Posted on Autism

Family-centered nutrition influences diet behaviors for autistic children

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Adapting family-centered nutrition programs can positively influence diet behaviors in children with autism, according to a new study in the Journal of Nutrition Education and Behavior, published by Elsevier.

Autism spectrum disorder (ASD) is one of the most common developmental disabilities in children. Because many children with autism battle with obesity, researchers evaluated the adaptation and implementation of an existing, evidence-based nutrition program for children with autism and their parents.

“Historically, children with autism have been excluded from this type of programming often designed for neurotypical kids. We know that children with autism face greater challenges. One of these challenges is that they often have two to five times the rate of obesity than other kids. So, we wanted to help this population that often lacks these specialized resources,” said Brenda Manzanarez, MS, RD, The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA.

Children aged 7−12 years with autism and their parents participated in six weekly, 90-minute classes attended by the whole family as part of the Kids N Fitness© program developed at Children’s Hospital Los Angeles. Each class was structured around four core elements: (1) family-centered nutrition education; (2) parent support; (3) physical activity; and (4) goal setting.

“We had trained staff that delivered the curriculum along with applied behavior analyst therapists who provided support and feedback on how we could improve the curriculum. At the end of the sessions, we found it challenging to keep up the retention of families, with about 26% completing the program. Interestingly, we found that those who did complete the entire program did have 100% attendance,” Manzanarez continued. “The families voiced that they liked the program and seeing changes in their kids like improving their eating habits, being more positive, and engaging in exercise as a form of movement.”

Families reported valuing the opportunity to ask questions and share successful experiences and approaches to increase their child’s healthy food repertoire. On completing participation in the pilot, families reported their children to be more willing to try new foods, proactively added colorful foods to their plate during mealtimes, and expressed greater interest in exercise. In addition, the curriculum seemed to resonate with child participants, as documented by both staff and parents, who noted that children recalled main messages from prior weeks’ lessons.

The increasing prevalence of ASD and childhood obesity merits innovative interventions involving the whole family. Family-based community programs that address problematic mealtime behaviors and provide family-centered nutrition education may prove an important adjunct or alternative to more time a resource-intensive one-on-one interventions, such as traditional feeding therapies. As children with ASD are often excluded from traditional learning settings, findings from this pilot can contribute to the development of evidence-based practices of community-based nutrition interventions for children with ASD and their families.

Posted on Pain Management

Pain – Recent cannabis use linked to extremes of nightly sleep duration

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Recent cannabis use is linked to extremes of nightly sleep duration–less than 6 hours or more than 9 hours–reveals a study of a large representative sample of US adults, published online in the journal Regional Anesthesia & Pain Medicine.

This pattern was even more pronounced among heavy users–those using on 20 out of the previous 30 days, the findings show.

Cannabis use in North America continues to increase, with around 45 million adults in the USA reporting this in 2019, which is double the figure reported in the early 2000s.

This change has partly been driven by widespread decriminalisation in many states over the past decade, as well as research suggesting that cannabinoids may have therapeutic value for pain relief and possibly anxiety and sleep disorders as well, say the researchers.

Cannabis has become popular as a sleep aid, particularly as the prevalence of sleep deprivation and insomnia has increased. Only two thirds of Americans get the recommended 7-9 hours of sleep every night, and almost half report daytime sleepiness every day.

But the evidence to date on the impact of cannabis on the sleep-wake cycle has been equivocal.

The researchers wanted to see if cannabis use might be linked to nightly sleep duration in a nationally representative sample of US adults (aged 20-59) who had taken part in the biennial National Health and Nutrition Examination Survey (NHANES) for the years 2005 to 2018 inclusive.  

And they wanted to know if respondents reported difficulty falling asleep, staying asleep, or slept too much in the preceding 2 weeks; whether they had ever consulted a doctor about a sleep problem; and whether they regularly experienced daytime sleepiness on at least 5 of the preceding 30 days.

Survey respondents were characterised as recent or non-users if they had or hadn’t used cannabis in the past 30 days. Sleep duration was defined as short (less than 6 hours), optimal (6–9 hours), and long (more than 9 hours). 

