Abstract
Introduction
Method
Results
Discussion
References
Tables
Appendix
Related Links
 
 


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kscola@anselm.edu

  The Relationship Between A Gluten and Casein-free Diet and
                                 Behavioral  Improvement in Children With Autism 
                                    and Other Pervasive Developmental Disorders 
                                                       By: Kristen N. Scola


 Abstract 

    There has been a recent trend of turning to the field of alternative medicine for the treatment of a variety of developmental disorders. This is especially evident in the realm of autism and its allied disorders. Researchers are currently examining the possibility that many symptoms of autism are in fact the results of a metabolic deficiency caused by food allergies. This study looks in particular at autistic individuals’ intolerance to gluten and casein, proteins found in wheat and dairy, and the efficacy of a gluten and casein-free diet as a treatment for characteristic autistic symptoms. The subjects of this study included 23 children with an autistic disorder or PDD-NOS, ranging from 2 to 14 years of age. All were currently participating in a gluten and casein-free diet. The parents of these children completed a modified version the ARU Post Dietary Questionnaire (Shattock, 2002). It was hypothesized that the gluten and casein-free diet would be correlated to an improvement in behavior. The length of time the child has been on the diet, the age in which the diet was implemented, and the level of adherence to the diet were also looked at in relation to the child’s behavioral outcomes. It was also expected that the parents of the children would attribute their children’s changes in behavior to the diet itself. A series of matched T-tests showed that the participants showed significant improvement in communication, social interaction, stereotypical behaviors, and eye contact after the implementation of the diet. Additionally, a significant correlation was found between how well the diet was adhered to, and an improvement in the children’s overall eating behaviors. The parents believed that the majority of the positive changes in their children’s behavior were a direct result of the gluten and casein-free diet. This study is a testament to the strong role that diet and nutrition can play in the treatment of developmental disorders. Furthermore, it raises awareness of the importance of early screening for allergic disease in young children in order to improve the likelihood of preventing the onset of autism and other related disorders. 

