The panel, chaired by Harvard's Timothy Buie, MD, included 28 experts in 12 scientific disciplines, including child psychiatry, pediatric allergy, pediatric gastroenterology, and pediatric nutrition. The panel evaluated scientific evidence regarding gastrointestinal disorders in all forms of autism, collectively called autism spectrum disorder or ASD.
The experts note that many parents and medical professionals have reported improvements in autistic behaviors after dietary treatments -- but that these observations aren't based on controlled, scientific studies.
"Anecdotal reports that restricted diets may ameliorate symptoms of ASDs in some children have not been supported or refuted in the scientific literature, but these data do not address the possibility that there exists a subgroup of individuals who may respond to such diets," Buie and colleagues carefully conclude.
The panel strongly recommends that if a child with autism is on any kind of restricted diet -- due to dietary treatment, food sensitivities, or food aversions -- the child should be evaluated by a nutritionist.
Perhaps the panel's strongest statement is that gastrointestinal woes often worsen autism-related problem behaviors.
"Problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders," Buie and colleagues conclude. "Symptoms associated with gastrointestinal disorders, especially pain, may function as setting events for problem behaviors."
And because gut troubles are particularly hard to diagnose in kids with autism, misdiagnosis (or missed diagnosis) can lead to time-consuming behavioral treatments that won't work. Signs of gut disorders may include:
- Frequent clearing of the throat or swallowing
- Sobbing for no reason
- Sighing, whining, or groaning
- Facial grimacing
- Gritting teeth
- Constantly applying pressure to the abdomen by leaning against furniture or pressing with hands
- Unusual posturing
- Pacing or jumping up and down
- Self-injurious behavior such as face slapping or head banging
- Aggressive behavior
- Difficulty falling or staying asleep
- Increased irritability
- Oppositional behavior
Many of these behaviors are typical of autism, and may result in behavioral treatment. Such treatment is no substitute for medical evaluation, however, although there's no reason to withhold behavioral treatment.
Behavioral treatments that address only psychosocial triggers or consequences for problem behavior are less likely to work than behavior treatments that promote communication skills and skills for coping with task demands during moments of pain or discomfort.
The bottom line of the panel's consensus report is that much more research is needed to explore the intriguing links between gut disorders and autism.
The report appears in a supplement to the January issue of Pediatrics.