Introduction
“There is one thing stronger than all the armies in the world, and that is an idea whose time has come.”
—Victor Hugo
Why Buy This Book?
Although written for children with Attention Deficit Hyperactivity Disorder (ADHD) or autism spectrum disorders (ASD), it can be helpful for any child with a variety of behavioral or developmental challenges. Because it may be easier to change the entire household’s diet at the same time, this book is also written for the families. Other family members are often surprised by improvements in their own health and behavior.
You may wonder how this book is different from other elimination diet recipe books. We believe this book is different in several ways:
When implementing a special diet, it is hard to take “on faith” that it may help. This book explains the reasons why diet changes may help your child’s brain and body function better.
We recognize that it is much easier to recommend a specialized diet than to actually implement it. This book includes helpful suggestions on how to begin and how to maintain a specialized diet.
We are aware that changing diets in children, especially children who are picky, can be a challenging undertaking. This book includes many helpful hints for dealing with the picky eater.
Not everyone likes or has time to cook. We have included “Quick N Easy” versions of recipes for parents on the go. For those who prefer more complex recipes, we have included those as well.
Children with ASD often have additional challenges, in both behavior and biochemistry, which can make feeding an even more difficult task. This book includes ways to hide or disguise nutritious and healthy foods in ways children will accept.
Many books about specialized diets focus only on the elimination of gluten and casein. There are subsets of children who may also react to other common offending foods such as soy, egg, corn, and nuts; yeast-promoting foods; and food components such as phenols (including salicylates), double sugars (disaccharides), and oxalates. This book includes recipes that are free of multiple offending foods.
This edition includes more of the diets currently being used for children with autism, ADHD, and other challenges. It also includes new recipes or modifications to previous recipes, appropriate to the additional diets.
This book focuses not only on what is being taken out of a diet, but also on what is put back in. The goal of elimination diets is not just removing unhealthy or potentially harmful foods, but also providing nutritious, appealing foods in their place.
What Is Attention Deficit Hyperactivity Disorder?
ADHD is a collection of symptoms including inattention, hyperactivity, and impulsivity. There is no blood test that can diagnose ADHD. It is diagnosed by a certain number of symptoms presenting in a particular combination. A paraphrasing of these symptoms from the manual that provides the current definition of ADHD, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, or DSM-5, follows:
INATTENTION SYMPTOMS: Failure to pay close attention to details or making careless mistakes in schoolwork or other activities, difficulty sustaining attention, often not seeming to listen when spoken to directly, often not following through on instructions or failure to complete tasks, difficulty organizing tasks and activities, avoiding tasks that require sustained mental effort (such as homework), losing things necessary for tasks and activities, easy distractibility, and frequent forgetfulness in daily activities (tying shoes, zipping up pants, etc.)
HYPERACTIVITY SYMPTOMS: Fidgeting or squirming, difficulty staying seated when expected to, running or climbing in situations in which it is in-appropriate, difficulty playing quietly, often acting as if driven by a motor, and talking excessively
IMPULSIVITY SYMPTOMS: Blurting out answers before questions are finished, difficulty awaiting his/her turn, and often interrupting conversations or intruding
Children who have at least six symptoms of inattention are described as having ADHD, Predominantly inattentive presentation. Children who have at least six symptoms in some combination of hyperactivity and impulsivity are described as having ADHD, Predominantly hyperactive-impulsive presentation. Children who meet both of these requirements are described as ADHD, combined presentation.
There are some important things to keep in mind regarding the diagnosis of ADHD:
Everyone can experience periods of difficulty with attention or hyperactivity. An ADHD diagnosis requires that symptoms be present for at least six months.
By definition, ADHD symptoms begin before age twelve. This does not mean symptoms were significantly impairing before twelve because symptoms may not become a problem until demands exceed the child’s abilities.
To have ADHD, symptoms must be impairing to social or academic functioning. ADHD symptoms are not always a problem; it is a matter of degree. They must also occur in more than one setting, such as at home and at school.
Symptoms must be inappropriate for the child’s developmental age, not chronological age. If a four-year-old child has developmental delays and is functioning at a two-year-old level, his ADHD symptoms must be out of the norm for a two-year-old, not a four-year-old.
Most important, not every child who presents with ADHD symptoms has ADHD. Part of the definition is that these symptoms must not be better explained by some other diagnosis. Children who are anxious or depressed or who have learning disabilities or allergies and food intolerances will also not pay attention well.
There are many approaches to treating ADHD. This book is not meant to diagnose ADHD or take the place of advice from your child’s medical professional. Rather, it provides ideas for how to optimize your child’s nutrition so that his or her brain can work at its best. For some children, diet changes alone may be sufficient to treat symptoms. For others, some combination of diet, nutritional supplements, school accommodations, therapies, tutoring, and/or medication results in the best outcome. When the brain is working at its best, a child can be more responsive to these other treatments.