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Introduction

Within the past few years, there has emerged a much more holistic approach for treating children with behavioral and neurological disorders. Prior to this, there was the popular trend of turning to prescription drugs for many of children’s behavior problems. A prime example of this would be the surge in Ritalin prescriptions for all children who displayed the slightest cases of hyperactivity or an inability to concentrate. However, parents are now beginning to realize thhat there are serious medical consequences to heavilymedicating such young children.The side effects of Ritalin alone can include reduced appetite, weight loss, stomachaches, and insomnia. Although prescription drugs are necessary in many cases, a good portion of the answer may lie on the dinner table and in the snack-food aisle, and not in the medicine cabinet (Schardt, 2000).
      In the 1970’s, Dr. Benjamin Feingold, an allergist from California, claimed that he observed remarkable improvements in the behavior of his patients after placing them on restricted diet plans due to their food allergies. Feingold hypothesized that food additives and dyes as well as salicylates, which is a naturally occurring chemical in many fruits, were the culprits behind the problem behaviors in many children with ADHD and other behnavior problems (Schardt, 2000).
     Another excellent example of a more natural approach to treating illness in children is the widespread use of the ketogenic diet for children with epilepsy. Epilepsy is a neurological disorder, typically marked by uncontrollable seizures. The ketogenic diet consists of foods that are high in fat content, and low in carbohydrates and protein.In 1994, Dr. John Freeman tested the efficacy of this diet using 125 children who suffered from severe and frequent epileptic seizures, and were not previously on the ketogenic diet. After three months, of the 125 children, 3% were seizure free and 57% had a decrease in seizures of between 50 and 90 percent.
     Up until the past 10 years, the vast majority of treatments for individuals with autism and other pervasive developmental disorders have been mostly behavioral in nature (Whiteley, Rogers, Savery, & Shattock, 1999). Recently there has emerged a great deal of research regarding the biochemical and metabolic origins of autism. There are three basic categories of types of interventions for children with  these disorders. First researchers have looked at the relationship between Candidasis and autism. Second, the use of megavitamin therapy has proved succesful in imporoving language and coginitive functioning in children (Pheiffer & Norton, 1995). Finally, there has been a recent examination ofconducted on the possibility of food sensitivities and allergies being a possible cause of autism in some individuals; specifically focusing on intolerance to gluten and casein. 
      Gluten is a protein commonly found in wheat, oats, barley and rye, while casein can be found in cow’s milk. Both substances however, have a comparable chemical make-up. For this reason, it is believed that if an individual is particularly sensitive to one of these proteins, then they more than likely will be sensitive to the other as well (Adams & Conn, 1997).  If a person consumes these substances, and is unable to metabolize them, a peptide will form. A peptide is a short chain of amino acids. Normally, these peptides will be removed through the individual’s urine. However, in some cases an excess of these peptides can cause a small amount of them to move into the brain, and adversely affect signal transmission (Schardt, 2000). This in turn will hinder normal functioning of the nervous system, resulting in behaviors characteristic of autism. This theory has been coined the “opioid-excess theory” (Schardt, 2000). A great deal of literature has demonstrated that diets that are free of both gluten and casein are extremely beneficial to individuals with autism.
      In 1999,Whitley, Rodgers, Savery, and Shattock conducted a study on the short-term effectiveness of gluten-free diets on a group of children with a variety of developmental disorders. Twenty-two children completed the gluten-free diet trial. The parents of these children reported an initial regression of behavior upon the implementation of the diet.  However, after the children had remained on the diet for a 3 month period, the parents reported that 50% of the children showed improvements in verbal and non-verbal communication 45% showed better attention and concentration, 45% showed a decrease in aggressive behaviors and 36% showed improved physical coordination and motor skills, as well as a heightened self and environment awareness (Whiteley et al, 1999). As for the teachers of these children, they reported that 13 of the 22 demonstrated “global improvement in their behavior”Additionally, 94% of these parents stated that their children would remain on the gluten free diet following the study (Whiteley et al, 1999). 
     In another study,Knivsberg, Reichelt, Noland, and Hoien looked at how diet can affect an autistic child’s capacity to learn (1995).Although the expressed traits of autism can be extremely different from one case to the next, almost all autistic children share one common symptom, which is an indifference or unwillingness to learn. They do not have the typical curiosity about the world around them that other children have, nor do they have the instinctive drive to seek knowledge (Knivsberg et al., 1995). A longitudinal study was conducted that followed 15 young individuals with autism, who were undergoing thegluten and casein-free diet, for a period of four years.Each of the participants had partaken in a preliminary urine analysis that demonstrated that they had an elevated number of peptides present in their bodies. After only one year, 12 of the 15 children showed a remarkable increase in problem-solving skills, visual & auditory reception and expression, and memory. Also, the linguistic skills of the children demonstrated greater improvement than the skills of typical children do in one year’s times. 
     As of right now, the amount of research regarding the links between autism and diet are extremely scarce. The possibility of autism being an allergic disease or a byproduct of food intolerance has only recently been explored. In the 1970’s the estimated occurrence of autism was approximately 1 out of every 10, 000 children.. Today, it has risen to a frightening 1 in 1,000 children (Worth, 2000). At the same time there has been a very similar rise in the number of cases of allergic disease. Between six and eight percent of all infants are born with an adverse allergy to some food substance ). If there is a possible connection between these two phenomenons, then further research of the metabolic roots of autism may shed light on a future cure for the disease. 
     In the present study, “improved behavior” will be operationally defined as an increased level of social interaction, increased eye contact, increased verbal and non-verbal communication, decreased self-injurious behavior, and a decrease in aggression. It is hypothesized that the gluten and casein-free diet will be correlated to an improvement in behavior. Second, it is believed that the child’s age at the implementation of the diet will be positively related to the child’s improvement in behavior. Third, it is expected that a child’s length of time on the gluten and casein-free diet will be correlated to the child’s behavior pattern. Finally it is predicted that the more strictly the diet is adhered to, the greater the behavioral outcome will be.

