Christison GW and Ivany K . "Elimination Diets in Autism Spectrum Disorders: Any Wheat Amidst the Chaff?." Journal of Developmental and Behavioral Pediatrics 27. (2006): 162-171. ( 1/2006 )
The use of complimentary or alternative treatment approaches in children with autism spectrum disorders (ASDs) is increasing, and the most popular of such approaches are diets that eliminate either gluten or casein, or both. The popularity of these diets points to a need for more rigorous research into their efficacy. Because of significant methodologic flaws, the currently available data are inadequate to guide treatment recommendations. The purpose of this review is to examine the available trials of gluten/casein diets in children with ASDs regarding the strength of their findings and also concerning points that may be useful in the design of future studies. Seven trials of these diets in ASD are critically reviewed; six of these were uncontrolled trials and one used a single-blind design. All reported efficacy in reducing some autism symptoms, and two groups of investigators also reported improvement in measures of non-verbal cognition. Design flaws in all of the studies weaken the confidence that can be placed in their findings. Careful double-blind, placebo-controlled studies are needed to evaluate whether actual benefit undergirds the diets? popularity and to provide better guidance to clinicians and caregivers. The literature currently available suggests that diets eliminating both gluten and casein (rather than either alone) should be studied first, and that outcome measures should include assessments of non-verbal cognition.