Assuring Pediatric Nutrition in the Community
FREQUENTLY
ASKED QUESTIONS:
Specific Diagnoses - Autism and Pervasive Developmental Disorder (PDD)
Is
a wheat free-milk-free diet beneficial for children with autism?
Does DMG make a difference? Has megadosing shown any promise?
What are the latest resources/recommendations for nutrition
and children with autism?
A 4 1/2 year old child with autism presented to outpatient nutrition counseling at request of patient's father for a milk-free and wheat-free diet. Parents have been limiting milk and wheat in an effort to help improve her behavior. She takes Nystatin and Dimethylglycine (DMG) 125 mg/day.
Growth rate has been consistent and appropriate over the last few years. Her parents have had some interaction with other families of children with autism via the internet. The family receives information from several parent organizations which send some research-based and anecdotal information. The information they gave me was centered around megadosing of vitamin B6/magnesium therapy and use of secretin for autism.
Is
a wheat free-milk-free diet beneficial for children with autism?
Does DMG make a difference? Has megadosing shown any promise?
What are the latest resources/recommendations for nutrition
and children with autism?
Is
a wheat free-milk-free diet beneficial for children with autism?
Although there have been a few anecdotal reports of symptoms related to
autism improving with a gluten-free or casein-free diet, no controlled,
double-blind studies demonstrating a connection between autism and gluten
intolerance have been published. In fact, two published studies suggest
that there is no link:
Sponheim E. [Gluten-free diet in infantile autism. A therapeutic trial] Tidsskrift For Den Norske Laegenforening. 1991; 111(6) 704-7. (abstract). In this small study (n=7), children with autism were provoked with gluten/placebo in a double-blind study or were given a gluten-free diet for six months. No behavioral changes were observed with the gluten-free diet.
Pavone L, et al. Autism and celiac disease: failure to validate a hypothesis that a link might exist. Biological Psychiatry 1997; 42: 72-5. Eleven children with autism were screened for celiac disease (IgA and IgG antigliadin antibodies and/or jejunal biopsy). None of the children were diagnosed with celiac disease. Of 120 children with celiac disease screened for autism, none were found to have autistic behaviors.
Does
DMG make a difference? Has megadosing shown any promise?
Dimethylglycine (DMG) is sold in health food stores and by the same company
that sells NuThera (a vitamin B6 and magnesium supplement touted to improve
autistic behaviors). No controlled studies of DMG have been done, and
no side effects are known. The thought behind megadoses of vitamin B6
and magnesium is that autism might be related to a B6 deficiency. Again,
no controlled, double-blind studies have been published. The company that
sells NuThera states that a typical dose is 1 gram vitamin B6. Toxicity
has been seen in adults at doses of 2 grams. The Autism Research Institute
sends out information about studies they've conducted, but none of these
have been published, and much of the information is based on testimonials.
What
are the latest resources/recommendations for nutrition and children with
autism?
There are few published recommendations for nutrition and children with
autism. Nutrient needs seem to be the same for children with autism as
for typically developing children.
Some children with autism may be at nutritional risk for reasons related to behaviors around foods and eating. Some are very selective (picky) eaters. Many will eat only a few, very specific foods (e.g., a certain brand of macaroni and cheese or french fries from McDonalds, but not Burger King.) This type of behavior can put a child at nutritional risk when entire groups of foods (e.g., dairy or fruits and vegetables) are refused. Convincing a child who refuses entire groups of foods to take a supplement can be challenging as well!
Many of the behavioral problems around food and eating can be incorporated into the child's educational program. (Many children with autism have a very specific program that incorporates behavior-therapy concepts.)
When working with families who have tried/are trying nutritional therapies to treat the behaviors associated with autism, it is helpful to identify possible harmful effects of these therapies (for example, low calcium intake with a milk-free diet, struggles around food with an already picky eater, and the expense of a supplement when finances were strained) and make recommendations. It is important to support families when they feel a therapy is effective and not to alienate. Parents are generally much more willing to share information and to accept the results of the published studies when an objective approach to special diets and supplements was taken.
Reference
Lucas B, Pechstein S, Ogata B. Nutrition concerns of children with autism
spectrum disorders. Nutrition Focus. 17(1), 2002.
A concerned mother of a child with autism requests information. This family lives in a rural community with little support. The child is almost three years old and 50% wt/age and length/age. Her family works very well with her and a strict routine is used but like other autistic children her diet is very limited.
In reveiwing her diet this has a very limited protein/iron intake. She is not on a vitamin or mineral supplement. The main concern that mom has is that the child aggressively seeks and chews paper products, book binding are her favorite, bag wire twisties. Mom and doctor are very concerned about her safety. Mom wants to know if this is typical, is it a typical behavior or could it be due to her limited diet/deficiencies?
There is limited
research with pica specifically in children with autism.
Sturmey notes in The Journal of the American Board of Family Practice,
"In persons with developmental disability, pica can take the form
of eating a variety of nonnutritive substances. Pica can be a minor, but
stigmatizing behavior that interferes with appropriate behavior and education".
For some children with autism, the pica behavior can be a self-stimulating
activity. It is difficult to determine if pica is related directly to
nutritional deficiencies. However, this child's growth parameters appear
to be within the normal range for age. It is important to consistently
monitor this child's growth and nutritional intake in relation to previous
growth and dietary data.
A multi-vitamin would be still recommended to supplement the low intake of a variety of foods.
It is also important
that the parents monitor this child so he/she does not ingest harmful
substances. It is noted in American Journal Disabled Child, "Such
children can ingest dangerous amounts of lead even in environments that
are usually considered safe. Mean blood lead concentration was higher...Screening
for blood lead should be part of the
medical care of these vulnerable children with pica."
An overall resource
for families of children with autism is the Autism
Society, http://www.autism-society.org/.
References
- Sturmey, P. Pica
and Developmental Disability. The Journal of the
American Board of Family Practice Jan/Feb 2001; 14:80-81. - Cohen DJ, Johnson
WT, Caparulo BK. Pica and Elevated Blood Lead Level in Autistic and
Atypical Children. American Journal Disabled Child Jan 1976;130: 47-48.