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Method

Participants

     The subjects of this study included 23 with an autistic disorder or PDD-NOS. The children ranged in age from 2 1/2 to 14 years of age, with an average age of 6 1/2 years. All of these children have been placed on a diet free of gluten and casein proteins. Twenty-two of the parents reside in the United States, and one resides in Canada.  They are all members of a national dietary intervention support group. The parents were recruited via email or written letters. 

Instruments
     The measure for this study, which is provided in Appendix A, was a modified version of Paul Shattocks’ Post Dietary Questionnaire. The survey is a total of five pages in length, and was completed by the parents of the children.  At the beginning of the survey there was a statement of informed consent. The statement explained the purpose and goals of the study, and ensured complete confidentiality to the participants. In order for the information of these questionnaires to be used, the parents must have signed the written consent form. The questionnaire is divided into three sections. Section 1 consists of general information about the child. (e.g.  age, date of diagnosis, length of time on the diet, etc.) Section 2 of the survey asks the parents to rate the dietary effects on the children’s behavior. The parents were required to rate the degree in which a certain behavior changed following the implementation of the diet. The parent rated the child’s behavior as either a “Substantial Improvement,” Improvement,” “No Change,” “Worsening,” or “Substantial Worsening.” Section 3 contains two open ended questions in which the parents are asked to state the main changes they have noticed in their child over the course of their diet, and the main problems they have encountered over the course of the diet thus far.

Procedure
     A written questionnaire was mailed to the participant’s homes in September of 2003. The parents will be instructed to provide accurate background information about their child, and then to honestly rate their children’s improvement in their daily behaviors. Following the survey’s completion, the surveys were returned using the self-addressed stamped envelope provided. The responses provided by the participants will then be read and recorded for analysis. 
 

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Results

Diet Implementation 
   A significant, negative correlation was observed between the age the child began the gluten and casein-free diet and the amount of aggression the child displayed, 
r(23)= -.43, p<.05. In other words, the younger the child was when the diet was implemented, the better control over aggressive behaviors while on the diet.
There was also a significant correlation between age of diet implementation and stereotypical behaviors, r (23) =. 43, p<.05. The younger the child was at the start of the diet, the less stereotypical behaviors were observed once they were placed on the diet.
However, when estimated annual household income and the number of hours per day spent one-on-one between parent and child were controlled for, using a partial correlation, the results for both of these correlations were no longer significant.

Adherence to Diet
 There was also a significant relationship between how well the child adhered to the restrictions of the diet and their change in overall eating behaviors, r (23)=.44, p<.05.  In other words, the more strictly the diet was adhered to, the more positive eating habits the child developed.

Behavioral Change
A series of matched t-tests were computed to examine parental reports of behavioral change pre- and post-diet. The behaviors that were examined included: verbal and non-verbal language, eye contact, social behavior, stereotypical behaviors, and self-injurious behavior. As for verbal and non-verbal language, a significant matched t-test was found, t(21))= 4.16, p<.001.  The children showed substantial improvement (M=2.48, SE= .11) in their communication skills following the implementation of the diet (M=1.70, SE= .15). There was also significant improvement in the children’s social interactions after the start of the diet, t(22) =6.58, p<.001. Social interactions were better (M=1.78,SE=.13) after the diet compared to before the diet.(M=2.87, SE=.13). A significant t-test was found for stereotypical behaviors as well, t(22)=2.71,p<.05. The children engaged in fewer behaviors that were stereotypical to their disorder (M=2.43, SE=.15) once the diet was imposed (M=1.96,SE=.13) Additionally, there was a significant difference between the children’s ability to make eye contact, t(21)=3.38, p<.01. The children were more successful at sustaining eye contact after the implementation of the diet (M=1.63,SE=.14) than they were before (M=2.32, SE=.12).
   Another series of matched t-tests was performed to look at the relationship between the children’s behavioral outcomes and how greatly the parents attributed these outcomes to the diet itself. Significance was found for ignoring behaviors, social interaction, eye contact, hyperactivity, stereotypical behaviors, self-injurious behaviors, aggression, eating patterns, attention, and physical coordination.(See Table 1). Meaning that the parents viewed their children’s positive changes in the aforementioned behaviors, as a direct result of the gluten and casein-free diet