What Is Autism? Why Is It Called Autism Spectrum Disorder?
Autism is a developmental disorder that is also defined according to the DSM-5, The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. It is a much more complex disorder than ADHD, but like ADHD, it has no specific blood test or brain scan that can make the diagnosis. It is also a collection of symptoms. In May 2013, when the DSM was revised to its 5th edition, there were some significant changes made to the diagnostic criteria for autism. Previously, autism was characterized by symptoms in 3 different areas: social interaction, communication, and restricted interests/repetitive behaviors, with a combination of some, but not all, symptoms required for a diagnosis. In the DSM-5 criteria, social interaction and communication were combined into a single category. Individuals must now have all 3 criteria in the social interaction and communication category along with at least 2 out of 4 criteria in the restricted interests and repetitive behaviors domain. In addition, for the first time, sensory symptoms were included in the diagnostic criteria. The diagnostic categories are:
PERSISTENT DEFICITS IN SOCIAL COMMUNICATION AND SOCIAL INTERACTION:
1. Deficits in social-emotional reciprocity: Ranging from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
2. Deficits in nonverbal communicative behaviors used for social interaction: Ranging from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact or body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication
3. Deficits in developing, maintaining, and understanding relationships: Ranging from difficulties adjusting behavior to fit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers
RESTRICTED, REPETITIVE PATTERNS OF BEHAVIOR, INTERESTS, OR ACTIVITIES:
1. Stereotyped or repetitive motor movements, use of objects or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases)
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal and nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day)
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests)
4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)
Another significant change within the DSM-5 was the elimination of previous diagnostic categories such as Pervasive Developmental Disorder (PDD) and Asperger’s Disorder; they are now all included under the broad label of Autism Spectrum Disorder (ASD). The term ASD encompasses the wide range of combinations of symptoms and levels of severity that can be seen within an autism diagnosis. From a functional medicine perspective, the distinctions are less critical, since the goal of treatments such as elimination diets is to improve function regardless of the “label” applied to the symptoms.
DSM-5 also changed the age of onset criteria. The previous criteria required that symptoms be present before age 3 years. In the DSM-5, symptoms must be present in the early developmental period, but the criteria allow for the fact that these may not become fully evident until social demands exceed the child’s limited capacities.
An important feature of ASD is that the diagnosis is not just about delayed development or lack of certain skills. Much of it is about the quality of a skill or interaction. A child can amass a great deal of language, but if it is not used to communicate, that is unusual. For example, a child may be able to recite an entire book from memory but not be able to have a conversation. His language may seem advanced, but his ability to communicate is not typical.
Regardless of the label given to a particular child’s symptoms, many children with ADHD or ASD respond very well to changes in diet and nutrition. The purpose of optimizing nutrition is to also optimize brain and body function, so that children can respond to all the other treatments provided and have the best possible outcome. Other chapters in this book will describe some of the unique biochemical problems children with ASD have that are different from those seen in children with ADHD.
What If I’m Not Sure If My Child Has ADHD or Autism? Can This Book Still Help?
Your child does not need to have a specific diagnosis in order to benefit from this book. As you read about the symptoms and the dietary connections, you may find that some of the advice resonates with your child’s symptoms. Again, this book provides help in giving the brain and body what is needed and taking away what is not needed in order to achieve optimum results.
Will Diet Alone Be Enough to Treat My Child’s Symptoms?
Children with ADHD or ASD often require a comprehensive set of treatments. There is no one cause of ADHD or autism and, therefore, no single treatment. Particularly for the child with autism, he or she may have genetic predispositions, inborn errors of metabolism, immune dysfunction, maldigestion, malabsorption syndromes, and food reactions. These differences are then modified by a wide range of environmental factors that can potentially increase susceptibility to autism: birth trauma, pathogen exposure, toxins, heavy metal exposures, unusual vaccination reactions, allergens, pesticides, poor diet, nutritional deficiencies, and other stressors. Typically, it is not any single factor that is the cause, but the cumulative effect known as the “total load” that tilts the balance in these children. The current research focus is aimed toward identifying the many potential risk factors, establishing more preventive measures, improving early diagnosis, establishing early interventions, and expanding the effectiveness of therapies and treatments.
We visualize our approach as three “legs” on the treatment “table,” all of which are important for keeping the table steady and balanced.
THERAPIES. These can include behavioral therapies or organizational strategies and educational interventions (special education, speech or occupational therapy, etc.).
MEDICATIONS. Depending on the need, medications are used as appropriate to each child.
