RE: Autism not linked to GI disorders.

[Guest guest]

Gastrointestinal pathologies in children with autism or other ASDs

Binstock

Researcher in Developmental & Behavioral Neuroanatomy

July 29, 2009

Do children with autism or other autism-spectrum disorders have more

gastrointestinal pathology? The answer depends. Indeed, choose your favorite

flavor, choose your science.

In the increasingly politicized arena of autism, a group of Mayo Clinic

researchers recently concluded that " No significant associations were found

between autism case status and overall incidence of gastrointestinal symptoms or

any other gastrointestinal symptom category. " (2) Not surprisingly, a New York

Times science writer jumped onto the Mayo bandwagon and presented a ramification

rooted in medical orthodoxy, " Restrictive Diets May Not Be Appropriate for

Children With Autism " .

In stark contrast, a different research group recently concluded, our " ...study

confirms previously reported findings of an increase in bowel symptoms in

children with autism " (1), thus reinforcing a previous observation that

" Constipation is a frequent finding in children with gastrointestinal symptoms

and autism, particularly in the rectosigmoid colon, often with acquired

megarectum. " (4)

Perhaps doctrinaire preference for an ancient paradigm enthralled the Mayo

Clinic group whose personnel found no increased prevalence of gastrointestinal

pathology in autism. Note their conclusion: " As constipation and feeding

issues/food selectivity often have a behavioral etiology, data suggest that a

neurobehavioral rather than a primary organic gastrointestinal etiology may

account for the higher incidence of these gastrointestinal symptoms in children

with autism. " (2)

Perhaps their conclusion's rhetoric -- Constipation " often " has a " behavioral

etiology " -- reflects a belief system. Are we to believe that chronic diarrhea

(as reported by many parents of autistic children) or persistent constipation in

autism (eg, 4) has a " behavioral etiology " ? To borrow from popular psychology,

is the child's chronic diarrhea an acting out?

Alternatively, reactivity to gluten affects more individuals than had been

previously recognized and occurs in individuals having none of the overt

symptoms which previously defined celiac disease (5). Furthermore, in an ongoing

data-collection project by Autism Research Institute, more than 60% among >2500

autism parents have reported improvements when their autistic child is on a

gluten-free (GF) and/or casein-free (CF) diet (6).

Given prior, peer-reviewed findings of gastrointestinal pathology in autistic

children, a question arises, " How did Mayo personnel achieve their finding?

Among various factors, the researchers relied upon cumulative incidence and

seemed to avoid comparing chronic vs rarely occurring gastro pathology.

As a physician who is an autism-specialist noted: " It is very common to

have one or two bouts with constipation or diarrhea over your entire childhood.

The important difference is how chronic it is, not if you’ve ever had it. So

[in the newly published study (2)] having a viral illness with diarrhea that

lasts for a week or two was counted the same as children who may have had

chronic loose stools every day of their life. They do not distinguish these

issues in their study data. " (name withheld, personal communication).

Strikingly, a case study recently reported that one autistic child's

gastrointestinal pathology and autism were alleviated by a gluten free diet

(7-8).

References:

1. Are there more bowel symptoms in children with autism compared to normal

children and children with other developmental and neurological disorders? A

case control study

RA et al.

Autism 2009 13(4) 343–355.

There is considerable controversy as to whether there is an association between

bowel disorders and autism. Using a bowel symptom questionnaire we compared 51

children with autism spectrum disorder with control groups of 35 children from

special school and 112 from mainstream school.There was a significant difference

in the reporting of certain bowel symptoms (constipation, diarrhoea, flatulence)

and food faddiness between the autism group and the mainstream school control

group. There was no significant difference between the autism group and children

in the special schools except for faddiness, which is an autism specific symptom

and not a bowel symptom. This study confirms previously reported findings of an

increase in bowel symptoms in children with autism. It would appear, however,

that this is not specifically associated with autism as bowel symptoms were

reported in similar frequency to a comparison group of children with other

developmental and neurological disorders.

2. Incidence of Gastrointestinal Symptoms in Children With Autism: A

Population-Based Study

Ibrahim SH et al.

Pediatrics 2009;124:680–686.

OBJECTIVE: To determine whether children with autism have an increased incidence

of gastrointestinal symptoms compared with matched control subjects in a

population-based sample.

DESIGN/METHODS: In a previous study including all of the residents of Olmsted

County, Minnesota, aged <21 years between 1976 and 1997, we identified 124

children who fulfilled criteria on the basis of Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition, for a research diagnosis of autism.

Two matched control subjects were identified for each case subject. Through the

Rochester Epidemiology Project, all medical diagnoses, are indexed for

computerized retrieval. Gastrointestinal diagnoses before 21 years of age were

grouped into 5 categories: (1) constipation; (2) diarrhea; (3) abdominal

bloating, discomfort,

or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding issues

or food selectivity. The cumulative incidence of each

category was calculated by using the Kaplan-Meier method. proportional

hazards models were fit to estimate the risk ratios (case subjects versus

control subjects) and corresponding 95% confidence intervals.

RESULTS: Subjects were followed to median ages of 18.2 (case subjects) and 18.7

(control subjects) years. Significant differences between autism case and

control subjects were identified in the cumulative incidence of constipation

(33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No

significant associations were found between autism case status and overall

incidence of gastrointestinal symptoms or any other gastrointestinal symptom

category.

CONCLUSIONS: As constipation and feeding issues/food selectivity often have a

behavioral etiology, data suggest that a neurobehavioral rather than a primary

organic gastrointestinal etiology may account for the higher incidence of these

gastrointestinal symptoms in children with autism.

3. {my comment: As usual, a NYTimes writer chose an ideologically correct

position while ignoring methodological flaws in the Mayo " study " touted by a

well known trade journal (2, above) and also ignoring contrary findings (1,

above).

Regimens: Restrictive Diets May Not Be Appropriate for Children With Autism

By RONI CARYN RABIN

http://www.nytimes.com/2009/07/28/health/28autism.html

4. Constipation with acquired megarectum in children with autism

Afzal N et al.

Pediatrics. 2003 Oct;112(4):939-42.

OBJECTIVE: Recent evidence suggests that autistic children may have significant

gastrointestinal symptoms. Although constipation occurs in 2% to 5% of healthy

children, its clinical diagnosis is often difficult in children with behavioral

disorders. We thus aimed to assess the prevalence of fecal loading in autistic

children with gastrointestinal symptoms and to identify possible predictors of

constipation. METHODS: We studied abdominal radiographs of 103 autistic children

(87 boys) who were referred for gastroenterological assessment, in comparison

with 29 control radiographs from children who were referred to the emergency

department, most with abdominal pain. Radiographs were scored independently, in

blinded manner, by 4 pediatric gastroenterologists and a radiologist. The

severity of constipation was determined using a validated index. Details of

stool habit, abdominal pain, dietary history, and laxative use were obtained

from case notes. RESULTS: The incidence of constipation in the control subjects

with abdominal pain was higher than reported for normal children. Despite this,

moderate or severe constipation was more frequent in the autistic group than in

the control subjects (36% vs 10%). Analysis of rectosigmoid loading showed more

striking differences (54.4% of autistic children had moderate/severe loading or

acquired megarectum compared with 24.1% of control subjects). Multivariate

regression analysis showed consumption of milk to be the strongest predictor of

constipation in the autistic group, whereas stool frequency, gluten consumption,

soiling, and abdominal pain were not predictive of constipation. CONCLUSIONS:

Constipation is a frequent finding in children with gastrointestinal symptoms

and autism, particularly in the rectosigmoid colon, often with acquired

megarectum. The absence of any correlation between the clinical history and the

degree of fecal impaction in autistic children confirms the importance of an

abdominal radiograph in the assessment of their degree of constipation.

