The aim of this qualitative study was to explore the experiences and meaning of touch between parents and children with autism before and after attending a Touch Therapy Programme. The sample comprised 12 parents (1 father and 11 mothers) of children (1 female and 11 male) with autism. Parents were interviewed before and immediately after the 8-week programme. Pre-programme results suggested that children were controlling the experience of touch. Parents felt 'hurt' in response to the 'aloof nature of autism, and natural parenting instincts (e.g. spontaneous cuddles) were restricted. Post-programme results suggested that children appeared to tolerate touch. Parents reported that routine tasks (e.g. dressing) were accomplished more easily and that children appeared generally more relaxed. Parents reported feeling 'closer' to their children and felt that the touch therapy had opened a communication channel between themselves and their children.

OBJECTIVES:To determine whether children with autism spectrum disorder (ASD) would tolerate an acupressure/acupuncture intervention and whether parents would adhere to a twice-weekly, 8-week intervention protocol. Second, to further understand best measures to use to capture impact of intervention on behavioral and regulatory functions.

DESIGN:This is an observational pilot study with pre-, mid-, and postintervention measures.

SETTINGS/LOCATION:The intervention was carried out in a private practice office in a large metropolitan area.

SUBJECTS:A total of 10 children of ages 3-10 years with ASD and one of their parents participated.

INTERVENTIONS:A total of 16 biweekly treatment sessions of acupressure and/or acupuncture were carried out by a licensed acupuncturist, and a daily home-based acupressure intervention was carried out by a parent.

OUTCOME MEASURES:Attendance, tolerance of intervention, parent compliance with home program, and parent compliance in completing daily diary and five standardized measures of behavioral and regulatory functions pre-, mid-, and postintervention were recorded.

RESULTS:The 10 children in this observational study, collectively, tolerated the intervention and parents adhered to the 16 sessions, biweekly protocol, and home protocol, as well as completing daily diary and five standardized measures at three different time intervals. The five measurements appeared to be sensitive to behavioral and regulatory functions that may improve with this type of intervention.

CONCLUSIONS:The results of this observational pilot study suggest that acupressure/acupuncture is a feasible intervention for children with ASD that merits rigorous evaluation through a randomized controlled trial.

With continuing cooperation from 18 domestic and international brain banks over the last 36 years, we have analyzed the aluminum content of the temporal lobe neocortex of 511 high-quality human female brain samples from 16 diverse neurological and neurodegenerative disorders, including 2 groups of age-matched controls. Temporal lobes (Brodmann areas A20-A22) were selected for analysis because of their availability and their central role in massive information-processing operations including efferent-signal integration, cognition, and memory formation. We used the analytical technique of (i) Zeeman-type electrothermal atomic absorption spectrophotometry (ETAAS) combined with (ii) preliminary analysis from the advanced photon source (APS) hard X-ray beam (7 GeV) fluorescence raster-scanning (XRFR) spectroscopy device (undulator beam line 2-ID-E) at the Argonne National Laboratory, US Department of Energy, University of Chicago IL, USA. Neurological diseases examined were Alzheimer's disease (AD; N = 186), ataxia Friedreich's type (AFT; N = 6), amyotrophic lateral sclerosis (ALS; N = 16), autism spectrum disorder (ASD; N = 26), dialysis dementia syndrome (DDS; N = 27), Down's syndrome (DS; trisomy, 21; N = 24), Huntington's chorea (HC; N = 15),multiple infarct dementia (MID; N = 19), multiple sclerosis (MS; N = 23), Parkinson's disease (PD; N = 27), and prion disease (PrD; N = 11) that included bovine spongiform encephalopathy (BSE;"mad cow disease"), Creutzfeldt-Jakob disease (CJD) and Gerstmann-Straussler-Sheinker syndrome (GSS), progressive multifocal leukoencephalopathy (PML; N = 11), progressive supranuclear palsy (PSP; N = 24), schizophrenia (SCZ; N = 21), a young control group (YCG; N = 22; mean age, 10.2 ± 6.1 year), and an aged control group (ACG; N = 53; mean age, 71.4 ± 9.3 year). Using ETAAS, all measurements were performed in triplicate on each tissue sample. Among these 17 common neurological conditions, we found a statistically significant trend for aluminum to be increased only in AD, DS, and DDS compared to age- and gender-matched brains from the same anatomical region. This is the largest study of aluminum concentrationin the brains of human neurological and neurodegenerative disease ever undertaken. The results continue to suggest that aluminum's association with AD, DDS, and DS brain tissues may contribute to the neuropathology of those neurological diseases but appear not to be a significant factor in other common disorders of the human brain and/or CNS.

