11/8/2012

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.  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...

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.

The article ends with a discussion on the lack of accepted treatments for GI problems specific to children with ASD and outlines six key research objectives:

1. Determine the pathology of GI conditions in ASD.

2. Increase animal research in this area.

3. Identify biomarkers to guide treatment.

4. Better evaluate nutritional status.

5. Identify behavioral phenotypes related to poor nutritional status.

6. Develop evidence-based algorithms to help guide clinicians in the evaluation and treatment of GI problems in ASD.

By the time I finished reading, the cynical frame of mind with which I usually read mainstream articles about autism treatment was replaced with optimism. Finally, mainstream research is planning to look at the gastrointestinal and nutritional aspects of biomedical treatment for autism. For twenty years or more, biomedical physicians have been treating GI problems in autism without much support from thorough mainstream research, and we’ve endured much criticism for doing so. Even worse, parents of children with autism have been begging pediatricians for help, will little acknowledgement that there is any possibility of a gut-brain connection in autism. The tide began to turn in January 2010 with Dr. Tim Buie’s consensus report on GI problems in autism (Pediatrics. 2010;125(suppl 1):S1-S18). And now the tide is actually surging in our favor.

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...

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