Optimise diet

Children resonate to high calorie, low nutrition (junk) foods, like sweets and fast-food. Good eating habits are extablished early on in life by good role modelling, discipline around food and desensitisation of sensory challenging options. It is, however easier said than done, as one often only realises you have a problem when you reach the end of the line.

There are several good choices of “brain nurturing” foods. The best diet for a child is a whole foods diet (avoiding processed and refined options), including all food groups with variation. It is a well-known fact that the intake of sugar increases ADHD symptoms and hyperactivity. Poor diet worsens mood disorders. There are obviously reasons for exclusion diets, but that should be determined on an individual basis, with specific reasons for doing so. Gastro-intestinal inflammation, which could be confirmed by a stool analysis would be one of the reasons why one would look at excluding certain food groups. Specific food allergies would lead to gastro-intestinal symptoms in younger children, as well as eczema, hay fever, asthma and anaphylaxis. This could be tested by doing a blood test and/or skin prick tests. Food sensitivities would give more subtle symptoms and is evaluated by doing an IgG Food sensitivity screening (also a blood test). The problem with the IgG test is that the results are quite variable, changing from week to week. If there is any inflammation, or a permeable gut, there would be upregulated sensitivities, so this test is better done after gut healing therapy has been followed, if indicated.

To supplement or not?

I like to use indicated, individualised supplements for therapeutic value. There are a lot of ways in which one could develop an understanding of what a particular child needs, but it involves extensive biomedical assessment. As it is an individualised process, there is no one size-fits-all magic formula, although one would find a lot of blanket approach options out there! My advice would be that one gets help from someone who is experienced and knowledgeable.

There are, generally speaking, a few good-option supplements that one could look at without any further digging. The first is Omega 3. Omega 3 from sustainable sourced fish origin is best, but there are vegan options, from kelp too. Our Western diet gives us a lot of Omega 6, from grains, so, unless one is following a grain free diet, one should concentrate on Omega 3 rich products. One would preferably want a good quality product, as the inferior products  contain higher levels of peroxides that are noxious or ethyl esters that could be harmful for pregnant mothers or children.

A good, general multivitamin may be of value, but one must be careful to rather use organic options, as synthetic vitamins are often not metabolised properly. One can never get a plate of food into a capsule, though!

Gut health is extremely important, so if there are any indications, it can do no harm to use an array of good probiotics. Probiotics are a whole science on their own, so using different brands and gauging the response from each to be able to select the appropriate one, is a good strategy. I find that children often don’t get enough fibre in their diet, especially if they are self-selective about food. Fibre is a prebiotic and acts like a fertiliser for probiotic flora. A good example of an effective probiotic is Inulin, a good supplement to add for some nutritious fibre. It is useful to know that, if inulin causes symptoms, the gastro-intestinal tract needs to be investigated, as that might implicate that it is stimulating abnormal, harmful flora.

Iron supplementation should only be given when there is proven iron deficiency, which could be determined by doing a blood test. It is important to investigate further if an iron deficiency is diagnosed in a child, as that could be a solid pointer to underlying gastro-intestinal inflammation or – disease. Giving iron when there is no deficiency could be quite pro-inflammatory, so should be avoided.

Zinc supplementation is generally immune boosting. In the COVID-19 season, we have found, from time to time, that Zinc has been sold out, as there are certain antiviral benefits from Zinc. Zinc can build up, so it is necessary to interrupt the supplementation programme every now and again by skipping a month or 2 of supplementation.

Vitamin C is good to give. What is not so well known, is that synthetic ascorbic acid (vit C) is very short acting, so one needs to give more than one dose per day or use other forms of vit C, such as liposomal options or more organic products, such as Rose-hip.

That’s not all, folks!

Optimal neurological health is something we all, as neuro-diverse beings should aspire to. A healthy lifestyle involves a balance in everything. Exercise cannot be over-emphasized. Family time is hugely important. Stress management is a skill that we need to teach our kids. Some of them will find it harder and we need to understand that. Acceptance, positive feedback and healthy interaction form the support structure to launch a child successfully. To all the parents and caregivers, never forget to invest in and take care of your own health and wellbeing!