Information was gathered on potentially influential factors: age; race; educational attainment; weekly working hours; a history of high blood pressure, diabetes, and coronary artery disease; weight (BMI); smoking; heavy alcohol use (4 or more drinks daily); and prescriptions for opioids, benzodiazepines, ‘Z drugs’ (approved for insomnia), barbiturates, other sedatives, and stimulants.

Some 25,348 people responded to the surveys between 2005 and 2018, but the final analysis is based on 21,729 who answered all the questions, representing an estimated 146.5 million US adults. 

The average nightly sleep duration was just short of 7 hours across the entire sample.  Some 12% reported  less than 6 hours, while 4% reported more than 9 hours a night. 

A total of 3132 (14.5%) respondents said they had used cannabis in the preceding 30 days. Recent users were more likely to report not sleeping enough or sleeping too much.

They were 34% more likely to report short sleep and 56% more likely to report long sleep than those who hadn’t used cannabis in the preceding 30 days, after accounting for potentially influential factors.

And they were also 31% more likely to report difficulty falling asleep, staying asleep, or sleeping too much in the preceding 2 weeks, and 29% more likely to have discussed a sleeping problem with a doctor. But recent cannabis use wasn’t associated with frequent daytime sleepiness.

Further analysis of the frequency of cannabis use revealed that moderate users, defined as using on fewer than 20 out of the past 30 days, were 47% more likely to sleep 9 or more hours a night compared with non-users. 

Heavy users, defined as using on 20 or more out of the preceding 30 days, were 64% more likely to experience short sleep and 76% more likely to experience long sleep compared with non-users.

These findings differed little across the survey years.

This is an observational study, and as such, can’t establish cause, or reverse causality, for that matter. 

The researchers also point to several study limitations, including the reliance on self-reported data and the lack of information on cannabis dose. The historical and the historical and ongoing stigma associated with cannabis use may also have affected the responses to questions about cannabis use, they suggest.

But they say: “Increasing prevalence of both cannabis use and sleep deprivation in the population is a potential cause for concern.

“Despite the current literature demonstrating mixed effects of cannabis and various cannabinoid formulations on sleep architecture and quality, these agents are being increasingly used as both prescribed and unprescribed experimental therapies for sleep disturbances.”

They add: “Our findings highlight the need to further characterize the sleep health of regular cannabis users in the population…Sleep-wake physiology and regulation is complex and research about related endocannabinoid pathways is in its early stages.”

Posted on Diabetes

Glucose control is a key factor for reduced cancer risk in obesity and type 2 diabetes

Sjöholm-and-Taube

Kajsa Sjöholm and Magdalena Taube, University of Gothenburg, Sahlgrenska Academy. CREDIT Photo: University of Gothenburg and Emelie Taube

Good glucose control is important for reduction of cancer risk in obesity and type 2 diabetes. Large durable weight loss, as such, appears to afford protection against cancer, but with good glucose control the number of cancer cases also drops radically, a University of Gothenburg study shows.

That obesity is a risk factor for both type 2 diabetes and several types of cancer is a known fact. Similarly, intentional weight loss through, for example, bariatric surgery often results in amelioration of diabetes and many patients achieve normal blood-glucose control.

I patients with obesity, cancer risk, too, can be reduced after major, long-lasting weight loss. However, there have been relatively few studies on the association between weight loss, risk of cancer and glucose control in patients with both obesity and type 2 diabetes.

The present study, published in the journal Diabetes Care, used data from the “SOS” (Swedish Obese Subjects) intervention trial, which is led and coordinated from the University of Gothenburg, as well as data from other sources, such as the Swedish Cancer Registry.

Cancer risk 60 percent lower

The researchers studied a group of 393 people with type 2 diabetes who underwent bariatric surgery, and compared them with a control group of 308 people with the same clinical characteristics; i.e., they had severe obesity and type 2 diabetes, but had not undergone bariatric surgery. In other respects, such as in terms of gender composition, blood glucose, and smoking, the two groups were comparable.