5. Celiac Disease Insights: Clues to Solving Autoimmunity

Alessio Fasano

Scientific American 2009

http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights

6. Parent Ratings of Behavorial Effects of Biomedical Interventions

Autism Research Institute

http://www.autism.com/treatable/form34qr.htm

7. Celiac Disease Presenting as Autism

Genuis SJ, Bouchard TP. J Child Neurol. 2009 Jun 29.

http://jcn.sagepub.com/cgi/rapidpdf/0883073809336127v1

Gluten-restricted diets have become increasingly popular among parents seeking

treatment for children diagnosed with autism. Some of the reported response to

celiac diets in children with autism may be related to amelioration of

nutritional deficiency resulting from undiagnosed gluten sensitivity and

consequent malabsorption. A case is presented of a 5-year-old boy diagnosed with

severe autism at a specialty clinic for autistic spectrum disorders. After

initial investigation suggested underlying celiac disease and varied nutrient

deficiencies, a gluten-free diet was instituted along with dietary and

supplemental measures to secure nutritional sufficiency. The patient's

gastrointestinal symptoms rapidly resolved, and signs and symptoms suggestive of

autism progressively abated. This case is an example of a common malabsorption

syndrome associated with central nervous system dysfunction and suggests that in

some contexts, nutritional deficiency may be a determinant of developmental

delay. It is recommended that all children with neurodevelopmental problems be

assessed for nutritional deficiency and malabsorption syndromes.

8. Gluten & autism: case study in Journal of Child Neurology

Binstock Jul 02, 2009

http://www.generationrescue.org/binstock/090702-autism-gluten-jcn.htm

From: elyse-g@...

Date: Fri, 31 Jul 2009 18:42:17 +0000

Subject: Autism not linked to GI disorders.

Autism not linked to GI disorders.

Mayo Clinic researchers have examined the incidence of constipation,

diarrhea, abdominal bloating/discomfort, reflux or vomiting, and

feeding issues/food selectivity in 124 children with autism and a

larger control group of children without autism. Feeding issues and

constipation were more common among the autistic children, which the

authors concluded might be due to neurobehavioral factors associated

with autism, such as need for routine and insistence on sameness in

the diet. There was no evidence of increased incidence of

malabsorption or inflammation in the digestive tract (as claimed by

doctors who provide " biomedical treatments " for autism). No

significant associations were found between autism case status and

overall incidence of gastrointestinal symptoms or any other

gastrointestinal symptom category. Some medications used to treat

children with autism also can lead to appetite suppression and

constipation. The authors cautioned that children with autism should

not be treated indiscriminately with restrictive diets or dietary

supplements. [ibrahim SH. Incidence of gastrointestinal symptoms in

children with autism: A population-based study. Pediatrics

124:680-686, 2009]

http://pediatrics.aappublications.org/cgi/content/abstract/124/2/680

[Guest guest]

It seems like none of these studies that come out do any favors for children

like my son who have tested off the charts for food intolerances such as dairy,

eggs, peanuts, citrus, wheat, etc.  He is among the many so studies like

this only serve to hurt children because now parents who don't know any better

are unlikely have their kids tested or follow a diet that is meant to heal their

bodies.  Sickening.  It seems like their is a conspiracy to make people

believe that their kids are born with autism and this is not a result of

autoimmune disease

that can be treated. Things seem to be getting worse, but not better for our

kids in

relation to the mainstream medical world.

 

Lynn

From: <jrodrig6605@...>

Subject: RE: Autism not linked to GI disorders.

nids

Date: Friday, July 31, 2009, 2:49 PM

Gastrointestinal pathologies in children with autism or other ASDs

Binstock

Researcher in Developmental & Behavioral Neuroanatomy

July 29, 2009

Do children with autism or other autism-spectrum disorders have more

gastrointestinal pathology? The answer depends. Indeed,  choose your favorite

flavor, choose your science.

In the increasingly politicized arena of autism, a group of Mayo Clinic

researchers recently concluded that " No significant associations were found

between autism case status and overall incidence of gastrointestinal symptoms or

any other gastrointestinal symptom category. " (2)  Not surprisingly, a New York

Times science writer jumped onto the Mayo bandwagon and presented a ramification

rooted in medical orthodoxy, " Restrictive Diets May Not Be Appropriate for

Children With Autism " .

In stark contrast, a different research group recently concluded, our " ...study

confirms previously reported findings of an increase in bowel symptoms in

children with autism " (1), thus reinforcing a previous observation that

" Constipation is a frequent finding in children with gastrointestinal symptoms

and autism, particularly in the rectosigmoid colon, often with acquired

megarectum. " (4)

Perhaps doctrinaire preference for an ancient paradigm enthralled the Mayo

Clinic group whose personnel found no increased prevalence of gastrointestinal

pathology in autism. Note their conclusion: " As constipation and feeding

issues/food selectivity often have a behavioral etiology, data suggest that a

neurobehavioral rather than a primary organic gastrointestinal etiology may

account for the higher incidence of these gastrointestinal symptoms in children

with autism. " (2)

Perhaps their conclusion's rhetoric -- Constipation " often " has a " behavioral

etiology " -- reflects a belief system. Are we to believe that chronic diarrhea

(as reported by many parents of autistic children) or persistent constipation in

autism (eg, 4) has a " behavioral etiology " ?  To borrow from popular psychology,

is the child's chronic diarrhea an acting out?

Alternatively, reactivity to gluten affects more individuals than had been

previously recognized and occurs in individuals having none of the overt

symptoms which previously defined celiac disease (5). Furthermore, in an ongoing

data-collection project by Autism Research Institute, more than 60% among >2500

autism parents have reported improvements when their autistic child is on a

gluten-free (GF) and/or casein-free (CF) diet (6).

Given prior, peer-reviewed findings of gastrointestinal pathology in autistic

children, a question arises, " How did Mayo personnel achieve their finding?

Among various factors, the researchers relied upon cumulative incidence and

seemed to avoid comparing chronic vs rarely occurring gastro pathology.

        As a physician who is an autism-specialist noted: " It is very common

to have one or two bouts with constipation or diarrhea over your entire

childhood.  The important difference is how chronic it is, not if you抳e ever

had it.  So [in the newly published study (2)] having a viral illness with

diarrhea that lasts for a week or two was counted the same as children who may

have had chronic loose stools every day of their life.  They do not distinguish

these issues in their study data. " (name withheld, personal communication).

Strikingly, a case study recently reported that one autistic child's

gastrointestinal pathology and autism were alleviated by a gluten free diet

(7-8).

References:

1. Are there more bowel symptoms in children with autism compared to normal

children and children with other developmental and neurological disorders? A

case control study

RA et al.

Autism 2009 13(4) 343�355.

There is considerable controversy as to whether there is an association between

bowel disorders and autism. Using a bowel symptom questionnaire we compared 51

children with autism spectrum disorder with control groups of 35 children from

special school and 112 from mainstream school.There was a significant difference

in the reporting of certain bowel symptoms (constipation, diarrhoea, flatulence)

and food faddiness between the autism group and the mainstream school control

group. There was no significant difference between the autism group and children

in the special schools except for faddiness, which is an autism specific symptom

and not a bowel symptom. This study confirms previously reported findings of an

increase in bowel symptoms in children with autism. It would appear, however,

that this is not specifically associated with autism as bowel symptoms were

reported in similar frequency to a comparison group of children with other

developmental and

neurological disorders.

2. Incidence of Gastrointestinal Symptoms in Children With Autism: A

Population-Based Study

Ibrahim SH et al.

Pediatrics 2009;124:680�686.

