Special Diets May Do Nothing Special

A study by researchers at the Mayo Clinic and published in the most recent edition of Pediatrics has found that autistic children are no more likely to have gastrointestinal problems than children who are not on the spectrum. The medical records of 100 autistic children over an 18-year period were compared to those of more than 200 children as controls. 77 percent of the autistic children had common GI problems (constipation, diarrhea, abdominal bloating, reflux, vomiting); 72 percent of the control group had these. Researchers did find that the autistic children were more likely to have constipation (34 percent to 17.6 percent) and to be picky eaters (24.5 percent to 16 percent). Only one autistic child had Crohn's disease and none had celiac disease.

The study suggests that "special diets"---in particular the gluten-free casein-free diet, which many families have placed their autistic children---are not warranted as treatments for autism. As noted in the July 27th New York Times, placing an autistic child on a restrictive child should only be done "after having appropriate diagnostic tests done."

I'm one of many parents who have placed their child on "the diet." In the early days, we swore by it and policed every drop of food that went into Charlie's mouth and into our house --- we had many bagel-free, pizza-free years as a result. (Jim and I agreed, if we were not letting Charlie eat something, we would not eat the "forbidden" food in his presence---fair's fair.) I thought I saw changes in Charlie while on his food regimen, which overlapped with him starting an intense ABA home program.

Or was it that, I saw the changes that I was so wanting to see?

As Charlie got older, the diet became restrictive in more and more ways, namely, our vigilance about "NO cupcakes, not even a bite" at school parties for other students started to restrict Charlie socially. We gradually started him eating wheat; no big deal. Milk and other dairy products did seem to disagree with Charlie so we've still kept him off of those.

When Charlie was just diagnosed and everything was chaos and confusion, "doing the diet" made us feel that we were doing something, that we were somehow contributing to helping Charlie as we waited to get evaluations done, searched for therapists, set up a home program. Whatever its actual merits as a treatment, putting on Charlie on the diet did have the positive side-effect of getting him to have to try new foods (when we started the diet, he mostly ate carbohydrates; some days, he'd only eat chocolate chip cookies). Our search for "ok foods" led us to introduce Charlie to many ethnic restaurants and to this day his favorites include Vietnamese summer rolls and mien and sushi.

Regarding the researchers' findings of more constipation and picky eating, I found some of the commentary in the New York Times article of interest:

Dr. [Samar] Ibrahim suggested that the loss of appetite and difficulty gaining weight in autistic children may be related to the use of stimulant medications, which are often prescribed for the condition, and that the constipation may be due to children not consuming enough fiber or drinking enough water.

Well, maybe, but not every child takes stimulant medications. There have been times when Charlie has limited himself to very few foods and, therefore, eaten very little; we've learned that his food choices are sometimes rooted in his sensory issues. As for constipation---some children may simply not want or be able to use just any bathroom (i.e., they may insist only on using a bathroom at home, versus one at school or in a store or restaurant), and this insistence can lead to some interesting scenarios. One thing I've learned time and again in trying to figure out why something or other is going on with Charlie that the most obvious answer isn't always the one that turns out to be right.