In the surgery group, 68 individuals (approximately 17 percent) developed cancer in parallel with a significant weight loss. The corresponding emerging cancer cases in the control group amounted to 74 (24 percent), while these individuals retained their condition of severe obesity. The median follow-up period was 21 years. Overall, the risk of getting cancer was 37 percent lower in the group that underwent obesity surgery.

However, the largest difference was observed when cancer risk was analyzed in the patients who achieved normal glucose control and had no relapse of diabetes over a ten-year period. Among these patients, the incidence of cancer was only 12 out of 102 (12 percent), against 75 out of 335 (22 percent) in the group whose diabetes had recurred in the same period. Thus, the results show a 60% reduction in cancer risk in the group where normal glucose control was maintained over 10 years.

Guidance for preventing cancer

“What we see is that, among patients with type 2 diabetes, many cancer cases are preventable. These results are an important contribution that enhances our understanding of the connection between glucose control and cancer prevention,” says Kajsa Sjöholm, Associate Professor of Molecular Medicine at Sahlgrenska Academy, University of Gothenburg, and the study’s first author.

Magdalena Taube, Associate Professor of Molecular Medicine at Sahlgrenska Academy, University of Gothenburg, is the senior author of the study.

“The global epidemic of both obesity and diabetes leads to an increased risk of cancer, as well as an increased risk of premature death. It has been estimated that, over the next 10 to 15 years, obesity may cause more cancer cases than smoking in several countries. This is a clear illustration of how serious the condition is,” she says.

“Strategies are need to prevent this development, and our results can provide vital guidance for prevention of cancer in patients with obesity and type 2 diabetes,” Taube concludes.

Posted on Autism

Strong professional development networks benefit autistic students

Because each person on the autism spectrum is very different, there is a saying that when you have met one person on the autism spectrum, you have met one person on the autism spectrum. Due to these many differences, providing learning in school settings can be challenging for teachers of autistic students, as well as for the professional development providers – such as district or regional autism experts who train and coach teachers.

Researchers from Drexel University’s A.J. Drexel Autism Institute recently published a study on the social networks of professional development providers who coach teachers to implement evidence-based teaching practices (EBPs) in their classrooms for their autistic students. When professional development providers have strong networks of professional support, they can potentially gain access to helpful resources – EBP knowledge, coaching support and financial resources – to provide higher quality, successful individualized coaching for teachers.

Teachers need to learn how to select and implement the EBPs that meet the individualized needs of their students on the spectrum; however, most teachers are not trained in how to implement autism-specific EBPs which is critical for students’ success.

“We found that the networks of professional development providers do help them be successful coaches for teachers of autistic students,” said Elizabeth McGhee Hassrick, PhD, an assistant professor in the Autism Institute and lead author of the report. “Specifically, professional development providers who have more people in their networks who were autism EBP experts, as well as more people in their networks who supported them with how to individualize their professional development efforts to specific teachers or districts, had a higher performance as teacher coaches.”

Professional development providers face barriers accessing the needed supports to conduct high quality professional development and lack experience with individualizing their methods for training and coaching teachers. Identifying the kinds of network connections that make professional development providers for teachers of autistic students successful can help change the ecosystem of support around autistic children to enable them to have better learning outcomes.  

Because regional special education and school districts often search for ways to help teachers of autistic students, this study identifies specific kinds of network supports that regional and district leaders can invest in to increase the quality of training that teachers receive. McGhee Hassrick gives the example of district leaders often hiring professional development providers because of their years of experience. But their findings suggest that EBP knowledge is as an essential characteristic of effective professional development providers – more than years of experience.  

Regional or district level interventions to improve instruction for autistic students are relatively new. The state of California uses the California Autism Professional Training and Information Network (CAPTAIN), a statewide interagency collaboration with the goal of scaling up use of EBPs for autistic individuals through targeted implementation supports and coaching. CAPTAIN professional development providers are required to provide EBP training and coaching to teachers and other educators each year. McGhee Hassrick and her co-authors conducted social network analysis with CAPTAIN professional development providers who worked with teachers who had autistic students in their classroom. They filled out the network survey, identifying coaching and financial supporters of their teaching training work. The research team then tried to determine if professional development providers with larger networks had better self-rated performance as teacher trainers.

