Gastrointestinal concerns are very common among children with autism.  It becomes, therefore, more difficult to differentiate between behaviors and the symptoms parents report so often, which are also the most common symptoms in children not on the spectrum.  

Dr. Joseph Levy, FAAP, is a Professor of Pediatrics and Director of the Division of Pediatric Gastroenterology at New York University School of Medicine and a member of the YAI Autism Advisory Committee.  Dr. Levy has recently participated in the Consensus Conference to evaluate the nutritional and intestinal issues affecting children with autism.  Here are some of his extremely important insights, derived from years of field experience.
 
• A child on the spectrum is first and foremost, a child.  They are allowed to have the immaturities that all children have, and so are prone to get constipated, have food intolerance, or acid reflux.  There is no established universal validity to the claims that there is a specific intestinal disorder that afflicts these children. Autistic enterocolitis is not a medical entity.
• Diet restrictions aimed at improving behavior can create potential health hazards.   One should always work with a knowledgeable nutritionist to ensure that no imbalances are created as a result of the foods selected.  The popular gluten free and casein free diets need to be undertaken with an open mind but at the same time, with a critical sense.  They are not easy diets to follow, and their benefit are far from being established.  Therefore, if parents do not see a difference after a few months of trying them, there is probably no need to persevere and continue the sacrifice. 
• Disrupted sleep and self-injurious behaviors can be expressions of physical discomfort.  Behavioral explanations for those manifestations should not be automatically ascribed the spectrum diagnosis.  Your child could be acting up because he is experiencing headaches from sinusitis, cramps from consuming too many high-fiber foods, heartburn from acid reflux or burning on urination from a urinary infection, and there would be no way of determining the source unless the possibility is considered and a proper exam (and tests, if indicated) undertaken.
• Crankiness can be the result of disrupted sleep.  Sleeping difficulties are quite common in children on the spectrum and can have a significant impact on their quality of life.  Some “night owls” could be experiencing obstructive apnea from enlarged tonsils and adenoids, and if their sleep is fitful, their day-time behaviors can be nightmarish.  Sleep deprivation can impact on the ability to learn and might compromise the best educational program.
• Food allergies are much less prevalent than parents have been lead to believe.  To ascribe certain behaviors, such as impulsivity, lack of concentration, or hyperactivity on food allergies based on blood tests (some of which have never even been validated as reflective of abnormal reactions to food antigens) is unfair to the child and to the family.  It contributes to unnecessarily restricted diets and places the onus for controlling the complex behaviors of a child on the spectrum on the parents.  Those behaviors are, by their very nature, a moving target, and rarely will a simple diet restriction resolve them.  Parents can worry that they are contributing to their child outbursts by not being more compulsive and strict about their diet. 

Dr. Levy graduated from Hebrew University Hadassah Medical School, Jerusalem.  Following a fellowship in pediatric gastroenterology at the Children’s Hospital of New York-Presbyterian, he remained there as director of the clinical service. He later became Chief of Pediatric Gastroenterology at New York Hospital-Cornell, before moving back to Columbia to set up the Children’s Digestive Health Center and the Neurogastroenterology program.

Dr. Levy was the first Chair of the Public Education Committee of the North American Society for Pediatric Gastroenterology and Nutrition, contributing to the multi-lingual information brochures posted in the website of the society and downloaded by thousands of parents and practitioners.  He is a member of the Scientific Advisory Board of the Children’s Digestive Health Foundation for the Celiac Disease education project. Dr. Levy has recently participated in the Consensus Conference to evaluate the nutritional and intestinal issues affecting children with autism.