The Gluten- and Casein-Free Diet and Autism: Communication Outcomes from a Preliminary Double-Blind Clinical Trial

By Seung, HyeKyeung; Rogalski, Yvonne et al. | Journal of Medical Speech - Language Pathology, December 2007 | Go to article overview

The Gluten- and Casein-Free Diet and Autism: Communication Outcomes from a Preliminary Double-Blind Clinical Trial


Seung, HyeKyeung, Rogalski, Yvonne, Shankar, Meena, Elder, Jennifer, Journal of Medical Speech - Language Pathology


This study retrospectively examined the efficacy of a gluten-free and casein-free (GFCF) diet intervention as a means to improve verbal/nonverbal communication in children with autism spectrum disorders. Data were analyzed retrospectively from a randomized, double-blind, repeated measures crossover design study that included 13 children aged 2-16 years with autism spectrum disorders. Video recordings of at-home parent-child play were analyzed. Recordings were made at baseline, after 6 weeks on one of the diets (GFCF or regular diet), and after 6 weeks on the alternate diet. Findings of the current study indicated no statistically significant differences in verbal and nonverbal communication outcomes between GFCF and regular diet conditions. While results of this study demonstrate that double-blind clinical trials of diet intervention are feasible, they are inconclusive regarding the efficacy of diet for improving communication, perhaps due to the relatively short period of diet intervention used. Directions for future research are discussed as well as implications for clinical practice.

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Autism is a developmental neurobiological disorder (Rutter, 2005). It is more common in males than females, and its overall prevalence has increased dramatically in recent years (Bryson & Smith, 1998; Fombonne, 2003). The etiology of autism is still unclear, so the diagnosis is made based on the behavioral manifestations of the underlying etiology (Filipek et al., 1999; Rutter, 2005). Individuals with autism experience deficits in three areas: social interaction, verbal/nonverbal communication, and repetitive/restricted interests (APA, 2000). Autism is a lifelong condition, but functioning can be improved through a variety of intense interventions (Mundy & Crowson, 1997; Rogers, 1998; Stone & Yoder, 2001). There is empirical support for some educational interventions (National Research Council, 2001) that improves social skills and functional independence of individuals with autism. The types and intensity of intervention that are effective for each individual varies, but early identification of autism and intensive intervention appears to be critical for positive outcomes. Contrary to the intervention methods that have been studied (e.g., discrete trials, pivotal intervention, incidental learning, etc.), there are a number of available alternative or novel treatments that still lack evidence as to their efficacy. These novel treatments include sensory integration therapy (Case-Smith, 2004), auditory integration therapy, hippo therapy, hyperbaric oxygen therapy, vitamin supplement therapy, and gluten- and casein-free (GFCF) diet intervention (Kidd, 2003; Levy & Hyman, 2005; Wong & Smith, 2006).

One example of an as yet unproven intervention is hippo therapy which uses the movement of a horse in occupational, physical, and speech therapy sessions. The American Hippotherapy association claims that hippo therapy has shown improvement in muscle tone, posture, coordination, motor development, and emotional well-being. However, there does not appear to be any empirical evidence on its efficacy. Another example is hyperbaric-oxygen therapy that provides the patient with 100% oxygen at 2 to 3 times of the atmospheric pressure at sea level in an oxygen chamber. This method has shown to be effective for treating carbon monoxide poisoning and thermal burns (Tibbles & Edelsberg, 1996). While there is no proven evidence of its effectiveness for treating symptoms of autism, several websites are available that claim benefits. Research into such complementary and alternative medical interventions is clearly needed (Levy & Hymna, 2005; Levy, Mandell, Merhar, Ittenbach, & Pinto-Martin, 2003). Without such research, parents of children with autism will continue to use or try such interventions based on unsubstantiated claims.

The GFCF diet intervention has received much attention recently owing largely to a high frequency of parent testimonial reports. …

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