OBJECTIVE: To determine whether children with autism have an increased incidence

of gastrointestinal symptoms compared with matched control subjects in a

population-based sample.

DESIGN/METHODS: In a previous study including all of the residents of Olmsted

County, Minnesota, aged <21 years between 1976 and 1997, we identified 124

children who fulfilled criteria on the basis of Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition, for a research diagnosis of autism.

Two matched control subjects were identified for each case subject. Through the

Rochester Epidemiology Project, all medical diagnoses, are indexed for

computerized retrieval. Gastrointestinal diagnoses before 21 years of age were

grouped into 5 categories: (1) constipation; (2) diarrhea; (3) abdominal

bloating, discomfort,

or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding issues

or food selectivity. The cumulative incidence of each

category was calculated by using the Kaplan-Meier method. proportional

hazards models were fit to estimate the risk ratios (case subjects versus

control subjects) and corresponding 95% confidence intervals.

RESULTS: Subjects were followed to median ages of 18.2 (case subjects) and 18.7

(control subjects) years. Significant differences between autism case and

control subjects were identified in the cumulative incidence of constipation

(33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No

significant associations were found between autism case status and overall

incidence of gastrointestinal symptoms or any other gastrointestinal symptom

category.

CONCLUSIONS: As constipation and feeding issues/food selectivity often have a

behavioral etiology, data suggest that a neurobehavioral rather than a primary

organic gastrointestinal etiology may account for the higher incidence of these

gastrointestinal symptoms in children with autism.

3. {my comment: As usual, a NYTimes writer chose an ideologically correct

position while ignoring methodological flaws in the Mayo " study " touted by a

well known trade journal (2, above) and also ignoring contrary findings (1,

above).

Regimens: Restrictive Diets May Not Be Appropriate for Children With Autism

By RONI CARYN RABIN

http://www.nytimes.com/2009/07/28/health/28autism.html

4. Constipation with acquired megarectum in children with autism

Afzal N et al.

Pediatrics. 2003 Oct;112(4):939-42.

OBJECTIVE: Recent evidence suggests that autistic children may have significant

gastrointestinal symptoms. Although constipation occurs in 2% to 5% of healthy

children, its clinical diagnosis is often difficult in children with behavioral

disorders. We thus aimed to assess the prevalence of fecal loading in autistic

children with gastrointestinal symptoms and to identify possible predictors of

constipation. METHODS: We studied abdominal radiographs of 103 autistic children

(87 boys) who were referred for gastroenterological assessment, in comparison

with 29 control radiographs from children who were referred to the emergency

department, most with abdominal pain. Radiographs were scored independently, in

blinded manner, by 4 pediatric gastroenterologists and a radiologist. The

severity of constipation was determined using a validated index. Details of

stool habit, abdominal pain, dietary history, and laxative use were obtained

from case notes. RESULTS:

The incidence of constipation in the control subjects with abdominal pain was

higher than reported for normal children. Despite this, moderate or severe

constipation was more frequent in the autistic group than in the control

subjects (36% vs 10%). Analysis of rectosigmoid loading showed more striking

differences (54.4% of autistic children had moderate/severe loading or acquired

megarectum compared with 24.1% of control subjects). Multivariate regression

analysis showed consumption of milk to be the strongest predictor of

constipation in the autistic group, whereas stool frequency, gluten consumption,

soiling, and abdominal pain were not predictive of constipation. CONCLUSIONS:

Constipation is a frequent finding in children with gastrointestinal symptoms

and autism, particularly in the rectosigmoid colon, often with acquired

megarectum. The absence of any correlation between the clinical history and the

degree of fecal impaction in autistic children

confirms the importance of an abdominal radiograph in the assessment of their

degree of constipation.

5. Celiac Disease Insights: Clues to Solving Autoimmunity

Alessio Fasano     

Scientific American 2009

http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights

6. Parent Ratings of Behavorial Effects of Biomedical Interventions

Autism Research Institute

http://www.autism.com/treatable/form34qr.htm

7. Celiac Disease Presenting as Autism

Genuis SJ, Bouchard TP.  J Child Neurol. 2009 Jun 29.

http://jcn.sagepub.com/cgi/rapidpdf/0883073809336127v1

Gluten-restricted diets have become increasingly popular among parents seeking

treatment for children diagnosed with autism. Some of the reported response to

celiac diets in children with autism may be related to amelioration of

nutritional deficiency resulting from undiagnosed gluten sensitivity and

consequent malabsorption. A case is presented of a 5-year-old boy diagnosed with

severe autism at a specialty clinic for autistic spectrum disorders. After

initial investigation suggested underlying celiac disease and varied nutrient

deficiencies, a gluten-free diet was instituted along with dietary and

supplemental measures to secure nutritional sufficiency. The patient's

gastrointestinal symptoms rapidly resolved, and signs and symptoms suggestive of

autism progressively abated. This case is an example of a common malabsorption

syndrome associated with central nervous system dysfunction and suggests that in

some contexts, nutritional deficiency may be a

determinant of developmental delay. It is recommended that all children with

neurodevelopmental problems be assessed for nutritional deficiency and

malabsorption syndromes.

8. Gluten & autism: case study in Journal of Child Neurology

Binstock  Jul 02, 2009

http://www.generationrescue.org/binstock/090702-autism-gluten-jcn.htm

From: elyse-g@...

Date: Fri, 31 Jul 2009 18:42:17 +0000

Subject: Autism not linked to GI disorders.

 

Autism not linked to GI disorders.

Mayo Clinic researchers have examined the incidence of constipation,

diarrhea, abdominal bloating/discomfort, reflux or vomiting, and

feeding issues/food selectivity in 124 children with autism and a

larger control group of children without autism. Feeding issues and

constipation were more common among the autistic children, which the

authors concluded might be due to neurobehavioral factors associated

with autism, such as need for routine and insistence on sameness in

the diet. There was no evidence of increased incidence of

malabsorption or inflammation in the digestive tract (as claimed by

doctors who provide " biomedical treatments " for autism). No

significant associations were found between autism case status and

overall incidence of gastrointestinal symptoms or any other

gastrointestinal symptom category. Some medications used to treat

children with autism also can lead to appetite suppression and

constipation. The authors cautioned that children with autism should

not be treated indiscriminately with restrictive diets or dietary

supplements. [ibrahim SH. Incidence of gastrointestinal symptoms in

children with autism: A population-based study. Pediatrics

124:680-686, 2009]

http://pediatrics.aappublications.org/cgi/content/abstract/124/2/680

[Guest guest]

Thank you for the information below with various sources and references

which is clearly very helpful.

G-d help all parents but particularly those of newly diagnosed children for

having to sift through the ideological self serving subjective nonsense

that gets published and rehashed through the media as some sort of

definitive truth!!

According to this report my child's constant hanging over the sofa arm

when he was a non verbal, car lining up, nappy/diaper wearing toddler was

actually behavioural in origin ...... so how come he has finally been diagnosed

with a GI dysfunction? He was 13 years old when we saw Dr Goldberg in

December 08 (thank you for your kindness Dr G in seeing us at relatively short

notice during our visit from the UK) and Dr G said that if he would have

seen him as the toddler I describe above with his history he would have

diagnosed him as being Autistic. My son was never diagnosed with the A word

despite seeing numerous specialists from aged 3 and instead he was diagnosed

with severe SLI (Specific language Impairment) and we later had APD (Auditory

Processing Disorder) added when it was diagnosed by a specialist in the

US, he also clearly had sensory processing issues. There is debate from

within the ranks of professionals as to whether SLI and APD are in fact part of

the spectrum or indeed separate to ASD but there is no consensus of view

that I am aware of. Now somewhere along the line my son went from being

'Autistic' to clearly not being 'Autistic' without us ever being aware that he

was in fact 'Autistic', so how on earth did we achieve that or more

appropriately how did our son achieve that. Aged 10 he had a breakdown because

he

could no longer survive what had been evident for years namely the complete

failure of official bodies to adequately meet his needs within mainstream.

