Kuzey Kıbrıs’ta Otizm Spektrum Tanılı Çocukların Tıbbi Beslenme Tedavisi Uygulama Durumlarının Değerlendirilmesi

Öz

Amaç olarak değiştirilmeli: Otizm nörogelişimsel, sosyal iletişimdeki eksikliğin yanısıra ilgi ve davranışlarda kısıtlama ile karakterize yaşam boyu süren hastalıktır. Tedavisinde glutensiz kazeinsiz diyet, eliminasyon diyetleri, feingfold diyeti, ketojenik diyet, düşük okzalatlı diyet gibi popüler diyet yaklaşımları dikkat çekmektedir. Bu nedenle bu çalışmada çocuklara uyguladıkları Tıbbi Beslenme Tedavisi (TBT) ve semptomlar üzerindeki etkinliğin sorgulanması amaçlanmıştır. Materyal ve Metod: Araştırma Ocak – Haziran 2014 tarihleri arasında, Kuzey Kıbrıs’taki devlet ve özel eğitim merkezlerinde eğitim gören kırk sekiz çocuk ile yürütülmüştür. Çocukların uyguladıkları TBT uygulama durumları, tanılarına yönelik TBT alma durumları, TBT alıyorlarsa bu tedaviyi neden ve kimin tavsiyesi üzerine uygulandığı, ve tedavide etkinliğini kapsayan anket formu araştırmacı tarafından yüz yüze görüşme tekniği uygulanmıştır. Verilerin istatistiksel değerlendirmesi SPSS-21 programı ile yapılmıştır. Bulgular: Araştırma kırk otizm spektrum tanılı çocuk ile tamamlanmıştır. Çalışma sonucunda otizmli çocukların %25,0’i hastalıklarına yönelik tıbbi beslenme tedavisi uygulamakta ve en sık uygulanan tedavi şekli ise %40,0 oranı ile glutensiz ve kazeinsiz diyettir. Uygulanan tıbbi beslenme tedavisinin sonucunda ise otistik çocukların %50,0’sinin semptomlarında iyileşme gözlemlenmiştir. Aileleri otizmde beslenme hakkında bir profesyonelden eğitim alma oranı %5,0, beslenme bilgilerinin yetersiz olduğunu düşünen %82,5 olup büyük bir çoğunluğunun otizm ve beslenme konusunda bilgi almak istediğini bildirmiştir. Sonuç: Bu çalışma ile ailelerin özellikle glütensiz-kazeinsiz diyet modelini semptomları iyileştirmek için tercih ettiği, ayrıca otizm ve beslenme konusunda beslenme bilgi düzeylerini artırmak için profesyonel destek almak istedikleri belirlenmiştir.

Anahtar Kelimeler

• Otizm
• Beslenme Eğitimi
• Tıbbi Beslenme Tedavisi

Evaluation of Medical Nutrition Therapy Application Status of Children Diagnosed with Autisom Spectrum in Northern Cyprus

Öz

Objectives: Autism is a lifelong disease characterised by a lack of neurodevelopmental and social communication and limited interests and behaviours. Popular dietary approaches such as gluten-free, casein-free, elimination, Feingold, ketogenic, and low-oxalate diets draw attention to its treatment. For this reason, it is aimed to question the medical nutrition therapy applied on children and its effectiveness on symptoms. Materials and Methods: The research was conducted with forty-eight children studying in public and private education centres in Northern Cyprus between January and June 2014. The researcher applied a face-to-face interview technique to the questionnaire, which covers: the cases of nutrition therapy of the children; the status of receiving nutrition therapy for their diagnosis; if they are receiving nutrition therapy; why and on whose recommendation they apply this treatment; and its effectiveness in the treatment. Statistical evaluation of the data was made with the SPSS-21 program. Results: The study was completed with forty children with autism spectrum diagnoses. As a result of the survey, 25.0% of children with autism apply medical nutrition therapy for their disease, and the most frequently used treatment is a gluten-free and casein-free diet, with a rate of 40.0%. As a result of the applied medical nutrition therapy, an improvement in the symptoms of 50.0% of autistic children was observed. The rate of getting an education from a professional about nutrition in autism was 5.0%, and 82.5% of the families thought that their nutritional information was insufficient. Most of them reported that they want to get information about autism and nutrition. Conclusion: With this study, it was determined that families preferred the gluten-free and casein-free diet model to improve their symptoms, but they wanted professional support to increase their nutritional knowledge about autism and nutrition.

