Otizm Spektrum Bozukluğu Olan Çocuklarda Beslenme Tedavisi Yaklaşımları

Yıl 2023, , 33 - 42, 30.06.2023

Melis Akhalil , Seda Çiftçi , Zehra Batu

https://doi.org/10.59518/farabimedj.1237543

Öz

Otizm spektrum bozukluğu (OSB), gelişimin erken evrelerinde ortaya çıkan, sosyal iletişim ve etkileşim davranışlarındaki kısıtlamalar, tekrarlayıcı sınırlayıcı davranışlar ve sınırlı ilgilerle karakterize edilen nörogelişimsel bir bozukluktur. OSB'de görülen beslenme sorunları ve gastrointestinal şikayetler, hastalığın ilk tanısından itibaren bilinmekte ve hastalığın bir özelliği olarak kabul edilmektedir. OSB'li çocukların normal gelişim gösteren çocuklara göre beş kat daha fazla beslenme sorunu yaşadıkları bilinmektedir. OSB'li çocuklarda en sık görülen beslenme sorunları, besin seçiciliği, yeme becerisinde güçlük, seçici, garip ve sıra dışı yeme davranışı, belirli bir besin sunumuna karşı duyarlılık, yeni besinlerden kaçınma, bir tür besinin aşırı ve ısrarlı alımı ve yemek zamanı davranış sorunlarıdır. Glutensiz kazeinsiz diyet, ketojenik diyet, özel karbonhidrat diyeti, feingold diyeti, Candida vücut ekolojisi diyeti, elimine alerji diyetleri gibi beslenme yaklaşımları uygulanmaktadır. Ancak, bu uygulamalar için kanıt sınırlıdır. OSB'li çocukların yetersiz ve dengesiz beslenme açısından izlenmesi, kısıtlayıcı ve özel diyetlerin uygulanmasında beslenme sorunları ve yetersiz beslenmenin göz önünde bulundurulması önerilir.

Anahtar Kelimeler

otizm, beslenme, diyet

Nutrition Therapy Approaches in Children with Autism Spectrum Disorder

Öz

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that occurs in the early stages of development, characterized by limitations in social communication and interaction behaviors, repetitive limiting behaviors, and limited interests. Nutritional problems and gastrointestinal complaints seen in ASD have been known since the first diagnosis of the disease and are considered a feature of the disease. It is known that children with ASD have feeding problems five times more often than children with normal development. The most common nutritional problems seen in children with ASD are food selectivity, difficulty in eating skills, selective, strange, and unusual eating behavior, sensitivity to a particular presentation of food, avoidance of new foods, excessive and persistent intake of one type of food and meal time behavioral problems. Dietary approaches such as gluten-free, casein-free, ketogenic, special carbohydrate, Feingold, Candida body ecology, and eliminated allergy diets are applied. However, the evidence for these practices is limited. Therefore, it is recommended to monitor children with ASD in terms of inadequate and unbalanced nutrition and to consider feeding problems and malnutrition in applying restrictive and special diets.

