GFCF Diets in Children with ASD_Parents attitude

What is Gluten free/Casein free (GFCF) Diet?

GFCF, which is also called a gluten-free dairy-free diet, is a diet where the person’s eating plan stays away from foods that contain gluten (which can be found in breads and cereals) and casein (which can be found in milk and dairy products).

GFCF is a type of the Complementary and Alternative Medicines (CAM) which are treatments that are used with or instead of standard medical treatments like using acupuncture to help lessen some side effects of cancer treatment or using a special diet to treat certain diseases instead of drugs that are prescribed by the doctor.

Gluten free/Casein free (GFCF) diets are among the most common types of Complementary and Alternative Medicines (CAM) used to treat Autism Spectrum Disorders (ASD), but what are Autism Spectrum Disorders?

What Are Autism Spectrum Disorders (ASDs)?

Autism spectrum disorder (ASD) is a developmental disorder that impacts patient communication and behavior. Although we can diagnose Autism at any age, it is described as a “developmental disorder” because the symptoms usually manifest in the first two years of life.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association used to diagnose mental disorders, children with ASD have:

• Difficulty with communication and interaction with other people
• Restricted interests and repetitive behaviors
• Symptoms that hurt the person’s ability to function properly in school, work, and other areas of life

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience.

 

Use of CAM/GFCF in treating ASD

GFCF diet is used in ASD for different reasons, including treating symptoms of autism (35%), concentration/attention (19%), relaxation (23%), GIT problems (15%), sleep troubles (12%) and communication/speech (12%).

The use of GFCF diet in ASD is based on the theory that children with autism might have a high sensitivity or an allergy to foods containing gluten or casein. According to this theory, children with autism can’t process peptides and proteins in foods containing gluten and casein typically. Hypothetically, this difference in processing may trigger autistic symptoms.

The evidence on the benefits of GFCF diet is mixed and inconclusive. The American Academy of Pediatrics does not recommend the use of special diets for children with ASD because of inadequate evidence. With many studies reporting that the evidence that this diet was effective as a treatment for autism is "limited and weak" and "seriously flawed."

On the other hand, the Autism Research Institute recommends the use of GFCF/GFDF diet as a treatment for ASD, stating that “there is convincing empirical evidence that special diets help many with autism."

 

Parents Beliefs about using GFCF

Studies found that parents using special diets for their child rated improvements in behavior and communication, as 32.5% of parents of children with ASD believed CAM would improve their child’s quality of life. Parent’s use of CAM is influenced by many things like media sources, support groups, family, and the parent's perception about the cause of ASD.

When parents are considering on whether to use GFCF diets for their child with ASD, they also think of factors relating to their own ability to follow the diet.

Parents that don’t use CAM diets have negative attitudes and outcome beliefs about using a GFCF diet, with reduced perceived control and ability towards using the diet. Overall perceptions about control of parents on using GFCF diets are higher and more favorable compared to those who don’t use it, suggesting that parents may put increased emphasis on their beliefs about probable outcomes and their own ability to inform their decisions about whether to use the diet.

When looking at beliefs about the causes and treatment of ASD, studies found that parents usually have stronger beliefs in brain abnormalities, diets, and genes and drugs, ratting diet as the second-highest causal factor, which was also the only considerable predictor of high intentions to use GFCF diets.

When provided with the benefits of the diet, researchers found that an increase in positive attitudes, perceived pressure to use GFCF diets, and increased feelings of anticipated regret about not using the diet were positively linked with intentions to use GFCF diets.

The studies reveal that the parents’ beliefs about positive outcomes of the GFCF diets of improved GI symptoms and mood increased their intentions to use GFCF diets. And beliefs relating to a worsening in diet variety and introducing conflict were negatively linked with intentions, suggesting that increased negative outcome beliefs led to decreased intentions to use the diet. Parents place emphasis on the cost-to-benefit ratio when considering GFCF diets and place emphasis on the overall perceived outcome.

The parents’ belief that implementing a GFCF diet would require increased time allocation was linked with a reduced positive attitude, but it was not linked with a decrease in intentions, suggesting that this may have a lesser influence on the parent’s behavior.

Overall whether parents choose to continue or discontinue with any form of CAM, is ultimately influenced by the value parents place on the treatment, which may be affected by any number of variables, those treatments whereby parents invest more time and money may be more likely to continue, and parents may feel that their child will benefit; however, this, in turn, may magnify placebo effects on the efficacy of the treatment.

Studies that address cognitions of parents about GFCF diets for children with ASD are rare. Parents are guided by positive outcome beliefs and assess the cost-to-benefit analysis of GFCF diets when considering use. They also may be guided by feelings of regret for not using the diet, with the fear that they had not tried all available interventions. The parents perceived belief of control might be important for predicting their actual use of the diet. These types of studies are important as they assist with the development of interventions to bring parents’ expectations and outcome beliefs about GFCF diets in-line with current evidence and guidelines. Parents should be informed about the current information on causal attributes and therapy options for ASD.

 

Reference:

Marsden, R.E.F., Francis, J. & Garner, I. Use of GFCF Diets in Children with ASD. An Investigation into Parents’ Beliefs Using the Theory of Planned Behaviour. J Autism Dev Disord 49, 3716–3731 (2019). https://doi.org/10.1007/s10803-019-04035-8