Role of diet the improvement in behavior of children with autism spectrum disorders (ASD): A study in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
Dr. Mahmudul Hoque Chowdhury, Dr. Farzana Islam, Dr. Md Atiqul Islam, Naila Zaman Khan, Dr. Mustafa Mahbub
Background: It has been suggested that peptides from gluten and casein may have a role in the origins of autism and that the physiology and phsychology of autism might be explained by excessive opioid activity linked to these peptides. Research has reported abnormal levels of peptides in the urine and cerebrospinal fluid of people with autism. Objective: To find out the improvement in behavior of children with ASD who have received a specific dietary intervention for 6 months. Study design: Randomized control trial. Study setting and period: Department of Paediatrics neuro- science shishu bikash kendro out door of Dhaka Shishu (Children) Hospital, Dhaka, between April, 2012 to September, 2012. Study population: Children having Autism Spectrum Disorder (ASD) of both sexes who were 6 years old and below.Methods: Children with ASD were selected from the ongoing Early Intervention (EISCA) clinic and divided into two groups by randomly (using lottery method). In the first group behavior of the children who received a dietary intervention at the beginning of the program and followed up for a period of 6 months (group I). In the second group who didn't not receive a dietary intervention were also followed up for 6 months ((group II). Other treatments were same in both groups. Behavior of the children in both groups were measured by an Autism specific clinical interview questionnaire called PIA-CV at the beginning and at the end of the intervention period. Main outcome measure (s): Behavioral domains of children with ASD are the main outcome variables. Result: Autism Spectrum Disorders was more common in male children, where male to female ratio was 5.7:1 in group I and 19:1 in group II and 9:1 in the whole study patients. Most of the patients came from Dhaka district in both groups, which was 16(80.0%) in group I and 18(90.0%) in group II. No schooling patients was found 14(70.0%) in group I and 13(65.0%) in group II. Formal schooling was found 4(20.0%) in group I and 5(25.0%) in group II. Caesarean section was found 16(80.0%) in group I and 15(75.0%) in group II. Majority patient's birth history was uneventful in both groups, which was 18 (90.0%) in group I and 17 (85.0%) in group II. Mild stone of development of the study patients, it was observed that age appropriate was found 19(95.0%) in group I and 20(100.0%) in group II. Patients had previous medical help was found 16(80.0%) in group I and 17(85.0%) in group II. Most of the parents were master degree pass in both groups. Eighty percent (80.0%) in group I and 15(75.0%) in group II patients came from upper (20,000->50,000 TK) income group family. Single family was found 16(80.0%) in group I and 13(65.0%) in group II. About the specific behaviors, the mean pre social relationship was found 2.86±0.37 in group I and 2.76 in group I. The mean post social relationship was 3.67±0.47 in group I and 3.87±0.51 in group II. Mean pre per interaction was found 2.43±0.53 in group I and 2.28±0.48 in group II. The mean post peer interaction was 3.25±0.60 in group I and 3.29±0.53 in group II. Mean pre communication was found 2.58±0.61 in group I and 2.12±0.77 in group II. Mean post communication was found 3.77±0.61 in group I and 3.65±0.68 in group II. Mean pre sensory a response was found 2.82±0.59 in group I and 2.96±0.75 in group II. The mean post sensory responses was found 3.58±0.55 in group I and 3.64±0.48 in group II. All specific behaviors were significantly (p<0.05) improved within the groups from pre to post intervention period, but no significant (p>0.05) difference were found between the groups during post intervention period. Conclusion: The improvements in behavior of children with ASD were almost similar between two groups.