Clinic Notes: Autism and Gastrointestinal (GI) Disease

Some parents, autism researchers and clinicians think that autism is caused by GI disease, hence the gluten and casein free diets, and various vitamins and supplements that are given to children with autism. So is there a link between autism and GI disease? A recent large scale Mayo Clinic study has some interesting findings. Most of the children diagnosed with autism and the control subjects had received their care at the Mayo Clinic and detailed information was available for the study. The most interesting finding was that the children with autism did not differ from the control group in the frequency of GI disease. Two symptoms--feeding difficulties and constipation were found more often in the autism group. The researchers note that these two symptoms are probably related to autistic behavior--restrictive diets--lack of fiber, rather than a GI disease. Neither group had celiac disease, which is intolerance to gluten. The authors of the study conclude that GI disease should be treated when it is diagnosed independently from autism. But treating autism without verification of GI disease is not warranted.

Clinic Notes: Early Detection of Autism Redux

Autism is usually diagnosed between the second and third year of life when language fails to develop. (This is also the time when children receive vaccinations for common childhood diseases hence the association between the mercury in the vaccines being the cause of autism, which is still being hotly debated.) As I mentioned in a previous blog some research finds that ABA started as early as 18 months can actually prevent autism. There are no reliable early biological or behavior markers of autism and everyone agrees that if we could diagnosis at an earlier age and start ABA and other treatments then autism could be more effectively treated. According to a recent study, signs of autism appear in the first few weeks of life. Researchers at Flinders University found differences in attention, cognitive, temperament, and sensory processing between children who later developed autism and children who developed normally. If this study is replicated then therapist may be starting ABA and other therapies at a very early age.

Clinic Notes: Autism as a Systemic Disease

As I mentioned in a previous blog, a pediatrician, who's two year old had just been diagnosed with autism, contacted me. She had taken her child to the gastroenterology department at the hospital where she worked and the doctors there told her that autism was a gastric disorder. She went to the immunology department and they told her that autism was an immune deficiency disorder. In the neurology department she was told that autism was a neurological disorder. What is autism she asked me exasperated? I told her that autism is a neurological disorder although some children with autism have gastric and/or immune problems. Mark Hyman, MD now says that our current thinking about autism is all-wrong and autism is a systemic disorder that affects the brain. According to his theory a "toxic environment" triggers genes that cause frequent infections, gut problems, and finally neurological problems that cause the faulty wiring that causes the behavior abnormalities seen in autism. While this is an interesting theory I don't see it in my practice. Usually, I see between 35-40 kids on the autism spectrum each week. Some of these kids are frequently sick and have obvious immune problems. But others are never sick. Some have digestive disorders. Others do not. Some have a positive history of autism in the family while others do not. All have neurological disorders that underlie the symptomatic disorders of autism, which also vary. So what kind of systemic disease causes such variable problems? Are their different types of autism? Different etiologies? I don't see it.

Clinic Notes: Church and Autism

Many parents who bring their children with autism to my clinic complain that their child does not do well in church. Children with autism who have sensory issues may not do well in church because of the noise and the crowd. But at the same time these children, and adults with autism and other disabilities want desperately to take part in church activities. But all too often they feel excluded. I live and practice in the Bible-Belt and attending church is an important issue for families. Having children with autism in church is also an important issue for the church, especially if the child with autism exhibits behavior such as talking non-stop, hand flapping, not staying seated, or engaging in other behaviors, which are disruptive. Many parents get the message, either implicitly or explicitly, that their child with autism is not welcomed in church. The family then becomes even more isolated from society. Not being welcomed at church runs counter to Judeo-Christian and Muslim religions where acceptance of everyone is a central tenet. As the number of children with autism increase, some in the religious community are reaching out with written guidelines to include people with disabilities in all church activities. And this is a good first step. I do know of churches, usually small churches, that have "learned" to not be bothered by the child with autism. But unfortunately this is rare. Hopefully, churches will become more "educated" and accepting of children with autism and other disabilities.