Anahtar Kelimeler

autism, nutrition, diet

Kaynakça

• American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc. Arlington, VA. 2013. DOI: 10.1176/appi.books.9780890425596.
• Jeste SS, Geschwind DH. Disentangling the heterogeneity of autism spectrum disorder through genetic findings. Nat Rev Neurol. 2014; 10(2): 74-81. DOI: 10.1038/nrneurol.2013.278.
• Bell CC. DSM-IV: diagnostic and statistical manual of mental disorders. JAMA. 1994; 272(10): 828-829. DOI:10.1001/jama.1994.03520100096046.
• Hyman SL, Levy SE, Myers SM; Council on children with disabilities, section on developmental and behavioral pediatrics. Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics. 2020; 145(1): e20193447. DOI: 10.1542/peds.2019-3447.
• Marchezan J, Winkler Dos Santos EGA, Deckmann I, Riesgo RDS. Immunological Dysfunction in Autism Spectrum Disorder: A Potential Target for Therapy. Neuroimmunomodulation. 2018; 25(5-6): 300-319. DOI: 10.1159/000492225.
• Miles JH. Autism spectrum disorders--a genetics review. Genet Med. 2011; 13(4): 278-294. DOI: 10.1097/GIM.0b013e3181ff67ba.
• Özeren GS. Otizm spektrum bozukluğu OSB ve hastalığa kanıt penceresinden bakış. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2013; 4(2): 57-63.
• Fujiwara T, Morisaki N, Honda Y, Sampei M, Tani Y. Chemicals, nutrition, and autism spectrum disorder: A mini-review. Front Neurosci. 2016; 10: 174. DOI: 10.3389/fnins.2016.00174.
• Tanıdır C, Mukaddes NM. Otizm spektrum bozuklukları. İçinde: Akay Pekcanlar A, Ercan ES (Editörler). Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları. 1. Baskı. Ankara: Türkiye Çocuk ve Genç Psikiyatrisi Derneği Yayınları; 2016: 126-49.
• Troyb E, Knoch K, Barton M. Phenomenology of ASD: Definition, syndromes, and major features. Editors: Deborah A. Fein, The neuropsychology of autism. Publisher: Oxford University Press. 2011; 9-34.
• Hundley RJ, Shui A, Malow BA. Relationship between subtypes of restricted and repetitive behaviors and sleep disturbance in autism spectrum disorder. Journal of autism and developmental disorders. 2016; 46(11): 3448-57. DOI 10.1007/s10803-016-2884-4.
• Uçar K, Samur G. Otizmin Tedavisinde Güncel Beslenme Tedavisi Yaklaşımları (Contemporary Approaches to Autism Treatment). Journal of nutrition and dietetics. 2017; 45(1): 53-60.
• Broadstock M, Doughty C, Eggleston M. Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder. Autism. 2007; 11(4): 335-48. DOI: 10.1177/1362361307078132.
• Matson JL. Determining treatment outcome in early intervention programs for autism spectrum disorders: A critical analysis of measurement issues in learning based interventions. Research in developmental disabilities. 2007; 28(2): 207-18. DOI: 10.1016/j.ridd.2005.07.006.
• Herndon AC, DiGuiseppi C, Johnson SL, Leiferman J, Reynolds A. Does nutritional intake differ between children with autism spectrum disorders and children with typical development? Journal of autism and developmental disorders. 2009; 39(2): 212-22. DOI: 10.1007/s10803-008-0606-2.
• Barnhill K, Gutierrez A. Analysis of dietary intake and nutritional status in children with autism spectrum disorder. Autism. 2015; 5(3): 10.4172. DOI: 10.4172/2165-7890.1000154.
• Geraghty ME, Depasquale GM, Lane AE. Nutritional intake and therapies in autism: a spectrum of what we know: Part 1. ICAN: Infant, Child, & Adolescent Nutrition. 2010; 2(1): 62-9. DOI: 10.1177/1941406409358437.
• Esnafoğlu E. Otistik Spektrum Bozukluğu BulunanÇocuklarda Vitamin B12, Folat ve Vitamin D Seviyelerinin İncelenmesi. Klinik Tıp Aile Hekimliği. 2017; 9(4): 36-41.
• Adams JB, Audhya T, McDonough-Means S, et al. Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity. Nutr Metab (Lond). 2011; 8(1): 34. DOI: 10.1186/1743-7075-8-34.
• Hyman SL, Stewart PA, Schmidt B, et al. Nutrient intake from food in children with autism. Pediatrics. 2012; 130(Supplement2): S145-S53. DOI: 10.1542/peds.2012-0900L.