One of the first (there were many others) steps I took in this brave new

world of challenging the experts was the relatively easy 'no brainer' of

changing his diet and removing everything likely to stress an already stressed

immune system and somewhere along the way he became healthy enough to

start making progress across areas including academically, psychologically,

emotionally and socially. He is still not a completely 'physically well'

child, small for age etc but he has come a long way in a short time bearing in

mind how long I allowed the experts (aged 3 to 10) to work on him before I

took over in desperation. The point is I followed either instinct or

informed logic or made it up as I went along but I did not follow DAN/NID'S etc

as I was only just becoming aware that there was a world outside the very

limited one I had been living in.

I also watched a second son regress and lose gained language skills from

17 months and follow the same footsteps as his older (by seven years)

brother and cleaning up his diet as a first measure has also helped pull him

back

from the brink plus I have chosen to refuse further shots for him until I

can be confident that his immune system can cope. Interestingly recently my

12 year old daughter had the second of the trio of Cervical cancer shots

and she did what she and her siblings all did post shots as babies she slept

solidly for twelve hours and developed a high fever but this time we can

add GI problems and she felt like death.....babies can't articulate as well

as your average twelve year old! The third shot was never administered and

the reaction was recorded as an adverse reaction through official channels

here in the UK.

I think given my children's histories that there is certainly something

going on with their immune regulation given the reaction to shots even when

it may not ultimately have a neurological impact as in my daughter's case. I

wonder how many parents are told such reactions are within normal limits?

In the final analysis I am a parent struggling to understand and remedy to

the best of my ability issues that present for my children, which given

the global picture are clearly not just unique to us as a family and in that

climate of misinformation, misrepresentation and ignorance hoping I might

get just enough right to effect success. Dr Goldberg's model is a relatively

comfortable one for me because it goes some way to explaining what may

have gone wrong for my children which is precisely why I sought him out but I

also find information

from others in this arena including DAN to be informative!

In a message dated 31/07/2009 19:50:22 GMT Daylight Time,

jrodrig6605@... writes:

Gastrointestinal pathologies in children with autism or other ASDs

Binstock

Researcher in Developmental & Behavioral Neuroanatomy

July 29, 2009

Do children with autism or other autism-spectrum disorders have more

gastrointestinal pathology? The answer depends. Indeed, choose your favorite

flavor, choose your science.

In the increasingly politicized arena of autism, a group of Mayo Clinic

researchers recently concluded that " No significant associations were found

between autism case status and overall incidence of gastrointestinal

symptoms or any other gastrointestinal symptom category. " (2) Not

surprisingly, a

New York Times science writer jumped onto the Mayo bandwagon and presented

a ramification rooted in medical orthodoxy, " Restrictive Diets May Not Be

Appropriate for Children With Autism " .

In stark contrast, a different research group recently concluded, our

" ...study confirms previously reported findings of an increase in bowel

symptoms in children with autism " (1), thus reinforcing a previous observation

that " Constipation is a frequent finding in children with gastrointestinal

symptoms and autism, particularly in the rectosigmoid colon, often with

acquired megarectum. " (4)

Perhaps doctrinaire preference for an ancient paradigm enthralled the Mayo

Clinic group whose personnel found no increased prevalence of

gastrointestinal pathology in autism. Note their conclusion: " As constipation

and

feeding issues/food selectivity often have a behavioral etiology, data suggest

that a neurobehavioral rather than a primary organic gastrointestinal

etiology may account for the higher incidence of these gastrointestinal

symptoms

in children with autism. " (2)

Perhaps their conclusion's rhetoric -- Constipation " often " has a

" behavioral etiology " -- reflects a belief system. Are we to believe that

chronic

diarrhea (as reported by many parents of autistic children) or persistent

constipation in autism (eg, 4) has a " behavioral etiology " ? To borrow from

popular psychology, is the child's chronic diarrhea an acting out?

Alternatively, reactivity to gluten affects more individuals than had been

previously recognized and occurs in individuals having none of the overt

symptoms which previously defined celiac disease (5). Furthermore, in an

ongoing data-collection project by Autism Research Institute, more than 60%

among >2500 autism parents have reported improvements when their autistic

child is on a gluten-free (GF) and/or casein-free (CF) diet (6).

Given prior, peer-reviewed findings of gastrointestinal pathology in

autistic children, a question arises, " How did Mayo personnel achieve their

finding? Among various factors, the researchers relied upon cumulative

incidence and seemed to avoid comparing chronic vs rarely occurring gastro

pathology.

As a physician who is an autism-specialist noted: " It is very common to

have one or two bouts with constipation or diarrhea over your entire

childhood. The important difference is how chronic it is, not if you’ve ever

had

it. So [in the newly published study (2)] having a viral illness with

diarrhea that lasts for a week or two was counted the same as children who may

have had chronic loose stools every day of their life. They do not

distinguish these issues in their study data. " (name withheld, personal

communication).

Strikingly, a case study recently reported that one autistic child's

gastrointestinal pathology and autism were alleviated by a gluten free diet

(7-8).

References:

1. Are there more bowel symptoms in children with autism compared to

normal children and children with other developmental and neurological

disorders? A case control study

RA et al.

Autism 2009 13(4) 343–355.

There is considerable controversy as to whether there is an association

between bowel disorders and autism. Using a bowel symptom questionnaire we

compared 51 children with autism spectrum disorder with control groups of 35

children from special school and 112 from mainstream school.There was a

significant difference in the reporting of certain bowel symptoms

(constipation, diarrhoea, flatulence) and food faddiness between the autism

group and

the mainstream school control group. There was no significant difference

between the autism group and children in the special schools except for

faddiness, which is an autism specific symptom and not a bowel symptom. This

study confirms previously reported findings of an increase in bowel symptoms in

children with autism. It would appear, however, that this is not

specifically associated with autism as bowel symptoms were reported in similar

frequency to a comparison group of children with other developmental and

neurological disorders.

2. Incidence of Gastrointestinal Symptoms in Children With Autism: A

Population-Based Study

Ibrahim SH et al.

Pediatrics 2009;124:680–686.

OBJECTIVE: To determine whether children with autism have an increased

incidence of gastrointestinal symptoms compared with matched control subjects

in a population-based sample.

DESIGN/METHODS: In a previous study including all of the residents of

Olmsted County, Minnesota, aged <21 years between 1976 and 1997, we identified

124 children who fulfilled criteria on the basis of Diagnostic and

Statistical Manual of Mental Disorders, Fourth Edition, for a research

diagnosis of

autism. Two matched control subjects were identified for each case

subject. Through the Rochester Epidemiology Project, all medical diagnoses, are

indexed for computerized retrieval. Gastrointestinal diagnoses before 21

years of age were grouped into 5 categories: (1) constipation; (2) diarrhea;

(3) abdominal bloating, discomfort,

or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding

issues or food selectivity. The cumulative incidence of each

category was calculated by using the Kaplan-Meier method. proportional

hazards models were fit to estimate the risk ratios (case subjects versus

control subjects) and corresponding 95% confidence intervals.

RESULTS: Subjects were followed to median ages of 18.2 (case subjects) and

18.7 (control subjects) years. Significant differences between autism case

and control subjects were identified in the cumulative incidence of

constipation (33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs

16.1). No significant associations were found between autism case status and

overall incidence of gastrointestinal symptoms or any other gastrointestinal

symptom category.