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Discussion
     The purpose of this study was to look at the efficacy of gluten and casein-free diets for the treatment of behavior problems in children with autism and other related developmental disorders. The first hypothesis, that the implementation of the diet would lead to an improvement in the children’s behavior, was supported. The behaviors that were examined pre and post-diet included verbal and non-verbal language, eye contact, social skills, stereotypical behavior (i.e. self-stimulatory behavior, echolalia, repetitive/obsessive behavior), and self-injurious behavior.  There were significant improvements in the children’s ability to communicate, make eye contact, and engage in social interactions, and a significant decrease in negative stereotypical behaviors. 
    These results should be extremely encouraging for parents carrying out a gluten and casein free diet for their children. The aforementioned behaviors (language, eye contact, social interaction, and stereotyped behaviors) are at the heart of most behavioral problems that children with these developmental disorders are plagued with. Therefore, if a dietary intervention can recover some of these skills, it provides great hope for parents whose search for possible treatments have thus far been fruitless. 
   The vast majority of parents who participated in this study were currently engaging their children in additional behavioral interventions. 74% of the children were undergoing either TEACCH, ABA therapy, SONRISE, auditory integration therapy, or were using a facilitated communication device. However, he parents maintained that their children’s improvement in social interaction, eye contact, eating habits, attention, and physical coordination, as well as a decrease in ignoring behaviors, hyperactivity, stereotyped behaviors, self-injurious behaviors, and aggression, were all directly connected to eliminating gluten and casein from their children’s diet. 
     The second hypothesis of this study was not supported. It was expected that children who began the diet at a younger age would respond better to the diet (i.e. show more dramatic improvement), than those who did not begin the diet until they were older. This notion was based upon literature discussing the “opioid excess theory” which ascribes to the metabolic origins of autistic behavior (Schardt, 2000).Thus resulting, in many of the symptoms mentioned. If a child had continued on with a digestive imbalance for many years, one would think that it would give a greater opportunity for increased peptide build-up in the nervous system, thus allowing for increased impairment. In turn, the diet would not have as profound of an effect as compared with a young child, who began the diet immediately after their diagnosis. The statistics, nonetheless, showed that the children, regardless of age of diet implementation, showed a similar pattern of behavioral improvement. The Pearson test showed that improvement in stereotyped behaviors, and aggression were correlated with the age in which the diet was began. Once the variables of annual household income, and the number of hours spent one-on-one with child were controlled for, these results did not hold. In other words, it is quite possible that confounding factors such as amount of money invested in the child, and amount of alone time spent between parent and child could have the same effect on these two isolated symptoms.
 Furthermore, it was predicted that the longer the children were on the diet, the more marked their changes in behavioral symptoms would be.  The results of this particular study showed this not to be the case.  These results should not be disheartening to parents who are undergoing this diet plan with their children and are expecting their children’s improvement to continue as time goes on. This diet is still extremely new. The prevalence of dietary intervention as a treatment for children with autism, and other related disorders has only emerged within the past decade. Fifty-two percent of the children had been on the diet for a period of a year or less, 35% had been on the diet for less than two years, and 17% had been on the diet between 3 and 4 years. Therefore, one cannot assume anything about the future of the diet until these individuals have continued to live gluten and casein-free for a much longer period of time. 
      Finally, the fourth hypothesis was partially supported. A correlation was found between adherence to the diet and improvement in eating behaviors.  A common trait in many children with autism and other developmental disorders is a refusal to eat, or extremely finicky eating patterns (i.e. no variety in their food choices, or only eating non-nutritive foods). This study demonstrates that the more strictly the diet was followed, the more positive eating habits the children would develop. 
      However, one has to be cautious when interpreting these findings. Due to the nature of this study, one cannot infer a direct cause and effect relationship between the diet and the behavioral outcome. Prior history of the children, levels of severity of their disorder, and their home environments cannot be controlled for. Also, their change in behavior was not accurately charted by a medical professional throughout the course of the diet.   Another major factor that is absent in the design of this study, is a control group. In an ideal study that tests the effectiveness of dietary intervention, there would be a population sample that had never undergone, and would not undergo any dietary or behavioral treatment, and they would be compared to the experimental group.
    Metabolic dysfunction may not be the one and only root of autistic behavior. Nonetheless, a study such as this shows that there is clearly a connection between the two. There is a tremendous amount of opportunity for future research in the area. Ideally, there will be a follow-up of this cohort to see their behavioral progress 3 to 5 years down the road.  With such a vast amount of allergic disease among children, there should be increased testing of possible dietary and metabolic imbalances at infancy. IgG and IgE screening can test for increased levels of immunoglobins, which can predict sensitivity to certain foods (Guptar & Aggarwal, 1996). Early detection of these allergies could prevent these behavioral symptoms from ever arising. In the future, with hope, we will be able to avert the onset of these childhood metabolic deficiencies, and dramatically decrease the behavioral syndromes that can arise from them. 
 

