study, we assessed food selectivity in 18 children with ASD at two time points (mean age = 6.8 and 13.2 years), and examined changes in food selectivity. While food refusal improved overall, we did not observe an increase in food repertoire (number of unique foods eaten). These findings support the need for interventions early in childhood to increase variety and promote healthy eating among children with ASD.
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Affiliation(s)
- Linda G Bandini
- Department of Pediatrics, E.K. Shriver Center, UMass Medical School, 55 Lake Avenue North S3-324B, Worcester, MA, 01655, USA. .,Department of Health Sciences, Boston University, 635 Commonwealth Ave., Boston, MA, 02215, USA.
| | - Carol Curtin
- Department of Family Medicine and Community Health, E.K. Shriver Center, UMass Medical School, 55 Lake Avenue North S3-317, Worcester, MA, 01655, USA
| | - Sarah Phillips
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA, 02111, USA
| | - Sarah E Anderson
- College of Public Health, The Ohio State University, 336 Cunz Hall, 1841 Neil Ave., Columbus, OH, 43210, USA
| | - Melissa Maslin
- E.K. Shriver Center, UMass Medical School, 55 Lake Avenue North S3-24C, Worcester, MA, 01655, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA, 02111, USA
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37
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Moore M, Evans V, Hanvey G, Johnson C. Assessment of Sleep in Children with Autism Spectrum Disorder. CHILDREN-BASEL 2017; 4:children4080072. [PMID: 28786962 PMCID: PMC5575594 DOI: 10.3390/children4080072] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 01/30/2023]
Abstract
Sleep disturbances in children with autism spectrum disorder (ASD) are significantly more prevalent than found in typically developing (TD) children. Given the detrimental impact of poor sleep on cognitive, emotional, and behavioral functioning, it is imperative to screen and assess for sleep disturbances in this population. In this paper, we describe the screening and assessment process, as well as specific measures commonly used for assessing sleep in children with ASD. Advantages and limitations for use in children with ASD are discussed. While subjective measures, such as parent-report questionnaires and sleep diaries, are the most widely used, more objective measures such as actigraphy, polysomnography, and videosomnography provide additional valuable information for both diagnostic purposes and treatment planning. These objective measures, nonetheless, are limited by cost, availability, and feasibility of use with children with ASD. The current review provides an argument for the complementary uses of both subjective and objective measures of sleep specifically for use in children with ASD.
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Affiliation(s)
- Makeda Moore
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Victoria Evans
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Grace Hanvey
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Cynthia Johnson
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
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38
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Matheson BE, Douglas JM. Overweight and Obesity in Children with Autism Spectrum Disorder (ASD): a Critical Review Investigating the Etiology, Development, and Maintenance of this Relationship. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-017-0103-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Jones RA, Downing K, Rinehart NJ, Barnett LM, May T, McGillivray JA, Papadopoulos NV, Skouteris H, Timperio A, Hinkley T. Physical activity, sedentary behavior and their correlates in children with Autism Spectrum Disorder: A systematic review. PLoS One 2017; 12:e0172482. [PMID: 28245224 PMCID: PMC5330469 DOI: 10.1371/journal.pone.0172482] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/06/2017] [Indexed: 11/18/2022] Open
Abstract
Autism Spectrum Disorder affects up to 2.5% of children and is associated with harmful health outcomes (e.g. obesity). Low levels of physical activity and high levels of sedentary behaviors may contribute to harmful health outcomes. To systematically review the prevalence and correlates of physical activity and sedentary behaviors in children with Autism Spectrum Disorder, electronic databases (PsycINFO, SPORTDiscus, EMBASE, Medline) were searched from inception to November 2015. The review was registered with PROSPERO (CRD42014013849). Peer-reviewed, English language studies were included. Two reviewers screened potentially relevant articles. Outcomes of interest were physical activity and sedentary behaviour levels and their potential correlates. Data were collected and analysed in 2015. Of 35 included studies, 15 reported physical activity prevalence, 10 reported physical activity correlates, 18 reported sedentary behavior prevalence, and 10 reported sedentary behavior correlates. Estimates of children’s physical activity (34–166 mins/day, average 86 mins/day) and sedentary behavior (126–558 mins/day in screen time, average 271 mins/day; 428–750 mins/day in total sedentary behavior, average 479 mins/day) varied across studies. Age was consistently inversely associated, and sex inconsistently associated with physical activity. Age and sex were inconsistently associated with sedentary behavior. Sample sizes were small. All but one of the studies were classified as having high risk of bias. Few correlates have been reported in sufficient studies to provide overall estimates of associations. Potential correlates in the physical environment remain largely unexamined. This review highlights varying levels of physical activity and sedentary behavior in children with Autism Spectrum Disorder. Research is needed to consistently identify the correlates of these behaviors. There is a critical need for interventions to support healthy levels of these behaviors.