BACKGROUND/AIM: Children with autism exhibit significant deficits in imitation skills, which impede the acquisition of more complex behavior and socialization. Imitation is often targeted early in intervention plans and continues to be addressed throughout the child's treatment. The use of integrated approach to yoga therapy (IAYT) as a complementary therapy for children diagnosed with autism spectrum disorder (ASD) is rarely reported and little is known on the effectiveness of such therapies. This study investigated IAYT as a treatment method with children with ASD to increase imitative skills. MATERIALS AND METHODS: Parents and six children with ASD participated in a 10-month program of 5-weekly sessions and regular practice at home. Pre, mid and post treatment assessments included observers and parent ratings of children's imitation skills in tasks related to imitation skills such as gross motor actions, vocalization, complex imitation, oral facial movements and imitating breathing exercises. RESULTS: Improvement in children's imitation skills especially pointing to body, postural and oral facial movements. Parents reported change in the play pattern of these children with toys, peers and objects at home. CONCLUSIONS: This study indicates that IAYT may offer benefits as an effective tool to increase imitation, cognitive skills and social-communicative behaviors in children with ASD. In addition, children exhibited increased skills in eye contact, sitting tolerance, non-verbal communication and receptive skills to verbal commands related to spatial relationship.

ETHNOPHARMACOLOGICAL RELEVANCE:Withania somnifera (Family: Solanaceae), commonly known as Ashwagandha or Indian ginseng is distributed widely in India, Nepal, China and Yemen. The roots of plant consist of active phytoconstituents mainly withanolides, alkaloids and sitoindosides and are conventionally used for the treatment of multiple brain disorders.

AIM OF THE REVIEW:This review aims to critically assess and summarize the current state and implication of Ashwagandha in brain disorders. We have mainly focussed on the reported neuroactive phytoconstituents, available marketed products, pharmacological studies, mechanism of action and recent patents published related to neuroprotective effects of Ashwagandha in brain disorders.

MATERIALS AND METHODS:All the information and data was collected on Ashwagandha using keywords"Ashwagandha"along with"Phytoconstituents","Ayurvedic, Unani and Homeopathy marketed formulation","Brain disorders","Mechanism"and"Patents". Following sources were searched for data collection: electronic scientific databases such as Science Direct, Google Scholar, Elsevier, PubMed, Wiley On-line Library, Taylor and Francis, Springer; books such as AYUSH Pharmacopoeia; authentic textbooks and formularies.

RESULTS:Identified neuroprotective phytoconstituents of Ashwagandha are sitoindosides VII-X, withaferin A, withanosides IV, withanols, withanolide A, withanolide B, anaferine, beta-sitosterol, withanolide D with key pharmacological effects in brain disorders mainly anxiety, Alzheimer's, Parkinson's, Schizophrenia, Huntington's disease, dyslexia, depression, autism, addiction, amyotrophic lateral sclerosis, attention deficit hyperactivity disorder and bipolar disorders. The literature survey does not highlight any toxic effects of Ashwagandha. Further, multiple available marketed products and patents recognized its beneficial role in various brain disorders; however, very few data is available on mechanistic pathway and clinical studies of Ashwagandha for various brain disorders is scarce and not promising.

CONCLUSION:The review concludes the results of recent studies on Ashwagandha suggesting its extensive potential as neuroprotective in various brain disorders as supported by preclinical studies, clinical trials and published patents. However vague understanding of the mechanistic pathways involved in imparting the neuroprotective effect of Ashwagandha warrants further study to promote it as a promising drug candidate.

Importance:Maternal infections and fever during pregnancy are associated with increased risk for autism spectrum disorders (ASDs). To our knowledge, no study has investigated the association between influenza vaccination during pregnancy and ASD.

Objective:To investigate the association between influenza infection and vaccination during pregnancy and ASD risk.

Design, Setting, and Participants:This cohort study included 196 929 children born at Kaiser Permanente Northern California from January 1, 2000 to December 31, 2010, at a gestational age of at least 24 weeks.

