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Excessive weight gain and central obesity (usually begins after age 2 years) Higher pain threshold Substantially slow metabolic rate Hypothalamic hypogonadism Scoliosis and/or kyphosis Sleep-disordered breathing, central sleep apnea (under age 2 years), obstructive sleep apnea, hypoventilation, excessive daytime sleepiness, narcolepsy, cataplexy Small hands and feet Articulation challenges, Apraxia of Speech, hypernasal speech, language processing challenges Thick viscous saliva Absent vomit reflex or elevated vomiting threshold Temperature regulation irregularities Temperament, emotional regulation, and behavioral challenges beginning after age 2 years Clinical Symptoms in Older Children and Adults without intervention: Symptoms in the young children and: Hyperphagia: insatiable drive to eat or find food to eat later, lack of normal satiety

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