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Affiliation(s)
- Rachel A. Jones
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Katherine Downing
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Nicole J. Rinehart
- Deakin University, Deakin Child Study Centre, School of Psychology, Burwood, Victoria, Australia
| | - Lisa M. Barnett
- Deakin University, School of Health and Social Development, Burwood, Victoria, Australia
| | - Tamara May
- Deakin University, Deakin Child Study Centre, School of Psychology, Burwood, Victoria, Australia
- University of Melbourne, Department of Paediatrics, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jane A. McGillivray
- Deakin University, Deakin Child Study Centre, School of Psychology, Burwood, Victoria, Australia
| | - Nicole V. Papadopoulos
- Deakin University, Deakin Child Study Centre, School of Psychology, Burwood, Victoria, Australia
| | - Helen Skouteris
- Deakin University, Centre of Social and Early Emotional Development, School of Psychology, Burwood, Victoria, Australia
| | - Anna Timperio
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Trina Hinkley
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
- * E-mail:
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40
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Must A, Eliasziw M, Phillips SM, Curtin C, Kral TV, Segal M, Sherwood NE, Sikich L, Stanish HI, Bandini LG. The Effect of Age on the Prevalence of Obesity among US Youth with Autism Spectrum Disorder. Child Obes 2017; 13:25-35. [PMID: 27704874 PMCID: PMC5278796 DOI: 10.1089/chi.2016.0079] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND We sought to assess the association between age and the prevalence of obesity among children with and without autism spectrum disorder (ASD) in the 2011-2012 National Survey of Children's Health. METHODS Analyses were restricted to 43,777 children, ages 10-17, with valid measures of parent-reported weight, height, and ASD status. Exploratory analyses describe the impact of sex, race/ethnicity, and household income on the relationship between age and obesity in ASD. RESULTS Although the overall prevalence of obesity among children with ASD was significantly (p < 0.001) higher than among children without ASD (23.1% vs. 14.1%, 95% confidence interval for difference 3.6 to 14.4), child age significantly (p = 0.035) modified this difference. In a multivariable logistic regression analysis, adjusted for sex, race/ethnicity, and household income, the odds of obesity among children with ASD compared with children without ASD increased monotonically from ages 10 to 17 years. This pattern arose due to a consistently high prevalence of obesity among children with ASD and a decline in prevalence with advancing age among children without ASD. These findings were replicated using a propensity score analysis. Exploratory analyses suggested that the age-related change in obesity disparity between children with and without ASD may be further modified by sex, race/ethnicity, and household income. CONCLUSIONS The patterns of prevalence observed with increasing age among children with and without ASD were unexpected. A better understanding of the etiological and maintenance factors for obesity in youth with ASD is needed to develop interventions tailored to the specific needs of these children.
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Affiliation(s)
- Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Sarah M. Phillips
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Carol Curtin
- Department of Family Medicine and Community Health, E.K. Shriver Center, UMass Medical School, Charlestown, MA
| | - Tanja V.E. Kral
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Mary Segal
- The Research Center for Health Care Decision-Making, Inc., Wyndmoor, PA
| | | | - Linmarie Sikich
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Heidi I. Stanish
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA
| | - Linda G. Bandini
- Department of Family Medicine and Community Health, E.K. Shriver Center, UMass Medical School, Charlestown, MA.,Department of Health Sciences, Boston University, Boston, MA
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Bonis SA, Sawin KJ. Risks and Protective Factors for Stress Self-Management in Parents of Children With Autism Spectrum Disorder: An Integrated Review of the Literature. J Pediatr Nurs 2016; 31:567-579. [PMID: 27637421 DOI: 10.1016/j.pedn.2016.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/15/2016] [Accepted: 08/20/2016] [Indexed: 01/01/2023]
Abstract
PROBLEM Stress in parents of children with autism spectrum disorder (ASD) has been reported to be very high. However, little is known about what risk and protective factors influence parental stress self-management in this population. Accordingly, this manuscript is a synthesis of the risk and protective factors that impact self-management of stress in these parents. The concepts in the individual and family self-management theory context domain were used as a framework to guide data collection and analysis. ELIGIBILITY CRITERIA Searches were conducted using CINAHL, MedLine and PsychInfo. Studies were included if they addressed context factors in parents of children with ASD and were written in English. SAMPLE Ninety-eight studies met review criteria. RESULTS This review highlighted risk factors to parental stress self-management within the context of condition-specific factors, physical and social environment, and individual and family. The most concerning of these findings is that parents struggle accessing a diagnosis and services for their child and are frustrated with health care providers' knowledge of ASD and lack of communication. CONCLUSIONS The risks parents experience as they care for their child with ASD far outweigh the protective factors for self-management of parental stress. IMPLICATIONS Nurses who are aware of these issues can make important changes to their practice and have a significant impact on parental stress self-management and the care of children with ASD.