CONCLUSIONS: As constipation and feeding issues/food selectivity often

have a behavioral etiology, data suggest that a neurobehavioral rather than a

primary organic gastrointestinal etiology may account for the higher

incidence of these gastrointestinal symptoms in children with autism.

3. {my comment: As usual, a NYTimes writer chose an ideologically correct

position while ignoring methodological flaws in the Mayo " study " touted by

a well known trade journal (2, above) and also ignoring contrary findings

(1, above).

Regimens: Restrictive Diets May Not Be Appropriate for Children With Autism

By RONI CARYN RABIN

http://www.nytimes.com/2009/07/28/health/28autism.html

4. Constipation with acquired megarectum in children with autism

Afzal N et al.

Pediatrics. 2003 Oct;112(4):939-42.

OBJECTIVE: Recent evidence suggests that autistic children may have

significant gastrointestinal symptoms. Although constipation occurs in 2% to 5%

of healthy children, its clinical diagnosis is often difficult in children

with behavioral disorders. We thus aimed to assess the prevalence of fecal

loading in autistic children with gastrointestinal symptoms and to identify

possible predictors of constipation. METHODS: We studied abdominal

radiographs of 103 autistic children (87 boys) who were referred for

gastroenterological assessment, in comparison with 29 control radiographs from

children

who were referred to the emergency department, most with abdominal pain.

Radiographs were scored independently, in blinded manner, by 4 pediatric

gastroenterologists and a radiologist. The severity of constipation was

determined using a validated index. Details of stool habit, abdominal pain,

dietary

history, and laxative use were obtained from case notes. RESULTS: The

incidence of constipation in the control subjects with abdominal pain was

higher than reported for normal children. Despite this, moderate or severe

constipation was more frequent in the autistic group than in the control

subjects (36% vs 10%). Analysis of rectosigmoid loading showed more striking

differences (54.4% of autistic children had moderate/severe loading or acquired

megarectum compared with 24.1% of control subjects). Multivariate

regression analysis showed consumption of milk to be the strongest predictor of

constipation in the autistic group, whereas stool frequency, gluten

consumption, soiling, and abdominal pain were not predictive of constipation.

CONCLUSIONS: Constipation is a frequent finding in children with

gastrointestinal

symptoms and autism, particularly in the rectosigmoid colon, often with

acquired megarectum. The absence of any correlation between the clinical

history and the degree of fecal impaction in autistic children confirms the

importance of an abdominal radiograph in the assessment of their degree of

constipation.

5. Celiac Disease Insights: Clues to Solving Autoimmunity

Alessio Fasano

Scientific American 2009

http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights

6. Parent Ratings of Behavorial Effects of Biomedical Interventions

Autism Research Institute

http://www.autism.com/treatable/form34qr.htm

7. Celiac Disease Presenting as Autism

Genuis SJ, Bouchard TP. J Child Neurol. 2009 Jun 29.

http://jcn.sagepub.com/cgi/rapidpdf/0883073809336127v1

Gluten-restricted diets have become increasingly popular among parents

seeking treatment for children diagnosed with autism. Some of the reported

response to celiac diets in children with autism may be related to

amelioration of nutritional deficiency resulting from undiagnosed gluten

sensitivity

and consequent malabsorption. A case is presented of a 5-year-old boy

diagnosed with severe autism at a specialty clinic for autistic spectrum

disorders. After initial investigation suggested underlying celiac disease and

varied nutrient deficiencies, a gluten-free diet was instituted along with

dietary and supplemental measures to secure nutritional sufficiency. The

patient's gastrointestinal symptoms rapidly resolved, and signs and symptoms

suggestive of autism progressively abated. This case is an example of a common

malabsorption syndrome associated with central nervous system dysfunction

and suggests that in some contexts, nutritional deficiency may be a

determinant of developmental delay. It is recommended that all children with

neurodevelopmental problems be assessed for nutritional deficiency and

malabsorption syndromes.

8. Gluten & autism: case study in Journal of Child Neurology

Binstock Jul 02, 2009

http://www.generationrescue.org/binstock/090702-autism-gluten-jcn.htm

From: elyse-g@...

Date: Fri, 31 Jul 2009 18:42:17 +0000

Subject: Autism not linked to GI disorders.

Autism not linked to GI disorders.

Mayo Clinic researchers have examined the incidence of constipation,

diarrhea, abdominal bloating/discomfort, reflux or vomiting, and

feeding issues/food selectivity in 124 children with autism and a

larger control group of children without autism. Feeding issues and

constipation were more common among the autistic children, which the

authors concluded might be due to neurobehavioral factors associated

with autism, such as need for routine and insistence on sameness in

the diet. There was no evidence of increased incidence of

malabsorption or inflammation in the digestive tract (as claimed by

doctors who provide " biomedical treatments " for autism). No

significant associations were found between autism case status and

overall incidence of gastrointestinal symptoms or any other

gastrointestinal symptom category. Some medications used to treat

children with autism also can lead to appetite suppression and

constipation. The authors cautioned that children with autism should

not be treated indiscriminately with restrictive diets or dietary

supplements. [ibrahim SH. Incidence of gastrointestinal symptoms in

children with autism: A population-based study. Pediatrics

124:680-686, 2009]

http://pediatrics.aappublications.org/cgi/content/abstract/124/2/680

[Non-text portions of this message have been removed]

------------------------------------

Responsibility for the content of this message lies strictly with

the original author(s), and is not necessarily endorsed by or the

opinion of the Research Institute, the Parent Coalition, or the

list moderator(s).

Groups Links

[Guest guest]

I know that not EVERY child with ASD has digestive issues, but my daughter does,

and allergies, including food allergies have been a huge piece of her puzzle.

Probably the biggest piece! That may change in the future, though.

I know that the Protocol does help kids digestive issues by normalizing the

immune system, but it didnt help my child with her chronic diarrhea (she had it

everyday a few times a day for years) until I did the elimination diet and did

some better probiotics, I mean stuff I had to get from a doctor. Now her stools

are totally normal as long as I dont give her an offending food.

I do really believe that ASD is an immune disease but I think the immune system

is so incredibly complex you have to do what it " wants " you to do in order to

cool it down. For some kids its viruses, some kids its yeast...my kid- its the

dreaded allergies!!!!

Does that make sense? I only share this to inform and help other people who are

trying to figure out how the heck to help their child! This is a rough road.

-

>

>

>

>

>

>

>

> Gastrointestinal pathologies in children with autism or other ASDs

>

>

>

>

>

>

>

> Binstock

> Researcher in Developmental & Behavioral Neuroanatomy

> July 29, 2009

>

> Do children with autism or other autism-spectrum disorders have more

gastrointestinal pathology? The answer depends. Indeed, choose your favorite

flavor, choose your science.

>

> In the increasingly politicized arena of autism, a group of Mayo Clinic

researchers recently concluded that " No significant associations were found

between autism case status and overall incidence of gastrointestinal symptoms or

any other gastrointestinal symptom category. " (2) Not surprisingly, a New York

Times science writer jumped onto the Mayo bandwagon and presented a ramification

rooted in medical orthodoxy, " Restrictive Diets May Not Be Appropriate for

Children With Autism " .

>

> In stark contrast, a different research group recently concluded, our

" ...study confirms previously reported findings of an increase in bowel symptoms

in children with autism " (1), thus reinforcing a previous observation that

" Constipation is a frequent finding in children with gastrointestinal symptoms

and autism, particularly in the rectosigmoid colon, often with acquired

megarectum. " (4)

>

> Perhaps doctrinaire preference for an ancient paradigm enthralled the Mayo

Clinic group whose personnel found no increased prevalence of gastrointestinal

pathology in autism. Note their conclusion: " As constipation and feeding

issues/food selectivity often have a behavioral etiology, data suggest that a

neurobehavioral rather than a primary organic gastrointestinal etiology may

account for the higher incidence of these gastrointestinal symptoms in children

with autism. " (2)

>

> Perhaps their conclusion's rhetoric -- Constipation " often " has a " behavioral

etiology " -- reflects a belief system. Are we to believe that chronic diarrhea

(as reported by many parents of autistic children) or persistent constipation in

autism (eg, 4) has a " behavioral etiology " ? To borrow from popular psychology,

is the child's chronic diarrhea an acting out?

