Sunday, January 17, 2010

Consensus Report on Gastrointestinal Disorders in Autism, Part 3

Picking up where I left off last time ...

Gastrointestinal problems can lead to problematic behaviors such as sleep disturbances, vocal or motor behaviors, aggression, or self-injury in people with autism. It is sometimes difficult to relate these behaviors back to an underlying condition however it is important that care providers consider the possibility that these behaviors could be caused by gastrointestinal symptoms. Care providers need to become more aware of what the typical and atypical signs and symptoms are in people with autism.

Primary care providers also need to be alert to potential nutritional problems in patients with autism. Children with autism are known to be picky eaters and restricted diets might be nutritionally inadequate. However, even children who are not on a restricted diet have been shown to have nutritional problems.

Strangely, this is one of the areas where the panel does not call for additional research. My opinion is that this area is critical to understanding the role of gastrointestinal dysfunction in autism. If a child has a problem absorbing nutrients from their diet there are going to developmental consequences.

Moving along, we come to what is probably the most cited part of the report, the section on special diets. I think the exact wording of this section is important so I am going to include it -

"Anecdotal reports have suggested that there may be a subgroup of individuals with ASDs who respond to dietary intervention. Additional data are needed before pediatricians and other professionals can recommend specific dietary modifications."

"Available research data do not support the use of a casein-free diet, a gluten-free diet, or combined glutenfree, casein-free (GFCF) diet as a primary treatment for individuals with ASDs."

Notice what the panel is actually saying here - there are some anecdotal (parental) reports that suggest that diets work in subsets but there is not enough evidence to recommend using the diet as a primary treatment for autism. This is not a blanket statement that diets don't work but rather a qualified on that there is some reason to believe that a certain subset of people with autism could benefit from special diet. However, modern medicine will not (and should not) recommend a treatment based solely on anecdotal data and so the panel does not recommend it.

So, contrary to what is suggested by media reports, the problem isn't that research has looked at the question and found that diets don't work but rather that the the question has not been properly examined as of yet. The panel does give some suggestions on how a trial of a special diet should be conducted but does not call for additional research in this area. Go figure.

The report goes onto talk about how care providers should look compile a detailed history of their patients and look for physical signs of food allergies to identify potential associations between exposure and behavioral symptoms. A guide on how to evaluate and treat common gastrointestinal problems with children with autism published in the same issue of Pediatrics.

I want to call out one other statement that was made concerning gastrointestinal symptoms and autism because it runs directly counter to what you will often see quoted on the Internet -

"The patient's parents, teachers, or other caretakers are an important source of information, because they are in a position to observe an association between exposure and the person's response"

Got that?  Parents DO have some idea what they are talking about.

There are a few points in the report on how there is a possible link between immune dysfunction and autism but that this is (yet another) area that needs further study. But that is a topic for another time.

The report concludes with how it is likely that there is more than one type of autism. Given the differences in people with autism and the conflicting research findings "it is likely, therefore, that different pathogenic mechanisms underlie ASDs in individuals who have received this diagnosis".

So there you have it, in three rather long parts, what this report says rather than the simplistic version presented in the media. If you have made it here and read all three parts, I think you deserve a gold star.

No comments:

Post a Comment