Obesity in young children with autism spectrum disorders: prevalence and associated factors.

BACKGROUND: The purpose of this study was to identify rates of overweight and obesity in young children with autism spectrum disorders (ASD) and factors related to overweight. METHODS: Retrospective chart reviews were conducted for 273 children with ASD [i.e., autistic disorder, Asperger's disorder, pervasive developmental disorder not otherwise specified (PDD-NOS)] after receiving outpatient services with a developmental pediatrician or the developmental team at a children's hospital. Information on child demographics, height and weight, medications prescribed, and adaptive functioning was collected from charts. RESULTS: Rates of overweight and obesity in children with ASD were found to be above nationally representative prevalence estimates for children. Among children with autistic disorder, 17.16% had a body mass index (BMI) percentile in the overweight range and 21.89% had a BMI percentile in the obese range. For children with Asperger's disorder/PDD-NOS, 12.50% were considered overweight and 10.58% were considered obese. Neither psychotropic medications prescribed nor adaptive functioning was found to be related to whether the child was overweight or obese. CONCLUSIONS: Children with ASD are at risk for overweight and obesity, and children with autistic disorder are at greater risk for weight problems than children with Asperger's disorder/PDD-NOS. Further research is needed to identify factors related to overweight in children with ASD.

Health-related quality of life, depression, and metabolic parameters in overweight insulin-resistant adolescents.

INTRODUCTION: The purpose of this study was to examine the incidence and severity of depression and health-related quality of life (HRQoL) in youth with insulin resistance (IR) who are overweight/obese and to examine the impact on making lifestyle changes. METHOD: New patients presenting for treatment in an IR clinic were screened for depression and HRQoL and reassessed twice during a 1-year treatment period. Metabolic and growth parameters were obtained for each participant. RESULTS: Elevated symptoms of depression were reported in 51% of the sample, and these symptoms were stable over time. Approximately 10% of these youth reported moderate or severe symptoms of depression. HRQoL scores indicated a good quality of life overall with slight improvement in some areas over time. Depression scores were not associated with demographic variables or metabolic parameters. DISCUSSION: More than 50% of adolescents with IR and obesity reported elevated symptoms of depression. These results provide sufficient evidence for the need to conduct routine screening of depression for all youth with IR so that appropriate mental health referrals can be made.

Developing criteria for pediatric/adolescent bariatric surgery programs.

The prevalence of morbid obesity in adolescents is rising at an alarming rate. Comorbidities known to predispose to cardiovascular disease are increasingly being diagnosed in these children. Bariatric surgery has become an acceptable treatment alternative for morbidly obese adults, and criteria have been developed to establish center-of-excellence designation for adult bariatric surgery programs. Evidence suggests that bariatric surgical procedures are being performed with increasing numbers in adolescents. We have examined and compiled the current expert recommendations for guidelines and criteria that are needed to deliver safe and effective bariatric surgical care to adolescents.

Psychosocial functioning of pediatric renal and liver transplant recipients.

The current study examined child- and parent-reported child psychosocial functioning in a large sample of children who received solid organ transplantation. Participants included 64 children who received kidney or liver transplantation and 64 parents who completed a standardized measure of children's psychosocial functioning (BASC; Reynolds & Kamphaus, 1992). Although post-transplant children reported significantly fewer psychosocial difficulties than the normative average, parents reported that children had some psychosocial difficulties, particularly internalizing problems. There were no differences in psychosocial functioning between deceased donor organ and living donor organ recipients. Given the discrepancy between parent and child report, the results suggest that children may underreport psychosocial difficulties following transplantation or parents may over-report children's difficulties. Clinicians and researchers are encouraged to obtain assessment information from multiple reporters when assessing psychosocial functioning in this population.

The relationship of hope and illness-related uncertainty to emotional adjustment and adherence among pediatric renal and liver transplant recipients.

OBJECTIVE: To examine, using partial least squares (PLS) modeling, the associations among hope, illness-related uncertainty, anxiety, depression, and adherence in a sample of children with renal and liver transplantations. METHODS: Seventy pediatric renal and liver transplant recipients and their caregivers participated in a 3-month study which involved completing questionnaires and monitoring adherence via self-report and electronic monitoring (MEMS caps). A PLS estimation procedure was used to examine the associations among constructs in the theoretical model. RESULTS: Hope and uncertainty were associated with both depressive symptoms and anxiety, and depressive symptoms were associated with treatment adherence. The association of hope and adherence to treatment was fully mediated by depressive symptoms. CONCLUSIONS: Findings suggest mechanisms for identifying patients that may be at risk for nonadherence and components for intervention programs to improve adherence rates among pediatric transplant recipients.

Pediatric asthma: a look at adherence from the patient and family perspective.

Although extensive research has been done in an effort to understand and promote adherence in pediatric asthma, little progress has been made in reducing the prevalence of nonadherence. Some researchers argue that a paradigm shift is necessary to advance the adherence field. Despite the recent trend for increasing the role of families in determining treatment plans, a patient-centered approach has been lacking in adherence to a daily regimen. It is clear that, although patients and families show evidence of inadvertent nonadherence (eg, forgetfulness), they also engage in volitional or intentional nonadherence, via reasoned and purposeful decisions. Patients conduct "experiments" with their regimen components in an effort to balance the burden of disease with the burden of treatment. These experiments typically involve some degree of nonadherence. Perhaps, if researchers strive to better understand the decision-making process involved in these experiments, health care providers can guide families in making adherence decisions that would lead to attainment of treatment goals, improvement in quality of life, and realization of positive clinical outcomes.

Patterns of maternal distress among children with cancer and their association with child emotional and somatic distress.

OBJECTIVE: To identify patterns of distress among mothers of children with cancer over the initial 6 months of treatment and to examine these patterns as predictors of child somatic and emotional distress. METHOD: Data were gathered regarding maternal perceived stress and affective distress from mothers of children (N = 65, mean age = 8.3 years) with cancer at 2 to 5 weeks postdiagnosis, then at 12 to 14 weeks and 22 to 24 weeks. Mothers and nurses provided indexes of child somatic and emotional distress at these assessments. RESULTS: Hierarchical and k-means cluster analyses revealed four distinct patterns of maternal distress: high, moderate, declining, and low. The high maternal distress group reported higher child emotional distress at all three points but higher child somatic distress only at the final assessment. Maternal distress group was unrelated to nurse-reported child distress. CONCLUSIONS: The identification of four empirically derived patterns of maternal distress may explain some of the variance in the literature regarding parental distress vis-à-vis pediatric cancer treatment and may have relevance to intervention efforts. Differences in the relations between maternal distress groups and mother- and nurse-reported child distress underscore the importance of collecting child distress data from multiple sources.