>

> Alternatively, reactivity to gluten affects more individuals than had been

previously recognized and occurs in individuals having none of the overt

symptoms which previously defined celiac disease (5). Furthermore, in an ongoing

data-collection project by Autism Research Institute, more than 60% among >2500

autism parents have reported improvements when their autistic child is on a

gluten-free (GF) and/or casein-free (CF) diet (6).

>

> Given prior, peer-reviewed findings of gastrointestinal pathology in autistic

children, a question arises, " How did Mayo personnel achieve their finding?

Among various factors, the researchers relied upon cumulative incidence and

seemed to avoid comparing chronic vs rarely occurring gastro pathology.

> As a physician who is an autism-specialist noted: " It is very common

to have one or two bouts with constipation or diarrhea over your entire

childhood. The important difference is how chronic it is, not if you've ever

had it. So [in the newly published study (2)] having a viral illness with

diarrhea that lasts for a week or two was counted the same as children who may

have had chronic loose stools every day of their life. They do not distinguish

these issues in their study data. " (name withheld, personal communication).

>

> Strikingly, a case study recently reported that one autistic child's

gastrointestinal pathology and autism were alleviated by a gluten free diet

(7-8).

>

> References:

>

> 1. Are there more bowel symptoms in children with autism compared to normal

children and children with other developmental and neurological disorders? A

case control study

> RA et al.

> Autism 2009 13(4) 343–355.

>

> There is considerable controversy as to whether there is an association

between bowel disorders and autism. Using a bowel symptom questionnaire we

compared 51 children with autism spectrum disorder with control groups of 35

children from special school and 112 from mainstream school.There was a

significant difference in the reporting of certain bowel symptoms (constipation,

diarrhoea, flatulence) and food faddiness between the autism group and the

mainstream school control group. There was no significant difference between the

autism group and children in the special schools except for faddiness, which is

an autism specific symptom and not a bowel symptom. This study confirms

previously reported findings of an increase in bowel symptoms in children with

autism. It would appear, however, that this is not specifically associated with

autism as bowel symptoms were reported in similar frequency to a comparison

group of children with other developmental and neurological disorders.

>

>

> 2. Incidence of Gastrointestinal Symptoms in Children With Autism: A

Population-Based Study

> Ibrahim SH et al.

> Pediatrics 2009;124:680–686.

>

> OBJECTIVE: To determine whether children with autism have an increased

incidence of gastrointestinal symptoms compared with matched control subjects in

a population-based sample.

> DESIGN/METHODS: In a previous study including all of the residents of Olmsted

County, Minnesota, aged <21 years between 1976 and 1997, we identified 124

children who fulfilled criteria on the basis of Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition, for a research diagnosis of autism.

Two matched control subjects were identified for each case subject. Through the

Rochester Epidemiology Project, all medical diagnoses, are indexed for

computerized retrieval. Gastrointestinal diagnoses before 21 years of age were

grouped into 5 categories: (1) constipation; (2) diarrhea; (3) abdominal

bloating, discomfort,

> or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding

issues or food selectivity. The cumulative incidence of each

> category was calculated by using the Kaplan-Meier method. proportional

hazards models were fit to estimate the risk ratios (case subjects versus

control subjects) and corresponding 95% confidence intervals.

> RESULTS: Subjects were followed to median ages of 18.2 (case subjects) and

18.7 (control subjects) years. Significant differences between autism case and

control subjects were identified in the cumulative incidence of constipation

(33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No

significant associations were found between autism case status and overall

incidence of gastrointestinal symptoms or any other gastrointestinal symptom

category.

> CONCLUSIONS: As constipation and feeding issues/food selectivity often have a

behavioral etiology, data suggest that a neurobehavioral rather than a primary

organic gastrointestinal etiology may account for the higher incidence of these

gastrointestinal symptoms in children with autism.

>

> 3. {my comment: As usual, a NYTimes writer chose an ideologically correct

position while ignoring methodological flaws in the Mayo " study " touted by a

well known trade journal (2, above) and also ignoring contrary findings (1,

above).

>

> Regimens: Restrictive Diets May Not Be Appropriate for Children With Autism

> By RONI CARYN RABIN

> http://www.nytimes.com/2009/07/28/health/28autism.html

>

> 4. Constipation with acquired megarectum in children with autism

> Afzal N et al.

> Pediatrics. 2003 Oct;112(4):939-42.

>

> OBJECTIVE: Recent evidence suggests that autistic children may have

significant gastrointestinal symptoms. Although constipation occurs in 2% to 5%

of healthy children, its clinical diagnosis is often difficult in children with

behavioral disorders. We thus aimed to assess the prevalence of fecal loading in

autistic children with gastrointestinal symptoms and to identify possible

predictors of constipation. METHODS: We studied abdominal radiographs of 103

autistic children (87 boys) who were referred for gastroenterological

assessment, in comparison with 29 control radiographs from children who were

referred to the emergency department, most with abdominal pain. Radiographs were

scored independently, in blinded manner, by 4 pediatric gastroenterologists and

a radiologist. The severity of constipation was determined using a validated

index. Details of stool habit, abdominal pain, dietary history, and laxative use

were obtained from case notes. RESULTS: The incidence of constipation in the

control subjects with abdominal pain was higher than reported for normal

children. Despite this, moderate or severe constipation was more frequent in the

autistic group than in the control subjects (36% vs 10%). Analysis of

rectosigmoid loading showed more striking differences (54.4% of autistic

children had moderate/severe loading or acquired megarectum compared with 24.1%

of control subjects). Multivariate regression analysis showed consumption of

milk to be the strongest predictor of constipation in the autistic group,

whereas stool frequency, gluten consumption, soiling, and abdominal pain were

not predictive of constipation. CONCLUSIONS: Constipation is a frequent finding

in children with gastrointestinal symptoms and autism, particularly in the

rectosigmoid colon, often with acquired megarectum. The absence of any

correlation between the clinical history and the degree of fecal impaction in

autistic children confirms the importance of an abdominal radiograph in the

assessment of their degree of constipation.

>

> 5. Celiac Disease Insights: Clues to Solving Autoimmunity

> Alessio Fasano

> Scientific American 2009

> http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights

>

> 6. Parent Ratings of Behavorial Effects of Biomedical Interventions

> Autism Research Institute

> http://www.autism.com/treatable/form34qr.htm

>

> 7. Celiac Disease Presenting as Autism

> Genuis SJ, Bouchard TP. J Child Neurol. 2009 Jun 29.

> http://jcn.sagepub.com/cgi/rapidpdf/0883073809336127v1

>

> Gluten-restricted diets have become increasingly popular among parents seeking

treatment for children diagnosed with autism. Some of the reported response to

celiac diets in children with autism may be related to amelioration of

nutritional deficiency resulting from undiagnosed gluten sensitivity and

consequent malabsorption. A case is presented of a 5-year-old boy diagnosed with

severe autism at a specialty clinic for autistic spectrum disorders. After

initial investigation suggested underlying celiac disease and varied nutrient

deficiencies, a gluten-free diet was instituted along with dietary and

supplemental measures to secure nutritional sufficiency. The patient's

gastrointestinal symptoms rapidly resolved, and signs and symptoms suggestive of

autism progressively abated. This case is an example of a common malabsorption

syndrome associated with central nervous system dysfunction and suggests that in

some contexts, nutritional deficiency may be a determinant of developmental

delay. It is recommended that all children with neurodevelopmental problems be

assessed for nutritional deficiency and malabsorption syndromes.

