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03/Feb/2021

The rate of obesity amongst children is increasing rapidly and becoming a serious global health problem with an increase in associated chronic health risks, like diabetes, heart disease, sleep disorders, metabolic problems, musculo-skeletal problems, etc. Studies have shown that the incidence of overweight and obesity is even higher in the autistic population. The rates of overweight and obesity in children on the autistic spectrum is estimated to be 33% for overweight and 18% for obesity, which is higher than the rates for neurotypical developing children. (Hill AP, 2015)

There are several risk factors which could contribute to overweight and obesity in the Autistic Spectrum group. A Malaysian study found older child age, high maternal BMI, older paternal age, low physical activity, low likelihood of food refusal and high likelihood of food selectivity to be risk factors for high BMI in ASD children. (Kamal Nor Norazlin, 2019)

Health and Nutrition

Before venturing into management strategies, one has to exclude nutritional deficiencies and health problems. Commonly associated nutritional problems associated with obesity are iron deficiency, zinc deficiency, and lead toxicity. We are seeing more and more insulin resistance in children, which contributes to ánd is a result of midline weight gain. Metabolic disorders, mitochondrial dysfunction and low motor function also lead to obesity and need to be tested for.

Gut-brain connection

Gastro-intestinal health is pivotal in the prevention and management of obesity and overweight. Gastro-intestinal disease and -inflammation is common in autistic children. Underlying changes in the gut microbiome (organism component of the gastro-intestinal tract) has been shown to determine weight control. (Gupta, 2020).

The body’s energy balance is controlled by the hypothalamus in the brain, but overeating triggers the activation of inflammatory and stress response pathways and resultant hormonal dysregulation. (Kaneko K, 2019). Low grade systemic inflammation and oxidative stress, fired by a typical Western diet is associated with food addiction, reducing feedback inhibition pathways for food restriction.

Self-selective eating

ASD children are commonly self-selective about food. Children will typically resonate towards nutrient deficient, high calorie foods, so their food selection needs to be managed from a very early stage. A higher BMI is associated with food selectivity and children with a higher BMI seem to select specific foods, mostly crunchy textures and carbohydrates. I find the most challenging developmental stage for food refusal, manipulation and development of sensory sensitivity related to food the 2-4-year-old group. This is where good guidelines must already be put into place.

Management strategies and parental guidance

One of the first things to do when a child is developing sensory resistance to certain foods, is to do sensory integration therapy and work with desensitisation techniques. Repetitive offering of healthy options and positive feedback around eating are good investments. Speech therapy and behaviour management techniques could all contribute to better outcomes. It is well known that most negative eating patterns are maintained by negative feedback. Creating a positive, stress free environment is a good start to developing balanced feeding behaviour. Positive reinforcement helps. Food reinforcers for behavioural modification can play a negative role in that a child becomes motivated to eat more and develop impulsivity around food intake. Care should be taken around certain behavioural techniques and the association with food rewards,

Sleep

Up to 98.7% of autistic children have some form of sleep disturbance. The recommended duration of sleep for 5-10-year-olds is at least 10-13 hours. Dysregulated sleep has consequences on growth, circadian rhythms, metabolic processes, behaviour and eating habits. Several studies have alluded to the inverse relationship between sleep duration and weight gain. Just as sleep deprivation can lead to overweight and obesity, obesity in its turn can lead to obstructive sleep apnoea, thus sleep deprivation. There are several strategies and medications or supplements to improve sleep in children, so best is to team up with a professional who can help with effective sleep management.

Physical activity

There are several factors associated with ASD which would lead to less time spent doing physical activities. Social and behavioural challenges narrow down the options. Related  motor skills deficits or compromised coordination limit sport opportunities and preferences. There is a major shift toward indoor activities. Schooling for the special needs group often happens in smaller groups, where organised sport is less freely available. In the autistic neurodiverse group, the resonance is toward technology and the safe social environment thereof, which leads to more sedentary time and less physically active time. Developing a balance and applying technology in moderation has become a particular struggle in todays’ world. Complicated by the addictive nature of technology, self-motivation in this regard is mostly lacking. The trick here is to find some physical activity that is fun for the individual, relatively easy and sustainable.

Genetic determinants

Genetics definitely underpins the risk of childhood obesity. Lifestyle factors in families also play a role. Interestingly genetic vulnerabilities are linked to both autism and obesity. Some researchers have found specific genetic links between the 2 conditions, where they have been able to show 36 common genes between these 2 conditions. (Dhaliwal, 2019). There are several genetic/chromosomal disorders associated with obesity and often related to autism, such as Down -, Prader-Willi -, Smith-Lemli-Opitz -, William syndrome, and others. With genomics SNP analysis being available some of the epigenetic pathways can be examined and addressed.

Medication

Most children presenting autism will be offered a prescription for an anti-psychotic medication (Risperidone or Aripiprazole) somewhere down the line. Unfortunately, the side-effects of these commonly used medications have a bad imprint on sugar metabolism. In certain individuals the combination of this medication with their genetic constitution leads to weight gain and eventually insulin resistance and diabetes. Care must be taken to limit, or preferably completely avoid, refined carbohydrates, sugar and sweets when using this medication.

Comorbid conditions, such as ADHD, anxiety, OCD and depression are commonly associated with autism. The medication used to manage these conditions (SSRIs, methylphenidate, atomoxetine, etc.) also have a negative impact on weight control, so measures need to be taken to limit the impact. Best is to make good food choices and to try to avoid hunger and cravings that lead to the intake of high calorie, nutrient deficient foods.

