Autistic Spectrum Disorders are the result of a Bowel Disorder?

1
Autistic Spectrum Disorders are the result of a
Bowel Disorder?
2
Diagnostic Problems.

• Multiple Diagnostic Criteria
• Overlap with Attention Deficit, Dyspraxia and
  Dyslexia.
• Children with severe Global Developmental delay.
• The role of Genetic Factors specific Chromosome
  Disorders and less specific genetic factors.

3
Patterns of Presentation.

• Features from early infancy.
• Plateauing of Development.
• Regression, particularly in second year of Life.

4
Features of Regressive Pattern

• Clear evidence of normal development in first
  year.
• High incidence of allergic disorders in child and
  family.
• Probable increased frequency of Low IgA.
• Frequent Upper Respiratory infections in the
  first year of life.

5
Features of Regressive Pattern

• Frequent incidence of bowel symptoms - ?finding
  of lymphoid nodular hypoplasia.
• History of frequent use of antibiotics in first
  year of life.

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Preliminary Review 1997-99.
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57 Cases.

• Age Range 2-15 years.
• Mean Age 4 years 1 mont.
• Number with regression 35.
• Average age of regression 16 months.
• Bowel symptoms 36
• Excessive Thirst 33

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Recommended Treatment.

• None 13
• Anti-fungal 24
• Gluten/Casein Free 9
• Anti-fungal Gluten/Casein Free Diet. 11.

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Outcomes.

• Definite and sustained improvement 28
• (15 reporting deterioration when intervention
  discontinued).
• Uncertain improvement. 6

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A Review of Children referred for Consideration
of Dietary Management for the Autistic
Continuum.2001.Dr. Clive Jones.
11
Pattern of referrals reviewed.
12
Pattern of Symptoms.
13
Comorbidity

• 1 child previously diagnosed as Coeliac.
• 1 child previously diagnosed as ?Gluten
  enteropathy.
• 1 child suffered myoclonic seizures.

14
Associated Symptoms.Bowel Problems 44 (64).
15
Allergic Features.43 (62).
16
Combination of allergy / bowel symptoms.

• Number with gt1 allergic feature 22
• Number with gt2 allergic features 11
• Number with allergic features and bowel
  symptoms. 22 (38).
• Number who had either bowel or allergic
  features. 58(84).

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Soft Symptoms
18
Other features.

• 5 had a history of diarrhoea after ingestion of
  soya.
• 13 had a history of food cravings or dislikes.
• 11 had evidence of prior fungal infection.
• 30 had a history of prior antibiotic therapy.

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Clinical Findings.
20
Family History
21
Prior Management

• 22 had had urinalysis at University of
  Sunderland. 9 positive for casomorphine and 5 for
  glutamorphine.
• 41 had tried gluten free/casein free diet to some
  degree, often without adequate support. Many
  reported improvement with this, especially with
  casein free diet, those who reported improvement
  generally reported initial regression.

22
Prior Management

• Many were on a complex mixture of other
  supplements, interventions including DMG. Some
  had tried secretin (real or homoeopathic without
  clear benefit).
• 10 were on an educational type intervention - 7
  using LOVAAS 3 ABA.

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Interventions recommended.

• A preliminary assessment of likelihood of
  responding to nutritional interventions.
• A review of the current interventions, including
  supplements and the nutritional adequacy of the
  diet being followed.
• Low sugar/low yeast diet with nystatin in 40
  Gluten Free/Casein Free diet in 5.

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Nystatin Therapy.

• Effectiveness of nystatin in polysymptomatic
  patients. A randomized, double-blind trial with
  nystatin versus placebo in general practice.
  Heiko Santelmann, Even
  Laerum, Joergen Roennevig and Hans E Fagertun.
  Family Practice, Vol.18, No. 3. 258-265.

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Response to treatment.

• Almost all children reacted to the introduction
  of nystatin with an increase in symptoms, most
  requiring subsequent titration of the dose to see
  optimum improvement. (This is a reaction not
  generally seen when children or adults are
  treated with nystatin).

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Response to Treatment.

• Data on 13 children treated with nystatin
  followed through for at least 6 months.
• 8M 3F appeared to exhibit very positive
  responses in both autistic and associated
  symptoms - usually substantiated by reports from
  other professionals.
• Average age of this group at inital consultation
  was 4.1 years. (Range 2.5-7.2)

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Conclusions.

• In addition to earlier reports these data
  indicate a potential for managing some children
  in the autistic continuum with diet and or
  anti-fungal treatment. There is clearly a need
  for further prospective studies, however there
  will be considerable problems in arranging these
  on a double blind basis.

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Conclusions.

• This data has further refined the clinical
  criteria that should be used to identify children
  to be entered into such a study.
• The clinical input appears to have helped some
  parents to recognise that dietary approaches were
  unlikely to be helpful for their own child, and
  thereby helped to rationalise prior interventions.

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The Way Ahead?

• A Double Blind Placebo Controlled Trial of
  Nystatin in a specific sub-group of patients.
  (MRC has recognised a need for research into
  Bowel disorders and bowel flora and autistic
  spectrum disorders).
• In the interim follow the principal of sequential
  intervention and ensure that any changes do not
  cause more problems.