AAAP Today

Mothers’ pre-pregnancy obesity and diabetes increase risk of autism in offspring

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Children born to obese women with diabetes have four times the risk of developing autism spectrum disorder compared to children born to non-obese women without diabetes. Researchers from the Johns Hopkins Bloomberg School of Public Health published this finding on January 29, 2016 in the journal Pediatrics.

The data was obtained from 2,734 mother-child pairs recruited between 1998 and 2014 at the Boston Medical Center; 102 children with autism were identified during the course of the study. Data on mothers’ weight and diabetes history prior to the pregnancy and whether obesity and diabetes developed during the pregnancy period were collected.

The research findings suggest that risk for autism is present in utero and indicates the importance of controlling the diabetes and weight even before the pregnancy period. Why the combination of obesity and diabetes influences the risk of autism in children is a question for future research.

Reference: Mengying Li; M. Daniele Fallin; Anne Riley; et al. The association of maternal obesity and diabetes with autism and other developmental disabilities. Pediatrics, January 2016 DOI: 10.1542/peds.2015-220

HORSEBACK RIDING BENEFITS SOCIAL FUNCTIONING IN PERSONS WITH AUTISM

Reported by Lirio Sobrevinas-Covey, Ph.D.

Autism spectrum disorder (ASD) has many symptoms. No “cure” has yet been established for the condition itself but, as in the case of most medical and psychiatric conditions, symptom reduction and improved well-being can take place.

Lack of empathy, maladaptive behaviors, and a tendency towards repetitive and ordered behaviors are among the common and disabling symptoms of ASD.

Equine-assisted activities and therapy, or simply put, therapeutic horseback riding, has been examined with generally positive results as an intervention for improving the cognitive, physical, emotional, and social well-being of persons with disabilities. The underlying rationale stems from horses’ natural ability to detect humans’ body language and communicating those detected emotional states to the rider. A number of studies have been conducted to determine if therapeutic riding (TR) can be helpful for persons with autism.

Such studies have varied from 20 to 127 participants with autism who attended TR programs that varied in duration from 12 weeks to 6 months. Impressively, six out of seven reported studies found significant improvements in several areas of social functioning, including social integration, social motivation, directed attention, and spontaneous communication.

Most recently, a study designed to build on positive findings from prior research examined the effects of horsemanship skills and TR on indices of social functioning and of repetitive behaviors in children and adolescents with autism using highly refined and validated measures of both the interventions and the outcomes. The intervention consisted of first, a baseline week of parent-reported assessments and the children-participants performing a range of horsemanship activities – including grooming and leading the horses around the horse-farm site. This was followed by 5 weeks of one 3-hour therapeutic riding session per week delivered by experienced equine activity instructors who were also trained to work with persons with disabilities. The outcome measures included established indicators of adaptive behavior, mal-adaptive behavior, and the Empathising and Systemising Quotient. Empathising affects a person’s social skills ability; systemising relates to the person’s need to organize, control, or engage in repetitive behaviors.

Analysis of study results found that the horseback riding activities reduced scores on maladaptive behavior and improved empathising, but did not affect systemising or adaptive behavior scores. In other words, well-designed and executed therapeutic riding, using the natural relationship between the horse and its rider, although not effective for all aspects of autistic behavior, can have positive effects on social functioning and possibly, the general health and psychological well-being of persons with autism. This desirable outcome warrants more investigation.

Reference: Anderson S, Meints K. Brief Report: The effects of equine-assisted activities on social functioning in children and adolescent with autism spectrum disorder. J Autism Dev. Disord. Published online: 25 July, 2016

Restricted, Repetitive Behaviors – a core symptom of ASD

By Lirio Sobrevinas-Covey, Ph.D.

If you live with a person with autism, no doubt you have seen, over and over again, that person engaging in what appear to be unusual behaviors that he/she performs repeatedly, sometimes, obsessively. Like lining up toys, twirling a stick, continuously flapping hands, rocking, jumping or walking in circles. Among infants, there may be repeated jerking of a foot. Among older persons, there may be repeated hitting of one’s body part, that can sometimes cause self-injury. These types of restricted, repetitive behaviors (RBB) comprise one of the core symptoms that make up the diagnosis of Autism Spectrum Disorder (ASD). (The other core criterion of an ASD diagnosis is social interaction and communication deficits).

RBB occurring in the early lives of children can have negative consequences for the person’s development, negatively impacting learning and socialization. Certain RBB, on the other hand, can have positive consequences, such as when the repetition of behaviors results in a highly developed skill that brings satisfaction or vocational success for the autistic person.

Researchers have categorized RBB as lower order or higher order RBB. Examples of lower order behaviors are perseverating manipulation of objects, repetitive movements, some of which can be self-injurious. Higher order behaviors are more complex and are characterized by rigidness and cognitive aspects such as compulsions, insistence on sameness, and circumscribed interests.

RBB are not specific to ASD but occur at higher frequencies and severity compared to other neurodevelopmental disorders (such as Tourette’s syndrome and Obsessive Compulsive Disorder). There is broad heterogeneity among RBB. This heterogeneity may be influenced by genetic factors and underlying neural circuitry. There is not a perfect correlation between dimensions and severity of RBB and the social impairments that also characterize ASD.

What may influence the manifestation and expression of RBB?

– RBB can occur during the person’s early years but is usually well-noticed by others by 2-3 years of age. Lower order RBB tend to be stable over time; whereas higher order RBB can increase in severity over time.

– Lower intellectual ability is associated with lower order RBB; the relation between intellectual ability and higher order RBB is less clear.

– Social communication deficits do not fully account for the expression of RBB found in ASD.

– By implication, interventions focused solely on improving social communication skills may not impact the RBB found in ASD.

Intervention for RBB. Animal research has shown that stereotypical behaviors are more likely to occur in the absence of environmental stimulation. This finding influenced three types of interventions for treating RBB : 1) consequence based interventions that disrupts the RBB-reinforcement relationship, 2) antecedent based intervention that involves modifying the environment to prevent the occurrence of the RBB, 3) antecedent based intervention that enriches the subject’s environment or skills in order to reduce or prevent the occurrence of RBB.

Intervention that focuses on consequences and antecedents of the RBB is compatible with the tenets of Applied Behavior Analysis (ABA) Therapy. Functional analysis, a tenet of ABA, consists of assessing the reasons behind the problem behaviors. Functional analysis seeks to understand whether the RBB attempts to gain attention or to escape internal sensory experiences. Some research has indicated that RBBs serve non-social reinforcement purposes; and, although, this complicates the development of effective, targeted treatment strategies, functional analysis methods, by applying relevant sensory stimulation options, have shown some success .

Reference: Brian A. Boyd, Stephen G. McDonough, and James W. Bodfish, Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism, J Autism Dev Disord. 2012 June ; 42(6): 1236–1248.