• Mahan, L.K.; Raymond, J.L. Krause’s Food & The Nutrition Care Process, 14th ed.; Elsevier Inc.: St. Louis, MO, USA, 2017; pp. 910.
• Lindsay RL, Eugene Arnold L, Aman MG, et al. Dietary status and impact of risperidone on nutritional balance in children with autism: a pilot study. Journal of Intellectual and Developmental Disability. 2006; 31(4): 204-9 DOI: 10.1080/13668250601006924.
• Xia W, Zhou Y, Sun C, Wang J, Wu L. A preliminary study on nutritional status and intake in Chinese children with autism. European journal of pediatrics. 2010; 169(10): 1201-6. DOI: 10.1007/s00431-010-1203-x.
• Ranjan S, Nasser JA. Nutritional status of individuals with autism spectrum disorders: do we know enough? Advances in Nutrition. 2015; 6(4): 397-407. DOI: 10.3945/an.114.007914.
• Kałużna-Czaplińska J, Socha E, Rynkowski J. B vitamin supplementation reduces excretion of urinary dicarboxylic acids in autistic children. Nutrition research. 2011; 31(7): 497-502. DOI: 10.1016/j.nutres.2011.06.002.
• Al-Farsi YM, Waly MI, Al-Sharbati MM, et al. Levels of heavy metals and essential minerals in hair samples of children with autism in Oman: a case–control study. Biological trace element research. 2013; 151(2): 181-6. DOI: 10.1007/s12011-012-9553-z.
• Peretti S, Mariano M, Mazzocchetti C, et al. Diet: the keystone of autism spectrum disorder? Nutritional neuroscience. 2019; 22(12): 825-39. DOI: 10.1080/1028415X.2018.1464819.
• Health NIo. https://ods.od.nih.gov/HealthInformation/Dietary_Reference_Intakes.aspx 2022 , AD:10.01.2022.
• Ristori MV, Quagliariello A, Reddel S, et al. Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions. Nutrients. 2019; 11(11): 2812. DOI: 10.3390/nu11112812.
• Shabo Y, Barzel R, Margoulis M, Yagil R. Camel milk for food allergies in children. Immunology and Allergies. 2005; 7(12): 796.
• Zibaee S. Nutritional and therapeutic characteristics of camel milk in children: a systematic review. Electronic physician. 2015; 7(7): 1523. DOI: 10.19082/1523.
• Al-Ayadhi LY, Halepoto DM, Al-Dress AM, Mitwali Y, Zainah R. Behavioral benefits of camel milk in subjects with autism spectrum disorder. J Coll Physicians Surg Pak. 2015; 25(11): 819-23.
• Bent S, Bertoglio K, Hendren RL. Omega-3 fatty acids for autistic spectrum disorder: a systematic review. Journal of autism and developmental disorders. 2009; 39(8): 1145-54. DOI: 10.1007/s10803-009-0724-5.
• Meguid NA, Atta HM, Gouda AS, Khalil RO. Role of polyunsaturated fatty acids in the management of Egyptian children with autism. Clinical Biochemistry. 2008; 41(13): 1044-8. DOI: 10.1016/j.clinbiochem.2008.05.013.
• Politi P, Cena H, Comelli M, et al. Behavioral effects of omega-3 fatty acid supplementation in young adults with severe autism: an open label study. Archives of medical research. 2008; 39 (7): 682-5 DOI: 10.1016/j.arcmed.2008.06.005.
• Gogou M, Kolios G. The effect of dietary supplements on clinical aspects of autism spectrum disorder: A systematic review of the literature. Brain and Development. 2017; 39(8): 656-64. DOI: 10.1016/j.braindev.2017.03.029.
• Bener A, Khattab AO, Al-Dabbagh MM. Is high prevalence of Vitamin D deficiency evidence for autism disorder?: In a highly endogamous population. Journal of pediatric neurosciences. 2014; 9(3): 227. DOI: 10.4103/1817-1745.147574.
• Stewart PA, Hyman SL, Schmidt BL, et al. Dietary supplementation in children with autism spectrum disorders: common, insufficient, and excessive. Journal of the Academy of Nutrition and Dietetics. 2015; 115(8): 1237-48. DOI: 10.1016/j.jand.2015.03.026.
• Kawicka A, Regulska-Ilow B. How nutritional status, diet and dietary supplements can affect autism. A review. Rocz Panstw Zakl Hig. 2013; 64(1): 1-12.
• Hendren RL, James SJ, Widjaja F, Lawton B, Rosenblatt A, Bent S. Randomized, placebo-controlled trial of methyl B12 for children with autism. Journal of child and adolescent psychopharmacology. 2016; 26(9): 774-83. DOI: 10.1089/cap.2015.0159.
