Sunday, December 13, 2020

Autism Traits in Childhood Linked to Eating Disorders in Adolescence

Autism Traits in Childhood Linked to Eating Disorders in Adolescence

BY LAURA DATTARO  /  4 JUNE 2020

Children with social difficulties are more likely than those without to develop disordered eating by age 14, according to a recent study. The researchers analyzed data from a longitudinal study to understand the relationship between autism and eating disorders over time.

At least 20 percent of adults and 3 percent of children with eating disorders also have autism. But much of what researchers know about link between the two conditions has come from studies of people seeking treatment for eating disorders, which makes it difficult to understand whether one condition sets the stage for the other or something else explains the overlap.

It is possible that eating disorders can cause traits that look like autism, says lead investigator Francesca Solmi, senior research fellow at University College London in the United Kingdom. Research suggests, for example, that the starvation associated with anorexia nervosa can cause problems with emotional processing.

“From all the research we had so far, we cannot see really well whether autism comes first and eating disorders second, or whether people with eating disorders have high levels of autistic traits because it’s somehow a manifestation of the eating disorder,” Solmi says.

Mapping Trajectories:

To investigate whether autism traits precede disordered eating, Solmi and her colleagues analyzed data from the Avon Longitudinal Study of Parents and Children, which tracks nearly 14,000 people born in Bristol, England, in 1991 and 1992.

Mothers of individuals in the cohort filled out a questionnaire about social behaviors associated with autism, such as persistent interrupting or being unaware of others’ feelings, when their children were 7, 11, 14 and 16 years old. At age 14, the children answered questions about their eating habits, such as whether and how often they fasted, purged, or used diet pills to lose weight. They were also asked about the frequency of binging behavior.

Of the 5,381 adolescents included in the new study, 421 — nearly 8 percent — engaged in some type of disordered eating at least monthly. Almost 3 percent, or 148 children, did so every week. Girls were roughly three times as likely to report such behaviors as boys were.

The Avon study does not include data on food habits before age 14, but other work shows that disordered eating rarely occurs before puberty.

The researchers found that adolescents with disordered eating habits had more autism traits at ages 7, 11 and 14, suggesting that these traits raise the odds of developing an eating disorder. The more autism traits a teenager had, the more frequent her disordered eating behaviors.

Those patterns held true for both boys and girls, which was surprising, Solmi says. Autism tends to be underdiagnosed in girls, and eating disorders are underdiagnosed in boys, making it difficult to study both conditions in people seeking treatment.

The work was published 3 May in the Journal of Child Psychology and Psychiatry.

Common Biology: 

The study could help researchers better understand early childhood behaviors that lead to eating disorders, says Susanne Koch, associate professor of clinical medicine at the University of Copenhagen in Denmark, who was not involved in the research.

“It’s not enough just to look at persons when they have had an eating disorder,” Koch says. “We need to look at the development of the eating disorder.”

The emergence of disordered eating may be related to the social stresses of adolescence, Solmi says, and that stress can be particularly intense for people with autism traits.

“If you have difficulties relating to your peers, this might result in feelings of anxiety or depression,” Solmi says. “In the case of eating disorders, it could be that eating then becomes one way in which people cope.”

Other experts say further work is needed to understand the mechanisms underlying both social difficulties and eating disorders. It is likely that they share common biology, rather than one condition causing the other, says Walter Kaye, executive director of the Eating Disorders Program at the University of California, San Diego, who was not involved in the work.

“Until we understand more about mechanisms and neurobiology, it’s going to be hard to come up with better treatments,” Kaye says.

Regardless, the study may hold a valuable message for clinicians who work with autistic people and those who treat eating disorders, says Jennifer Wildes, associate professor of psychiatry and behavioral neuroscience at the University of Chicago in Illinois, who was not involved in the research. They can be on the lookout for eating disorders in autistic people as adolescence approaches and watch for social difficulties in people struggling with eating disorders, including typically developing individuals.

“That may inform how they work with those people in treatment and how they work with their families as well,” Wildes says.

References:

1.       Solmi F. et al. J. Child Psychol. Psychiatry Epub ahead of print (2020) PubMed

2.      Oldershaw A. et al. Eur. Eat. Disord. Rev. 20, 502-509 (2012) PubMed

3.      Hudson J.I. et al. Biol. Psychiatry 61, 348-358 (2007) PubMed

4.      Sonneville K.R. and S.K. Lipson Int. J. Eat. Disord. 51, 518-526 (2018) PubMed

This article was published on Spectrum, the leading site for autism research news. 


