News and Knowledge

Note to readers: In each issue of The OARacle, we provide a helpful resource on a topic of interest within the autism community. This month’s article focuses on developing healthy lifestyles for people with ASD. Special thanks to Linda Meyer and Erin Richard from the Alpine Learning Group in Paramus, N.J., a private, non-profit school that provides educational services to individuals with autism, for their contribution.

It’s a dangerous epidemic: America’s youth are overweight. Researchers say childhood obesity has become a national health crisis.

We used to think of obesity as an adult disease, but recent national surveys indicate that 25 to 30 percent of children ages 6 to 11 are obese (20 percent above average weight). According to guidelines for the National Association for Sports and Physical Education, children between the ages of 5 and 12 need at least one hour of moderately vigorous exercise per day. Only 20 to 40 percent of American children receive that much. Doctors say that overweight children are prime candidates for heart disease. In a recent study, overweight 3- and 4-year olds showed signs of high blood pressure and cholesterol, putting them at high risk for future heart attacks and strokes. Youngsters are showing up in doctors’ offices with shortness of breath, leg pain, asthma, sleep apnea, and fatty livers. For the first time in history, children as young as 10 are developing Type II diabetes, a disease that once exclusively affected people over 40.

Research has revealed that the single most important predictor of weight problems in children under the age of six is whether they have overweight parents. Heredity does play a part, but it’s not the dominant source of the condition. Genetic makeup may predispose the condition, but the child’s environment causes it. For individuals with autism spectrum disorders, the risk of obesity is the same as the general community.

To assess your family’s or students’ risk of obesity, evaluate your children’s or school environment and ask yourselves these critical questions:

• What type of foods does your family or students with ASD eat? How much? How often? Is the phrase, “Super size it!” part of your everyday vocabulary? A small order of French fries at McDonald’s is 210 calories. Super-size your fries and you’re consuming 610 calories.
• Does your child with ASD have the skills to participate in family activities such as bike riding or roller blading? Do you participate in family outings such as walking on the beach? Or do you sit on the couch and watch TV?
• Does your family or school program frequently use food as a reinforcer for good behavior? In some homes and schools, unlimited access to food is considered a “leisure” activity.At Alpine Learning Group (ALG), our staff calculates the Body Mass Index (BMI), a ratio between a person’s height and weight, of each of our learners to find out if they are at a healthy weight. We used the BMI-for-age growth chart created by the Centers for Disease Control and Prevention (CDC) to categorize our learners’ BMI based on their age and gender. The chart recognizes three risk categories: underweight, at risk of overweight, and overweight. In May, 2002, we calculated the BMI of the 23 learners at ALG 6 years of age and older. and found that among them, only eight — or 35 percent — were a healthy weight. The good news was that our learners fell above the national average in healthy weight. The bad news was we still had a lot of work to do. After one year, we once again calculated the BMI’s of each learner over 6 years of age. The results indicated that 44 percent of ALG learners are a healthy weight.

Although we are not certified trainers, nutritionists, or medical personnel, our staff employed research-based intervention strategies to teach and practice skills for weight management and exercise, as well as curricula and strategies to promote a safe, healthy, and active lifestyles. For anyone who wants to start such a program, you should consult your child’s physician at the start and throughout any weight loss and/or exercise program.

Just as we teach our learners with ASD skills across dozens of curricula areas, including fine motor, reading, mathematics, self-help skills, and expressive and receptive language, we teach skills for exercise and weight control using the principles of applied behavior analysis.

We teach these skills for a variety of purposes:

• The program promotes the productive use of leisure time in less restrictive settings. If our learners are engaged in appropriate activities, there is less time and opportunity for the occurrence of inappropriate behavior. Appropriate behavior increases access to community facilities.
• A healthy lifestyle enhances one’s appearance. Generally our learners with ASD are not motivated by parental or peer opinion and, therefore, their behavior is not maintained by social consequences. Many individuals with ASD will be discriminated against in the community due to their appearances and inappropriate behavior. Quality programs serving individuals with autism teach learners to practice appropriate social and personal care skills, including hygiene practices, exercise, and self-monitoring of appearance.
• Exercise increases stamina and flexibility to enhance job performance. As our learners began to participate in ALG’s supported volunteer program at age 14, we realized their lack of stamina and inflexibility limited their job performance.