Anahtar Kelimeler

• Autism
• Nutrition Education
• Medical Nutrition Therapy

Kaynakça

1. Gockley, J., Willsey, J., Dong, S., Dougherty, J., Constantino, J., Sanders, S. (2015).The Female Protective Effect in Autism Spectrum Disorder is not Mediated by a Single Genetic Locus. Molecular Autism, 6 (25): 1–10.
2. Granich, J., Hunt, A., Ravine, D., Wray, J., Whitehouse, A. (2014). High Use of Complementary and Alternative Medication among Children with Autism is not Associated with the Severity of Core Symptoms. Journal of Autism, 1 (4): 1 – 8.
3. Harris, C., Card, B. (2012). A Pilot Study to Evaluate Nutritional Influences on Gastrointestinal Symptoms and Behavior Patterns in Children with an Autism Spectrum Disorder. Complementary Therapies in Medicine, 20 (6): 437 – 440.
4. Hoppenbrouwers, M., Vandermosten, M., Boets, B. (2014). Autism as a Disconnection Syndrome: A Qualitative and Quantitave Review of Diffusion Tensor Imaging Studies. Research in Autism Spectrum Disorders, 8 (4): 387-412.
5. Ismail N., Ramli N., Hamzaid N., and Hassan N. (2020). Exploring Eating and Nutritional Challenges for Children with Autism Spectrum Disorder: Parents’ and Special Educators’ Perceptions. Nutrients, 12: 25-30.
6. James, S., Cutler, P., Melnyk, S., Jernigan, S., Junak, L., Gaylor, D., et al. (2004). Metabolic Biomarkers of Increased Oxidative Stress and Impaired Methylation Capacity in Children with Autism. American Clinical Journal of Clinical Nutrition, 80 (6),1611-1617.
7. Johnson, C., Myers, S. (2007). Identification and Evaluation of Children with Autism Spectrum Disorders. Pediatrics, 120 (5): 1183-1215.
8. Kanner, L. (1943). Autistic Disturbances of Affective Contact. Nervous Child. 2: 217- 250.