Lee A. Wilkinson, PhD, is author of the award-winning books,  A Best Practice Guide to
Guide Using CBTHe is also editor of a text in the APA School Psychology Book

Saturday, December 5, 2020

Autism: Empathizing-Systemizing Cognitive Styles

 


The empathizing-systemizing (E-S) theory describes a distinct cognitive style or way of thinking. The E-S theory attempts to explain many of the social-communication problems experienced by autistic individuals by focusing on two factors or psychological dimensions, empathizing (E) and systemizing (S). Empathizing (E) is defined as the drive to identify emotions and thoughts in others and to respond to these appropriately. In contrast, Systemizing (S) is defined as the drive to analyze and construct systems, with the goal of identifying and understanding rules in order to predict systemic behavioral events. The Systemizing Mechanism theory seeks out If-and-then patterns.

Five Cognitive Styles

The E-S model assumes that we all have both systemizing and empathizing skills and that they are normally distributed across the population and independent of each other. According to Baron-Cohen, about one-third of all people (40 percent of women and 24 percent of men) are Type E — strong on empathy and somewhat weaker on systemizing, another third of all people (40 percent of men and 26 percent of women) are Type S — strong on systemizing and weaker on empathy, and a final third are Type B — with balanced abilities.  People who are Extreme Type E have very strong empathy (hyper-empathizers) but are below average on systemizing. In contrast, Extreme Type S individuals are very strong at systemizing (hyper-systemizers) but below average on empathy. These five brain types are defined by where individuals fall on the empathy and systemizing dimensions and is consistent with the viewpoint of “neurodiversity.” Autistic individuals and hyper-systemizers should be seen as just one of many types of brains and that add to human neurodiversity. 

Baron-Cohen posits that autistic people have a more "masculinized" profile. that is they show the Type S or Extreme Type S brain types that are more common in the male population and where their systemizing is higher than their empathy. An extension of the E-S theory, the Extreme Male Brain (EMB) theory suggests that autistic people, on average, will score lower than the typical population on tests of empathy (E) and will score the same as if not higher than the typical population on tests of systemizing (S).
The E-S theory seeks to explain the following strengths and weaknesses in autism by referring
to delays and deficits in empathy (E), and intact or even superior skill in systemizing (S).
  • talented in mathematics or music
  • superior attention to detail
      •  excellent understanding of a whole system

      •  preference for repetition 

      •  difficulty reading emotions

      •  difficulty coping in social groups

      •  difficulty seeing another person’s perspective

      •  a tendency for black and white thinking

      •  sensory hypersensitivity.

A final comment regarding the E-S theory of autism. Theories are used to provide a model for understanding human thoughts, emotions, and behaviors. By definition, a theory is an idea or set of ideas that is intended to explain facts or events, but is not known or proven to be true. It is important to remember that the E-S theory is among several that seek to explain the behavior and psychological profile of individuals with autism. Likewise, it may not explain all of the characteristics or features associated with being on the autism spectrum or account for the whole range of autistic traits.

Adapted from Wilkinson, L. A. (2015). Overcoming anxiety and depression on the autism spectrum: A self-help guide using CBT. London: Jessica Kingsley Publishers.

                                                         References and Further Reading

Baron-Cohen, S. (2004) The Essential Difference: Male and Female Brains and the Truth about Autism. New York, NY: Basic Books.

Baron-Cohen, S. (2008) Autism and Asperger Syndrome: The Facts. New York, NY: Oxford University Press.

Baron-Cohen, S., Richler, J., Bisarya, D., Gurunathan, N., and Wheelwright, S. (2004) ‘The Systemizing Quotient: An Investigation of Adults with Asperger Syndrome or High-Functioning Autism, and Normal Sex Differences.’ In U. Frith and E. Hill (eds) Autism: Mind and Brain. New York, NY: Oxford University Press.

Baron-Cohen, S., and Wheelwright, S. (2004) ‘The Empathy Quotient (EQ ): An investigation of adults with Asperger Syndrome and high-functioning autism, and normal sex differences.’ Journal of Autism and Developmental Disorders, 34, 163–175.

Baron-Cohen, S., Wheelwright, S., Lawson, J., Griffin, R., Ashwin, C., Billington, J., and Chakrabarti, B. (2005) ‘Empathizing and Systemizing in Autism Spectrum Conditions.’ In F. R. Volkmar, R. Paul, A. Klin, and D. Cohen (eds.) Handbook of Autism and Pervasive Developmental Disorders, Volume 1: Diagnosis, Development, Neurobiology, and Behavior (third edition). Hoboken, NJ: Wiley.

