Parents' perceptions of the impact of the novel coronavirus (COVID-19) on the eating behaviors and routines of children with autism spectrum disorders (ASD)

Background

Restricted interests and repetitive behavior are characteristics of autism spectrum disorder (ASD). The likelihood that persons with ASD will respond adversely to unfamiliar situations is great. The novel coronavirus outbreak has resulted in disruptions to all aspects of routine and behavior. Hence, this study proposed to investigate the impact of the outbreak on the eating behavior and routines of children with ASD in Saudi Arabia through the perceptions of their parents.

Method

A cross-sectional study with a quantitative approach was utilized to obtain data from 150 parents of children with ASD aged ≤18 years in Saudi Arabia. The data collected included demographic data of the parents, the ASD status of the family, impact of COVID-19 to the family, eating behavior of the children with ASD, and daily routines of the children with ASD. Moreover, parents were able to provide comments regarding their children's eating behavior or daily routines.

Results

The study found that changes in the eating behavior of children with ASD were found to differ significantly (p<0.05) based on the number of children with ASD, the age of the children with ASD, the gender of the children with ASD, and the severity of their ASD symptoms. Moreover, changes to dinner-time routines were found to differ significantly (p<0.05) based on the age of the children with ASD. Also, changes to morning routines were found to differ significantly (p<0.05) based on the age of the children with ASD, their gender, and the severity of their ASD symptoms. Additionally, impact of COVID-19 to the family had a significant impact to eating behavior and daily routines of the children with ASD.

Conclusion

This study found that the eating behavior and daily routines of children with ASD in Saudi Arabia have been considerably worsened and changed. The study recommends the collaboration of multidisciplinary teams and parents to modify or design interventions that help to change their eating behavior and routine can be implemented in the home. It also recommends the provision of virtual helplines to aid parents of children with ASD in such cases.

Eating and Sensory Features of Children With Autism Spectrum Disorder and Their Typically Developing Peers

IMPORTANCE

Impaired sensory processing is associated with eating problems. There seem to be no previous studies that compare those who have autism spectrum disorder (ASD) with eating problems (ASD-W) and those with ASD without eating problems (ASD-WO) with typically developing (TD) groups. Comparisons are expected to provide further knowledge to guide the intervention programs.

OBJECTIVE

To investigate differences among ASD-W, ASD-WO, and TD groups in eating and sensory features; to detect associations between sensory and eating behaviors and any most involved sensory dimensions; and to search for age-related differences in sensory and eating features in ASD.

DESIGN

Nonrandomized comparison study.

SETTING

Questionnaires administered as parent interviews.

PARTICIPANTS

A total of 165 children were recruited: 117 with ASD and 48 TD children.

OUTCOMES AND MEASURES

Standardized questionnaires: the Brief Autism Mealtime Behaviors Inventory for eating problems; the Short Sensory Profile and the Sensory Experience Questionnaire for sensory problems.

RESULTS

The ASD-W group showed generalized, impaired eating behaviors and turned out to be the most impaired with regard to sensory responsiveness. No differences in feeding behaviors were found between the ASD-WO and TD groups. All children with ASD showed sensory hyper- or hyporesponsiveness. Four main sensory dimensions were found to be associated with eating behaviors in ASD. No age differences were found in the eating and sensory behaviors of children with ASD.

CONCLUSIONS AND RELEVANCE

Differing eating and sensory profiles were found between the ASD and TD groups, especially in children with ASD-W. Early eating interventions using sensory stimulations are strongly recommended. What This Article Adds: This study reports novel information derived from the comparisons of children with ASD with eating problems and those with ASD without eating problems with typically developing groups of children.

Association between body mass index and subcortical volume in pre-adolescent children with autism spectrum disorder: An exploratory study