Obesity in children is associated with social, emotional and physical challenges, which compound the difficulties associated with the autistic spectrum presentation. Because Autistic Spectrum Diverse children have several problems that result in poor socialisation and social acceptance, successfully preventing and/or managing obesity could contribute positively to inclusion.


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17/Nov/2020

One of the core deficits associated with the diagnosis of Autistic Spectrum Disorder (Diversity) is the complications around speech development and social communication. The term non-verbal has been the term referred to as part of the diagnostic criteria. Non-speaking would be a better term, as non-verbal would refer to an inability to be able to communicate at all, while non-speaking would refer to the inability (or degrees of ability) to use oral speech. As with everything on the spectrum of autism, the ability to speak is also presented in a spectrum, with some autistic individuals with exceptional speech development, rich vocabularies and an ability to discuss complex subjects and others who have no or limited speaking skills, for whom it is difficult to grasp the concept of words and sentences.

Speech development is a process, starting with preverbal skills and progressing through several stages to the ultimate ability to use language appropriately in social communication and communicating needs. There are 2 main areas of language, namely receptive language (understanding) and expressive language (using language). To be able to develop language, a lot of factors play a role. Let’s look at a few of the aspects that could be addressed through biomedical treatment.

1. Sensory Experience
For optimal language development, one has to use one’s sensory organs appropriately. One has to be able to see or hear. Sensory dysregulation can affect the sensory experience and have an effect on speech development. Anxiety plays a big role in sensory dysregulation, so needs to be addressed to be able to improve sensory integration. The gut microbiome is also involved in the background of sensory integration, anxiety and optimal functioning.

2. Processing
From the sensory organ(s) the information has to be processed to or communicated with the brain. From the brain the information has to be processed to execution, mostly to the mouth, as organ of speech. Methylation disorders, amongst other biochemical processes, play a role in the ability to focus/concentrate and in the processing of information.

3. Brain function
The brain has to store the information and be able to recollect the information appropriately to be able to respond by action or by communication. The classic areas involved in speech are known to be the Broca’s area, in the frontal area of the dominant hemisphere (mostly left) and the Wernicke’s area, in the back part of the temporal area, also of the dominant hemisphere. Broca’s area traditionally was seen to be involved with speech production and pronunciation, while Wernicke’s area is associated with the comprehension of written and spoken language. Without going into too much detail, one has to add that there are a host of other areas involved in speech too, including the cerebellum (small brain) and the motor cortex (governing motor skills). Inflammation in the brain, biochemical changes and genetic constitution affect expression of speech.

4. Motor skills
To be able to form words orally, the muscles of the mouth, lips, jaw, cheeks and tongue have to work together. This articulates recognisable words. One of the first signs of motor skills disorder around the mouth is when a baby is unable to breastfeed properly. I often get the history of a mom “not producing enough milk” while in actual fact the production of milk is really dependent on the stimulatin by the baby’s ability to suckle. Low motor tone, coordination difficulties and lack of endurance all play a role in the motor development around the mouth and subsequently the ability to speak.

To address speech development, one has to think holistically. All the areas of involvement need to be optimised. Some autistic children will never develop oral speech, but will develop the ability to communicate in other ways. That is also OK.


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05/Nov/2020

PANS (Paediatric Acute onset Neuro-Psychiatric Syndrome) is a diagnosis associated with sudden onset OCD, tics or severe eating restrictions with at least two other associated cognitive, behavioural and neurological symptoms. PANDAS (Paediatric Auto-immune Neuro-psychiatric Disorder associated with Streptococcus) is a subgroup diagnosis of the above, but associated with a sudden onset of symptoms after an infection. The diagnosis is difficult to recognize in autistic children, as there is often an overlap of symptoms.


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18/Oct/2018

Oxidation is a perfectly normal and healthy function in the human body, but though oxidative stress is equally common and unavoidable, it has the potential to cause damage to the system and should be managed and, if possible, prevented. This becomes even more crucial for children affected by autism spectrum disorder


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13/Aug/2018

Neurodevelopmental problems can turn the life of a parent and that of the child into an ongoing trauma. Autism can be isolating because it impairs the child’s ability to communicate and, consequently, to function effectively in any social situation. This results in distress for the parent, the child, and for others involved in interactions with the sufferer.

So much is known about the restrictive symptoms of the autism spectrum (ASD), the causes of which are regarded as partly genetic, yet insufficient focus is placed on an investigation as to whether the patient can be helped by a change in diet or the avoidance of allergy-triggering elements in the wider environment. In many cases the removal of substances thought to cause allergic reactions or inflammation in a child’s system, has resulted in dramatic improvements in the severity of the ASD symptoms suffered.


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12/Jun/2018

Autism Spectrum Disorder (ASD) is a fast-growing developmental disability in many countries, characterised by impaired social interaction and communication, as well as restricted and repetitive behaviour. Research into the background of autism, the etiology and associated biomedical interventions is ongoing. Treatment is often limited to targeting the behavioural challenges.


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Dr Louise Lindenberg runs an integrative medical practice in Durbanville, Cape Town. She incorporates dietary intervention, supplementation, nutrition, phytotherapy/herbal medicine, and allopathic medicine in a holistic health care environment. Her passion is working with children on the Autistic Spectrum, including Autism, PDD, ADD, ADHD and behavioural problems.

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Copyright by Dr L Lindenberg 2020. All rights reserved.