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JUNE 2017

QUESTION 1

QUESTION:
Many children with autism have problems with their stomach and intestines. What do you currently know about whether one's diet can have a negative/positive influence on the symptoms of autism? What do you currently know about gluten- and dairy-free diet for children with autism? Gaps diet? And so on...
Also wondering about toxins and parasites? Are there any DAN doctors in Sweden? Where is it possible to get these tests performed in Sweden?

ANSWER:
Different types of stomach-related and intestinal problems may occur both in children with and without disorders such as for example autism. In each individual case where a child has stomach-related and intestinal (gastrointestinal) problems, a paediatrist or a child psychiatrist must decide on what is needed in terms of examination and treatment. For some children, paediatrists specialised in the field of stomach-related and intestinal diseases in children, i.e. child gastroenterology, are consulted. Autism is a disorder with many causal factors, and the majority of children with autism also have other disorders. Every child with autism needs a medical evaluation regarding causal factors and whether the child has other specific medical symptoms/problems. If the child has gastrointestinal symptoms, the doctor will make an assessment and decide whether certain tests should be taken. A child with autism may of course have a concurrent intolerance to gluten, allergy to cow's milk, lactose intolerance or some other food allergy or intolerance in need of special treatment. Scientific studies concerning whether gluten and caseine free diet might be able to improve the symptoms of autism have been ongoing at least since the new millenium began. Based on the various research studies that have been done, there is insufficient support for the idea that gluten free or caseine free diet can be considered a generally viable treatment for children with autism. Every child with autism and stomach/intestine problems needs to be assessed to determine potential causes, as well as to decide how the stomach/intestine problems should be treated. If the child with autism also suffers from gluten intolerance, he or she should of course be provided a gluten-free diet.

I assume your question about toxins and parasites refers to whether any link is known between toxins and parasites and autism. I do not know of any such connection, but many different factors are investigated when a child has gastrointestinal troubles.

As far as I know, there are no DAN (DAN=Defeat Autism Now) doctors in Sweden.

As to your question on where one can conduct tests, my answer would be at paediatric clinics.

Some references where several studies about gluten- and caseine-free diet have been examined:

Elder, J.H., Kreider, C.M., Schaefer, N.M., & de Laosa, M.B. (2015). A review of gluten- and casein-free diets for treatment of autism: 2005-2015. Nutrition and Diet Supplements, 7, 87-101.

Ly, V., Bottelier, M., Hoekstra, P.J., Arias Vasquez, A., Buitelaar, J.K., & Rommelse, N.N. (2017). Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. European Child & Adolescent Psychiatry, (Epub ahead of print).

Marí-Bauset, S., Zazpe, I., Mari-Sanchis, A., Llopis-González, A., & Morales-Suárez-Varela, M. (2014). Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review. Journal of Child Neurology, 29, 1718-1727.

ELISABETH FERNELL


QUESTION 2

QUESTION:
As the mother of an autistic boy, we have some questions and thoughts regarding a certain medication that a doctor prescribed for us last week. That was (as yet) the first and only time he had met the boy. The boy is 11 years old and very intelligent, but sometimes struggles with obsessive-compulsive thoughts, e.g. scratching his fingers until they bleed, and even then he won’t stop doing it. The medication is called Sertrone 25 mg. It says that it should usually not be given to children, unless they have obsessive-compulsive thoughts etc. Is it truly alright for us to give our son this medication? What are some of the risks associated with it? We realise that it will obviously be of help as well, but we still have our doubts. Please give us some more facts on this. Can’t find much information online.

ANSWER:
Sertrone is the same substance as Sertraline. It is used to combat obsessive-compulsive thoughts and actions, and can for that purpose be given to children as well. The dosage, 25 mg, is low, so there is no cause for concern. However, in order for the medication to actually be effective against obsessive-compulsive behavior, the dosage probably has to be increased slightly.