• Mazlum B. Antioksidan vitaminler ve psikiyatride kullanımı. Psikiyatride Güncel Yaklaşımlar. 2012; 4(4): 486-505. DOI:10.5455/cap.20120429.
• Adams JB, Holloway C. Pilot study of a moderate dose multivitamin/mineral supplement for children with autistic spectrum disorder. Journal of Alternative & Complementary Medicine. 2004; 10(6): 1033-9. DOI: 10.1089/acm.2004.10.1033.
• Liu J, Liu X, Xiong XQ, et al. Effect of vitamin A supplementation on gut microbiota in children with autism spectrum disorders - a pilot study. BMC Microbiol. 2017; 17(1): 204. DOI: 10.1186/s12866-017-1096-1.
• Malhotra S, Subodh B, Parakh P, Lahariya S. Brief report: childhood disintegrative disorder as a likely manifestation of vitamin B12 deficiency. Journal of autism and developmental disorders. 2013; 43(9): 2207-10. DOI: 10.1007/s10803-013-1762-6.
• James SJ, Melnyk S, Fuchs G, et al. Efficacy of methylcobalamin and folinic acid treatment on glutathione redox status in children with autism. The American journal of clinical nutrition. 2009; 89(1): 425-30. 0.3945/ajcn.2008.26615.
• Bjørklund G, Waly MI, Al-Farsi Y, et al. The role of vitamins in autism spectrum disorder: what do we know? Journal of molecular neuroscience. 2019; 67(3): 373-87. DOI: 10.1007/s12031-018-1237-5.
• Latif A, Heinz P, Cook R. Iron deficiency in autism and Asperger syndrome. Autism. 2002; 6(1): 103-14 DOI: 10.1177/1362361302006001008.
• Dosman CF, Drmic IE, Brian JA, et al. Ferritin as an indicator of suspected iron deficiency in children with autism spectrum disorder: prevalence of low serum ferritin concentration. Developmental medicine and child neurology. 2006; 48(12): 1008-9 DOI: 10.1017/S0012162206232225.
• Bilgiç A, Gürkan K, Türkoğlu S, Akça ÖF, Kılıç BG, Uslu R. Iron deficiency in preschool children with autistic spectrum disorders. Research in Autism Spectrum Disorders. 2010; 4(4): 639-44. DOI: 10.1016/j.rasd.2009.12.008.
• Cornish E. A balanced approach towards healthy eating in autism. Journal of Human Nutrition and Dietetics. 1998; 11(6): 501-9. DOI: 10.1046/j.1365-277X.1998.00132.x.
• Dosman CF, Brian JA, Drmic IE, et al. Children with autism: effect of iron supplementation on sleep and ferritin. Pediatric neurology. 2007; 36(3): 152-8. DOI: 10.1016/j.pediatrneurol.2006.11.004.
• Meguid NA, Anwar M, Bjørklund G, et al. Dietary adequacy of Egyptian children with autism spectrum disorder compared to healthy developing children. Metabolic brain disease. 2017; 32(2): 607-15. DOI: 10.1007/s11011-016-9948-1.
• Hergüner S, Keleşoğlu FM, Tanıdır C, Çöpür M. Ferritin and iron levels in children with autistic disorder. European journal of pediatrics. 2012; 171(1): 143- DOI: 10.1007/s00431-011-1506-6 6.
• Kodak T, Piazza CC. Assessment and behavioral treatment of feeding and sleeping disorders in children with autism spectrum disorders. Child and adolescent psychiatric clinics of North America. 2008; 17(4): 887-905. DOI: 10.1016/j.chc.2008.06.005.
• Yorbik O, Akay C, Sayal A, et al. Zinc status in autistic children. The Journal of Trace Elements in Experimental Medicine: The Official Publication of the International Society for Trace Element Research in Humans. 2004; 17(2): 101-7. DOI: 10.1002/jtra.20002.
• Faber S, Zinn GM, Kern Ii JC, Skip Kingston H. The plasma zinc/serum copper ratio as a biomarker in children with autism spectrum disorders. Biomarkers. 2009; 14(3): 171-80. DOI: 10.1080/13547500902783747.
• Babaknejad N, Sayehmiri F, Sayehmiri K, Mohamadkhani A, Bahrami S. The relationship between zinc levels and autism: a systematic review and meta-analysis. Iranian journal of child neurology. 2016; 10(4): 1.
• Li SO, Wang JL, Bjørklund G, Zhao WN, Yin CH. Serum copper and zinc levels in individuals with autism spectrum disorders. Neuroreport. 2014; 25(15): 1216-20. DOI: 10.1097/WNR.0000000000000251.