“This study suggests that the quantity and quality of professional development providers’ social networks can influence the quality of coaching support for teachers of children on the autism spectrum,” said McGhee Hassrick. “Building larger support networks that include experts who know how to coach teachers may have potential as an intervention to improve EBP use and scale up in educational settings.”   

Researchers found the size of the coaching networks influenced performance outcomes over and above greater system-level characteristics, indicating the importance of networks for professional development providers. While this is the first analysis testing the impact of the networks of higher-level professional development providers on their performance as coaches for classroom teachers of autistic students, this aligns with the existing literature on the impact that networks have on teachers, principals and district leaders.

Additionally, it appears that coaching support is more important than financial support for professional development providers’ performance. McGhee Hassrick added that although these data were collected from within one state public education system, the implications for professional development providers can be applied more broadly. For example, publicly provided educational services nationally and internationally often rely on regionalized expertise for program development and improvements. Educational professionals in professional development provider roles will likely benefit from support networks, regardless of location and organizational structures.   

Posted on Autism

Experts set out future of autism with focus on personalized and lifelong approaches

Seven Ages of Man by William Shakespeare read by Tom O'Bedlam - YouTube
  • Autism affects 78 million people and families worldwide, most of whom do not have access to support outside their own resources
  • Autism is a heterogeneous condition that manifests differently across a person’s life and between people diagnosed with autism; effective assessment and care requires personalised, stepped care approaches that meet individual needs throughout their lives.
  • Greater investment is urgently needed to develop and refine practical interventions that can improve the lives of people with autism and their families today and build the framework for better approaches to care in the future
  • Commission introduces the concept of “profound autism” to distinguish individuals who have high dependency needs and how a stepped model of care will best meet the unique needs of all people living with autism 

A new, comprehensive model of autism care and treatment that prioritises personalised, stepped care approaches is urgently needed, according to a new international report published in The Lancet.




The authors of the Lancet Commission on the future of care and clinical research on autism call for global coordination between governments, health care providers, education, financial institutions, and social sectors to reform research, care, and treatment for autism that will include individualised treatments throughout a person’s life with active participation from patients and their families.

The Commission was formed in 2018 by international experts, including clinicians, healthcare providers, researchers, advocates, self-advocates, and parents of children with autism. The report identifies urgent actions required in the next five years to address the current needs of people with autism and families worldwide and to build a foundation for improved care and treatment in the future. The report sets out a new standard of care that all services and social care systems worldwide should adopt to best support the needs of people with autism and their families.




The Commission also calls for global research efforts to expand beyond basic science toward developing evidence-based practical interventions tailored to the heterogeneous needs of people living with autism and could be applied to other neurodevelopmental conditions.

Personalised, stepped model approach to care 

At least 78 million people are living with autism worldwide, the majority of whom do not receive adequate support or care services, especially those living in low-and-middle-income countries or other low-resource settings. Given the heterogeneous nature of autism, a new personalised, stepped care approach is urgently needed. This new approach moves away from a categorical diagnosis toward a focus on support to improve the quality of life for individuals and their families centered around their unique concerns, needs, characteristics, and circumstances that can be adjusted throughout their lives.

“Although numerous well-tried interventions and treatments for autism exist, not enough is known about which treatments or services should be offered, when, to whom, for how long, with what expected outcomes and for what cost,” says Commission co-chair Dr Catherine Lord of the University of California, Los Angeles (USA). “Autism is an incredibly heterogeneous condition and treatment approaches must vary not only between people living with autism but throughout a person’s lifetime. This stepped care approach requires coordination on a global scale between governments, social sectors, healthcare providers, education and finance institutions, and among people living with autism and their families.”

