I have never posted a full article on my blog before, but I didn't want to risk that you wouldn't follow the link, this is too important. I have spoken before about how difficult it was to find a physician who would acknowledge the underlying physical issues that contribute to autism. The first developmental pediatrician we saw with Jack discouraged the use of special diets, stating there was no evidence that they worked. I have seen many people roll their eyes at all of the interventions we have attempted with the boys as if they are "hocus pocus". The relative who I spoke with who has 4 children on the spectrum was dealing with this issue back in the late 80's and early 90's, when all of this was considered "nutty". She worked closely with Dr. Buie, who is referenced in this article, to help her sons, and she was successful. Luckily for our children, the anectdotal evidence has been enough to motivate us to fight for these interventions for our children. My hope is that as further research is done, and further acknowledgment of these problems is obtained, full insurance coverage will be available to families who have literally been going bankrupt to help their children because autism is not a "physical condition". Way to go AAP!!! Big step in the right direction....
Gut-Brain Connection? Leaky Gut? No longer “Crazy Talk” says AAP
November 8, 2012
By Dr. Bob Sears, Pediatrician and TACA Physician Advisory Member
The American Academy of Pediatrics (AAP) has just taken a giant leap toward recognizing the association between gastrointestinal problems and Autism Spectrum Disorders (ASD.) The November 2012 issue of their journal, Pediatrics, has a 200-page supplement entitled Improving Health Care for Children and Youth With Autism and Other Neurodevelopmental Disorders (Note: this guide was not currently available online.) As I perused the various articles to see what the AAP was up to, one particular gem caught my eye: Gastrointestinal (GI) Conditions in Children With Autism Spectrum Disorder: Developing a Research Agenda. Curiously optimistic, I decided to pause the Saturday-afternoon college football game and read the article. After a mere three sentences, my jaw dropped. “Many individuals with ASDs have symptoms of associated medical conditions, including seizures, sleep problems, metabolic conditions, and gastrointestinal disorders (the italics are mine), which have significant health, developmental, social, and educational impacts.” A few lines later I found there is a “lack of recognition by clinicians that certain behavioral manifestations in children with ASDs are indicators of GI problems (eg, pain, discomfort, or nausea).”
My first thought was that someone from ARI or MAPS had snuck into the AAP and switched a few words in the article before it went to press, and no one had noticed. But as I read the entire piece, I was shocked to see other crazy ideas such as:
This article doesn’t actually support any particular treatments for GI problems in autism, and we are many years away from mainstream medical research coming to fruition in this area. But it is nice to know that mainstream help is on the way, and that if any doctor tries to ridicule parents for asking for help with their child’s GI problems, you now have the AAP on your side. You can waive this article in the doctor’s face. We pediatricians love that. But seriously, the full text of this article will likely become available online soon. You can view the first part of it here: http://pediatrics.aappublications.org/content/130/Supplement_2/S160.extract?cited-by=yes&legid=pediatrics;130/Supplement_2/S160 . If you have an open-minded pediatrician, and need help, hand he or she this article, and you may be able to get your doctor to test and treat some of your child’s GI problems.
As a side note, this same edition of the journal has an article on the importance of evaluating and treating constipation in ASDs. Definitely a good read for your pediatrician if your child struggles with this, and it even suggests testing such kids for thyroid disease, lead overload, and, get this . . . celiac disease! Here’s a link: http://pediatrics.aappublications.org/content/130/Supplement_2/S98.abstract
Thank you AAP!!!
Dr. Bob Sears
Pediatrician and TACA Medical Advisory
Pediatrician and author of The Autism Book: What Every Parent Need to Know About Early Detection, Treatment, Recovery, and Prevention and The Vaccine Book.
