News and Knowledge

As many as 18.5% of children in the United States are obese. Evidence suggests the percentage may be even higher among autistic children due to factors including unusual dietary preferences, decreased exercise, and use of medication that is associated with weight gain, among others. The guidelines and support that exist for preventing and treating obesity and unhealthy weight in neurotypical youth have not been adapted to address those same issues for autistic youth.

OAR-funded researchers William Sharp, Ph.D., Lindsey Burrell, Ph.D., and Larry Scahill, Ph.D., from the Marcus Autism Center in Atlanta, Georgia, developed the “Changing Health in Autism through Nutrition, Getting fit and Expanding variety” (CHANGE) program to fill that gap by providing an intervention specifically for use with autistic children. CHANGE uses a “parent as co-therapist” model designed to address the public health problems associated with obesity in autism in a cost-efficient and exportable manner.

The program combines behavioral intervention and nutrition education to address each child’s behavioral, feeding, and nutritional profile. The accompanying manual includes methods to increase dietary diversity and reduce grazing between meals/intake of sweetened beverages as well as in-clinic activities and homework assignments to promote physical activity. In addition, the manual includes behavior and nutrition worksheets that allow therapists and parents to individualize treatment components. It also includes scripts for therapists to use to deliver treatment consistently.

The curriculum comprises 10 weekly core sessions that provide caregivers with tools to build toward a healthier lifestyle, such as physical activity and nutritional planning, followed by six booster sessions to support continued progress.

The 2017 OAR-funded research study had three goals:

• Evaluate the acceptability and feasibility of the intervention.
• Assess the preliminary efficacy on selected outcome measures, including amount of weight lost, increased types of food eaten, increased physical activity, and decreased parenting stress.
• Make revisions to the manual based on parent feedback.

Methodology

Seven children between the ages of 5 and 12, along with a parent, participated in the two-year study. Therapists from the Pediatric Feeding Disorders Program at the Marcus Center also participated.

The CHANGE program included 16 sessions over six months. Interventions included:

• Decreasing excess calories from liquids and solids and creating a balanced meal plan.
• Using fading strategies to increase participation in exercise.
• Incorporating positive reinforcement to promote success with meeting goals.
• Providing problem-solving techniques to address challenges faced by parents, such as finding time to measure serving sizes.

By addressing families’ commitment to the program’s interventions, the treatment model emphasized problem solving and helping parents to identify ideas that worked for their family. To promote a flexible, individualized intervention, the research team combined a decision algorithm with detailed protocols. The algorithm included a decision tree to guide the introduction of treatment elements. If a child, for example, would not eat fruits and vegetables, a suggestion was offered to use a protocol to help increase acceptance of healthy foods. The standardized protocols included educational handouts, clinic-based activities and assessment procedures, and caregiver-directed homework and data collection. Post-treatment follow-up took place immediately after the intervention and at one, two, and three months after.

The research team measured body mass index percentile, types of food they ate, levels of physical activity, and levels of parenting stress before and after participation in CHANGE to determine if the intervention worked as hypothesized. They also conducted open-ended interviews with parents to find out how the program worked for them and what modifications and improvements they would suggest.

Results

The evaluation resulted in several findings:

• No participant experienced significant weight loss during the research study.
• Intervention, however, resulted in improvement in other target areas associated with a healthy lifestyle. This included increased participation in physical activity, with five of the seven participants (71%) meeting the target benchmark of one hour of exercise per day following intervention.
• Four of the seven participants (57%) also showed progress that included reduced grazing, adherence to a healthy meal plan, and improved portion control during meals.
• Feedback from caregivers suggested overall satisfaction with treatment, with a score of 4 out of 5 regarding treatment acceptability.

Those results provided provisional evidence to support continued study of the CHANGE program, including determining the long-term sustainability and impact of the observed healthy lifestyle changes.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.