• Mousain-Bosc M, Roche M, Polge A, Pradal-Prat D, Rapin J, Bali J. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. Magnesium research. 2006; 19(1): 46-52.
• Adams J. Vitamin/mineral supplements for children and adults with autism. Vitamin Mineral. 2015; 3(127): 1-4. DOI: 10.4172/2376-1318.1000127.
• Navarro F, Liu Y, Rhoads JM. Can probiotics benefit children with autism spectrum disorders? World journal of gastroenterology. 2016; 22(46): 10093. DOI: 10.3748/wjg.v22.i46.10093.
• Parracho HM, Gibson GR, Knott F, Bosscher D, Kleerebezem M, McCartney AL. A double-blind, placebo-controlled, crossover-designed probiotic feeding study in children diagnosed with autistic spectrum disorders. International Journal of Probiotics & Prebiotics. 2010; 5(2): 69.
• Berding K, Donovan SM. Microbiome and nutrition in autism spectrum disorder: current knowledge and research needs. Nutrition reviews. 2016; 74(12): 723-36 DOI: 10.1093/nutrit/nuw048.
• Emond A, Emmett P, Steer C, Golding J. Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics. 2010; 126(2): e337-e42. DOI: 10.1542/peds.2009-2391.
• Volkert VM, Vaz PC. Recent studies on feeding problems in children with autism. Journal of applied behavior analysis. 2010; 43(1): 155-9. DOI: 10.1901/JABA.2010.43-155.
• Emre Bolatbaş D, Yıldız Bıçakçı M. Bebeklik ve ilk çocukluk döneminde gelişimsel değerlendirme ve izlem, bebeklik ve ilk çocukluk döneminde (0-36 ay) gelişim, duyuların gelişimi ve desteklenmesi, editör: M. Yıldız Bıçakçı (2015): 179-210.
• Buie T, Campbell DB, Fuchs GJ, et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics. 2010; 125(Supplement 1): 1-18 DOI: 10.1542/peds.2009-1878C.
• Buie T, Fuchs GJ, Furuta GT, Kooros K, et al. Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. Pediatrics. 2010; 125(Supplement 1: S19-29. DOI: 10.1542/peds.2009-1878D.
• Najdowski AC, Wallace MD, Doney JK, Ghezzi PM. Parental assessment and treatment of food selectivity in natural settings. Journal of Applied Behavior Analysis. 2003; 36(3): 383-6. DOI: 10.1901/JABA.2003.36-383.
• Berry RC, Novak P, Withrow N, et al. Nutrition management of gastrointestinal symptoms in children with autism spectrum disorder: guideline from an expert panel. Journal of the Academy of Nutrition and Dietetics. 2015; 115(12): 1919-27. DOI: 10.1016/j.jand.2015.05.016.
• Levy SE, Souders MC, Ittenbach RF, Giarelli E, Mulberg AE, Pinto-Martin JA. Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders. Biological psychiatry. 2007; 61(4): 492-7. DOI: 10.1016/j.biopsych.2006.07.013.
• Seda Ö, Aslı U. Otizm spektrum bozukluğu tedavisinde beslenme yaklaşımları. Ankara Sağlık Bilimleri Dergisi. 2017; 6(1): 179-94.
• Salomone E, Charman T, McConachie H, Warreyn P. Prevalence and correlates of use of complementary and alternative medicine in children with autism spectrum disorder in Europe. European Journal of Pediatrics. 2015; 174(10): 1277-85. DOI: 10.1007/s00431-015-2531-7.
• Millward C, Ferriter M, Calver SJ, Connell‐Jones GG. Gluten‐and casein‐free diets for autistic spectrum disorder. Cochrane database of systematic reviews. 2008; 16(2). DOI: 10.1002/14651858.CD003498.pub3.
• Cubala-Kucharska M. The review of most frequently occurring medical disorders related to aetiology of autism and the methods of treatment. Acta Neurobiol Exp (Wars). 2010; 70(2): 141-6.
• Mulloy A, Lang R, O’Reilly M, Sigafoos J, Lancioni G, Rispoli M. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders. 2010; 4(3): 328-39. DOI: 10.1016/j.rasd.2009.10.008.
• Kałużna-Czaplińska J, Jóźwik-Pruska J. Nutritional strategies and personalized diet in autism-choice or necessity? Trends in Food Science & Technology. 2016; 49: 45-50. DOI: 10.1016/j.tifs.2016.01.005.
• Lange KW, Hauser J, Reissmann A. Gluten-free and casein-free diets in the therapy of autism. Current Opinion in Clinical Nutrition & Metabolic Care. 2015; 18(6): 572-5. DOI: 10.1097/MCO.0000000000000228.