ELISABET WENTZ


QUESTION 3

QUESTION:
What do you think about ABAS tests and children with autism, ADHD, language difficulties? I have read that that test can be inaccurate for such children. These diagnoses often involve late development, albeit unrelated to intelligence. Low ABAS test scores for children without any diagnosis equal low intelligence but not necessarily for children with diagnoses. What is your opinion on this? The study I’ve read is Barbro Pellsäter’s ABAS-II study.

ANSWER:
There is both a short and a long answer to your question. We will first present the shorter answer and then the more comprehensive answer.

SHORT ANSWER:
Thank you for your question! The scoring questionnaire ABAS-II is available in two versions; the parent-scored form and the teacher-scored form, and the scoring helps support assessment of so-called adaptive skills, i.e. “everyday skills” in children and adolescents. The scoring scale is used part of a larger investigation to gain information about how a child/adolescent functions in different everyday situations. This aspect must always be considered in an investigation and serves as a complement to other assessments and tests. The scoring questionnaire ABAS-II provides good information about how a child/adolescent functions relative to his/her peers in terms of e.g. learning, expressing themselves in speech and writing, listening and communicating with others, skills that are needed in order to function at home and at school, skills that are necessary for independence and being able to take responsibility, as well as for interacting with others.

LONG ANSWER:
Thank you for your question! The scoring questionnaire ABAS-II is available in two versions; the parent-scored form and the teacher-scored form, and the scoring helps support assessment of so-called adaptive skills, i.e. “everyday skills” in children and adolescents. The adaptive aspect of the child’s/adolescent’s function should always be considered when diagnosing, meaning that this is an important question to highlight the questionnaire’s usefulness when diagnosing, planning further measures after investigation as well as how ABAS might later be used to evaluate potential measures taken.
For the diagnoses that you mention; autism and ADHD, as well as linguistic difficulties, ABAS scores should be considered a description of the child’s/adolescent’s ability to use the intellectual function that he/she possesses, expressed through their adaptive function. When diagnosing, the disorder’s influence on the child’s everyday function is considered; for diagnosis to be given, the symptoms must impair their ability to function socially and/or in their working life. This thus means that the adaptive functions should generally be negatively affected for diagnosis to be given, and hence, considering ABAS results should be viewed as the norm, not the exception, when diagnosing children’s disorders in cases of both ADHD, autism and intellectual disability/mental retardation (formerly used term).
Adaptive disability constitutes one of the criteria when diagnosing intellectual disability, and in this context it is used as a measure of the degree of difficulty that the intellectual disability is causing the affected individual. The GNC performed a study in 2013, subsequently followed up in 2016, investigating whether ABAS/adaptive function could be used to differentiate between ADHD and mild intellectual disability (i.e. significant limitations with regard to intellectual function/intelligence). The results showed that adaptive function cannot be used to differentiate between ADHD and mild intellectual disability. In addition, there were indications that children with ADHD might potentially have even more limited adaptive function, and adaptive function was scored significantly lower for the group of children with ADHD aged 12 to 15 compared to children of the same age diagnosed with mild intellectual disability. The results also showed that pharmacological treatment has a positive influence on adaptive function in cases of ADHD.
Aspects influencing adaptive function should always be considered when interpreting low adaptive skills indicated through e.g. ABAS-II scoring, rather than automatically considering these results a measure of low intellectual function. Low ABAS scores occur both among people with disorders like ADHD and autism, but also among individuals with low intelligence and intellectual disability. ABAS should be viewed as an instrument for assessing the individual’s everyday skills and their ability to perform actions that people have to be able to do to get by on their own and in society, but also as an instrument for planning further measures after completed investigation, and finally also for effectively evaluating the efforts that the child/adolescent has been provided with. However, the instrument is not useful for the isolated purpose of assessing the individual’s intellectual function/intelligence without taking the individual’s cognitive abilities into account.

IDA LINDBLAD


 

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