Baron-Cohen S, Auyeung B, Nørgaard-Pedersen B, Hougaard DM, Abdallah MW, Melgaard L, Cohen AS, Chakrabarti B, Ruta L, Lombardo MV. Elevated fetal steroidogenic activity in autism. Mol Psychiatry. 2015 Mar;20(3):369-76. doi: 10.1038/mp.2014.48. Epub 2014 Jun 3. PMID: 24888361; PMCID: PMC4184868.

Baron-Cohen S (2020). The Pattern Seekers: How Autism Drives Human Invention. New York, NY: Basic Books.

Wilkinson, L. A. (2015). Overcoming anxiety and depression on the autism spectrum: A self-help guide using CBT. London: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Tuesday, December 1, 2020

Holiday Tips for Families of Children with Autism

Managing Holiday Stress

The holiday season can be a stressful time of year for everyone, especially for parents of children on the autism spectrum. The sights and sounds of the holidays can be stressful and over-stimulating. There are many changes in routine, family events, parties, and vacations that need to be planned. Sometimes the stress of these changes can become overwhelming and the joy and happiness of the holidays might be lost. Here are some helpful tips to lessen your child’s anxiety and increase your family’s enjoyment of the holiday season: 

 Decorating and Shopping  
  • If your child has difficulty with change, you may want to gradually decorate the house. Decorate in stages, rather than all at once. It may also be helpful to develop a visual  schedule or calendar that shows what will be done on each day.
  • Allow your child to interact with the decorations and help put them in place.
  • Flashing lights or musical decorations can disturb some children. To see how your child will respond, provide an opportunity experience these items in a store or at elsewhere first. 
  • Last minute holiday shopping can be stressful for children who rely on routines. If you do take your child shopping, allow enough time to gradually adapt to the intense holiday stimuli that stores exhibit this time of year.
 Family Routines and Travel
  • Meet as a family to discuss how to minimize disruptions to established routines and how to  support positive behavior when disruptions are inevitable. 
  • Continue using behavior support strategies during the holidays. For example, use social stories to help your child cope with changes in routine and visual supports to help prepare for more complicated days.
  •  Use a visual schedule if you are celebrating the holidays on more than one day to show when there will be parties/gifts and when there will not. 
  • Use rehearsal and role play to give children practice ahead of time in dealing with new social situations, or work together to prepare a social story that incorporates all the elements of an upcoming event or visit to better prepare them for that situation 
  • If you are traveling for the holidays, make sure you have child’s favorite foods, books or toys available. Having familiar items readily available can help to calm stressful situations. 
  • If you are going to visit family or friends, make sure there is a quiet, calm place to go to if needed. Teach your child to leave a situation and/or how to access support when a situation becomes overwhelming. For example, if you are having visitors, have a space set aside for the child as their calm space. They should be taught ahead of time to go to this space when feeling overwhelmed. This self-management strategy will also be helpful in future situations.
 Gifts and Play Time
  • If you put gifts under the Christmas tree, prepare well ahead of time by teaching that gifts are not to be opened without the family there. Give your child a wrapped gift and a reward for keeping it intact. 
  • Practice unwrapping gifts, taking turns and waiting for others, and giving gifts. Role play scenarios with your child in preparation for him/her getting a gift they may not want 
  • Take toys and other gifts out of the box before wrapping them. It can be more fun and less frustrating if your child can open the gift and play with it immediately. 
  • When opening gifts as a family, try passing around an ornament to signal whose turn it is to open the next gift. This helps alleviate disorganization and the frustration of waiting. 
  • Prepare siblings and young relatives to share their new gifts with others. 
  • If necessary, consider giving your child a quiet space to play with their own gifts, away from the temptation of grabbing at other children’s toys 
  • Prepare family members for strategies to use to minimize anxiety or behavioral incidents, and to enhance participation. Provide suggestions ahead of time that will make for a less stressful holiday season. 
  • Keep an eye out for signs of anxiety or distress, including an increase in behavior such as humming or rocking - this may indicate it's time to take a break from the activity.
  •  Understand how much noise and other sensory input your child can manage. Know their level of anxiety and the amount of preparation it may require. 
  • Try to relax and have a good time. Do everything possible to help reduce the stress level for your child and family during the holidays. If you are tense your child may sense that something is wrong. Don’t forget to prepare yourself! A calm and collected parent is better able to help their family enjoy this wonderful time of year.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

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