Posts Tagged ‘nutrition’

Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about their child’s behavior. Today’s question comes from Tom and Alissa who write,

“We have been told by a number of other parents that nutritional supplements are important and that we should be giving our child supplements every day. Which supplements should we give? Which supplements actually help with behavior? Which supplements help with autism?”

First, thanks for writing. I think you are being smart by asking the right questions regarding nutritional supplements. We know that the use of nutritional supplements has become more popular in recent years, and not just for children with autism. For example, a typical google search on nutritional supplements will reveal over 25,000,000 hits. Everyone is talking about the use of nutritional supplements. I am certainly not qualified to talk about which nutritional supplements are right for your child. I can, however, share what I have learned about nutritional supplementation. Then you can take that information with you when you meet with a qualified health care practitioner who is trained to help you and your child.

Nutritional Deficiencies

Second, we know that some people, including children with autism, may have nutritional deficiencies. Speaking personally, I was anemic from the first time I tried to donate blood (early 20s) until 2 years ago. Because of this, an iron supplement seemed like the appropriate treatment. Additionally, I was on the path to osteoporosis. Again, taking Vitamin D and Calcium seemed like an obvious treatment. Thus, it seems likely that nutritional supplementation is actually required in some instances.

Underlying Medical Conditions

Third, we know that some medical conditions can prevent certain individuals from absorbing the nutritional supplements they take. Conditions such as Celiac can cause inflammation in the GI tract. This inflammation can prevent the supplements (and nutrition from food) from being absorbed properly. Thus, treating the underlying medical condition should be a first goal.

Supplements Improve Behavior

Fourth, we know that some nutritional supplements can actually improve behavior. For example, the research on melatonin has been shown to improve the sleep of individuals with autism. Zinc supplementation can also result in improved taste and other sensations. Join us later this week as we review a study on the effects of fish oil on behavior.

Research on Supplements

Finally, a number of studies have been conducted, or are being conducted regarding the use of other supplements for children, including children on the spectrum. This includes the use of Vitamin C, Vitamin D, magnesium, zinc, omega fatty acids (fish oil), and Vitamin Bs.

So, my advice to you is to meet with an appropriately trained health care practitioner so that he/she can help you identify any underlying medical conditions or nutritional deficiencies in order to determine what your child may need as part of a regularly balanced diet.

Good luck and please keep us posted on the progress and findings.

Readers, please share! Do you take nutritional supplements? Do you give them to your children? Does it help?

If you have a behavior question for Missy, email askmissy at applied behavioral strategies dot com.

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Today’s post was developed in response to an article that originally appeared in the Austin American Statesman. You may read it here. You may read the original research article discussed in the paper here. This post is the original opinion letter that we sent to the editor at the Statesman. We were ultimately asked to shorten the letter and it appeared as a simple Letter to the Editor.

Ms. Roser’s recent article highlighting the Malloy and colleagues’ new study regarding gluten- and casein-free diets for children with autism spectrum disorders (ASD) puts special diets in the spotlight once again. Special diets are not new and they are not solely for children with ASD. In fact, special diets are necessary for many people.

For example, people diagnosed with phenylketonuria (PKU) require a highly specialized diet to prevent the development of mental retardation. PKU is a genetic condition wherein individuals lack an enzyme to digest certain amino acids. This is such a serious issue that every child in this country is screened for PKU via a heel prick at birth. Those who test positive during the test are required to follow a life-long reduced-protein diet.

A second example of a condition requiring a specialized diet is celiac disease. Those affected are allergic to gluten, a protein found in grains such as wheat and barley, and they must refrain from consuming gluten throughout their lifetime. Consumption of gluten can have many harmful side effects including anemia, osteoporosis, and intestinal cancers.

Finally, individuals with food allergies must also follow specialized diets. For those who are allergic to nuts, exposure to them may be deadly. Such was the case when a young woman with peanut allergies died after kissing her boyfriend shortly after he ate a peanut-butter-and-jelly sandwich. The most common food allergies for children include milk, egg, soy, wheat, peanut, tree nut, and seafood. If any of us had to give up these foods, particularly without effective guidance, we would feel restricted! Unfortunately, for people with food allergies, food restriction is the only way to prevent negative side effects.

Unfortunately, what Ms. Roser, as well as Malloy and colleagues, failed to mention in their writings was the fact that children with ASD often go on specialized diets because of gastrointestinal (GI), nutrition, and/or immune disorders, not because of the condition or diagnosis of ASD. The GI disorders that children with ASD often experience may be related to food allergies or intolerances, autoimmune conditions, or other environmental variables. Among physicians and psychologists who regularly treat individuals with autism, there is an understanding that such individuals may experience gastrointestinal disorders and lack the communication skills to express their discomfort. In response to this growing recognition, a team of 27 medical doctors and doctoral-level psychologists published a consensus report in the journal Pediatrics (Buie et al., 1/4/2010)”. The team stressed the importance of completing a proper and thorough work-up in determining the cause of GI symptoms for children with ASD. Instead of discussing the GFCF diet as a medical treatment for children with ASD, Ms. Roser, as well as Malloy and colleagues, imply that the specialized diets for children with ASD are designed to “normalize autism.” In fact, on page 4 of the Malloy paper, the authors actually state that they included only studies that examined “the amelioration of ASD symptoms.” It is no wonder their review of 14 studies found only 4 studies with positive effects from the diet; the authors excluded all the studies that examined changes in GI functioning!

