Marcus Skinner Marcus is a 4-year-old boy with autism spectrum disorder who has communication impairments and social difficulties and exhibits repetitive behavior. His treatment includes medical...

Extracted text: Marcus Skinner Marcus is a 4-year-old boy with autism spectrum disorder who has communication impairments and social difficulties and exhibits repetitive behavior. His treatment includes medical nutrition therapy,speech-language therapy, occupational therapy, and physical ther-apy. Marcus does not eat a well-balanced eating pattern for several reasons: a feature of his compulsive behavior is that he only accepts a limited variety of foods, he is unable to eat when overstimulated at mealtime, and he has poor fine motor coordination that impairs his ability to feed himself. He is on a gluten- free/casein-free diet because these peptides are believed to cause a variety of effects in the neurotransmitter systems of the brain. Eliminating all foods containing gluten (foods containing wheat, barley, and rye) and casein (the major protein in milk and other dairy products and used as an additive in other foods such as soy products) may improve behaviors in some children with autism, although there is insufficient evidence of benefit. Recall Marcus. His gluten-free/casein- free diet restricts many types of grain and milk products and some children following this Unfolding diet have developed amino acid deficiencies, which is essentially a form of protein malnutrition. Marcus has difficulty chewing meat, which further limits his intake of protein. What foods can provide protein within the context of his dietary restrictions? Should Marcus take amino acid supplements? Which vitamins may he be under consuming given his restricted intake of grains, milk, and meats? Will vitamin supplements compensate for the lack of variety in his intake? Think of Marcus. As with healthy adults, studies of children with autism taking supplements show that the children most likely to take supplements were less likely to need them, which may re- flect heightened awareness of nutrition by some families in regard to both food and supplements. Is too much better than too little? Recall Marcus. Because he has a restricted diet and accepts only a limited variety of foods, he may be under- or over consumng certain nutrients. His parents give him a multivitamin with Case minerals, plus additional supplements of vitamin D, vitamin C, and calcium. Should Marcus's parents keep a food diary so that his total vitamin intake from food and supplements be estimated? Which nutri- ents consumed in excess may cause health problems? Consider Marcus. One of his food obsessions is a fortified gluten-free cereal. It is fortified with 100% of the Daily Value (DV) for many vitamins-but those DVs are based on adult require-ments, not recommendations for children. Because he eats a few servings of this cereal daily, he is getting much larger amounts of certain vitamins and minerals than is required. Would you encourage Marcus'sparents to find a non fortified gluten- free cereal? Would you recommend they discon- tinue his vitamin and mineral supplements?