BIOMEDICAL COMPONENT. Diet and nutrition are critical components of the overall treatment plan because they address underlying core problems affecting the body and the brain. We are much more than what we eat—we are what we eat, digest, absorb, and utilize. Unfortunately, diet and nutrition are often overlooked or dismissed, when, in fact, many of the symptom presentations in ADHD or autism are directly related to nutritional deficiencies, disturbances in nutrient metabolism, poor diet, the negative effects of specific foods, and problems in digestion and absorption.
For optimum results, all three legs need to be considered. This book focuses on one part of the biomedical leg of that table—the diet.
What Are the Diets?
There is no one diet that is right for all people, and this is especially true in those with ADHD or autism who can benefit from one or more elimination diets. Based upon each individual’s unique biochemistry, digestive status, and reactions to foods and food components, there are many types of elimination diets that are helpful. It is important to understand that these diets or combination of diets are specific to the individual’s sensitivities and are not necessarily applicable to all children diagnosed with ADHD or autism. The most common, and frequently most effective, elimination diet for autism and ADHD is a regimen of eating and drinking that focuses on the elimination of gluten and casein. Although other foods may also be bothersome, these two proteins are by far the most common offenders. Casein is the main protein found in milk products, but don’t confuse “milk-free” with “casein-free,” as casein is found in products other than milk. It is found in other dairy products such as yogurt and ice cream and also in many baked goods and other unexpected places such as certain canned tuna.
Gluten is a protein found in wheat and other grains. Again, “wheat-free” is not the same as “gluten-free.” A more in-depth discussion of these proteins, their sources, and substitutes can be found in Chapter 4.
For many children, the elimination of casein and gluten is enough. There are increasing numbers of children who react to other foods such as soy or corn. Others may react to chemicals in foods (such as phenols or salicylates) or to artificial preservatives and dyes. Still others may have difficulty tolerating certain types of carbohydrates. A subset may need to adjust diet to address bacterial overgrowth of the intestine. This edition includes more in-depth discussions of diets beyond the gluten-free casein-free diet, including the Feingold/low phenol/low salicylate diet, the Specific Carbohydrate Diet (SCD), GAPS diet, low oxalate diet (LOD), FODMAP, and diets focused on targeting yeast overgrowth and inflammation. Most of the recipes in this book are gluten- and casein-free; others are also free of soy, corn, and other potentially bothersome foods. We have also adapted the recipes, where possible, to be compatible with the other diets discussed. In Chapter 2, we provide a concise overview of the diets and support strategies, followed by individual chapters on each of the diets beginning with specifics on a healthy diet. In Chapters 12 and 13, we provide tips on getting started and solutions for common concerns. In Part II, we provide some guidelines and recipes by categories. Our goal is to provide guidance and recipes for the broadest group of children on specialized diets.
Are There Tests to Help Determine If My Child Needs a Specialized Diet?
This question will be discussed in detail in later chapters. In general, nutritional and dietary treatment approaches should be based on determining the specific reactions, underlying biochemical, metabolic, immune, digestive, and nutritional imbalances present for each child. Fortunately, the science of nutrition has caught up with the decades of clinical and anecdotal observations. Now, there is an abundance of sophisticated testing that has improved our diagnostic abilities. Tests include analysis for maldigestion and malabsorption syndromes; food allergies, sensitivities, and intolerances; bowel pathogens; inflammation; immune disorders; exposure to toxic metals and other harmful substances; poor nutrient levels; and defects in the metabolism of amino acids, fatty acids, carbohydrates, vitamins, and minerals. Many of the children with ADHD or autism have problems with digestion of foods and absorption of nutrients. Some have accumulation of toxic metals. Almost all of the children have nutritional deficits, and those with the most severe presentations have multiple significant nutrient deficits and metabolic disturbances.
Most of these specialized tests are not always part of the routine work-up for people with ADHD and autism. Without these tests, significant problems can be missed, rendering treatment plans incomplete.
How Will This Book Help?
This book includes chapters that address the following issues:
Identifying sources and substitutes for the main culprits—gluten and casein—as well as soy, corn, eggs, salicylates, phenols, disaccharides, oxalates, and inflammatory foods
What makes a food “good” or “bad” for you
How to determine if your child is sensitive to particular foods
How to change your child’s diet
How to get your picky eater to accept new foods
Suggestions for dealing with common problems encountered when changing diets
In Their Own Words
No one tells the story better than the parents who have tenaciously sought and found the right treatment path for their children—and the children who have courageously walked it! The stories we’ve included throughout the book may differ because each child’s response is unique. While some respond dramatically to a single intervention, others respond best when a combination of treatments is utilized. It is important for parents not to give up when the results are not immediate and dramatic. Remember to be persistent and patient. We’ll start with Anne Evans’s poignant dedication in her book, Autism Treated and Cured.
“Dedicated to my loving Sarah who put up with the sickness, the suffering, and the agony of recovery to forge a path toward healing for other children on the spectrum.”