The rate of obesity amongst children is increasing rapidly and becoming a serious global health problem with an increase in associated chronic health risks, like diabetes, heart disease, sleep disorders, metabolic problems, musculo-skeletal problems, etc. Studies have shown that the incidence of overweight and obesity is even higher in the autistic population. The rates of overweight and obesity in children on the autistic spectrum is estimated to be 33% for overweight and 18% for obesity, which is higher than the rates for neurotypical developing children. (Hill AP, 2015)

There are several risk factors which could contribute to overweight and obesity in the Autistic Spectrum group. A Malaysian study found older child age, high maternal BMI, older paternal age, low physical activity, low likelihood of food refusal and high likelihood of food selectivity to be risk factors for high BMI in ASD children. (Kamal Nor Norazlin, 2019)

Health and Nutrition

Before venturing into management strategies, one has to exclude nutritional deficiencies and health problems. Commonly associated nutritional problems associated with obesity are iron deficiency, zinc deficiency, and lead toxicity. We are seeing more and more insulin resistance in children, which contributes to ánd is a result of midline weight gain. Metabolic disorders, mitochondrial dysfunction and low motor function also lead to obesity and need to be tested for.

Gut-brain connection

Gastro-intestinal health is pivotal in the prevention and management of obesity and overweight. Gastro-intestinal disease and -inflammation is common in autistic children. Underlying changes in the gut microbiome (organism component of the gastro-intestinal tract) has been shown to determine weight control. (Gupta, 2020).

The body’s energy balance is controlled by the hypothalamus in the brain, but overeating triggers the activation of inflammatory and stress response pathways and resultant hormonal dysregulation. (Kaneko K, 2019). Low grade systemic inflammation and oxidative stress, fired by a typical Western diet is associated with food addiction, reducing feedback inhibition pathways for food restriction.

Self-selective eating

ASD children are commonly self-selective about food. Children will typically resonate towards nutrient deficient, high calorie foods, so their food selection needs to be managed from a very early stage. A higher BMI is associated with food selectivity and children with a higher BMI seem to select specific foods, mostly crunchy textures and carbohydrates. I find the most challenging developmental stage for food refusal, manipulation and development of sensory sensitivity related to food the 2-4-year-old group. This is where good guidelines must already be put into place.

Management strategies and parental guidance

One of the first things to do when a child is developing sensory resistance to certain foods, is to do sensory integration therapy and work with desensitisation techniques. Repetitive offering of healthy options and positive feedback around eating are good investments. Speech therapy and behaviour management techniques could all contribute to better outcomes. It is well known that most negative eating patterns are maintained by negative feedback. Creating a positive, stress free environment is a good start to developing balanced feeding behaviour. Positive reinforcement helps. Food reinforcers for behavioural modification can play a negative role in that a child becomes motivated to eat more and develop impulsivity around food intake. Care should be taken around certain behavioural techniques and the association with food rewards,

Sleep

Up to 98.7% of autistic children have some form of sleep disturbance. The recommended duration of sleep for 5-10-year-olds is at least 10-13 hours. Dysregulated sleep has consequences on growth, circadian rhythms, metabolic processes, behaviour and eating habits. Several studies have alluded to the inverse relationship between sleep duration and weight gain. Just as sleep deprivation can lead to overweight and obesity, obesity in its turn can lead to obstructive sleep apnoea, thus sleep deprivation. There are several strategies and medications or supplements to improve sleep in children, so best is to team up with a professional who can help with effective sleep management.

Physical activity

There are several factors associated with ASD which would lead to less time spent doing physical activities. Social and behavioural challenges narrow down the options. Related  motor skills deficits or compromised coordination limit sport opportunities and preferences. There is a major shift toward indoor activities. Schooling for the special needs group often happens in smaller groups, where organised sport is less freely available. In the autistic neurodiverse group, the resonance is toward technology and the safe social environment thereof, which leads to more sedentary time and less physically active time. Developing a balance and applying technology in moderation has become a particular struggle in todays’ world. Complicated by the addictive nature of technology, self-motivation in this regard is mostly lacking. The trick here is to find some physical activity that is fun for the individual, relatively easy and sustainable.

Genetic determinants

Genetics definitely underpins the risk of childhood obesity. Lifestyle factors in families also play a role. Interestingly genetic vulnerabilities are linked to both autism and obesity. Some researchers have found specific genetic links between the 2 conditions, where they have been able to show 36 common genes between these 2 conditions. (Dhaliwal, 2019). There are several genetic/chromosomal disorders associated with obesity and often related to autism, such as Down -, Prader-Willi -, Smith-Lemli-Opitz -, William syndrome, and others. With genomics SNP analysis being available some of the epigenetic pathways can be examined and addressed.

