Healthy-Weight Kindergarten Children with Autism Spectrum Disorder May Become Overweight and Obese during the First Few Years of Elementary School.

Analysis of a population-based, nationally-representative longitudinal sample from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 identified an increase in healthy-weight children with autism spectrum disorder becoming overweight and obese between first and second grade, thus identifying a critical period for early prevention and treatment.

Improving web access for individuals who rely on augmentative and alternative communication.

People with significant speech and motor disabilities often face obstacles attempting to navigate the World Wide Web. This is especially true for the millions of children and adults worldwide who rely on or could benefit from augmentative and alternative communication (AAC). This study was designed to test the usability of WebAACcess, an accessibility enhancement tool designed to bypass some of the barriers to navigating the web. Using a repeated-measures research design, whereby subjects were their own controls, each of the 12 participants (7 with motor disabilities who used AAC and 5 peers without disabilities) navigated equivalent web pages using Internet Explorer alone and Internet Explorer with WebAACcess. Results consistently demonstrated that navigating using WebAACess with Internet Explorer was more efficient, easier, and equally effective for all of the participants than navigating with Internet Explorer alone.

Parental concern regarding obesity in children with autism spectrum disorder in the United States: National Survey of Children's Health 2016.

BACKGROUND: The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds that of the general population, but the level of parental concern about obesity in these children is unexplored. OBJECTIVE: We estimate the prevalence of obesity in children 10-17 years in the redesigned National Survey of Children's Health (NSCH) 2016, and compare parental concern about obesity between parents of children with and without ASD. METHODS: The nationally representative NSCH 2016 oversampled parents of children with parent-report of special health care needs, including ASD. Parents opted to complete the survey via the web or surface mail. Following report of their child's height and weight, parents were asked "Are you concerned about their weight?" Response options included: "Yes, it's too high," "Yes, it's too low," or "No, I am not concerned." Obesity (>95th percentile BMI) was defined using the 2000 CDC growth reference. We used logistic regression to compare odds of obesity, and odds of parental concern, between children with and without ASD. RESULTS: In 24,251 children, ASD (n = 699) increased obesity risk after adjusting for age, sex, and race/ethnicity (OR = 1.54, 95%CI: 1.11, 2.14). ASD medication did not significantly affect obesity. ASD increased obesity concern (OR = 2.17, 95%CI: 1.53, 4.81) among parents with obese children. Parents of boys with obesity and ASD had less obesity concern if he was taking medication for ASD (OR = 0.258, 95%CI: 0.09, 0.78). CONCLUSION: While the prevalence of obesity is elevated in children with ASD, parental obesity concern is high, suggesting opportunities for the development of parent-focused obesity prevention and treatment interventions for this population.

Genetic Testing for Obesity: Implications and Challenges.

PURPOSE OF REVIEW: This review summarizes the experimental literature on behavioral outcomes and psychological effects of genetic testing for obesity. Such tests, although of dubious value, are increasingly marketed to the public, and there has been concern that while results may encourage some consumers to increase the healthfulness of their lifestyles, others may interpret feedback in maladaptive ways. RECENT FINDINGS: Hypothetical vignettes have been used in artificial settings; few studies have investigated outcomes of actual test results. At present, the effects of genetic testing for obesity seem limited to improving consumers' weight control intentions and motivation rather than actual dietary behavior. Evidence for negative psychological consequences is scarce and seems of greater concern for normal weight persons than for those who are overweight. Better research designs carried out in the field rather than the laboratory with more diverse samples are needed.

The Effect of Age on the Prevalence of Obesity among US Youth with Autism Spectrum Disorder.

BACKGROUND: We sought to assess the association between age and the prevalence of obesity among children with and without autism spectrum disorder (ASD) in the 2011-2012 National Survey of Children's Health. METHODS: Analyses were restricted to 43,777 children, ages 10-17, with valid measures of parent-reported weight, height, and ASD status. Exploratory analyses describe the impact of sex, race/ethnicity, and household income on the relationship between age and obesity in ASD. RESULTS: Although the overall prevalence of obesity among children with ASD was significantly (p < 0.001) higher than among children without ASD (23.1% vs. 14.1%, 95% confidence interval for difference 3.6 to 14.4), child age significantly (p = 0.035) modified this difference. In a multivariable logistic regression analysis, adjusted for sex, race/ethnicity, and household income, the odds of obesity among children with ASD compared with children without ASD increased monotonically from ages 10 to 17 years. This pattern arose due to a consistently high prevalence of obesity among children with ASD and a decline in prevalence with advancing age among children without ASD. These findings were replicated using a propensity score analysis. Exploratory analyses suggested that the age-related change in obesity disparity between children with and without ASD may be further modified by sex, race/ethnicity, and household income. CONCLUSIONS: The patterns of prevalence observed with increasing age among children with and without ASD were unexpected. A better understanding of the etiological and maintenance factors for obesity in youth with ASD is needed to develop interventions tailored to the specific needs of these children.

Intellectual disability is associated with increased risk for obesity in a nationally representative sample of U.S. children.