Exposures:Data on maternal influenza infection and vaccination from conception date to delivery date, obtained from Kaiser Permanente Northern California inpatient and outpatient databases. Influenza infection was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification codes or positive influenza laboratory test results.

Main Outcomes and Measures:Clinical diagnoses of ASDs identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes 299.0, 299.8, or 299.9 recorded in Kaiser Permanente Northern California electronic medical records on at least 2 occasions any time from birth through June 2015.

Results:Within this cohort of 196 929 children, influenza was diagnosed in 1400 (0.7%) mothers and 45 231 (23%) received an influenza vaccination during pregnancy. The mean (SD) ages of vaccinated and unvaccinated women were 31.6 (5.2) and 30.4 (5.6) years, respectively. A total number of 3101 (1.6%) children were diagnosed with ASD. After adjusting for covariates, we found that maternal influenza infection (adjusted hazard ratio, 1.04; 95% CI, 0.68-1.58) or influenza vaccination (adjusted hazard ratio, 1.10; 95% CI, 1.00-1.21) anytime during pregnancy was not associated with increased ASD risk. In trimester-specific analyses, first-trimester influenza vaccination was the only period associated with increased ASD risk (adjusted hazard ratio, 1.20; 95% CI, 1.04-1.39). However, this association could be due to chance (P = 0.1) if Bonferroni corrected for the multiplicity of hypotheses tested (n = 8). Maternal influenza vaccination in the second or third trimester was not associated with increased ASD risk.

Conclusions and Relevance:There was no association between maternal influenza infection anytime during pregnancy and increased ASD risk. There was a suggestion of increased ASD risk among children whose mothers received an influenza vaccination in their first trimester, but the association was not statistically significant after adjusting for multiple comparisons, indicating that the finding could be due to chance. These findings do not call for changes in vaccine policy or practice, but do suggest the need for additional studies on maternal influenza vaccination and autism.

Autism is a highly heritable behavioral disorder. Yet, two decades of genetic investigation have unveiled extremely few cases that can be solely explained on the basis of de novo mutations or cytogenetic abnormalities. Vertical viral transmission represents a nongenetic mechanism of disease compatible with high parent-to-offspring transmission and with low rates of disease-specific genetic abnormalities. Vertically transmitted viruses should be found more frequently in the affected tissues of autistic individuals compared to controls. Our initial step was thus to assess by nested polymerase chain reaction (PCR) and DNA sequence analysis the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus type 1 (HSV1), herpes simplex virus type 2 (HSV2), human herpes virus 6 (HHV6), BK virus (BKV), JC virus (JCV), and simian virus 40 (SV40) in genomic DNA extracted from postmortem temporocortical tissue (Brodmann areas 41/42) belonging to 15 autistic patients and 13 controls. BKV, JCV, and SV40 combined are significantly more frequent among autistic patients compared to controls (67% versus 23%, respectively; P<.05). The majority of positives yielded archetypal sequences, whereas six patients and two controls unveiled single-base pair changes in two or more sequenced clones. No association is present with the remaining viruses, which are found in relatively few individuals (N

We report the history of a child with autism and epilepsy who, after limited response to other interventions following her regression into autism, was placed on a gluten-free, casein-free diet, after which she showed marked improvement in autistic and medical symptoms. Subsequently, following pubertal onset of seizures and after failing to achieve full seizure control pharmacologically she was advanced to a ketogenic diet that was customized to continue the gluten-free, casein-free regimen. On this diet, while still continuing on anticonvulsants, she showed significant improvement in seizure activity. This gluten-free casein-free ketogenic diet used medium-chain triglycerides rather than butter and cream as its primary source of fat. Medium-chain triglycerides are known to be highly ketogenic, and this allowed the use of a lower ratio (1.5:1) leaving more calories available for consumption of vegetables with their associated health benefits. Secondary benefits included resolution of morbid obesity and improvement of cognitive and behavioral features. Over the course of several years following her initial diagnosis, the child's Childhood Autism Rating Scale score decreased from 49 to 17, representing a change from severe autism to nonautistic, and her intelligence quotient increased 70 points. The initial electroencephalogram after seizure onset showed lengthy 3 Hz spike-wave activity; 14 months after the initiation of the diet the child was essentially seizure free and the electroencephalogram showed only occasional 1-1.5 second spike-wave activity without clinical accompaniments.