Conflicting associations exist between autism spectrum disorder (ASD) and subcortical brain volumes. This study assessed whether obesity might have a confounding influence on associations between ASD and brain subcortical volumes. A comprehensive investigation evaluating the relationship between ASD, obesity, and subcortical structure volumes was conducted. Data obtained included body mass index (BMI) and T1-weighted structural magnetic resonance images for children with and without ASD diagnoses from the Autism Brain Imaging Data Exchange database. Brain subcortical volumes were calculated using vol2Brain software. Hierarchical linear regression analyses were performed to explore the subcortical volumes similarly or differentially associated with BMI in children with or without ASD and examine association and interaction effects regarding ASD and subcortical volume impact on the Social Responsiveness Scale and Vineland Adaptive Behavior Scale (VABS) scores. Bilateral caudate nuclei were smaller in children with ASD than in control participants. Significant interactions were observed between ASD diagnosis and BMI regarding the left caudate, right and left putamen, and right and left ventral diencephalon (DC) volumes (β = -0.384, p = 0.010; β = -0.336, p = 0.030; β = -0.317, p = 0.040; β = 0.322, p = 0.010; β = 0.295, p = 0.021, respectively) and between ASD diagnosis and right and left ventral DC volumes regarding the VABS scores (β = 0.434, p = 0.014; β = 0.495, p = 0.007, respectively). However, each subcortical structure volume included in the ventral DC area could not be measured separately. The results identified subcortical volumes differentially associated with obesity in children with ASD compared with typically developing peers. BMI may need to be considered an important confounder in future research examining brain subcortical volumes within ASD.

Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy

Pediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. However, undiagnosed micronutrient deficiencies can cause cardiovascular derangements that significantly increase a patient's anesthetic risk. Vitamin C deficiency in particular, alone or in combination with severe malnutrition, is associated with a severe but reversible form of pulmonary arterial hypertension that, while life threatening in the acute phase, may significantly improve within days of starting ascorbic acid replacement therapy. Here we present a case of a 6-year-old boy with autism spectrum disorder (ASD), severe malnutrition, and undiagnosed chronic vitamin C deficiency who developed a pulmonary hypertensive crisis after induction of general anesthesia leading to cardiac arrest during endoscopic evaluation. While the association between food selectivity among youth with neurodevelopmental differences and vitamin C deficiency is well-described, and pulmonary hypertension is a recognized rare complication of scurvy, extant literature has not addressed next steps to improve patient outcomes. Using this case report as a foundation, we discuss specific patient populations to screen and treat for micronutrient deficiencies prior to anesthesia and propose a novel clinical algorithm for pre-anesthesia risk stratification and mitigation in patients specifically at risk for scurvy and associated pulmonary hypertension.

Dietary intake in children on the autism spectrum is altered and linked to differences in autistic traits and sensory processing styles

Diets of children and adolescents on the autism spectrum often differ when compared to their non-autistic peers. Most dietary studies have been limited by small sample sizes and rarely assess the heterogeneity of autism. Addressing this gap, this study compared the anthropometrics, dietary composition, dietary quality, and food variety of 154 Australian children and adolescents on the spectrum and 213 non-autistic children (71 siblings and 142 unrelated controls). Beyond the case-control approach, within-group comparisons assessed the influence of autism clinical presentations and sensory processing styles on body mass index (BMI) and measures of dietary intake among those on the spectrum. In this word first study of diet that included between-group comparisons with non-autistic peers (siblings and an unrelated comparison group) and within-autism group comparisons, we found that children on the spectrum consumed limited variety and lower quality of food and non-autistic siblings also ate comparably higher levels of energy-dense, nutrient poor food, and less diary. This may be due to autistic traits influencing family's diets or shared sensory sensitivities driving dietary intake. Within the autism group, higher autistic traits were associated with lower BMIs and a specific dietary pattern higher in simple carbohydrates and lower in unprocessed protein. Contrastingly, greater sensitivity to sensory stimuli was associated with a healthier diet. Increased age was linked to more varied diets but also diets higher in saturated fats and energy-dense, nutrient poor foods. Overall, this research highlights that potential mediators of dietary intake, such as familial influences, autistic traits, sensory processing styles, age and sex, need to be considered when assessing diet in the autistic population. LAY SUMMARY: In this study of dietary differences linked to autism, children, and teenagers on the spectrum ate fewer different foods and were less likely to eat recommended amounts of fruits and vegetables when compared to non-autistic siblings and unrelated children and teenagers. There were also family differences, in that those on the spectrum and their siblings ate more unhealthy foods and less dairy. Among those on the spectrum, dietary differences were linked to age, sex, autistic traits and sensory processing styles.