>

> 8. Gluten & autism: case study in Journal of Child Neurology

> Binstock Jul 02, 2009

> http://www.generationrescue.org/binstock/090702-autism-gluten-jcn.htm

>

>

>

>

> From: elyse-g@...

> Date: Fri, 31 Jul 2009 18:42:17 +0000

> Subject: Autism not linked to GI disorders.

>

>

>

>

>

>

> Autism not linked to GI disorders.

>

> Mayo Clinic researchers have examined the incidence of constipation,

> diarrhea, abdominal bloating/discomfort, reflux or vomiting, and

> feeding issues/food selectivity in 124 children with autism and a

> larger control group of children without autism. Feeding issues and

> constipation were more common among the autistic children, which the

> authors concluded might be due to neurobehavioral factors associated

> with autism, such as need for routine and insistence on sameness in

> the diet. There was no evidence of increased incidence of

> malabsorption or inflammation in the digestive tract (as claimed by

> doctors who provide " biomedical treatments " for autism). No

> significant associations were found between autism case status and

> overall incidence of gastrointestinal symptoms or any other

> gastrointestinal symptom category. Some medications used to treat

> children with autism also can lead to appetite suppression and

> constipation. The authors cautioned that children with autism should

> not be treated indiscriminately with restrictive diets or dietary

> supplements. [ibrahim SH. Incidence of gastrointestinal symptoms in

> children with autism: A population-based study. Pediatrics

> 124:680-686, 2009]

> http://pediatrics.aappublications.org/cgi/content/abstract/124/2/680

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

What everyone must keep in mind is that there truly are many " autismis " .  Our

son has not responded to any diets and we tried the GFCF for 6 months without

ANY changes.  He presents as very healthy, not much sickness, good appetite

very normal but he has moderate autism without any doubt.  His main issues are

neurological, abnormal EEGs etc and we have found very little help.

CR

Autism not linked to GI disorders.

>

>

>

>

>

>

> Autism not linked to GI disorders.

>

> Mayo Clinic researchers have examined the incidence of constipation,

> diarrhea, abdominal bloating/discomfort, reflux or vomiting, and

> feeding issues/food selectivity in 124 children with autism and a

> larger control group of children without autism. Feeding issues and

> constipation were more common among the autistic children, which the

> authors concluded might be due to neurobehavioral factors associated

> with autism, such as need for routine and insistence on20sameness in

> the diet. There was no evidence of increased incidence of

> malabsorption or inflammation in the digestive tract (as claimed by

> doctors who provide " biomedical treatments " for autism). No

> significant associations were found between autism case status and

> overall incidence of gastrointestinal symptoms or any other

> gastrointestinal symptom category. Some medications used to treat

> children with autism also can lead to appetite suppression and

> constipation. The authors cautioned that children with autism should

> not be treated indiscriminately with restrictive diets or dietary

> supplements. [ibrahim SH. Incidence of gastrointestinal symptoms in

> children with autism: A population-based study. Pediatrics

> 124:680-686, 2009]

> http://pediatrics.aappublications.org/cgi/content/abstract/124/2/680

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

My daughter did not respond to diet either...until we started addressing her

other immune problems with Dr. . I believe that our kids have " masked "

symptoms because they have so much other stuff going on! You have to address

anything and everything you can in order to cool down the immune system.

-

>

> >

>

> >

>

> >

>

> >

>

> >

>

> >

>

> >

>

> > Gastrointestinal pathologies in children with autism or other ASDs

>

> >

>

> >

>

> >

>

> >

>

> >

>

> >

>

> >

>

> > Binstock

>

> > Researcher in Developmental & Behavioral Neuroanatomy

>

> > July 29, 2009

>

> >

>

> > Do children with autism or other autism-spectrum disorders have more

gastrointestinal pathology? The answer depends. Indeed, choose your favorite

flavor, choose your science.

>

> >

>

> > In the increasingly politicized arena of autism, a group of Mayo Clinic

researchers recently concluded that " No significant associations were found

between autism case status and overall incidence of gastrointestinal symptoms or

any other gastrointestinal symptom category. " (2) Not surprisingly, a New York

Times science writer jumped onto the Mayo bandwagon and presented a ramification

rooted in medical orthodoxy, " Restrictive Diets May Not Be Appropriate for

Children With Autism " .

>

> >

>

> > In stark contrast, a different research group recently concluded, our

" ...study confirms previously reported findings of an increase in bowel symptoms

in children with autism " (1), thus reinforcing a previous observation that

" Constipation is a frequent f

> inding in children with gastrointestinal symptoms and autism, particularly in

the rectosigmoid colon, often with acquired megarectum. " (4)

>

> >

>

> > Perhaps doctrinaire preference for an ancient paradigm enthralled the Mayo

Clinic group whose personnel found no increased prevalence of gastrointestinal

pathology in autism. Note their conclusion: " As constipation and feeding

issues/food selectivity often have a behavioral etiology, data suggest that a

neurobehavioral rather than a primary organic gastrointestinal etiology may

account for the higher incidence of these gastrointestinal symptoms in children

with autism. " (2)

>

> >

>

> > Perhaps their conclusion's rhetoric -- Constipation " often " has a

" behavioral etiology " -- reflects a belief system. Are we to believe that

chronic diarrhea (as reported by many parents of autistic children) or

persistent constipation in autism (eg, 4) has a " behavioral etiology " ? To

borrow from popular psychology, is the child's chronic diarrhea an acting out?

>

> >

>

> > Alternatively, reactivity to gluten affects more individuals than had been

previously recognized and occurs in individuals having none of the overt

symptoms which previously defined celiac disease (5). Furthermore, in an ongoing

data-collection project by Autism Research Institute, more than 60% among >2500

autism parents have reported improvements when their autistic child is on a

gluten-free (GF) and/or casein-free (CF) diet (6).

>

> >

>

> > Given prior, peer-reviewed findings of gastrointestinal pathology in

autistic children, a question arises, " How did Mayo pers

> onnel achieve their finding? Among various factors, the researchers relied

upon cumulative incidence and seemed to avoid comparing chronic vs rarely

occurring gastro pathology.

>

> > As a physician who is an autism-specialist noted: " It is very common

to have one or two bouts with constipation or diarrhea over your entire

childhood. The important difference is how chronic it is, not if you've ever

had it. So [in the newly published study (2)] having a viral illness with

diarrhea that lasts for a week or two was counted the same as children who may

have had chronic loose stools every day of their life. They do not distinguish

these issues in their study data. " (name withheld, personal communication).

>

> >

>

> > Strikingly, a case study recently reported that one autistic child's

gastrointestinal pathology and autism were alleviated by a gluten free diet

(7-8).

>

> >

>

> > References:

>

> >

>

> > 1. Are there more bowel symptoms in children with autism compared to normal

children and children with other developmental and neurological disorders? A

case control study

>

> > RA et al.

>

> > Autism 2009 13(4) 343†" 355.

>

> >

>

> > There is considerable controversy as to whether there is an association

between bowel disorders and autism. Using a bowel symptom questionnaire we

compared 51 children with autism spectrum disorder with control groups of 35

children from special school and 112 from mainstream school.There was a

significant difference in the reporting of certain bowel symptoms (constipat

> ion, diarrhoea, flatulence) and food faddiness between the autism group and

the mainstream school control group. There was no significant difference between

the autism group and children in the special schools except for faddiness, which

is an autism specific symptom and not a bowel symptom. This study confirms

previously reported findings of an increase in bowel symptoms in children with

autism. It would appear, however, that this is not specifically associated with

autism as bowel symptoms were reported in similar frequency to a comparison

group of children with other developmental and neurological disorders.