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Affiliation(s)
- Susan A Bonis
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI.
| | - Kathleen J Sawin
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI; Department of Nursing Research, Children's Hospital of Wisconsin, Box 1997, Milwaukee, WI
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42
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Liu X, Liu J, Xiong X, Yang T, Hou N, Liang X, Chen J, Cheng Q, Li T. Correlation between Nutrition and Symptoms: Nutritional Survey of Children with Autism Spectrum Disorder in Chongqing, China. Nutrients 2016; 8:nu8050294. [PMID: 27187463 PMCID: PMC4882707 DOI: 10.3390/nu8050294] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023] Open
Abstract
Restricted diets and inadequate nutrient intake of children with autism spectrum disorder (ASD) have been reported. This study examined the nutritional statuses of children with ASD and the relationships between their behaviors and nutritional intake. A total of 154 children with ASD (age = 5.21 ± 1.83 years) and 73 typically-developing (TD) children (age = 4.83 ± 0.84 years) from Chongqing, China, were enrolled. The severity of ASD was evaluated using the Childhood Autism Rating Scale (CARS). The serum ferritin, folate, vitamin B12, 25(OH) vitamin D, and vitamin A concentrations in the children with ASD were determined. All participants underwent anthropometric examinations, dietary assessments, and questionnaire assessments about their feeding behaviors, and gastrointestinal symptoms. The ZHA, ZWA, and ZBMIA were found to be significantly lower in the children with ASD compared with those without ASD. In addition, the percentages of children exhibiting severe picky eating and severe resistance to new foods, as well as those with a reported general impression of severe eating problems and constipation, were higher among the children with ASD. These children consumed significantly fewer macronutrients compared with the children without ASD. In addition, the children with ASD had the highest rate of vitamin A deficiency, followed by iron deficiency. After adjusting for sex, the vitamin A concentration was found to be negatively correlated with the CARS score (rs = -0.222, p = 0.021). No correlation between the ferritin, folate, vitamin D, or vitamin B12 concentration and the CARS score was found. These results suggest that reduced macronutrient intakes, severe feeding behavior issues, constipation, and vitamin A deficiency are quite common among children with ASD. Further, a low serum vitamin A level may be a risk factor for symptoms of ASD. However, the underlying mechanism should be further studied.
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Affiliation(s)
- Xiao Liu
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Juan Liu
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Xueqin Xiong
- Pediatric Department of Clinical Medicine of Dazhou Vocational and Technical College, Dazhou 635001, China.
| | - Ting Yang
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Nali Hou
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Xiaohua Liang
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Jie Chen
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Qian Cheng
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
| | - Tingyu Li
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
- Children's Nutrition Research Center, Hospital of Chongqing Medical University, Chongqing 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
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Abstract
The purpose of this review is twofold. The first is to synthesize factors that impact parents' experiences of caring for a child with autism spectrum disorder (ASD); the second is to identify factors that impact parental stress and parental decision-making to use autism services or not. Parents of children with ASD score higher on levels of stress than other groups of parents. The daily challenges of caring for the child are endless and effect all aspects of the child's care as well as the parent's mental health and ability to manage the needs of the child and family. Understanding more about the challenges parents face will provide direction for research, intervention development, and practice. Accordingly, a search was conducted using CINAHL and Medline. Inclusion criteria included articles available in full text, published in English, and focused on children with ASD distinct from other diagnoses, as well as parental experiences of caring for a child with ASD. Articles (N = 132) that met the inclusion criteria were summarized. Challenging aspects of the child's diagnosis and care are discussed, as well as the factors that impact parental stress and decision-making to use autism services. Recommendations for research and practice include interventional development related to early diagnosis, disparity, access to care, parental decision-making to use autism services, and parental stress management.
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Affiliation(s)
- Susan Bonis
- a University of Wisconsin-Milwaukee, College of Nursing , Milwaukee , Wisconsin , USA
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