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References
Adams, L. &  Conn, Susan. (1997). Nutrition and its relationship to autism. Focus 
     on Autism & Other Developmental Disabilities, 12(1), 53-59. 

Freeman, J.M. (1998). The efficacy of the Ketogenic Diet-1998: A prospective 
     evaluation of intervention in 150 children. Pediatrics, 102(6), 1358-1364.

Guptar, S. & Argawal, S. (1996) Brief Report: Dysregulated immune system in children 
      with autism. Journal of Autism & Developmental Disorders, 26(4), 439-453.

Knivsberg, A. et al (1995). Autistic syndromes and diet: a follow up study.
     Scandinavian Journal of Educational Research, 39(3), 223-236.

Phieffer, S. & Norton, J. (1995). Autistic syndromes and diet: a follow up study. 
     Scandinavian Journal of Educational Research, 39(3), 223-236.

Schardt, D. (2000). Diet & Behavior in Children. Nutrition Action Health Letter
     27(2), 10-12.

Whitely, P et al. (1999). A gluten-free diet as an intervention for autism and associated 
     spectrum disorders: preliminary findings. Autism, 3(1), 45-65.

Williams, J.I. et al (1978). Relative effects of drugs and diet on hyperactive behaviors: 
     An  experimental study. Pediatrics, 61(6), 811-817.

Wood, R.A. (2003) The Natural history of food allergy. Pediatrics, 111(6), 
     1631-1638.

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Tables

Table 1
____________________________________________________________________ 
Behavior                      M                    SE                 M              SE             t            df 
Ignoring**                  1.70                 .10                 1.43           .11           2.79        22  Social*                       1.78                 .13                 1.52           .12           2.31        22
Eye contact**            1.61                 .14                 1.26           .09           2.91        22
Language                   1.70                 .15                  1.57           .15           1.41        22
Facial gestures           1.87                  .16                 1.87           .14           0.00        22
Hyperactivity*            2.14                 .19                 1.68          .17            2.66        21
Stereotypical**          1.96                 .13                 1.57          .14            3.92        22
Self-injurious*            2.23                 .19                 1.86          .19            2.16        21
Aggression***           2.14                 .17                 1.63          .17            3.92        21
Tantrums                    1.59                 .14                 1.31          .12            1.82        21
Resists change            1.78                 .15                 1.61          .14            1.28        22
Eating habits***         2.09                 .18                 1.39          .14            4.06        22
Attention**                1.91                 .14                 1.52          .14             3.22       22
Coordination*            2.26                 .14                 1.96          .16             2.61       22
_____________________________________________________________________ 
* p<.05    ** p<.01    *** p<.001 
 

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Appendix

 
 Post - dietary Questionnaire 
IMPORTANT:  Please read the information below.

The purpose of this questionnaire is to give parents an opportunity to comment on the results of using a gluten and/or casein free diet with children with autism or associated spectrum disorders. 
The first part of this questionnaire has been structured to gain specific information on aspects of the child’s functioning while on the diet/s, and the type and level of information and support parent’s received.  The second part of this question is designed in a very much more open fashion, allowing parents to comment on aspects of the diet which they believe are important. 