To those parents of children with ASD, heed not the advice of the researchers who merely summarized a small set of studies. Instead, if your child displays symptoms of GI disorders (e.g., reflux, diarrhea, constipation, stomach distension, etc.) or other health concerns, schedule an appointment with a knowledgeable clinician for appropriate treatment of symptoms.

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We just returned from the ARI conference in Las Vegas hosted by the Autism Research Institute. We were able to meet many people, parents and practitioners alike.

We feel that this conference is must for families who are learning to treat their child’s autism. If you could not make it to Las Vegas, consider attending the spring conference which will be held in Newark, NJ.

Attendees at the conference are able to attend a variety of lectures from experts in nutrition, medicine, and educational programming. In addition to lectures, participants may also drop in on demo room sessions where the experts show you how to do a particular technique. The demo room this year included, among others, tips from us on how to teach your child to swallow pills. Email us if you would like a copy of the brief handout that we provided.

Attendees are also able to visit the booths of many exhibitors including Talk About Curing Autism (TACA) and Kirkman Labs.

Lunch is provided on site allowing participants time to network, mingle, and speak intimately with presenters.

We were also very lucky to meet Alex Plank, Kirsten Lindsmith, and Jack Robison who were filming for Autism Talk TV. These young adults all have a formal diagnosis of autism spectrum disorders (ASD). They participate in the website Wrong Planet and they have proven that individuals with ASD can live a full and productive life.

We always feel renewed after such a great conference experience. We want to hear from you. Did you attend the conference? What was your favorite part?

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Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Today we would like to introduce you to a cute little fellow named Mikey. Mikey was 33 months old when we started intervention. Mikey was a typically developing toddler in every way except for his eating. Mikey preferred to drink his milk and he drank lots of it. His mother reported going through a gallon of milk in just one weekend. Mikey had some sensory processing issues which led to oral motor therapy from a speech and language pathologist (SLP). During oral motor therapy, he learned to tolerate having a toothbrush in his mouth and he learned to eat a few new foods.

Before we started intervention, Mikey occasionally ate cream cheese and jelly sandwiches on white bread. He also occasionally ate cheese sandwiches on white bread. His mother reported to us that she was very interested in Mikey becoming toilet trained.

We sent Mikey’s mom some written instructions on how to toilet train her child. We suggested that she start toilet training the weekend before we started feeding therapy. We have found, in our clinical practice, that children respond well when multiple areas of growth are targeted simultaneously. For Mikey, we could say that he was becoming a “big boy”. Big boys learn to pee on the potty and they learn to eat big boy food!

Mikey’s mom was a champion. She followed the toileting protocol that we provided and by the time we arrived for feeding therapy, Mikey was already urinating regularly on the toilet. He was also accurately reporting if he had to urinate when asked! His daytime diapers were gone and he was wearing big boy underpants.

The other curve ball we threw Mikey was that he was no longer allowed to drink from a sippy cup. He was starting preschool and big boys drink out of regular cups. We told Mikey that he could only have his sippy cup if he needed to drink while riding in the car to keep from spilling.

Prior to therapy, we encouraged Mikey’s mom to work with a nutritionist to determine if Mikey had any food sensitivities. Unbeknownst to her, Mikey was reactive to a number of common foods such as avocado. Additionally, Mikey suffered from a zinc deficiency. So, prior to therapy, Mikey’s mom started him on a few nutritional supplements. We believe that well-rounded nutrition is one of the best mechanisms to ensure success in our therapy sessions.

For Mikey, we provided all services in his home and his mother was present for every session. Mikey’s father attended one session to ensure that he knew how to support Mikey when therapy was finished. In addition to having well-rounded nutrition, we have found (along with other researchers) that hunger inducement is one of the best strategies for feeding intervention. When children are hungry, they are more likely to want to eat. For Mikey, this meant that multiple cups of milk were eliminated each day. Unfortunately, Mikey’s mom had to deal with Mikey’s unhappiness about this change in the early morning hours before the first session. As we said previously, she is a champ and she handled this challenge like a true fighter. Mikey was definitely hungry at mealtime and he soon learned to get along without all that milk.

Mikey received services over the course of 4 days. On the first and second day he received services at breakfast, lunch, and dinner. Mikey’s mom took over the meals starting at dinner on the second day. On the third day, Mikey received services for lunch and dinner. On the final day, he received services for breakfast. So in just 9 one-hour sessions, Mikey learned to eat new foods when asked.

We had several pleasant surprises when working with this client. First, Mikey had never eaten protein in solid form. We were all pleased that protein was becoming a fast favorite for Mikey. Additionally, Mikey loved fruits. We couldn’t find a fruit that he disliked. Despite the great progress that Mikey made in such a short period of time, Mikey will still need to work on chewing his new foods. As his mouth becomes accustomed to all the textures and flavors, he will become desensitized and more willing to use all of his mouth when eating. Additionally, as he learns to use his mouth to chew all of these foods, his overall motor function should improve.

Mikey, congrats on your progress. And to Mikey’s mom—he could not have done it without you. Now go get yourself that manicure, pedicure, or date night that you deserve. Tell your husband “it’s the doctor’s orders!”

Happy Eating!

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