Overweight and obese status in children with autism spectrum disorder and disruptive behavior.

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.

Overweight and Obesity in a Sample of Children With Autism Spectrum Disorder.

OBJECTIVE: To determine the prevalence of overweight/obese status in children with autism spectrum disorders (ASD), identify associated characteristics, and develop a model to predict weight status. METHODS: The prevalence of overweight and obesity was determined in 2769 children with ASD enrolled in the Autism Speaks Autism Treatment Network, a collaboration of 17 academic centers, and compared with a national sample matched for age, sex, and race. Associations in the ASD sample between weight status and demographic and clinical variables, such as age, race, head circumference, and adaptive functioning, were tested using ordinal logistic regression. The accuracy of a final model that predicted weight status based on early life variables was evaluated in a validation sample. RESULTS: The prevalence of overweight and obesity were 33.9% and 18.2%, respectively; ASD was associated with a higher risk of obesity (but not overweight) relative to the national sample (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.05-1.28; P = .003). In the adjusted analysis, overweight/obese status was significantly associated with Hispanic ethnicity (OR, 1.99; 95% CI, 1.37-2.89), parental high school education (OR, 1.56; 95% CI, 1.09-2.21), high birth weight (OR, 1.56; 95% CI, 1.11-2.18), macrocephaly (OR, 4.01; 95% CI, 2.96-5.43), and increased somatic symptoms (OR, 1.41; 95% CI, 1.01-1.95). A prediction model designed to have high sensitivity predicted low risk of overweight/obesity accurately, but had low positive predictive value. CONCLUSIONS: The prevalence of obesity in children with ASD was greater than a national sample. Independent associations with increased weight status included known risk factors and macrocephaly and increased level of somatic symptoms. A model based on early life variables accurately predicted low risk of overweight/obesity.

Disclosure of diagnosis: to tell or not to tell?

CASE: Jimmy is an 8-year-old boy with hepatitis B, e antigen (HBeAg)-positive, HIV and hepatitis C negative, who was adopted from Vietnam when he was 5 years and has been followed in your primary care practice since that time. Before adoption, he lived in an orphanage, where he was placed soon after birth. Jimmy currently lives with his adoptive mother and grandparents. His adoptive father has amyotrophic lateral sclerosis and recently moved to a nursing home due to a need for more intensive care. Jimmy continues to see him regularly.Jimmy's mother presents today upset about a recent encounter with his hepatologist. During this visit, Jimmy's doctor was insistent that Jimmy should be told about his illness immediately. He felt that Jimmy "had a right to know" and that it was important for the protection of other children. Jimmy's family practices universal precautions and Jimmy is compliant with these safety measures. Jimmy's mother has chosen not to share his diagnosis with the school and in addition has not felt the time was right to disclose the diagnosis to Jimmy. He is asymptomatic, takes no medications, and is followed yearly by a hepatologist. His mother is concerned that Jimmy would have difficulty managing this information and maintaining a "secret." However, she also worries that he may feel his trust has been violated if she delays telling him.Jimmy is currently 8 years old, in second grade, and is struggling academically with math and reading. Socially, he is reported to have difficulty making friends and reading social cues. For example, he displays inappropriate boundaries, often standing too close or touching others, which has resulted in children avoiding him. During your annual visit, Jimmy presented as a friendly and engaging boy. He maintained conversation about school and some of his interests, but he was often distractible, impulsive, at times grabbing things, and fidgety, frequently standing up and then sitting back down. Jimmy's mother reports that this behavior is similar to what he exhibits in the classroom. He is currently receiving English as a Second Language services and is enrolled in a weekly "lunch bunch." What advice would you give the family?