News and Knowledge

In October 2016, OAR’s Board of Directors authorized funding for six new applied autism research studies in 2017. These new grants, totaling $178,866, bring OAR’s total research funding to over $3.6 million since 2002. This is the fifth of six previews to be featured in “The OARacle” this year.

Children with autism spectrum disorder (ASD) are at increased risk for obesity compared to peers, which can lead to health issues, such as hypertension and diabetes, which may extend into adulthood. In addition to common predictors of obesity, children with ASD may have additional barriers to healthy lifestyles that make treating the problem difficult. Existing programs to treat obesity and teach healthy nutrition do not address those barriers.

Kristen Criado, Ph.D., a psychologist with the Feeding Disorders Program at Marcus Autism Center, and William Sharp, director of the program, recently completed the initial development of the Changing Health in Autism through Nutrition, Getting fit and Expanding variety (CHANGE) program, which is based on more than 10 years of experience developing and evaluating treatments for food selectivity and related dietary concerns (e.g., poor nutrition, obesity) in children with ASD. This program involves an innovative approach to weight management with the flexibility to address each child’s behavioral, feeding, and nutritional profile.

Methodology

Through a two-year OAR-funded study, Drs. Criado and Sharp will study the program’s effectiveness. Twenty children with ASD and obesity ages 5 to 12 years, along with a parent/caregiver, will participate in 16 sessions over a six-month period, followed by three monthly follow-up assessments/booster sessions. The first 10 appointments will take place weekly while the next six will be conducted biweekly. This gradual decrease is intended to correspond with parents’ enhanced ability to implement the program with less support from the research team.

CHANGE involves the use of established behavioral approaches to increase acceptance of healthy foods and exercise. The dietitian works to reduce the overall consumption of child-preferred foods (e.g., eliminating grazing/snacking) and rebalance the child’s current diet by increasing the portion of healthy food options available in the child’s limited food repertoire. Behavioral strategies to support these efforts are embedded in the nutrition protocols, such as using fading and reinforcement to prevent and manage behavior problems associated with a child’s over-reaction to changes in diet.

Behavioral treatment guides the introduction and establishment of new, healthy foods to expand dietary variety in children with ASD and food selectivity. As a child begins eating new foods, the dietitian replaces high fat/calorie foods with fruits, vegetables, lean proteins, and low-calorie starches.

CHANGE also relies on techniques derived from applied behavior analysis to increase physical activities with consideration of a child’s developmental and cognitive profile. Participants will learn strategies to engage in physical activity, such as walking with a therapist in clinic or implementing visual activity schedules to teach steps in an exercise or game (e.g., jumping jacks or hopscotch). Each participant will receive a Fitbit that will be used to measure steps and heart rate. Once engagement in physical activity is established, the time spent exercising is systematically increased.

CHANGE uses a “parent as co-therapist” model designed to address the public health problems associated with obesity in children with ASD. Caregivers are trained in the role of therapist so that they can translate these skills into the home setting. By addressing adherence at the level of individual families, the treatment model emphasizes problem solving and teaching parents to identify ideas that will work best for each family.

The manual includes methods to increase dietary diversity and in-clinic activities and homework assignments to promote physical activity.

Evaluation

Multi-method assessment measures include body mass index (BMI) percentile, intake of healthy food, problem behaviors during meals, physical activity (through tracking logs completed by parents, as well as Fitbit data), and parenting stress. The research team will conduct interviews with parents to provide input that will contribute to modification of the program for a large-scale randomized controlled trial.

Outcomes

If successful, this program will result in an exportable, cost-effective treatment model that promotes health and well-being in children with ASD and obesity. The primary deliverable for this study is a treatment manual intended to support an intervention that can be rapidly adopted by the ASD community.

The CHANGE program holds potential to provide practical tools to empower parents to overcome barriers to healthy eating and exercise, giving them the means to alter their child’s health and development. Learning healthy eating and fitness strategies early builds a foundation for a healthier and stronger adulthood.