Biomedical Treatments for ASDs

Biomedical treatments for autism took another hit recently. A consensus report published in the January issue of Pediatrics takes Andrew Wakefield’s ever popular “austistic enterocolitis” syndrome to task by reporting a lack of evidence that children with ASD have a higher incidence of digestive problems or that diet regimens (such as the highly publicized gluten-free and casein-free diet, or GFCF) are effective.

Despite already having been discredited over his MMR vaccine claims, Wakefield’s ideas with respect to alternative treatments for autism continue to capture the imagination of a frustrated (and frightened) parent community. And I hate to harp on Jenny McCarthy, but the combination of her lack of appreciation for scientific investigation and the gigantic podium that fame provides her are an unfortunate combination, particularly in light of evidence that diets like the GFCF diet may have detrimental effects on children’s health.

The report was the result of a review of research regarding GI symptoms, autism, and ASDs by an expert panel, specifically to investigate whether or not there is an association between ASDs and digestive complaints. When all was said and done, Wakefield’s notion of a unique GI pathophysiology was — like his notion about MMR vaccine – just a notion. In Statement 4, the panel writes:

The existence of a gastrointestinal disturbance specific to persons with ASDs (eg, "autistic enterocolitis") has not been established.

This statement is born of members of the scientific community taking a stand. Bravo — it’s an easy thing to do considering the alternative treatment fervor. They even wander further into the cold night by declaring that data do not support the use of the popular special diets as a primary treatment in children with autism.

Will their conclusions be accepted by the community at large? If the continued controversy regarding vaccines is any indication, the answer is “not likely.” In quiet — or, in some cases, not to quiet – desperation, parents will continue to try to treat children themselves with solutions that have “worked” for other people, like McCarthy.

Thus, here’s where your head might begin to hurt: the panel calls for pediatricians to monitor for potential diet-related nutritional problems among patients with ASDs, stating,

Pediatricians and other primary care providers should be alertto potential nutritional problems in patients with ASDs. Evaluation by a nutritionist who is familiar with nutrition support forindividuals with ASDs is recommended if caregivers raise concernabout the patient's diet or if the patient exhibits selectivityof intake or is on a restricted diet.

I don’t envy anyone an interventive conversation with a parent resorting to a special diet, particularly if the parent detects any kind of (real or imagined) changes. Then again, it could be just another day in the office, right?