Curcumin is widely consumed in Asia either as turmeric directly or as one of the culinary ingredients in food recipes. The benefits of curcumin in different organ systems have been reported extensively in several neurological diseases and cancer. Curcumin has got its global recognition because of its strong antioxidant, anti-inflammatory, anti-cancer, and antimicrobial activities. Additionally, it is used in diabetes and arthritis as well as in hepatic, renal, and cardiovascular diseases. Recently, there is growing attention on usage of curcumin to prevent or delay the onset of neurodegenerative diseases. This review summarizes available data from several recent studies on curcumin in various neurological diseases such as Alzheimer's disease, Parkinson's disease, Multiple Sclerosis, Huntington's disease, Prions disease, stroke, Down's syndrome, autism, Amyotrophic lateral sclerosis, anxiety, depression, and aging. Recent advancements toward increasing the therapeutic efficacy of curcuma/curcumin formulation and the novel delivery strategies employed to overcome its minimal bioavailability and toxicity studies have also been discussed. This review also summarizes the ongoing clinical trials on curcumin for different neurodegenerative diseases and patent details of curcuma/curcumin in India.

BACKGROUND: Although Autistic Disorder is associated with several congenital conditions, the cause for most cases is unknown. The present study was undertaken to determine whether breastfeeding or the use of infant formula supplemented with docosahexaenoic acid and arachidonic acid is associated with Autistic Disorder. The hypothesis is that breastfeeding and use of infant formula supplemented with docosahexaenoic acid/arachidonic acid are protective for Autistic Disorder.

METHODS: This is a case-control study using data from the Autism Internet Research Survey, an online parental survey conducted from February to April 2005 with results for 861 children with Autistic Disorder and 123 control children. The analyses were performed using logistic regression.

RESULTS: Absence of breastfeeding when compared to breastfeeding for more than six months was significantly associated with an increase in the odds of having autistic disorder when all cases were considered (OR 2.48, 95% CI 1.42, 4.35) and after limiting cases to children with regression in development (OR 1.95, 95% CI 1.01, 3.78). Use of infant formula without docosahexaenoic acid and arachidonic acid supplementation versus exclusive breastfeeding was associated with a significant increase in the odds of autistic disorder when all cases were considered (OR 4.41, 95% CI 1.24, 15.7) and after limiting cases to children with regression in development (OR 12.96, 95% CI 1.27, 132).

CONCLUSION: The results of this preliminary study indicate that children who were not breastfed or were fed infant formula without docosahexaenoic acid/arachidonic acid supplementation were significantly more likely to have autistic disorder.

OBJECTIVE: This purpose of this study was to identify clinicians' perceptions of the benefits of aquatic therapy for young children with autism. METHODS: Eighteen aquatic occupational therapists treating young children with autism responded to a survey soliciting their opinions on changes in skill performance resulting from aquatic therapy. RESULTS: A majority of clinicians reported a substantial increase in swim skills, attention,muscle strength, balance, tolerating touch, initiating/maintaining eye contact, and water safety. CONCLUSION: The impairments, activity limitations, and participation restrictions seen in children with autism can be wide-ranging and outcomes can be difficult to operationally define and measure. In this preliminary study, clinicians identified the areas they perceived as improving as a result of aquatic therapy. This information could help narrow the field of likely outcomes as a first step toward studies of the effectiveness of aquatic therapy for children with autism.

OBJECTIVE: To observe the effect of acupuncture on rehabilitation training for children's autism. METHODS: Forty autistic children receiving rehabilitation training were divided into a control group and a treatment group, 20 cases in each group. The control group received rehabilitation training including ABA training, the Conductive Education Approach and the training of sensory integration, about 90 sessions for each training; the treatment group received acupuncture treatment for 60-90 sessions after the rehabilitation training. Their results were detected by the revised Chinese version of Psycho-Educational Profile for autistic and developmentally disabled children (C-PEP). RESULTS: The markedly effective rate was 55.0% in the treatment group and 15.0% in the control group with a very significant difference between the two groups (P<0.01); the differences before and after training in some projects such as the total score of development, imitation, oral cognition in the treatment group were very significantly different from those in the control group (P<0.01). CONCLUSION: Acupuncture combined with scientific and effective rehabilitation training has a better therapeutic effect than that of the simple rehabilitation training for child's autism.