9. Kantzer, A., Fernell, E., Gilberg, C., Miniscalco, C. (2013). Autism in Community Preschoolers: Developmental Profiles. Research in Developmental Disabilities, 34 (9): 2900 – 2908.
10. Kawicka, A., Ilow, B. (2013). How Nutritional Status, Diet and Dietary Supplements can Affect Autism? A review. Roczniki Panstwowego Zakladu Higieny in English, 64 (1): 1–12.
11. Lai, M., Cohen, S., Buxbaum, J. (2015). Understanding Autism in the Light on Sex/ Gender. Molecular Autism, 6 (24): 1–5.
12. Lai, M., Lambardo, M., Auyeung, B., Chakrabarti, B., Cohen, S. (2015). Sex/Gender Differences and Autism: Setting the Scene for Future Research. Journal of the American Academy of Child and Adolescent Psychiatry, 54 (1): 11–24.
13. Levy, S. E., & DS, M. (2009). Schultz RT. Autism, Lancet, 374(9701), 1627-1638.
14. Louw, KA., Bentley, J., Sorsdahl, K., Adnams, C.M. (2013). Prevalence and Patterns of Medication Use in Children and Adolescents with Autism Spectrum Disorders in the Western Cape, South Africa. Journal of Child and Adolescent Mental Health, 25 (1): 69–79.
15. Mandell, D., Novak, M., Zubritsky, C. (2005). Factors Associated with Age of Diagnosis among Children with Autism Spectrum Disorders. Pediatrics, 116 (6): 1480–1486.Differences in the Evaluation and Diagnosis of Autism Spectrum Disorders Among Children. Disability and Health Journal, 3 (2): 107 –116.
16. Gockley, J., Willsey, J., Dong, S., Dougherty, J., Constantino, J., Sanders, S. (2015). The Female Protective Effect in Autism Spectrum Disorder is not Mediated by a Single Genetic Locus. Molecular Autism, 6 (25): 1–10.
17. Granich, J., Hunt, A., Ravine, D., Wray, J., Whitehouse, A. (2014). High Use of Complementary and Alternative Medication among Children with Autism is not Associated with the Severity of Core Symptoms. Journal of Autism, 1 (4): 1 – 8.
18. Harris, C., Card, B. (2012). A Pilot Study to Evaluate Nutritional Influences on Gastrointestinal Symptoms and Behavior Patterns in Children with an Autism Spectrum Disorder. Complementary Therapies in Medicine, 20 (6): 437 – 440.
19. Hoppenbrouwers, M., Vandermosten, M., Boets, B. (2014). Autism as a Disconnection Syndrome: A Qualitative and Quantitave Review of Diffusion Tensor Imaging Studies. Research in Autism Spectrum Disorders, 8 (4): 387-412.
20. Ismail N., Ramli N., Hamzaid N., and Hassan N. (2020). Exploring Eating and Nutritional Challenges for Children with Autism Spectrum Disorder: Parents’ and Special Educators’ Perceptions. Nutrients, 12: 25-30.
21. James, S., Cutler, P., Melnyk, S., Jernigan, S., Junak, L., Gaylor, D., et al. (2004). Metabolic Biomarkers of Increased Oxidative Stress and Impaired Methylation Capacity in Children with Autism. American Clinical Journal of Clinical Nutrition, 80 (6),1611-1617.
22. Johnson, C., Myers, S. (2007). Identification and Evaluation of Children with Autism Spectrum Disorders. Pediatrics, 120 (5): 1183-1215.
23. Kanner, L. (1943). Autistic Disturbances of Affective Contact. Nervous Child. 2: 217- 250.
24. Kantzer, A., Fernell, E., Gilberg, C., Miniscalco, C. (2013). Autism in Community Preschoolers: Developmental Profiles. Research in Developmental Disabilities, 34 (9): 2900 – 2908.
25. Kawicka, A., Ilow, B. (2013). How Nutritional Status, Diet and Dietary Supplements can Affect Autism? A review. Roczniki Panstwowego Zakladu Higieny in English, 64 (1): 1–12.
26. Lai, M., Cohen, S., Buxbaum, J. (2015). Understanding Autism in the Light on Sex/ Gender. Molecular Autism, 6 (24): 1–5.
27. Lai, M., Lambardo, M., Auyeung, B., Chakrabarti, B., Cohen, S. (2015). Sex/Gender Differences and Autism: Setting the Scene for Future Research. Journal of the American Academy of Child and Adolescent Psychiatry, 54 (1): 11–24.
28. Levy, S. E., & DS, M. (2009). Schultz RT. Autism, Lancet, 374(9701), 1627-1638.
29. Louw, KA., Bentley, J., Sorsdahl, K., Adnams, C.M. (2013). Prevalence and Patterns of Medication Use in Children and Adolescents with Autism Spectrum Disorders in the Western Cape, South Africa. Journal of Child and Adolescent Mental Health, 25 (1): 69–79.
30. Mandell, D., Novak, M., Zubritsky, C. (2005). Factors Associated with Age of Diagnosis among Children with Autism Spectrum Disorders. Pediatrics, 116 (6): 1480–1486.