However fun it might be, this sort of education doesn’t work for all families—and is not always enough. Some researchers, including Broder-Fingert, are adapting pediatric obesity treatments for young people on the spectrum. Compared with programs for typical children, these initiatives take a slower approach to weight loss, one that gives the children more choices. “There isn’t a need to reinvent the wheel; we just needed to make some small but important changes,” Broder-Fingert says.
For instance, clinicians might advise the parents of a typical child to throw away all the sugary drinks in the house and replace them with water, with the idea that the child might balk and whine at first, but will give in to thirst. A child with autism, however, might not switch so easily. Curtin instead recommends swapping out one soda for one seltzer water a day, gradually working toward a total substitution.
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At her clinic at the Medical University of South Carolina, the psychiatrist Eve Spratt was used to seeing families who had tried everything and given up. These families were told things such as “eat more fruits and vegetables,” Spratt says, but that was impossible when their children might eat only four foods and wouldn’t touch anything green. The parents were often told to take away the child’s iPad and send her outside to play—neither of which was really an option if losing screen time might provoke an hours-long meltdown or might cause the child to wander off, get lost, or hurt herself. The parents who came to Spratt knew they needed to address their children’s physical health issues, but had not found anything that worked.
In 2014, Spratt started codirecting a six-week day camp for teens and young adults with autism or other conditions—a program that has since expanded to offer after-school classes. To increase food variety, Spratt and her colleagues introduce participants to the university garden, showing them how the vegetables are grown, what nutrients they have and what they look like when they are freshly picked. This approach piques the teens’ interest in trying the vegetables, she says. The program also includes stress-management techniques, such as yoga and deep breathing, and physical activity. Due to their heightened senses, many young people with autism don’t like to sweat, nor do they like the pounding pulse that accompanies physical exertion or the loud music in many exercise classes. So when they work out, Spratt turns on fans, lowers the volume on the music, and helps them learn how to tolerate their discomfort. “I ask them to be brave enough to get a little bit out of their comfort zone,” she says.
Over the past three years, few of the participants have lost a significant amount of weight, but most of them have stopped gaining and have put on muscle. Most participants from the 2015 camp report that they now eat more fruits and vegetables. They also became less depressed. Spratt and her colleagues presented the findings at the 2016 meeting of the American Academy of Child and Adolescent Psychiatry.