Eating and sleep problems, related factors, and effects on the mental health of the parents in children with autism spectrum disorder

This study aimed to evaluate the frequency of sleep and eating problems in children with autism spectrum disorder (ASD), the factors associated with these problems, and the relationship with the risk of developing depression and anxiety in their parents. In the study, 156 children with ASD and their parents were included. The Brief Autism Mealtime Behavior Inventory (BAMBI), the Children's Sleep Habits Questionnaire (CSHQ), the Hospital Anxiety Depression Scale (HADS) were completed by the parents. The Childhood Autism Rating Scale (CARS) was administered by the researchers to evaluate the severity of ASD in children. The mean age of children was 8.08 ± 2.84, and 87.2% of the children were male. The mean score of CARS was 41.25 ± 6.16, the mean score of BAMBI was 45.67 ± 11.87, and the mean score of CSHQ was 51.67 ± 10.17. According to the CSHQ, 83.3% of the children had sleep problems. The response rate above the cut-off point in the HAD-A subscale was 59.6%, whereas it was 67.3% in the HAD-D subscale. There was a positive correlation between CARS and BAMBI, CSHQ, HAD-A, and HAD-D subscales. There was a positive correlation between BAMBI and CHSQ, HAD-A, and HAD-D subscales. There was a positive correlation between the CSHQ, HAD-A, and HAD-D subscales. There was a negative correlation between the age of the child with ASD, food refusal, and resistance to bedtime. As sleeping and eating problems affect a large portion of children diagnosed with ASD and their caregivers, large population-based studies evaluating both these problems must be designed and carried out to understand factors affecting the prevalence, development, and persistence of sleeping and eating problems and to determine interventions to reduce these issues.

Correlation among gut microbiota, fecal metabolites and autism-like behavior in an adolescent valproic acid-induced rat autism model

This study aims to understand the relationship between fecal metabolites and gut microbiota in an adolescent valproic acid-induced rat autism model (VPA-exposed offspring). We analyzed the fecal samples of VPA-exposed offspring using 16S rRNA gene sequencing and untargeted metabolomics. Autism-like behavior was evaluated by a three-chamber sociability test and a self-grooming test. Based on these data, we analyzed the association among fecal metabolites, gut microbiota and autism-like behavior. Behavioral tests showed that VPA-exposed offspring displayed typical autism-like behavior. Forty-nine named differential fecal metabolites and 14 enriched KEGG pathways were identified between the VPA and control groups. Five fecal metabolites may be used as characteristic metabolites. The richness and diversity of gut microbiota did not differ between the two groups, while the overall composition of gut microbiota was significantly different. Candidatus_Saccharimonas, Desulfovibrio, [Eubacterium]_xylanophilum_group and Ruminococcus_2 were the characteristic genera of VPA-exposed offspring. Correlation analysis revealed a tight relationship among gut microbiota, fecal metabolites and autistic behavior in VPA-exposed offspring. This study illustrates that specific alterations in gut microbiota and fecal metabolites may be regarded as characteristics of VPA-exposed offspring. The characteristic gut microbiota and fecal metabolites as well as their relationship may play a crucial role in autism-like behavior caused by prenatal exposure to VPA.

The evolving obesity challenge: targeting the vagus nerve and the inflammatory reflex in the response

Obesity and the metabolic syndrome (MetS), which have reached pandemic proportions significantly increase the risk for type 2 diabetes, cardiovascular disease, and other serious conditions. Recent data with COVID-19 patients indicate that obesity also is a significant risk factor for this novel viral disease and poor outcome of associated critical illness. These findings considerably change the view of obesity as a driver of serious, but slowly-progressing chronic diseases, and emphasize the urgency to explore new therapeutic approaches. Inflammation is a recognized driver of metabolic derangements in obesity and MetS, and a core feature of COVID-19 pathobiology. Recent advances in our understanding of inflammatory regulation have highlighted the role of the nervous system and the vagus nerve-based inflammatory reflex. Current bioelectronic and pharmacological therapeutic explorations centered on the inflammatory reflex offer new approaches for conditions characterized by immune and metabolic dysregulation and for ameliorating the escalating burden of obesity, MetS, and COVID-19.

Correlates of Feeding Difficulties Among Children with Autism Spectrum Disorder: A Systematic Review

Feeding difficulties related to selective intake, or eating a limited variety of foods, are very common in children with autism spectrum disorder (ASD). A systematic search of PubMed, Embase, PsycInfo, and CINAHL identified 29 studies that evaluated eight correlates: age, ASD symptoms and severity, cognitive and adaptive skills, sensory processing and perception, challenging behavior, weight status, gastrointestinal symptoms, and parenting stress. Feeding difficulties related to selective intake are consistently correlated with impaired sensory processing and perception and tend to be positively associated with rigidity and challenging behavior. These feeding difficulties tend to persist with advancing age. Other correlates demonstrated inconsistent findings. A significant limitation of research reviewed is variability in terminology, definitions, and measurement of feeding difficulties.

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

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.