Medication

Most children presenting autism will be offered a prescription for an anti-psychotic medication (Risperidone or Aripiprazole) somewhere down the line. Unfortunately, the side-effects of these commonly used medications have a bad imprint on sugar metabolism. In certain individuals the combination of this medication with their genetic constitution leads to weight gain and eventually insulin resistance and diabetes. Care must be taken to limit, or preferably completely avoid, refined carbohydrates, sugar and sweets when using this medication.

Comorbid conditions, such as ADHD, anxiety, OCD and depression are commonly associated with autism. The medication used to manage these conditions (SSRIs, methylphenidate, atomoxetine, etc.) also have a negative impact on weight control, so measures need to be taken to limit the impact. Best is to make good food choices and to try to avoid hunger and cravings that lead to the intake of high calorie, nutrient deficient foods.

Obesity in children is associated with social, emotional and physical challenges, which compound the difficulties associated with the autistic spectrum presentation. Because Autistic Spectrum Diverse children have several problems that result in poor socialisation and social acceptance, successfully preventing and/or managing obesity could contribute positively to inclusion.

One of the core deficits associated with the diagnosis of Autistic Spectrum Disorder (Diversity) is the complications around speech development and social communication. The term non-verbal has been the term referred to as part of the diagnostic criteria. Non-speaking would be a better term, as non-verbal would refer to an inability to be able to communicate at all, while non-speaking would refer to the inability (or degrees of ability) to use oral speech. As with everything on the spectrum of autism, the ability to speak is also presented in a spectrum, with some autistic individuals with exceptional speech development, rich vocabularies and an ability to discuss complex subjects and others who have no or limited speaking skills, for whom it is difficult to grasp the concept of words and sentences.

Speech development is a process, starting with preverbal skills and progressing through several stages to the ultimate ability to use language appropriately in social communication and communicating needs. There are 2 main areas of language, namely receptive language (understanding) and expressive language (using language). To be able to develop language, a lot of factors play a role. Let’s look at a few of the aspects that could be addressed through biomedical treatment.

1. Sensory Experience
For optimal language development, one has to use one’s sensory organs appropriately. One has to be able to see or hear. Sensory dysregulation can affect the sensory experience and have an effect on speech development. Anxiety plays a big role in sensory dysregulation, so needs to be addressed to be able to improve sensory integration. The gut microbiome is also involved in the background of sensory integration, anxiety and optimal functioning.

2. Processing
From the sensory organ(s) the information has to be processed to or communicated with the brain. From the brain the information has to be processed to execution, mostly to the mouth, as organ of speech. Methylation disorders, amongst other biochemical processes, play a role in the ability to focus/concentrate and in the processing of information.

3. Brain function
The brain has to store the information and be able to recollect the information appropriately to be able to respond by action or by communication. The classic areas involved in speech are known to be the Broca’s area, in the frontal area of the dominant hemisphere (mostly left) and the Wernicke’s area, in the back part of the temporal area, also of the dominant hemisphere. Broca’s area traditionally was seen to be involved with speech production and pronunciation, while Wernicke’s area is associated with the comprehension of written and spoken language. Without going into too much detail, one has to add that there are a host of other areas involved in speech too, including the cerebellum (small brain) and the motor cortex (governing motor skills). Inflammation in the brain, biochemical changes and genetic constitution affect expression of speech.

4. Motor skills
To be able to form words orally, the muscles of the mouth, lips, jaw, cheeks and tongue have to work together. This articulates recognisable words. One of the first signs of motor skills disorder around the mouth is when a baby is unable to breastfeed properly. I often get the history of a mom “not producing enough milk” while in actual fact the production of milk is really dependent on the stimulatin by the baby’s ability to suckle. Low motor tone, coordination difficulties and lack of endurance all play a role in the motor development around the mouth and subsequently the ability to speak.

To address speech development, one has to think holistically. All the areas of involvement need to be optimised. Some autistic children will never develop oral speech, but will develop the ability to communicate in other ways. That is also OK.

PANS (Paediatric Acute onset Neuro-Psychiatric Syndrome) is a diagnosis associated with sudden onset OCD, tics or severe eating restrictions with at least two other associated cognitive, behavioural and neurological symptoms. PANDAS (Paediatric Auto-immune Neuro-psychiatric Disorder associated with Streptococcus) is a subgroup diagnosis of the above, but associated with a sudden onset of symptoms after an infection. The diagnosis is difficult to recognize in autistic children, as there is often an overlap of symptoms.