>

> >

>

> >

>

> > 2. Incidence of Gastrointestinal Symptoms in Children With Autism: A

Population-Based Study

>

> > Ibrahim SH et al.

>

> > Pediatrics 2009;124:680†" 686.

>

> >

>

> > OBJECTIVE: To determine whether children with autism have an increased

incidence of gastrointestinal symptoms compared with matched control subjects in

a population-based sample.

>

> > DESIGN/METHODS: In a previous study including all of the residents of

Olmsted County, Minnesota, aged <21 years between 1976 and 1997, we identified

124 children who fulfilled criteria on the basis of Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition, for a research diagnosis of autism.

Two matched control subjects were identified for each case subject. Through the

Rochester Epidemiology Project, all medical diagnoses, are indexed for

computerized retrieval. Gastrointestinal diagnoses before 21 years of age were

grouped into 5 categories: (1) constipation; (2) diarrhea;

> (3) abdominal bloating, discomfort,

>

> > or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding

issues or food selectivity. The cumulative incidence of each

>

> > category was calculated by using the Kaplan-Meier method. proportional

hazards models were fit to estimate the risk ratios (case subjects versus

control subjects) and corresponding 95% confidence intervals.

>

> > RESULTS: Subjects were followed to median ages of 18.2 (case subjects) and

18.7 (control subjects) years. Significant differences between autism case and

control subjects were identified in the cumulative incidence of constipation

(33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No

significant associations were found between autism case status and overall

incidence of gastrointestinal symptoms or any other gastrointestinal symptom

category.

>

> > CONCLUSIONS: As constipation and feeding issues/food selectivity often have

a behavioral etiology, data suggest that a neurobehavioral rather than a primary

organic gastrointestinal etiology may account for the higher incidence of these

gastrointestinal symptoms in children with autism.

>

> >

>

> > 3. {my comment: As usual, a NYTimes writer chose an ideologically correct

position while ignoring methodological flaws in the Mayo " study " touted by a

well known trade journal (2, above) and also ignoring contrary findings (1,

above).

>

> >

>

> > Regimens: Restrictive Diets May Not Be Appropriate for Children With Autism

>

> > By RONI CARYN RABIN

>

> > http://www.nytimes.com/2009/07/28/health/28autism.html

>

> >

>

> > 4. Constipation

> with acquired megarectum in children with autism

>

> > Afzal N et al.

>

> > Pediatrics. 2003 Oct;112(4):939-42.

>

> >

>

> > OBJECTIVE: Recent evidence suggests that autistic children may have

significant gastrointestinal symptoms. Although constipation occurs in 2% to 5%

of healthy children, its clinical diagnosis is often difficult in children with

behavioral disorders. We thus aimed to assess the prevalence of fecal loading in

autistic children with gastrointestinal symptoms and to identify possible

predictors of constipation. METHODS: We studied abdominal radiographs of 103

autistic children (87 boys) who were referred for gastroenterological

assessment, in comparison with 29 control radiographs from children who were

referred to the emergency department, most with abdominal pain. Radiographs were

scored independently, in blinded manner, by 4 pediatric gastroenterologists and

a radiologist. The severity of constipation was determined using a validated

index. Details of stool habit, abdominal pain, dietary history, and laxative use

were obtained from case notes. RESULTS: The incidence of constipation in the

control subjects with abdominal pain was higher than reported for normal

children. Despite this, moderate or severe constipation was more frequent in the

autistic group than in the control subjects (36% vs 10%). Analysis of

rectosigmoid loading showed more striking differences (54.4% of autistic

children had moderate/severe loading or acquired megarectum compared with 24.1%

of control subjects). Multivariate regression analysis showed consumption of

milk to be the20strongest predictor of constipation in the autistic group,

whereas stool frequency, gluten consumption, soiling, and abdominal pain were

not predictive of constipation. CONCLUSIONS: Constipation is a frequent finding

in children with gastrointestinal symptoms and autism, particularly in the

rectosigmoid colon, often with acquired megarectum. The absence of any

correlation between the clinical history and the degree of fecal impaction in

autistic children confirms the importance of an abdominal radiograph in the

assessment of their degree of constipation.

>

> >

>

> > 5. Celiac Disease Insights: Clues to Solving Autoimmunity

>

> > Alessio Fasano

>

> > Scientific American 2009

>

> > http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights

>

> >

>

> > 6. Parent Ratings of Behavorial Effects of Biomedical Interventions

>

> > Autism Research Institute

>

> > http://www.autism.com/treatable/form34qr.htm

>

> >

>

> > 7. Celiac Disease Presenting as Autism

>

> > Genuis SJ, Bouchard TP. J Child Neurol. 2009 Jun 29.

>

> > http://jcn.sagepub.com/cgi/rapidpdf/0883073809336127v1

>

> >

>

> > Gluten-restricted diets have become increasingly popular among parents

seeking treatment for children diagnosed with autism. Some of the reported

response to celiac diets in children with autism may be related to amelioration

of nutritional deficiency resulting from undiagnosed gluten sensitivity and

consequent malabsorption. A case is presented of a 5-year-old boy diagnosed with

severe autism at a specialty clinic for autistic spectrum disorders. After

initial investigation suggested underlying celia

> c disease and varied nutrient deficiencies, a gluten-free diet was instituted

along with dietary and supplemental measures to secure nutritional sufficiency.

The patient's gastrointestinal symptoms rapidly resolved, and signs and symptoms

suggestive of autism progressively abated. This case is an example of a common

malabsorption syndrome associated with central nervous system dysfunction and

suggests that in some contexts, nutritional deficiency may be a determinant of

developmental delay. It is recommended that all children with neurodevelopmental

problems be assessed for nutritional deficiency and malabsorption syndromes.

>

> >

>

> > 8. Gluten & autism: case study in Journal of Child Neurology

>

> > Binstock Jul 02, 2009

>

> > http://www.generationrescue.org/binstock/090702-autism-gluten-jcn.htm

>

> >

>

> >

>

> >

>

> >

>

> > From: elyse-g@

>

> > Date: Fri, 31 Jul 2009 18:42:17 +0000

>

> > Subject: Autism not linked to GI disorders.

>

> >

>

> >

>

> >

>

> >

>

> >

>

> >

>

> > Autism not linked to GI disorders.

>

> >

>

> > Mayo Clinic researchers have examined the incidence of constipation,

>

> > diarrhea, abdominal bloating/discomfort, reflux or vomiting, and

>

> > feeding issues/food selectivity in 124 children with autism and a

>

> > larger control group of children without autism. Feeding issues and

>

> > constipation were more common among the autistic children, which the

>

> > authors concluded might be due to neurobehavioral factors associated

>

> > with autism, such as need for routine and insistence on20sameness in

>

> > the diet. There was no evidence of increased incidence of

>

> > malabsorption or inflammation in the digestive tract (as claimed by

>

> > doctors who provide " biomedical treatments " for autism). No

>

> > significant associations were found between autism case status and

>

> > overall incidence of gastrointestinal symptoms or any other

>

> > gastrointestinal symptom category. Some medications used to treat

>

> > children with autism also can lead to appetite suppression and

>

> > constipation. The authors cautioned that children with autism should

>

> > not be treated indiscriminately with restrictive diets or dietary

>

> > supplements. [ibrahim SH. Incidence of gastrointestinal symptoms in

>

> > children with autism: A population-based study. Pediatrics

>

> > 124:680-686, 2009]

>

> > http://pediatrics.aappublications.org/cgi/content/abstract/124/2/680

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