BACKGROUND: Data on obesity prevalence in children with intellectual disability (ID) are scarce. OBJECTIVE: We estimated rates of obesity among children aged 10-17 years with and without ID in a nationally representative dataset that included measures of child weight and ID status, as well as family meal frequency, physical activity, and sedentary behavior. METHODS: Chi-square tests compared prevalence of obesity, demographic and behavioral characteristics between children with and without ID as reported in the 2011 National Survey of Children's Health. Tests for interaction in logistic regression models determined whether associations between obesity and behavioral characteristics were different between children with/without ID. RESULTS: Obesity prevalence for children with ID was 28.9% and 15.5% for children without ID. After adjusting for age, sex, race/ethnicity and poverty level, the odds ratio was significantly 1.89 times greater among children with ID than among those without ID (95% CI: 1.14 to 3.12). Among children with ID, 49.8% ate at least one meal with family members every day compared to 35.0% without ID (p < 0.002), and 49.5% with ID participated in frequent physical activity compared to 62.9% (p < 0.005). Prevalence of obesity was higher among all children who ate family meals every day compared to fewer days per week, and the effect was significantly more pronounced among those with ID (p = 0.05). CONCLUSIONS: Prevalence of obesity among youth with ID was almost double that of the general population. Prospective studies are needed in this population to examine the impact of consistent family mealtimes and infrequent physical activity.

Research issues in genetic testing of adolescents for obesity.

Obesity is often established in adolescence, and advances are being made in identifying its genetic underpinnings. We examine issues related to the eventual likelihood of genetic tests for obesity targeted to adolescents: family involvement; comprehension of the test's meaning; how knowledge of genetic status may affect psychological adaptation; minors' ability to control events; parental/child autonomy; ability to make informed medical decisions; self-esteem; unclear distinctions between early/late onset for this condition; and social stigmatization. The public health arena will be important in educating families about possible future genetic tests for obesity.

Predictors of uptake of obesity genetic testing among affected adults.

Given that a large number of candidate genes coding for a tendency toward obesity have been identified and some findings have been replicated, we explored characteristics of those who would be most likely to obtain future genetic testing for this tendency. During a series of focus groups, obese respondents rated their likelihood of obtaining testing under conditions in which either genetically-targeted drug treatment would be available, a positive test would be associated with a prognosis for developing diabetes, or neither of these. Interest in testing was greater given the first two scenarios than the third. Older age and belief that genetics were an important cause of obesity were associated with greater interest. For the first two scenarios, higher educational status was associated with greater interest, while for the third, respondents who said emotional issues caused overweight and those who crash-dieted intermittently were more likely to want genetic testing. Although further research is required to validate these findings, this study is the first published report of respondents' ratings of likelihood to obtain genetic testing for propensity to obesity, and suggests strong interest in genetic testing among some people, even in the absence of further treatment implications of the test.

Adults' values and attitudes about genetic testing for obesity risk in children.

OBJECTIVE: We explored personal attitudes about genetic testing of children for obesity risk among parents of overweight children. We also gathered telephone opinions from the parents and from obese adults about policy related to such genetic testing. METHODS: We conducted three parents' focus groups, during which they produced numerical ratings on whether they would want their children to be tested according to scenarios in which 1) genetically-targeted drug treatment would be available, 2) a positive test would be associated with a prognosis for developing diabetes, or 3) neither of these. Quantitative data were also gathered during follow-up calls. RESULTS: Parents were more likely to want testing for their children under the first two scenarios, although there was interest in the third scenario, particularly among separated/divorced parents, and those whose children were not dieting. Even if treatment were not available, more than three-quarters believed testing should be available, more than one-third of them at birth. The youngest child age to divulge a positive result, on average, was 10 years. A primary reason was the perceived helpfulness of the result in framing behavior of both parent and child in preventing development of obesity. Respondents generally failed to perceive the possible negative consequences of a positive test result, insufficiently to consider implications of a negative result. CONCLUSIONS: Additional research is required in order to understand the best ways to educate parents about genetic testing for obesity risk, given the strong interest shown in having such testing available and divulging results to minor children.

Caregiving burden responses differ for Internet and telephone data collection.

We compared data collected by internet and by telephone from chronic patients' family members about the experience of caregiving. We used a within-subject design, and dual administration of scales including caregiving burden, caregiver social support, depression, and locus of control regarding patient health.

The accuracy of artificial neural networks in predicting long-term outcome after traumatic brain injury.

OBJECTIVE: This study compared the accuracy of artificial neural networks to multiple regression and classification and regression trees in predicting outcomes of 1,644 patients in the Traumatic Brain Injury Model Systems database 1 year after injury. METHODS: Data from rehabilitation admission were used to predict discharge scores on the Functional Independence Measure, the Disability Rating Scale, and the Community Integration Questionnaire. RESULTS: Artificial neural networks did not demonstrate greater accuracy in predicting outcomes than did the more widely used method of multiple regression. Both of these methods outperformed classification and regression trees. CONCLUSION: Because of the sophisticated form of multiple regression with splines that was used, firm conclusions are limited about the relative accuracy of artificial neural networks compared to more widely used forms of multiple regression.