December Post 2015 - Gina

Summary:

The prevalence of Autism Spectrum Disorder (ASD) seems to be on the rise. The latest statistics indicate 1 in every 68 children in the US meets the diagnostic criteria for ASD (Berry et al., 2015). ASD presents in varying degrees of severity with the common characteristics of social communication deficits accompanied by persistent and repetitive behaviors as well as restriction in interests. Medical comorbidities occur at an unusually high rate within the ASD population; GI dysfunction being one of the most prevalent issues. With respect to the unique challenges to implementing the nutrition care process in the growing pediatric ASD population, it was deemed necessary to create a framework, tailored specifically to these individuals, to guide evaluation and treatment of GI symptoms and nutritional deficiencies.

Many unique challenges are faced by caregivers and medical providers for the pediatric ASD population. To start, children with ASD are frequently very selective about the foods they will eat. Documented by Hubbard and colleagues (2014), ASD children are significantly more likely than typically developing children to refuse foods based on a number of characteristics including texture, mixtures, and taste, among others. A “strong preference” for processed foods, snacks, and sweets has been noted along with low fiber, fruit and vegetable intakes. Limited food acceptance by the child and communication barriers complicate the nutrition care processes from assessment of symptoms to evaluation of treatment effectiveness.

Beyond the child’s preferences, caregivers may have initiated dietary treatment on their own. Prospective [scientific] research exploring the potential for dietary treatment and the possible contribution of diet to ASD manifestations as well as GI issues continues to be generated. Anecdotal evidence regarding dietary treatment of ASD is also prevalent. Some fairly popular caregiver initiated diets can be very restrictive in their own respects, as with gluten free or casein free diets. Shmaya and colleagues (2015) discovered a trend toward higher nutritional deficiencies in an ASD population when compared with typically developing children. Caregiver initiated diets may further increase risk for deficiencies as accepted and allowed foods are restricted even further.

After the likely origin or trigger of symptoms is identified, the challenges with food acceptance continue to add layers of complexity to treatment implementation with ASD clients. Dietary modifications can cause a great deal of stress for the child with ASD and the caregivers, due to the risk for behavioral reactions. The need for professional dietary guidance in pediatric ASD populations exists. For these reasons, a guide specific to working with these individuals and families is necessary.

The resultant algorithm was developed by a panel of experts as a first step in establishing standards of practice for working with pediatric ASD populations regarding GI issues. It is a map of sorts to help navigate the additional challenges and considerations which must be taken into account with this population and their caregivers. The algorithm provides clearer lines for practice within the scope of an RD as well as indications for referral to various other healthcare providers. This series of checkpoints will help guide proper assessment, treatment, and interdisciplinary of care for these individuals as official standards of practice are developed.

All 3 articles are available as PDFs on our Class of 2016 group Facebook page for easier access.

AND Continuing Education Article:

Berry, R. C., Novak, P., Withrow, N., Schmidt, B., Rarback, S., Feucht, S., & ... Sharp, W. G. (2015). Nutrition management of gastrointestinal symptoms in children with Autism Spectrum Disorder: Guideline from an expert panel. Journal of the Academy of Nutrition and Dietetics, 115(12), 1919-1927. doi:10.1016/j.jand.2015.05.016

Supplemental Article 1:

Hubbard, K. L., Anderson, S. E., Curtin, C., Must, A., & Bandini, L. G. (2014). A comparison of food refusal related to characteristics of food in children with Autism Spectrum Disorder and typically developing children. Journal of the Academy of Nutrition and Dietetics, 114(12), 1981-1987. doi:10.1016/j.jand.2014.04.017

Supplemental Article 2:

Shmaya, Y., Eilat-Adar, S., Leitner, Y., Reif, S., & Gabis, L. (2015). Nutritional deficiencies and overweight prevalence among children with Autism Spectrum Disorder. Research in Developmental Disabilities, 38, 1-6. doi:10.1016/j.ridd.2014.11.020