In Pediatrics Dr. Timothy Buie and colleagues published a paper providing evidence-based recommendations for pediatricians who evaluate and treat gastrointestinal problems in patients with Autism. The authors, who represent many important scientific groups concerned with allergies, gastrointestinal disorders, nutrition, and similar problems, concluded that children with Autism and related disorders should be assessed and, as approriate, given medical care just as would individuals without Autism. The team encouraged pediatricians to develop and employ “evidence-based algorithms for the assessment of abdominal pain, constipation, chronic diarrhea, and gastroesophageal reflux disease (GERD).”
The participants included representatives from the Allergy Working Group, the GI Symptoms Working Group, the Genetics Working Group, the Immunology/Inflammation Working Group, the Interpretation of Abdominal Pain Working Group, the Metabolism and Maldigestion Working Group, and the Nutrition Working Group. The multidisciplinary team found that estimates about the prevalence of gastro-intenstinal problems in children with Autism vary widely (9% to 70%), but each study providing prevalence data had at least one scientific flaw. They also reported that “The existence of a gastrointestinal disturbance specific to persons with ASDs (eg, ‘autistic enterocolitis’) has not been established” and that “available research data do not support the use of a casein-free diet, a gluten-free diet, or combined gluten-free, casein-free (GFCF) diet as a primary treatment for individuals with ASDs.”
For parents and others concerned about individuals with Autism, this report provides about the best scientific guidance available regarding gastro-intestinal disorders in Autism. Although there are many books, articles, blogs, and other sources recommending special diets for treating Autism, people who are considering such treatments should review this report first. The contributors to this report know what the science shows; I’d favor them over advocates who stand to gain from selling products.
Here is the abstract for the paper by Buie et al.:
Autism spectrum disorders (ASDs) are common and clinically heterogeneous neurodevelopmental disorders. Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, but key issues such as the prevalence and best treatment of these conditions are incompletely understood. A central difficulty in recognizing and characterizing gastrointestinal dysfunction with ASDs is the communication difficulties experienced by many affected individuals. A multidisciplinary panel reviewed the medical literature with the aim of generating evidence-based recommendations for diagnostic evaluation and management of gastrointestinal problems in this patient population. The panel concluded that evidence-based recommendations are not yet available. The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.
Pediatrics, the prestigious journal of the American Academy of Pediatrics, published the paper as a supplement 4 January 2010. I’ve reported only some of the recommendations here. The full article is available for free from the journal’s Web site as HTML or PDF.
Buie, T., Campbell, D. B., Fuchs, G. J., Furuta, G. T., VandeWater, J., Whitabker, A. H., Bauman, M. L.,… & Zeltzer, L. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with asds: A consensus report. Pediatrics, 125 Supplement, S1-S18. doi:10.1542/peds.2009-1878C