Nutrition Interventions for Children with Special Health Care Needs

Chapter 23 - Nutrition Interventions for Autism Spectrum Disorder
Gastrointestinal symptoms, such as constipation and diarrhea, seen in some children
with ASD have also led to use of the GFCF diet. And some studies, mostly in vitro,
have demonstrated GI inflammation and other abnormalities, in children with ASD,
whether they were on a GFCF diet or not (8).
Nutrients at risk in the GFCF diet include calcium, vitamin D, zinc, and many
B vitamins. Most of the positive reports of the diet have been anecdotal, and
randomized, well-controlled studies and systematic reviews have not found the diet
to be effective. The Cochrane Database found only two small, randomized controlled
trials (RCTs) that were well-controlled, and small positive treatment effects in some
of the children (9). Many families still want to try the GFCF diet for their children,
and there is need for large scale, quality RCTs. The role of the RD is to discuss the
known effectiveness with the family, and then help them provide a GFCF diet that is
adequate in nutrients and energy to promote good growth and development.
Specific Carbohydrate Diet (SCD)
This diet is more restrictive than the GFCF diet as it eliminates grains, dairy, sucrose,
and complex carbohydrates; and limits vegetables and fruits. Originally intended for
irritable bowel syndrome, ulcerative colitis, and Crohn’s disease, it is supposed to
combat bacterial and yeast overgrowth. There is no evidence to support the diet in
any disease, and the diet is likely to be inadequate.
Supplements
Specific vitamin-mineral supplements, such as Super Nu-Thera®, and single
supplements such as vitamin B6, magnesium, and fatty acids, are common
in children with ASD. Although there are few well-controlled studies of these
supplements, the evidence that exists does not support any effectiveness (10,11).
Caregivers do not always realize that the components in multivitamin mixtures can
also be found in other supplements their child is taking. Families should be counseled
as to the tolerable upper limits (ULs) now set for most vitamins and minerals, and
should be encouraged not to exceed these levels.
Understanding the nature and scope of alternative therapies is important in providing
the best quality family-centered care. Families who are searching for effective
treatments for their child are often unable to discriminate between anecdotal reports
and research-based scientific evidence. RD’s and other health professionals must be
able to evaluate information about alternative nutrition therapies for ASD, and use
266 Nutrition Interventions for Children With Special Health Care Needs