ChildsWork News, Feb. 17, 2012: Revisiting Childhood Obesity and the New Autism Diagnosis

As we head into the weekend, I wanted to take some time to revisit a couple of important topics we’ve discussed before. First, on the heels of my report earlier this week about the new requirements for BMI screenings in Kentucky, a study from February 6’s issue of the journal Pediatrics has found some interesting facts about parental involvement and childhood obesity. As schools begin to change their role in children’s health through measures like the one in Kentucky, looking for “home grown” solutions such as positive parenting may help to alleviate the burden. The next article comes from Columbus, Ohio’s The Columbus Dispatch. While we all remember the news from a few weeks age about the change to the diagnostic definitions of autism spectrum disorders (ASD) many people are now worried about what that change will mean for their lives. This is particularly centered on those with Asperger’s Syndrome who fear being classified with those whose autism reminds people of “Rainman.” What are your feelings? Childhood Obesity Prevented with Positive Parenting By Grace Rattue, writing for Medical News Today A study published online in the February 6 issue of Pediatrics reveals that programs that help parents during the early years of their child's life may help prevent childhood obesity. At present, 1 out of 5 children in the U.S. is classified as obese. Compared to children of normal weight, overweight children are five times more likely to be obese by the time they reach their teenage years. Furthermore, obese children and adolescents, especially low-income and minority youth, are at greater risk for a variety of social, academic and medical problems. In order to find out whether early family intervention, which was effective for parents with children of behavior problems, helped to lower obesity rates, Laurie Miller Brotman, PhD, professor of Child and Adolescent Psychiatry and Director of the Center for Early Childhood Health and Development at the NYU Child Study Center, and team conducted a study that involved 186 children from low-income, minority families at high risk for obesity. The team took advantage of two long-term follow-up investigations of high-risk children who had taken part in assessments of either ParentCorps, a culturally-informed family program for young children, or the "Incredible Years," another effective parenting program, during early childhood. When the children were around four years of age, they were randomly assigned to family intervention or a control group. Each week, children assigned to the behavioral family intervention group went to a 2-hour parent and child group over a 6-month period. Weight, nutrition, and activity were not addressed in the interventions. Dr. Brotman explained: "Children who enter school with behavior problems are at very high risk for academic underachievement and school dropout, antisocial behavior, delinquency, obesity and other health problems. ParentCorps engages parents of high-risk children, reduces harsh and ineffective parenting and prevents early behavior problems from escalating into more serious and intractable problems." Dr. Brotman and her team have created and assessed programs for parents and young children living in urban poverty for more than 10 years. ParentCorps helps parents to be more effective in their approach to discipline, and be more nurturing and responsive. Parents who participate in ParentCorps praise positive behaviors, such as sharing with peers, are more attentive and attuned to their children, and spend more time reading as well as playing with their children. Furthermore, parents use more effective strategies for punishment, such as time out, instead of physical punishment. ParentCorps is especially helpful for parents of children with behavioral problems, and has benefits for socioeconomically and ethnically diverse families. In both follow-up studies, children in the control group and those in the intervention group were assessed between 3 to 5 years later. As the children approached adolescence, body mass index, physical activity and sedentary activity were included in the examination. One of the studies also measured nutritional intake and blood pressure. The researchers found that rates of obesity were considerably lower among children who received family intervention during early childhood, than children in the control group. Furthermore, they found that half of the children in the control group with early behavior problems were obese by second grade, while only 24% of children with behavior problems who received ParentCorps in early childhood were obese. The researchers also found positive effects on physical activity and sedentary behavior. The study that analyzed nutritional intake and blood pressure revealed relatively lower intake of carbohydrates and lower rates of blood pressure in teenagers who received family intervention during early childhood. According to the researchers family intervention programs, such as ParentCorps, that prevent behavior problems at a young age and promote effective parenting, may help to lower the obesity rate among low-income, minority youth. Revising Autism Diagnoses Raises Worry By Rita Price, writing for The Columbus Dispatch For now, Justin Rooney has Asperger’s syndrome. He’s not sure what label might apply next year. The American Psychiatric Association has proposed criteria for autism that would eliminate both Asperger’s and a condition known as “pervasive developmental disorder, not otherwise specified,” or P.D.D.-N.O.S., as separate diagnoses in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. All would be consolidated under a single category of autism spectrum disorder, with different levels of severity. The plan has set off a firestorm of worry among parents, doctors, advocacy groups and, naturally, people such as Rooney. “After so much work to get people to recognize what we are, it feels like we might lose that,” said the 30-year-old Grove City man. The notion of being on a continuum with nonverbal, severely autistic people can seem jarring. “More often than not, when people think of autism, they find themselves in Rain Man territory,” he said. “It makes me worry that it will be that much harder to work past the patronizing attitudes.” As a diagnosis, Asperger’s has distinguished itself — some would even say it’s verging on trendy — in a relatively short time. The condition noted primarily for impaired social interaction wasn’t even included in the DSM, a guide for mental-health professionals and government agencies, until 1994. That also is the most-recent revision of the manual. Some researchers think the changes might narrow the criteria enough to curb the rising tide of autism diagnoses, although others disagree. The psychiatric association says its only goal is to meet the need for clearer criteria, so that diagnoses are more consistent and more accurate in schools, clinics and centers throughout the country. That, in turn, will lead to better treatment, said Dr. James Scully, the association’s medical director. In Ohio schools and elsewhere, autism disorders are by far the fastest-growing category of disability. Ohio had 15,449 students with an autism diagnosis during the 2010-11 school year, according to the state Department of Education. That’s an increase of 584 percent from a decade earlier, when the total was 2,257. Overall enrollment held fairly steady during that period at about 1.7 million students. Asperger’s syndrome and P.D.D.-N.O.S. already are considered forms of autism, the association says. People with Asperger’s have normal or above-normal intelligence and sometimes are referred to as having mild, or high-functioning, autism. “Asperger’s is not really going away; it’s just being subsumed,” said Dr. Carol Lebeiko, a child psychiatrist in Dublin. “Of the kids I see, the kids that I think are on the spectrum would still be on the spectrum. It would be clearer.” Lebeiko understands, however, that many families worry about losing a diagnosis that can help them obtain services. Lebeiko is participating in field trials of the proposed criteria. That means she will use them to evaluate at least two patients through December, possibly applying a diagnosis of level 1, 2 or 3 on the autism spectrum. “I think it probably will tighten criteria a little, but that’s as it should be,” she said. Pat Cloppert, program manager for parent and family support at Ohio State University’s Nisonger Center, said there sometimes are problems with inaccurate diagnoses. “There’s a need for much more consistency than we’re seeing now,” said Cloppert, who has a son with Asperger’s. “People in the same facility can look at the same chart and come up with different diagnoses.”