Nutrition for the child with autism spectrum disorder
Do you or someone you know have a child that has been diagnosed with Autism Spectrum Disorder (ASD)?
ASD is estimated to affect 1 in 59 children in the US.
ASD is a condition that can affect a person’s social skills, behavior, and communication. No two individuals with ASD are the same. It is thought to be influenced by both genetic and environmental factors. Other conditions associated with ASD include sensory sensitivities, gastrointestinal problems, seizures, sleep disorders, and other mental conditions (attention issues, anxiety, and depression).
Many families living with ASD turn to alternative or complimentary treatments and that includes changes to a diet’s diet and nutrition.
There are many reasons to believe that an individual with ASD may have some nutrient deficiencies. Many children with ASD display food neophobia (fear of new food) and have a limited diet that may not include all the food groups. Some children with ASD may also have a difficulty taking pills, therefore, taking a vitamin is not something that can be easily implemented.
Let us look at different nutrition interventions with ASD.
There are many studies that have looked at vitamin therapy. One study looked at how taking a specific vitamin supplement designed for children with autism affected their symptoms. It was a double-blind study, which means neither the participants or the care giver knew whether the subject was receiving the supplement or the placebo. Overall, the study showed improvement in those who took the vitamin compared to controls in the areas of hyperactivity, tantrums, and receptive language. The vitamin used contained greater than the recommended amounts of most of the B vitamins (Thiamin, Riboflavin, pyridoxine-B6, cyanocobalamin-B12, and Folic Acid) because previous studies showed that these tend to be low in those with autism. Coenzyme Q10 was also added to the preparation. Copper and Iron were not added because the investigators felt that historically those with autism were not deficient in these minerals.
Vitamin B6 and Magnesium
Many times, Vitamin B6 is supplemented along with Magnesium to enhance absorption. Many vitamins and minerals including B6 and Magnesium are involved in the pathways of neurotransmission. These systems are thought to be involved in the development of autism, which is why taking vitamins involved in this pathway is thought to help. When reviewing research of B6 and Magnesium therapy in ASD there has been some benefit seen in small samples, but at this time there is no conclusive evidence as to the efficacy of this treatment and this is mainly due to small sample sizes and lack of a controlled design.
There is some evidence that shows women who were deficient in folic acid during their pregnancy have a higher risk of having a child with ASD. Evidence to shows that there may be a link between the MTHFR (methylenetetrahydrofolate reductase) gene mutation and ASD in countries where their food supply is not fortified with folic acid. MTHFR is an enzyme in the body that speeds up the body processes to form folate and eventually forms methyl groups, which are are important in the function of DNA and protein. Some families receive testing to determine if their child with ASD has the MTHFR mutation and may supplement with folinic acid, which is the natural form of folate found in food, which is thought to be better for those with MTHFR mutation than the synthetic form, folic acid. However, the medical community does not recommend widespread testing for this gene mutation and the recommendation is if the test is positive for the gene, a medical provider needs to evaluate for the cause to determine if supplementation is necessary.
If you would like suggestions on food sources of B vitamins and Magnesium click here
Vitamin D is thought to play a role in autism in a couple of ways. The first is that some studies show that women who are deficient in vitamin D during pregnancy may have a higher chance of having a child with ASD. Secondly, there is research to show that children with ASD have low vitamin D levels and that some symptoms may improve with supplementation. Vitamin D supplementation is recommended in people with or without ASD if they are found to have low serum levels. More research is needed into the efficacy of Vitamin D supplementation to be part of the treatment and management of autism.
Essential Fatty Acids
Essential Fatty Acids, including docosohexanoic acid (DHA) and eicosapentanoic acid (EPA), have been reported to possibly be helpful in the management of ASD. Some studies report lower levels of essential fatty acids in children with ASD when compared to neurotypical children. However, there have been some double-blind small studies done that do not demonstrate a significant difference between an intervention and a control group when supplemented with essential fatty acids.
Many children with ASD experience gastrointestinal symptoms such as abdominal pain and constipation. Sometimes it may be difficult for children with ASD to communicate these discomforts and it is thought this could make behaviors worse. There is research to show that those with ASD have an abnormal microbiome. The gut microbiome is the unique collection of bacteria in your gut that contributes to the health of the gut. It is thought that supplementing with probiotics can help improve the health of the gut microbiome. Improved gut health may improve symptoms in children with autism. However, use of probiotics should be done with caution as overuse can lead to increased GI symptoms. There is some promising evidence that probiotic supplements may help some children with ASD and GI symptoms.
Gluten Free – Casein Free Diet
There has been some focus on a gluten free- casein free diet helping to improve symptoms of autism. There have been some small studies looking at this. Some studies have shown there may be improvement in communication and some autistic traits. However, a recent review of the evidence on the use of this diet in ASD concluded that there is little overall evidence to support the use of this diet to treat symptoms of autism. One study found that those that tried the gluten free casein free diet had lower weights, energy intake, and lower levels of some vitamins and minerals. There is no danger in trying this diet but given the concerns for some deficits would recommend working with a dietitian to help improve any nutritional gaps.
Take home points for parents considering these interventions:
· Many of these interventions are based on the belief that there are nutrition deficiencies. As mentioned earlier children with autism may have very limited diets, which can lead to deficiencies. If a limited diet is of concern, then would recommend looking into behavioral therapy with involvement of occupational and/or speech therapy to help with increasing food variety as it may be difficult to introduce big diet changes without help.
· Since these interventions suggest supplementation, this could be difficult for a child with ASD that has difficulty taking pills. Therefore, would suggest only including supplements that are clinically indicated and will be easiest for the child to take.
· Work with a registered dietitian to evaluate the adequacy of your child’s diet and work together to fill any nutritional gaps identified.
· Whenever choosing to try a new treatment or supplement be sure to discuss this with your care provider.
If you have a child with ASD and you would like his or her diet evaluated, I can help. Contact me about making an appointment.