We are eventually hoping to use the information you have provided here to further examine the use of diets of this kind, and provide both parents and clinicians with more detailed evidence of how the diets are used and how successful as interventions they are viewed. 

I would ask you to sign the consent form below if you do not object to the information you provide in this questionnaire being used in this way.  In the event that material you have included in this questionnaire is used in the production of research publications, or other such material, we will contact you and discuss the appropriate use of this information.  The child’s identity will be protected at all times. 


Consent form.
Name of child’s parent or guardian  ..................................................................................................... 

Signature .............................................................  Date ............ / .................. / .................. 
 

Please complete the information below (in block capitals). 

Child’s Date of birth .... / .... / ....Child’s SexMF

Current address: .................................................................................................................................. 

City: ........................................................................ Postal code: .............................................. 

Home telephone number (including dialing code):………………………………

Some questions have, as part of their answer format, a circle (shown as O). 
In such cases, please mark the circle which best describes your response. 
For example:  O   Yes       O   No
 

1. General Information.

1.1   Has your child got an official diagnosis:  O   Yes       O   No
1.2   Official diagnosis of child: ........................................................................................................
1.3   Date diagnosis was given: .................... / .................... / ....................
1.4   What kind of dietary intervention did you use?
O   Gluten - free diet  O   Casein - free diet  O   Both

1.5   How old was your child when s/he started the diet? .......... (Years) .......... (Months)
1.6   Which month of the year did your child start the diet? ....................................................
1.7   How long has your child been on the diet?  .......... (Years) .......... (Months)

1.8   Please indicate which of the following interventions your child is currently following:
O TEACCH (or similar educational scheme)    specify: ...............................................
O Lovaas therapy
O Option (Son - Rise Program)
O Higashi
O Auditory Integration therapy
O Facilitated Communication
O Vitamin therapy
O Drug therapy          specify: ...............................................
O DMG
O Other elimination diets (e.g. Feingold) specify: ...............................................
O Other          specify: ...............................................
O None

1.9 Where did you first hear about the use of dietary interventions and autism?
O   Autistic society O   Support group O   Newspaper / Magazine O   Television
O   Conference  O   Internet  O   Other
      specify: .................................................................
  1.10   Please rate the following items according to your child’s capabilities before dietary 
           intervention. 
Language (vocal communication)   O No problems O Some difficulty O No speech 
Eye contact                                      O No problems O Some difficulty O No eye contact 
Developing social relationships      O No problems O Some difficulty O Great difficulty 
Forming and exchanging 
emotional bonds                              O No problems O Some difficulty O Great difficulty 
Engaging in imaginative play         O No problems O Some difficulty O Great difficulty 
Stereotyped behaviors                    O No problems O Some difficulty O Great difficulty 
Self - injurious behavior                 O No problems O Some difficulty O Great difficulty

1.11   When did you first recognize your child was having problems? 
O   From birth        O   Within the first year        O   12 - 17 months        O   18 - 24 months 
O   Other   specify: ............................................... 
1.12. What is your annual household income?
1.13   How many hours do you spend with your child on an average day?
2. Dietary effects. 
2.1   How well did your child adhere to the diet/s? 
O   Always O  Nearly  Always O   Sometimes  O   Rarely O   Never 
2.2   How much would you say behavior has changed as a result of the new diet/s ? 
O   Substantial     O Improvement    O   No change    O   Worsening    O   Substantial 
     Improvement                                                                                             Worsening 

