DIET AND BEHAVIOR IN YOUNG CHILDREN WITH AUTISM

自闭症谱系障碍(ASD)最流行的治疗方法之一是不含面筋和酪蛋白的饮食(GFCF饮食)。无论这种饮食所基于的理论是否有价值，许多父母报告说，当遵循该理论时，行为问题有所减少，而与面筋或酪蛋白接触有关的行为问题增加。与其他干预措施一样，似乎有一些儿童对这种治疗反应良好，而另一些儿童对这种治疗几乎没有效果。因为选择或拒绝这种饮食的家庭很可能代表着在难以评估的方面存在差异的群体，我们建议最好在所有接受这种饮食的儿童队列中研究这种饮食的影响。然后孩子们将接受测试，以确定他们的 用面筋和酪蛋白应对挑战。所有参与的儿童在开始饮食之前都会有良好的性格特征，并将在整个18周的研究中接受同一计划中密集的早期行为干预。营养学家将帮助家庭遵守并计划营养完整的饮食，并在整个研究过程中监测营养状况。参与者将在学校接受特别准备和单独管理的零食的形式的挑战。家长、老师和研究团队会对零食的内容视而不见。老师和家长会 监测三种行为：a)与自闭症有关的行为[例如，刻板印象行为、社会互惠]，b)非自闭症特有的行为[例如，活动水平、睡眠模式、食欲]，以及c)体质措施[例如，大便模式、心率]。这项研究的第一个目标是确定挑战是否会引发可测量的行为变化。第二个是确定参与者的表型特征是否区分应答者和非应答者。第三个目标是确定提出的六个自闭症遗传易感因素中是否有任何一个与GFCF饮食治疗的结果有关。

One of the most popular treatments for autism spectrum disorders (ASDs) is a diet free of gluten and casein (the GFCF diet). Whether or not the theory on which the diet is based has merit, many parents report a decrease in behavioral problems when it is followed and report an increase in behavioral problems with exposure to gluten or casein. As with other interventions, there appear to be children who respond well to this treatment and others for whom it has little or no effect. Because families choosing or rejecting this diet are likely to represent groups that differ in ways difficult to assess, we propose that the effects of the diet are best studied in a cohort of children in which all receive the diet. The children will then be tested for their response to challenges with gluten and casein. All children who participate will be well-characterized before the diet is instituted and will receive intensive early behavioral intervention in the same program throughout the 18 weeks of the study. A nutritionist will assist families with compliance and with planning diets that are nutritionally complete, and nutritional status will be monitored throughout the study. Participants will receive challenges at school in the form of specially prepared and individually administered snacks. Parents, teachers, and the research team will be blind to the contents of the snacks. Teachers and parents will monitor three kinds of behaviors: a) behaviors related to ASDs [e.g., stereotyped behaviors, social reciprocity], b) behaviors not specific to ASDs [e.g., activity level, sleep pattern, appetite], and c) constitutional measures [e.g., stooling pattern, heart rate]. The first goal of the study is to determine whether challenges elicit measurable behavioral change. The second is to determine whether phenotypic characteristics of the participants identify responders and non-responders. The third goal is to determine whether any of six proposed genetic susceptibility factors for ASDs are related to outcome of the GFCF diet treatment.