Autism is one of many developmental disorders. Infantile autism is described as a pervasive developmental disorder characterized by abnormal emotional, social, and linguistic development in a child. Symptoms include abnormal ways of relating to people, objects, and situations (Mosby, 1998).
Autism tends to affect more males than females. The ratio of affected males
to females is approximately four to one. Autism and its associated behaviors have been estimated to occur in as many as 1 in 500 individuals (Autism, 2001). It is estimated that one half million people in the United States today have autism or some form of pervasive developmental disorder (Autism, 2001).
The etiology of autism is unclear and can be determined in only approximately 20 percent of the diagnosed children (Huffman, 2001). Researchers continue their search for the cause. It has been noted that autism may have multiple causes, including structural abnormalities of the brain, viruses, genetic disorders, chromosomal abnormalities, metabolic disorders, or seizure disorders (Ekvall, 1993). Autism is a physical condition linked to abnormal biology and neurochemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research (Greene, 2001).
Children with autism share some biochemical abnormalities. Studies have shown that serum calcium levels run low, while urinary calcium levels are high. Uric acid levels are decreased in both serum and urine (book).
There are no biochemical tests used in the diagnoses of autism. In order to diagnose autism, the person's behaviors are documented. The behaviors are
evaluated and compared to a standard list of diagnostic criteria. If eight of
the sixteen listed items are present, autism is considered.
There is debate in whether or not the MMR vaccine causes autism. A recent review from the US Institute of Medicine rejects that such a relationship exists (Heller 2001). Intake of gluten (wheat protein) and casein (milk protein) has also been blamed for causing autistic behavior. A theory exists that autistic persons cannot completely break down these proteins. The undigested proteins (peptides) then enter the bloodstream and cause abnormal brain development and an opiate-like effect (Gluten-free 2001). According to professional journals, this theory has not been proven. Neither is it recognized by the Centers for Disease Control (CDC) or other government agencies.
It has also been suggested that there is an association between inflammatory bowel disease and autism. Research has not yet proven this hypothesis (Fombonne 1998).
Vitamin and dietary treatments have been investigated for their possible role in helping children with autism and other developmental disorders. Implementation of megadoses of vitamin B6 and magnesium has been studied,
as well as folate and calcium supplementation. In some cases, supplementation appeared to help autistic children, though it remains unproven. Therefore, supplementation is not recommended at this time (Ekvall 2001).
A cure for autism has yet to be found. Although there is no cure, early intervention may help maximize the child's functional level. A teaching regimen should be specifically developed for each child. Teaching should include a highly structured schedule of activities, an extensive use of visuals to accompany instruction, and the use of positive reinforcement (Autism 2001). No one approach is effective in alleviating symptoms of autism in all cases. Various types of therapies are available, including applied behavior analysis, auditory integration training, dietary interventions, music therapy, occupational therapy, physical therapy, sensory integration, speech/language therapy, and vision therapy. Medications may be useful for treating some of the behaviors. Selective serotonin reuptake inhibitors and trazodone, among others, have been widely used in children. Referral to a child psychiatrist may be needed to help guide treatment decisions (Autism, 2001).
According to the Journal of the American Dietetic Association, the position of The American Dietetic Association states "Program planning for person with developmental disabilities should include comprehensive nutrition services as part of health care, vocational, and educational programs." The American Dietetic Association also recognizes that persons with developmental disabilities are at increased nutritional risk. Specifically, the factors that
contribute to the risk in autistic persons include feeding problems, drug-nutrient interactions, and pica (Journal of the American Dietetic Association 1997). Pica is the craving to eat nonfood substances, such as dirt, clay, chalk, glue, ice, starch, or hair (Anderson, 1998).
Autistic persons often have problems associated with food acceptance or rejection. Such behaviors contribute to poor dietary intake and bizarre feeding patterns (Ekvall, 1993). Caregivers that do not know how to manage the unusual feeding problems exemplify the problem. Also, autistic children often cannot effectively express feelings of hunger or thirst to the caregiver.
An increased frequency of physical anomalies and the persistence of primitive reflexes in children with autism may contribute to feeding problems as well. Delayed development of hand dominance, unusual postures, and unusual movements also affect the development of feeding skills. Food cravings, specific food or food preparation preferences, and retention of food bits in the mouth for long periods of time are common (Ekvall, 1993).
The three types of food habits most often seen are (1) the need for ritual; (2) specific eating behaviors; (3) limited and rigid food preferences. For example, some base their preferences due to texture, color, or flavor (Ekvall, 1993).
Despite the concern for the diets of autistic children, studies have shown that the intakes of children with autism were overall not statistically different
from those of the control children. However, autistic children should be
closely monitored for dietary adequacy. The desire for little food or water must be closely monitored to avoid deficiencies and dehydration (Ekvall, 1993). Other concerns include the possibility of obesity, particularly during adolescence due to certain medications. Positive reinforcement is often used when working with autistic children. If food reinforcers are used frequency, obesity may become a concern (Ekvall, 1993).
Teaching a child how to self-feed often presents a challenge to caregivers. Prompting is often practiced in teaching children how to feed themselves. Once the child completes a step in the process, a cue is given for the next
step. Upon completion of the task sequence, the selected goal would be accomplished (Ekvall, 1993).
When assessing the nutritional status of an autistic person, one must take into account that nutrient needs may be altered as a result of long-term medication therapy for conditions such as epilepsy, recurrent urinary infections, and behavioral problems. Disorders of vitamin D, calcium, and bone metabolism
result when anticovulsants are used for extended periods. The use of other medications may also affect food and nutrient intake (Journal of the American Dietetic Association, 1997).
Dietetics professionals who provide services to persons with developmental disabilities need to acquire and continuously update the specialized skills required to work successfully with this population (JADA, 1997).
The clinical dietitian must screen for nutrition-related problems to identify persons at nutritional risk and provide medical nutrition therapy to those individuals (JADA 1997). Assessing the child's intake and monitoring their growth curve is important. Drug-nutrient interactions also need to be closely watched. A clinical dietitian should also be prepared to answer questions from parents who are interested in the special diets that are highly publicized. It is also important to provide information to caregivers on how to deal with feeding issues.
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