OBJECTIVE: To observe the effect of acupuncture on rehabilitation training for children's autism. METHODS: Forty autistic children receiving rehabilitation training were divided into a control group and a treatment group, 20 cases in each group. The control group received rehabilitation training including ABA training, the Conductive Education Approach and the training of sensory integration, about 90 sessions for each training; the treatment group received acupuncture treatment for 60-90 sessions after the rehabilitation training. Their results were detected by the revised Chinese version of Psycho-Educational Profile for autistic and developmentally disabled children (C-PEP). RESULTS: The markedly effective rate was 55.0% in the treatment group and 15.0% in the control group with a very significant difference between the two groups (P<0.01); the differences before and after training in some projects such as the total score of development, imitation, oral cognition in the treatment group were very significantly different from those in the control group (P<0.01). CONCLUSION: Acupuncture combined with scientific and effective rehabilitation training has a better therapeutic effect than that of the simple rehabilitation training for child's autism.

The present study was aimed to test the hypothesis that paracetamol (PCM) can precipitate autistic like features when used to counteract vaccine-induced fever using experimental rat pups. The pups were treated with measles mumps rubella (MMR) vaccine, diphtheria tetanus and pertussis (DPT) vaccines and lipopolysaccharide (LPS) with subsequent PCM treatment. The pups were evaluated for postnatal growth (weight gain, eye opening) and behavior alterations (swimming performance, olfactory discrimination, negative geotaxis, nociception, and locomotor activity) by performing battery of neurobehavioral test. Significant correlation was observed between social behavioral domains (nociception, anxiety and motor coordination) and pro-inflammatory load in the pups when treated with MMR/LPS along with PCM. A significant change in pro and anti-inflammatory (IL-4, IL-6, IL-10) markers were observed in rats treated with PCM, MMR, LPS, DPS alone or in combination with MMR, LPS and DPT (5128.6 ± 0.000, 15,488 ± 0.000, 9661.1 ± 157.29, 15,312 ± 249.29, 10,471 ± 0.00, 16,789 ± 273.34and 12,882 ± 0.00). Pups were also scrutinized for the markers of oxidative stress, inflammation and histopathologically. All the treatment groups showed significant alteration in the behavioral changes, oxidative markers (TBARS-in control-4.33 ± 0.02, PCM-9.42 ± 0.18, MMR-5.27 ± 0.15, MMR + PCM-8.57 ± 0.18, LPS-6.84 ± 0.10, LPS + PCM-4.51 ± 0.30, DPT-5.68 ± 0.12, DPT + PCM-7.26 ± 0.18) and inflammatory markers without following any specific treatment. These observation could be accorded to variable phenotypes of autistic spectrum disorders (ASDs).

OBJECTIVES:Studies on the gluten-free and/or casein-free (GFCF) dietary intervention for children with autism spectrum disorders (ASDs) suggest that some children may positively respond to implementation of the dietary intervention. Other research suggests that children diagnosed with ASD can be classified into subpopulations based on various factors, including gastrointestinal (GI) abnormalities and immune function.

METHODS:This study analyzes parental report data collected using a 90-item online questionnaire from 387 parents or primary caregivers of children diagnosed with ASD on the efficacy of the GFCF diet. Parents reported on their child's GI symptoms, food allergy diagnoses, and suspected food sensitivities, as well as the degree and length of their diet implementation.

RESULTS:Overall, diet efficacy among children whose parents reported the presence of GI symptoms, food allergy diagnoses, and suspected food sensitivities included greater improvement in ASD behaviors, physiological symptoms, and social behaviors compared with children whose parents reported none of these symptoms, diagnoses, or sensitivities (P<0.05). Parental report of strict diet implementation, indicated by complete gluten/casein elimination and infrequent diet errors during and outside of parental care, also corresponded to improvement in ASD behaviors, physiological symptoms, and social behaviors (P<0.05).

DISCUSSION:These findings suggest that various intricacies related to diet implementation and GI and immune factors may play a role in differentiating diet responders from diet non-responders and substantiate the importance of further investigations into the various, nuanced factors that influence efficacy of the intervention among children with ASDs.

Previous studies by our group suggest that the neuropathology of autism is characterized by a disturbance of cortical modularity. In this model a decrease in the peripheral neuropil space of affected minicolumns provides for an inhibitory deficit and a readjustment in their signal to noise bias during information processing. In this study we proposed using low frequency transcranial magnetic stimulation (rTMS) as a way increasing the surround inhibition of minicolumns in autism. Thirteen patients (ADOS and ADI-R diagnosed) and equal number of controls participated in the study. Repetitive TMS was delivered at 0.5 Hz, 2 times per week for 3 weeks. Outcome measures based on event-related potentials (ERP), induced gamma activity, and behavioral measures showed significant post-TMS improvement. The results suggest that rTMS offers a potential therapeutic intervention for autism.