Previous research has suggested that some children using these types of dietary intervention show variable patterns of improvement and regression in behavior at different stages of the diet/s. 
The following questions are designed to gauge parental observations of behavior changes (if any) at different times of dietary intervention (initial changes and substantial changes). 
2.3   How long after the implementation of the diet did you notice an initial change in behavior? 
Gluten - free diet: 
O    Never    O    Within that day    O    A few days    O    A week    O    A couple of weeks 
O    A month    O    A few months    O    Longer 
Was this initial change an improvement or worsening of behavior? 
O   Improvement O   Worsening 
Casein - free diet: 
O    Never    O    Within that day    O    A few days    O    A week    O    A couple of weeks 
O    A month    O    A few months    O    Longer 
Was this initial change an improvement or worsening of behavior? 
O   Improvement O   Worsening 
2.4   How long after the implementation of the diet did you notice a more substantial change in behavior? 
Gluten - free diet: 
O    Never    O    Within that day    O    A few days    O    A week    O    A couple of weeks 
O    A month    O    2 - 3 months    O    up to 6 months        O    Longer 
Was this substantial change an improvement or worsening of behavior?
O   Improvement O   Worsening 
Casein - free diet: 
O    Never    O    Within that day    O    A few days    O    A week    O    A couple of weeks 
O    A month    O    2 - 3 months    O    up to 6 months        O    Longer 

Was this substantial change an improvement or worsening of behavior? 
O   Improvement O   Worsening 
 

2.5   Please indicate the level of change (if any) with regard to the following behaviors: 
Ignores people                    O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                             Improvement                                                                                 Worsening 
Poor social interaction          O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                             Improvement                                                                                  Worsening 
Poor eye contact                  O   Substantial     O Improvement    O   No change    O   Worsening    O   Substantial 
                                              Improvement                                                                                 Worsening 
Lack of vocal / non - voca     O   Substantial     O Improvement    O   No change    O   Worsening    O   Substantial 
communication                        Improvement                                                                                Worsening 

Lack of appropriate facial       O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
gestures                                  Improvement                                                                                 Worsening 
Hyperactivity                      O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                             Improvement                                                                                  Worsening 
Stereotyped behaviors           O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                              Improvement                                                                                 Worsening 
Self - injurious behavior        O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                             Improvement                                                                                  Worsening 
Aggression to others             O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                               Improvement                                                                                 Worsening 
Frequency & severity of        O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
tantrums                                  Improvement                                                                                  Worsening 
Resistance to change             O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                             Improvement                                                                                    Worsening 
Eating problems                  O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                             Improvement                                                                                    Worsening 
Unstable attention                O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
                                              Improvement                                                                                  Worsening 
Lack of physical                   O   Substantial     O  Improvement    O   No change    O   Worsening    O   Substantial 
co - ordination                          Improvement                                                                                   Worsening 

2.6   How much would you say these changes are due to the introduction of the diet/s ? 
Ignores people                                   O   Directly connected  O   Possibly connected O   No connection 
Poor social interaction                        O   Directly connected  O   Possibly connected O   No connection 
Poor eye contact                                O   Directly connected O   Possibly connected O   No connection 
Lack of vocal / non - vocal comm.        O   Directly connected O   Possibly connected O   No connection 
Lack of appropriate facial gestures         O   Directly connected O   Possibly connected O   No connection 
Hyperactivity                                    O   Directly connected O   Possibly connected O   No connection 
Stereotyped behaviors                        O   Directly connected O   Possibly connected O   No connection 
Self - injurious behavior                     O   Directly connected O   Possibly connected O   No connection 
Aggression to others                          O   Directly connected O   Possibly connected O   No connection 
Frequency & severity of tantrums         O   Directly connected O   Possibly connected O   No connection 
Resistance to change                          O   Directly connected O   Possibly connected O   No connection 
Eating problems                                O   Directly connected O   Possibly connected O   No connection 
Unstable attention                             O   Directly connected O   Possibly connected O   No connection 
Lack of physical co - ordination           O   Directly connected O   Possibly connected O   No connection 
 
 

3.  Your views. 
3.1   What are the main changes you have noticed over the period of the diet? 
 
 
 
 
 
 
 

3.2 What were the main problems you encountered over the course of the diet?
 

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Related links

For more information on Gluten and Casein-Free diets:
 http://www.gfcfdiet.com/
 

GFCF Kids Support Group:
 http://health.groups.yahoo.com/group/gfcfkids/
 

St. Anselm College Website:
http://www.anselm.edu/
 
 
 

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