• Hyman SL, Stewart PA, Foley J, et al. The gluten-free/casein-free diet: a double-blind challenge trial in children with autism. Journal of autism and developmental disorders. 2016; 46(1): 205-20. DOI: 10.1007/s10803-015-2564-9.
• El-Rashidy O, El-Baz F, El-Gendy Y, Khalaf R, Reda D, Saad K. Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metabolic brain disease. 2017; 32(6): 1935-41. DOI: 10.1007/s11011-017-0088-z.
• Whiteley P, Haracopos D, Knivsberg A-M, et al. The ScanBrit randomised, controlled, single-blind study of a gluten-and casein-free dietary intervention for children with autism spectrum disorders. Nutritional neuroscience. 2010; 13(2): 87-100. DOI: 10.1179/147683010X12611460763922.
• Mulloy A, Lang R, O’Reilly M, Sigafoos J, Lancioni G, Rispoli M. Addendum to “gluten-free and casein-free diets in treatment of autism spectrum disorders: A systematic review”. Research in Autism Spectrum Disorders. 2011; 5(1): 86-8. DOI: 10.2147/NDS.S74718.
• Sharma S, Jain P. The ketogenic diet and other dietary treatments for refractory epilepsy in children. Annals of Indian Academy of Neurology. 2014; 17(3): 253. DOI: 10.4103/0972-2327.138471.
• Napoli E, Dueñas N, Giulivi C. Potential therapeutic use of the ketogenic diet in autism spectrum disorders. Frontiers in pediatrics. 2014; 2: 69. DOI: 10.3389/fped.2014.00069.
• Evangeliou A, Vlachonikolis I, Mihailidou H, et al. Application of a ketogenic diet in children with autistic behavior: pilot study. Journal of child neurology. 2003; 18(2): 113-8. DOI: 10.1177/08830738030180020501.
• Castro K, Faccioli LS, Baronio D, Gottfried C, Perry IS, dos Santos Riesgo R. Effect of a ketogenic diet on autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders. 2015; 20: 31-8. DOI:10.1016/j.rasd.2015.08.00.5.
• Suskind DL, Wahbeh G, Gregory N, Vendettuoli H, Christie D. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. Journal of pediatric gastroenterology and nutrition. 2014; 58(1): 87-91. DOI: 10.1097/MPG.0000000000000103.
• Kakodkar S, Farooqui AJ, Mikolaitis SL, Mutlu EA. The specific carbohydrate diet for inflammatory bowel disease: a case series. Journal of the Academy of Nutrition and Dietetics. 2015; 115(8): 1226-32. DOI: 10.1016/j.jand.2015.04.016.
• Barnhill K, Devlin M, Moreno HT, et al. Brief report: implementation of a specific carbohydrate diet for a child with autism spectrum disorder and Fragile X syndrome. Journal of autism and developmental disorders. 2020; 50(5): 1800-8. DOI: 10.1007/s10803-018-3704-9.
• Gottschall E. Digestion-gut-autism connection: the specific carbohydrate diet. Medical Veritas. 2004; 1(2): 261-71. DOI: 10.1588/medver.2004.01.00029.
• Waring R, Reichelt K. The biochemistry of the autistic syndrome. Autism on the Agenda NAS, London. 1996: 125-7.
• Feingold B. Why your child is hyperactive: Random House Incorporated; 1985.
• Abdallah H, Soliman S, El-kader A. Language Training Program Coupled With Feingold Diet For Caregivers To Develop Autisticreceptive Language Skills. Mansoura Nursing Journal. 2019; 6(2): 107-25. DOI: 10.21608/MNJ.2019.176375.
• Nanayakkara WS, Skidmore PM, O’Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and experimental gastroenterology. 2016; 9: 131. DOI: 10.2147/CEG.S86798.
• Hill P, Muir JG, Gibson PR. Controversies and recent developments of the low-FODMAP diet. Gastroenterology & hepatology. 2017; 13(1): 36.
• Magge S, Lembo A. Low-FODMAP diet for treatment of irritable bowel syndrome. Gastroenterology & hepatology. 2012; 8(11): 739.
• Catassi G, Lionetti E, Gatti S, Catassi C. The low FODMAP diet: many question marks for a catchy acronym. Nutrients. 2017; 9(3): 292. DOI: 10.3390/nu9030292.
• Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014; 146(1): 67-75. e5. DOI: 10.1053/j.gastro.2013.09.046.