OBJECTIVES: The objective of this study was to access whether there were any therapeutic effects of Thai Traditional Massage (TTM) on major behavioral and emotional disturbances in Thai autistic children. DESIGN: This was a randomized controlled trial study. Settings/location: The study was conducted at the Rehabilitation Centre of the Thai Red Cross Society. SUBJECTS: A total of 60 autistic children between the ages of 3 and 10 completed this study. Interventions: Standard sensory integration therapy (SI) was compared to the SI with TTM treatments. Outcome measures: Parents and teachers assessed major behavior disturbances using the Conners' Rating Scales at 0 and 8 weeks. Sleep Diary (SD), recorded by the parents, assessed the patient's sleeping patterns every week. RESULTS: Sixty (60) autistic children, mean age 4.67 +/- 1.82, were recruited. No statistical differences were seen in the demographic and baseline data among both groups. From both the Conners' Teacher Questionnaire and SD, statistical improvement was detected for conduct problem, hyperactivity, inattention-passivity, hyperactivity index, and sleeping behavior. However, results from the Conners' Parent Questionnaire revealed an improvement only for anxiety (p = 0.04) in the massage group, whereas when both groups were compared, a significant improvement in conduct problem (p = 0.03) and anxiety (p = 0.01) was found. Results indicated that TTM may have a positive effect in improving stereotypical behaviors in autistic children. CONCLUSIONS: Over a period of 8 weeks, our findings suggested that TTM could be used as a complementary therapy for autistic children in Thailand.

INTRODUCTION:Autism Spectrum Disorder (ASD) is a neuro developmental disorder which appears at early childhood age between 18 and 36 months. Apart from behaviour problems ASD children also suffer from sleep and Gastrointestinal (GI) problems. Major behaviour problems of ASD children are lack of social communication and interaction, less attention span, repetitive and restrictive behaviour, lack of eye to eye contact, aggressive and self-injurious behaviours, sensory integration problems, motor problems, deficiency in academic activities, anxiety and depression etc. Our hypothesis is that structured yoga intervention will brings significant changes in the problems of ASD children.

AIM:The aim of this study was to find out efficacy of structured yoga intervention for sleep problems, gastrointestinal problems and behaviour problems of ASD children.

MATERIALS AND METHODS:It was an exploratory study with pre-test and post-test control design. Three sets of questionnaires having 61 questions developed by researchers were used to collect data pre and post yoga intervention. Questionnaires were based on three problematic areas of ASD children as mentioned above and were administered to parents by teachers under the supervision of researcher and clinical psychologists. Experimental group was given yoga intervention for a period of 90 days and control group continued with school curriculum.

RESULTS:Both children and parents participated in this intervention. Significant changes were seen post yoga intervention in three areas of problems as mentioned above. Statistical analysis also showed significance value of 0.001 in the result.

CONCLUSION:Structured yoga intervention can be conducted for a large group of ASD children with parent's involvement. Yoga can be used as alternative therapy to reduce the severity of symptoms of ASD children.

The use of complementary or alternative treatment approaches in children with autism spectrum disorders (ASDs) is increasing, and the most popular of such approaches are diets that eliminate either gluten or casein, or both. The popularity of these diets indicates a need for more rigorous research into their efficacy. Owing to significant methodological flaws, the currently available data are inadequate to guide treatment recommendations. The purpose of this review is to examine the available trials of gluten/casein diets in children with ASDs regarding the strength of their findings and also concerning points that may be useful in the design of future studies. Seven trials of these diets in ASD are critically reviewed; 6 of these were uncontrolled trials and 1 used a single-blind design. All reported efficacy in reducing some autism symptoms, and 2 groups of investigators also reported improvement in nonverbal cognition. Design flaws in all of the studies weaken the confidence that can be placed in their findings. Careful double-blind, placebo-controlled studies are needed to evaluate whether actual benefit undergirds the diets' popularity and to provide better guidance to clinicians and caregivers. The literature currently available suggests that diets eliminating both gluten and casein (rather than either alone) should be studied first and that outcome measures should include assessments of nonverbal cognition.