Monday, February 12, 2007

When is DTT Unreasonable? When Diet Eliminates a Behavior!

When Pamela was five, only two books on Applied Behavioral Analysis (ABA) were accessible, and I bought them both: Let Me Hear Your Voice and The “Me” Book! We lived in Louisiana at the time, and ABA therapists were nonexistent in our area. I ran a Mommy ABA program, and Pamela learned her preschool academics very quickly (colors, shapes, numbers, letters, adjectives, verbs, etc.). I still find Discrete Trials Teaching (DTT) useful when Pamela struggles to learn a new concept.

Some ABA proponents pooh-pooh dietary interventions because "the lack of scientific evidence that casein and gluten cause autism is concerning" or "few if any conclusive, valid studies have been performed on them." They leave out many important points.

First, look up diet at the free online index of the Autism Research Review International, and you will find scientific studies on diet and autism. Unfortunately, these studies do not meet the golden standard of being double blind, placebo-controlled. That would require a group of autistic children to go on the gluten-free, casein-free diet. The researchers would have to split the group in half, randomly selected, and all would be given pills. Half would receive gluten/casein-laced pills, while the other half would receive non-allergenic pills. No one involved in evaluating the children, including parents, would know which children are truly free of gluten and casein. How many parents are willing to go through the hassle of a diet, not knowing if they are giving their child the troublesome ingredients?

Second, dietary intervention has helped tremendously with what appeared to be a major behavioral problem. From the ages of two through four, Pamela slept only four hours a night. She had night sweats, tossed and turned, gagged when stressed, and ground her teeth. She did have a history of food allergies (we had her skin-tested at eighteen months of age because her health was so poor). We had eliminated foods for which she tested positive: almonds and eggs. We thought it wise to search for connections between food and behavior. I split up her foods into four day cycles, trying to keep related food (i.e., rhubarb and buckwheat are related) on the same day. Miraculously, all of her sleep issues disappeared on all but one day! Through trial and error, we traced it back to apple products. Pamela lived for apples, applesauce, and apple juice. She was so sensitive that Thanksgiving sweet potatoes mashed with apple juice for liquid made her suddenly pull an all nighter after two months of normal sleeping patterns! In fact, every time she had a major disruption of her sleep cycle, we were able to trace it back to apples. Every time. That may not meet the golden standard for all autistic children, but it did in my sample size of one child!

Third, let us analyze that one situation using behavioral terms. The antecedent (apples in any form) causes a behavior (insomnia), and the consequences are a foggy child with foggy parents. The behaviorist would develop an elaborate program of antecedents designed at getting Pamela to stay in bed and try to sleep backed up by positive reinforcements (or negative ones) to encourage that behavior. Would it not be easier to eliminate the source of the problem, apples? Mr. William Ahearn would have advised me that children like Pamela “will not benefit from dietary restrictions of any kind unless they also have a food allergy or intolerance.” Her skin testing for apples revealed absolutely no food allergy or intolerance!

Fourth, the apple connection was not a lucky fluke. Removing gluten and casein from her diet solved other behavioral problems. After years of failing at potty training, Pamela established bladder control within two weeks of starting this diet. She was out of daytime diapers within two months. The issue was that the morphine in the gluten and casein was masking her ability to sense a full bladder. The typical antecedent for a child to go to the bathroom (a sense of fullness) was not present! This was not simply coincidence for one of the signs of eating gluten and casein was losing bladder control. In one instance, Pamela snuck half a biscuit at a family reunion. When someone told me of her offence, I predicted to my relatives that the next day she would be irritable, develop a rash, and wet herself--behaviors not displayed in the past couple of days at the reunion. All three predictions came true the next day. Once again, Pamela had no response to wheat (gluten) or milk (casein) to the skin testing done on her, but the behavioral connection was predictable and avoidable.

Finally, how can one ever determine that specific foods are antecedents to problem behaviors if one rules out them from the beginning? What ever happened to scientific curiosity and inquiry? One can still stay cloaked in the mantle of the scientific method and investigate a possible link between diet and behavior. Using the scientific method, why not form a hypothesis "Apples causes Pamela to have insomnia" and develop a study to test it? Dad can give Pamela apples (or the placebo of pears) on randomly selected days, secretly without Mom's knowledge. Then Mom can measure how long she sleeps and the wetness of her sheets. Is that not the scientific method in action?

I am sure that some scientifically minded types me write me off as some airheaded, bubble brain. I earned my degree in operations research (statistics) at the Naval Postgraduate School, and I do understand a thing or two about the scientific method and statistical research!

P.S. Mr. Ahearn expressed concern eliminating specific foods for children already self-limiting food choices. What he does not realize is that removing addictive (morphine-laced) foods allows children to expand their food choices down the road. In our travels, Pamela has tasted and enjoyed a wide variety of food: pickled octopus, salmon, raw oysters, sushi, quinoa noodles, fried yucca, baked plaintain, pupusas with curtido, chiramoya sorbet, collard greens, etc. Rather than bake with a few related foods (wheat, oats, barley, and rye), the flours I use are made from sorghum, rice, garbanzo beans, fava beans, tapioca, potato, soy, corn, amaranth, quinoa, corn, and buckwheat. What say you?

Another P.S. All of you Charlotte Mason homeschoolers are probably wondering what this has to do with masterly inactivity. In her books, she liked to juxtapose contrasting ideas and then poke holes in those she rejected. I am emulating her approach in outlining my principles of education as they apply to a person with autism.


Unknown said...

Man alive... this is so interesting. I'm so glad I found your blog. Keep up the great work. Your children are so blessed to have you as a mommy!

Stay away from the apples.

I have a 5yo that's hyper at times... that's all -- no big deal. But I think that if I watch his diet... there would be some changes. I need to do that don't I... first thing -- sugar. I'll watch as I eliminate that next month. (Grocery shop only once a month).

THANKS again from the great post.

walking said...

Let's just say I do not subscribe to the "an apple a day" theory!

Sugar is one place to start. And, if that does not help, it could be other things too.

A small subgroup of hyper kids do better when take off gluten and casein. Another subgroup do well on the Feingold diet. Sometimes it is other highly allergenic foods like corn, soy, etc. or high carbohydrate foods.

Great hearing from you, Jennifer!

Anonymous said...

Thank you for your answer to my CM question. I really feel a fit for me and want to make it work.

Seeing what/how you've had to adapt it encourages me.

How did you group your food-types? I wouldn't have know to pair rhubarb and buckwheat.

(Ugh. And I'm so intimidated when I think about learning to cook/food-prep differently.)

But thanks!

walking said...

I bought a book that explained how it all worked. I am not sure it is available any more, but click here for an example of a four day food cycle. Figuring out new recipes and cooking methods is a hassle, and I found this book that looks helpful: The Ultimate Food Allergy Cookbook and Survival Guide.

The bottomline is that, if the benefits of removing problem foods outweigh the pain of figuring out new recipes, you will be glad. Eventually, it all becomes second nature! If you see no improvements, you can check it off your list of things to investigate.

Anonymous said...


And, yup we're AKan. This is unquestionably home.