Our goal is to maximize the health and fitness of each of our learners. If you share the same goal for your own children or the children with whom you work, here are some ways we taught our learners to adopt healthy eating and fitness habits.

Promote Balanced Nutrition

To promote balanced nutrition, we started teaching our adolescent learners to shop for ingredients to prepare healthy meals and snacks. Learners purchase grocery items using a list (e.g., pictorial, textual, or a combination) and then work on food preparation skill programs that require them to prepare a snack or a salad at school. These cooking programs, as with most activities that require many actions, are generally taught using pictorial and/or textual schedules. Several of our learners mastered making salads at school and then generalized the skill to their homes for the whole family to enjoy.

ALG staff modifies commercial weight loss programs (e.g., Weight Watchers) to assist learners in reducing portion sizes and eating the right kinds of food. Learners who can read and write keep journals recording what they eat in school and at home. Self -monitoring enables learners, school staff, and parents to track food consumption as well as limit food intake. Monitoring intake is also promoted by posting lists of the types and amounts of allowable foods on refrigerators. One ALG learner learned to trade points earned while exercising for highly preferred snacks.

Monitor the Environment

Buy healthy snacks. We know if we don’t buy junk food, we won’t have it in the school or house, and we can’t eat it!

In order to limit access to food stored in cabinets it sometimes becomes necessary to keep certain kitchen cabinets locked. However, for one family with two neurotypical adolescent boys, the cabinets didn’t stay locked, allowing free access for their brother with autism. A family consultant set up a system whereby the older siblings were paid to monitor the cabinets throughout the day and keep them closed.

Increase Exercise and Activity

Activity schedules can teach learners to independently access a variety of gym equipment. An exercise routine including activities such as sit ups, using a treadmill or step machine, and riding an exercise bike can be written up on a schedule. Learners who are proficient at setting timers and following schedules can independently move from one activity to another. At first, our teachers use physical guidance and then fade back as learners increase independence. Our goal, of course, is to prepare our learners to workout in the community with neurotypical peers and family members. Moving exercise programs outdoors expands schedules like activities to include in-line skating, riding scooters and bicycles, and running laps around a track.

To prevent injury, we also schedule limited stretching exercises before exercise as well as more extensive stretching after a workout for our students. After a workout, stretching helps reduce muscle soreness and tension. In addition, stretching as an exercise by itself promotes circulation, improves coordination, improves posture, reduces the pain of menstrual cramps, and increases flexibility.

Stretching is best when started slowly and should take place under the advice of a trainer or therapist. For learners with ASD capable of observational learning, we teach stretching through video modeling (videos are individualized for each learner and made by ALG instructional staff and siblings). Photographic (digital photographs of instructors stretching) and textual activity schedules also guide learners through stretching routines.

Besides activity and stretching, our learners participate in paired or “team” activities including Nucomb (a modified version of volleyball), Around the World (a basketball shooting game), running with a partner, playing catch (football and baseball). Some learners do yoga by watching tapes or attend community yoga classes to practice stretching and breathing poses as well as to increase muscle tone and endurance.

In short, an active lifestyle along with healthy eating habits helps an individual with ASD at school and at home. Prior to beginning our exercise program, many of our learners experienced problems with down time. Although we teach our learners age-appropriate leisure activities (e.g., watching television appropriately and playing video games), time spent on these sedentary activities should be limited. All activity burns calories so any increase in activity is beneficial. In order to get their bodies moving, our adolescents are given a schedule of daily chores including activities such as setting the table for dinner, feeding pets, folding laundry, and using a Swiffer to clean the floor. Compared with sitting and watching television, they triple their caloric expenditure and reduce snacking. The added bonus is they practice learned skills and help out with the family’s chores.

The information included in this article was first presented in New Jersey at a workshop entitled: Pump It Up! Move It! Lose It! Don’t Eat It! It’s good advice. We’d like to recognize Carrie Hughes for her contributions to the original presentation.

Linda S. Meyer, Ed.D., MPA, is the Executive Director and Co-founder of the Alpine Learning Group, Inc., a private, nonprofit corporation based in Paramus, N.J. established in 1988 dedicated to providing state-of-the-art educational and intervention services to individuals with autism and their families. For more information about the school, please visit its Web site.

Erin Richard is a Head Teacher and Coordinator of Adult Day Services at the Alpine Learning Group. She teaches learners in the center-based program as well as in supported volunteer, employment, and leisure sites.