The American Academy of Pediatrics (AAP) has just taken a giant leap toward recognizing the association between gastrointestinal problems and Autism Spectrum Disorders (ASD.) The November 2012 issue of their journal, Pediatrics, has a 200-page supplement entitled Improving Health Care for Children and Youth With Autism and Other Neurodevelopmental Disorders (Note: this guide was not currently available online.) As I perused the various articles to see what the AAP was up to, one particular gem caught my eye: Gastrointestinal (GI) Conditions in Children With Autism Spectrum Disorder: Developing a Research Agenda. Curiously optimistic, I decided to pause the Saturday-afternoon college football game and read the article. After a mere three sentences, my jaw dropped. “Many individuals with ASDs have symptoms of associated medical conditions, including seizures, sleep problems, metabolic conditions, and gastrointestinal disorders (the italics are mine), which have significant health, developmental, social, and educational impacts.” A few lines later I found there is a “lack of recognition by clinicians that certain behavioral manifestations in children with ASDs are indicators of GI problems (eg, pain, discomfort, or nausea).”
My first thought was that someone from ARI or MAPS had snuck into the AAP and switched a few words in the article before it went to press, and no one had noticed. But as I read the entire piece, I was shocked to see other crazy ideas such as:
- “Clinical practice and research to date indicate the important role of GI conditions in ASDs and their impact on children as well as their parents and clinicians.”
- “Gut-brain connection, immune function, and genome-microbiome interaction.” Yes, it actually said gut-brain connection!
- “Increasingly, evidence supports a combination of changes in gut microflora, intestinal permeability (intestinal what?), inappropriate immune response, activation of specific metabolic pathways, and behavioral changes.”
- “Endoscopic analyses of children with ASD and GI symptoms have revealed the presence of a subtle, diffuse inflammation of the intestinal tract.”
- “Autoimmune responses in children with ASDs and a familial history of autoimmunity have been reported.”
- “Autoantibodies could indicate the presence of inflammatory processes and/or an autoimmune component that could affect the integrity of the mucosal barrier and contribute to decreased mucosal barrier integrity.”
- “Leaky gut.” Yes! It actually used those two foreign words that have been scoffed at for so long, and explains the research supporting this theory so that we general pediatricians can understand and begin to believe it.
- “Nutritional status and nutrient intake are inextricably related in children with autism.”
- A table on “Biomarkers as potential outcome measures” includes testing for: intestinal permeability to assess leaky gut, calprotectin for intestinal inflammation, celiac disease serology tests to assess gluten sensitivity, food allergy panels (not sure what for . . . maybe food allergies play some sort of role in all this?), organic acid testing for B12 or folate deficiency, and analysis of gut microbiota.
- Determine the pathology of GI conditions in ASD.
- Increase animal research in this area.
- Identify biomarkers to guide treatment.
- Better evaluate nutritional status.
- Identify behavioral phenotypes related to poor nutritional status.
- Develop evidence-based algorithms to help guide clinicians in the evaluation and treatment of GI problems in ASD.
This article doesn’t actually support any particular treatments for GI problems in autism, and we are many years away from mainstream medical research coming to fruition in this area. But it is nice to know that mainstream help is on the way, and that if any doctor tries to ridicule parents for asking for help with their child’s GI problems, you now have the AAP on your side. You can waive this article in the doctor’s face. We pediatricians love that. But seriously, the full text of this article will likely become available online soon. You can view the first part of it here: http://pediatrics.aappublications.org/content/130/Supplement_2/S160.extract?cited-by=yes&legid=pediatrics;130/Supplement_2/S160 . If you have an open-minded pediatrician, and need help, hand he or she this article, and you may be able to get your doctor to test and treat some of your child’s GI problems.
As a side note, this same edition of the journal has an article on the importance of evaluating and treating constipation in ASDs. Definitely a good read for your pediatrician if your child struggles with this, and it even suggests testing such kids for thyroid disease, lead overload, and, get this . . . celiac disease! Here’s a link: http://pediatrics.aappublications.org/content/130/Supplement_2/S98.abstract
Thank you AAP!!!
Dr. Bob Sears
Pediatrician and TACA Medical Advisory
Pediatrician and author of The Autism Book: What Every Parent Need to Know About Early Detection, Treatment, Recovery, and Prevention and The Vaccine Book.
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