DIET AND BEHAVIOR IN YOUNG CHILDREN WITH AUTISM

自闭症谱系障碍（ASD）最受欢迎的治疗方法之一是不含麸质和酪蛋白的饮食（GFCF饮食）。无论饮食所依据的理论是否有价值，许多父母报告说，当遵循它时，行为问题减少了，并报告说，接触麸质或酪蛋白会增加行为问题。与其他干预措施一样，似乎有些儿童对这种治疗反应良好，而其他儿童则几乎没有效果。因为选择或拒绝这种饮食的家庭很可能代表了难以评估的不同群体，我们建议最好在一组接受这种饮食的儿童中研究这种饮食的影响。然后孩子们将接受测试， 应对谷蛋白和酪蛋白的挑战。所有参与的儿童在饮食开始前都将得到良好的表征，并将在整个18周的研究中接受同一计划的强化早期行为干预。营养学家将协助家庭依从性和计划营养全面的饮食，并在整个研究期间监测营养状况。参与者将在学校接受特别准备和个人管理的零食形式的挑战。家长、老师和研究小组将对零食的内容视而不见。教师及家长 监测三种行为：a）与ASD相关的行为[例如，刻板行为，社会互惠]，B）不特定于ASD的行为[例如，活动水平、睡眠模式、食欲]，和c）体质测量[例如，排便模式、心率]。这项研究的第一个目标是确定挑战是否会引起可衡量的行为变化。第二是确定参与者的表型特征是否识别应答者和非应答者。第三个目标是确定六个提出的ASD遗传易感性因素中的任何一个是否与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.