The Commission also reiterates the value of neurodiversity among people with autism – or the natural variability within human brains and minds – to create stronger, wiser communities and positive social values. At the same time, the Commission proposes that the designation of ‘profound autism’ be adopted for people with autism who are minimally verbal or non-verbal, are not able to advocate for themselves, and require 24-hour access to an adult who can care for them. The authors propose that the designation be used for administrative purposes (rather than a formal diagnosis) in order to encourage both the clinical and research global communities to prioritise the needs of this vulnerable and underserved population. The authors validated the designation of profound autism against three databases [2], and found that it would apply to anywhere between 18% to 48% of people with autism (panel 2).

Prioritising meaningful research and clinical practice 

National and international infrastructures should be developed to help prioritize research that goes beyond biology and studies of single interventions to focus instead on those that integrate care across systems over time and take into account individual differences within the autism spectrum that lead to better outcomes.

Recent high-quality trials among young children with autism have identified psychosocial interventions that can result in changes that could mitigate the influence of autism on development for some people. Research is now needed to identify what factors enable people with autism to live positive, fulfilling lives, the key elements of effective interventions for children and adults, and the wider environmental barriers to change for people with autism.

“Basic science is often prioritised over more practical knowledge, leaving people living with autism, families, and providers without evidence-based guidance. Individuals with autism are a valued part of society. We urge commitment to greater investments in what can be done for people living with autism and their families now, with a focus on how to build on existing information to answer specific practical questions that will then better inform interventions and services to help people living with autism achieve their fullest potential,” says Commission co-chair Prof Tony Charman of King’s College London (UK).

Overcoming global inequities in assessment, care, and treatment

The needs of families who live with autism worldwide are universal. The World Health Organisation (WHO) has recognised autism as a global health priority, with key recommendations for all member states to implement. But many individuals with autism remain undiagnosed, especially in low-resource settings, where surveillance is rarely done for any neurodevelopmental disorder. Families often have limited access to evaluations and other resources to assess and treat autism or other neurodevelopmental conditions. In addition, many families may not seek out assessment or treatment due to limited awareness about autism, social and cultural stigma related to neurodevelopmental conditions, and financial barriers.

“It is imperative that we tackle the scarcity of resources that exist for autism care and treatment worldwide, especially for individuals and their families living in resource-limited settings where autism and other neurodevelopmental conditions may be stigmatised, or overlooked, leaving children undiagnosed until adulthood or in many cases never diagnosed. In these settings, where most of the world’s children live, individuals should not have to wait for months or years to start treatment because they are unable to find an appropriate assessment, and once identified as having specific needs, their geography, socio-economic and social status and access to services should not be a barrier for receiving care. Women, minority ethnic populations, people living with profound autism, and people with other co-occurring conditions such as anxiety, depression, behaviour challenges, or sleep disorders are also often further marginalised from services. We must do more for these populations and hold our governments and health systems accountable for providing life-changing support that will ultimately better our entire society,” says co-author Dr Gauri Divan of Sangath, India.

Improved care today and for the future

The authors write that much more can be done now for people living with autism that will lay the foundation for improved, comprehensive care in the future to ensure more equitable care and social justice for people living with autism. The Commission’s recommendations for both clinical practice and systems change are based on beginning with an individual’s needs and with continual involvement of stakeholders, including people with autism, families, supportive community members, and providers, at each step of the way. Capacity building is essential to strengthening care systems, particularly in low-resource settings and underserved communities. These multi-dimensional approaches will yield personalised, dynamic models of intervention and services that will be the key to a better future for individuals with autism and other neurodevelopmental conditions.

Writing an introductory Comment for the Commission, Dr Richard Horton, Editor-in-chief of The Lancet and Helen Frankish, Executive Editor of The Lancet say “The Commission’s recommendations emphasise improving the quality of life for all autistic people and their families through seeking better information about the needs, strengths, and most effective services for autistic individuals across the lifespan and developmental stages. Ultimately, the message of the Commission is one of hope. Studies have shown that much can be done to improve the life outcomes for autistic individuals. But concerted action is needed without delay to answer fundamental questions about the care for autistic people, together with the development of policies and programmes to improve the lives of all autistic individuals across the globe.”