Complementary and alternative medicine for autism spectrum disorder eating habits

Complementary and Alternative Medical Methods, Autism Spectrum Disorders, Eating Habits and Mealtime

The objective of the research in this study is to answer in what ways do complementary and alternative medical methods provide permanent treatment alternatives for autistic behavior in children ages 3 to 8.

Children with ASD are reported to have "complex feeding issues that go beyond normal fussy eating behaviors. They also do not usually respond to commonly used behavioral feeding modification methods." (British Dietetic Association, 2011, p.4) Additionally reported is that children who eat less than 20 different foods on a regular basis and are under the age of five years "appear to be the most vulnerable and will benefit from individual dietary assessment and advice." (British Dietetic Association, 2011, p.4) It is reported that a great many children with ASD also have "selective eating and therefore self-limiting diets as a direct result of their disorder." (British Dietetic Association, 2011, p.4)

Purpose of Study

The purpose of the study proposed in this work in writing is one that intends to examine children with Autism Spectrum Disorder (ASD) and to test the intervention of gluten-free and casein-free diets as it relates to the behavior of the child with ASD and further to test whether Complementary and Alternative Medicine (CAM) supplements trigger food allergies in children with ASD.

Significance of Study

The significance of the study proposed will be the additional knowledge that will be added to the already existing base of knowledge in this area of inquiry.

Ethical Concerns

Ethical concerns in the study include a lack of studies resulting in a lack of evidence. As well, ASD is a complex disorder and treatment methods while working for some of the children may not work for other children.

Literature Review

The work of Feucht (2011) examines nutrition and autism and reports that children with autism experience problems with changes "in mealtime routines" and that they may have tantrums, refuse any "unfamiliar food, dish, or location" and that there may be a "limited number of accepted foods" with late acceptance of solid foods in infancy. Children with Autism are hypersensitive to foods due to color, texture, temperature, and odors and have great difficulty when "making transitions to new textures or tastes." (p.1) At times children with Autism will experience gagging or vomiting of foods due to these hypersensitivities. The child with Autism will likely lose interest in the pursuit of eating within a few minutes and they fail to respond "to positive eating behaviors modeled by others." (Feucht, 2001, p.1) Of parents surveyed who have a child with Autism 77% reported that their child refused new foods, would only eat a limited selection, and had disruptive behavior at mealtime. (Feucht, 2011, paraphrased) When asked whether their child with Autism had strong dislikes, 93% of parents responded that their child with Autism did indeed have strong dislikes of certain food due to "texture, color, temperature, flavor, or food combinations." (Feucht, 2011, p.1) The work of Mulloy, et al. (2011) conducts a systematic review of research on the effects of gluten-free and/or casein-free (GFCF) diets in the treatment of ASD and states as follows:

"In typical functioning gastrointestinal tracts, enzymatic activity breaks proteins into peptides, and transforms peptides into amino acids. The intestinal lining then absorbs the amino acids into the blood stream, which carries the amino acids to the rest of the body, providing nutrition. The Opioid-Excess Theory alleges ASD can result from disruptions to this process. According to the theory, some individuals suffer from inadequate production of gluten- and casein-related digestive enzymes, and increased gut permeability. Without adequate levels of digestive enzymes, peptides derived from gluten and casein fails to become amino acids in large numbers. Increased gut permeability then allows the peptides to leak into the blood stream, where they circulate and eventually cross the brain -- blood barrier. Symptoms of ASD are theorized to result from peptides' attaching to opioid neuro-receptors." (p.2)

Stated to be another variable implicated in ASD is "urinary peptide levels (UPLs)." (Mulloy, et al., 2011, p.2) Specifically it is stated that if children with ASD "are not turning peptides into amino acids, then more peptides should be present in the urine of children with ASD than in children without ASD. There is evidence according to Mulloy et al. (2011) that peptides "formed from casein and gluten can cross the blood-brain barrier. However, causal relations involving the peptide's attachment to opiod neuro-receptors have been demonstrated only in animal models." (p.3) The study reported by Mulloy et al. reviewed 14 studies with 188 participants and examined gluten-free diets and casein-free diets, as well as GFCF diets. Dependent variables were behavior or biomedical variables reported as communication, stereotypy, and play and challenging behavior. Other studies reviewed used direct observation, standardized tests, or a combination of methods to measure changes in the dependent variables. The results reported by Mulloy, et al. (2011) in seven of the studies were positive results, however, the studies reported had stated limitations of certainty due to various reasons. Results in four studies yielded negative results, two studies reported mixed results, and one study on intervention effect stated that no determination was made. The work of Shattock and Whiteley (2002) report the fact that many parents and professionals globally have found "that removal of these exogenously derived compounds [gluten and casein] through exclusion diets can produce some amelioration in autistic and related behaviors." (p.1) It is reported in the work of Semple, Hewton, Paterson and Angley (nd ) That the use of CAM is increasing in children with chronic illness or disability and that there are "some instances where biochemical abnormalities have been demonstrated in studies which can be normalized with administration of CAM products." (p.51) It is additionally stated that intestinal hyper-permeability, altered gut fermentation products, altered GI microbiota profiles, and altered digestive enzyme capacity have been found in children with ASD.

Findings & Conclusion

There is evidence that gluten- and casein-free diets may assist in the behavioral problems in children with ASD and specifically those children with food allergies.

Recommendations

Arising from the literature reviewed in this brief review is a recommendation that research be undertaken to investigate the impact of gluten- and casein-free diets on the behavior or children with Autism Spectrum Disorder (ASD) and whether complementary and alternative medicine therapies trigger food allergies in children with ASD.