Table 2.

Participant Characteristics and Case Description

Participant 1 was a 14-year-old Caucasian male diagnosed with PDD-NOS1 and ADHD,2 combined type, and Learning Disorder (Reading and Written Expression). He had received psychiatric treatment since age 5, and at study enrollment was taking atomoxetine (Strattera) 100 mg daily, paroxetine (Paxil) 10 mg daily and risperidone (Risperdal) 3 mg daily. Medical comorbidities related to obesity included impaired fasting glucose.4 Prior to study participation, food limits being set in the home resulted in aggressive behavioral outbursts. Treatment was tailored as follows: To address parent modeling of responsive and assertive communication skills, the therapist worked with parents on how to identify and anticipate behavioral triggers prior to setting limits and boundaries. To address difficulties with recording foods related to learning disorder, daily family check-ins allowed the participant to narrate or dictate food intake to the participating parent, while the youth utilized Traffic Light Plan materials to identify nutrition data for each food item.

Participant 2 was a 14-year-old Caucasian female diagnosed with Mood Disorder Not Otherwise Specified and GAD.3 She had received psychiatric treatment since age 7, and at study enrollment was taking quetiapine (Seroquel) 100 mg twice daily and 200 mg at bedtime; sertraline (Zoloft) 150 mg daily. Medical comorbidity related to obesity included hypercholesterolemia.5 Parental health problems, including limited mobility and mild cognitive impairment impacted the ability to perform key parenting skills (e.g., regular grocery shopping, help with completing self-monitoring logs, facilitation of conversations to promote healthy behaviors at home and with peers). Treatment was tailored as follows: To reduce cognitive load, handouts incorporating visual cues and simplified messages regarding the primary message in each meeting were utilized to reinforce session content, and the one-page food and activity log was introduced to simplify self-monitoring. To address parental difficulties and communication challenges, the therapists modeled adaptive communication strategies and provided cues for collaborative problem solving.

Participant 3 was a 14-year-old Caucasian male diagnosed with PDD-NOS1 and ADHD,2 combined type. He had received psychiatric treatment since age 3, and at study enrollment was taking osmotic-release oral system (OROS)-methylphenidate (Concerta) 54 mg daily, quetiapine (Seroquel) 150 mg twice daily and 100 mg at bedtime and paroxetine (Paxil) 15 mg daily. Medical comorbidity related to obesity included dyslipidemia.5 This youth began treatment with a significant preference for RED foods, and taste aversion to most GREEN foods. Parents reported weight had gradually become a problem over time because their child had limited taste preferences and became severely agitated when new foods were introduced. Treatment was tailored as follows: To address distress about trying new foods related to sensory aversion, the interventionist worked with the family on communication strategies and provided support and education about distress tolerance for parents and youth. To engage the youth both during the session and during the week at home and school, a focus of therapy became rewarding attempts to try new GREEN foods using the taste log.

¹Pervasive Developmental Disorder Not Otherwise Specified

²Attention Deficit-Hyperactivity Disorder

³Generalized Anxiety Disorder

⁴Defined by American Diabetes Association Criteria (33)

⁵Defined by NCEP Expert Panel on Blood Cholesterol Levels in Children and Adolescents (34)