Effects of Gluten Free / Casein Free Diet in Young Children with Autism: A Pilot Study

  • Cynthia R. JohnsonEmail author
  • Benjamin L. Handen
  • Michelle Zimmer
  • Kelley Sacco
  • Kylan Turner
Original Article


With reports of the growing incidence of autism spectrum disorder ASD in the United States, a large number of families of affected children is seeking alternative or complementary forms of treatment. One of the more popular interventions has been use of elimination regimes, such as the gluten and casein free (GFCF) diet. This pilot study involved a three-month, prospective, open label, randomized, parallel groups design of a GFCF diet compared to a healthy, low sugar diet (attention control) for young children with ASD. Both treatment groups evidenced some gains across a range of variables, including measures of behavior, language, and ratings of the core features of ASD. No statistically significant differences were noted between treatment groups. While our results do not support use of a GFCF diet in ASD, it is possible that a greater period of time is required for treatment before gains can be observed. Moreover, no significant nutritional differences or side effects were observed on the GFCF diet compared to the control diet. However, adherence to the GFCF diet proved difficult based on our adherence data.


Gluten-fee Casein-free diet Autism Dietary restrictions 



The authors wish to thank Kathleen Colborn for her assistance on this project with respect to data management oversight and assisting with monitoring adherence. We would also like to thank Meg Mayer-Costa, MS, dietician, for her assistance in providing counseling to the participants’ families. The authors would also like to thank all of the participating families.

Funding Source

Supported by the John F. & Nancy A. Emmerling Fund / The Pittsburgh Foundation.

Financial Disclosures

Dr. Benjamin Handen disclosed consulting fees for Forest, Bristol Myer Squibb and has research funding from Forest, Bristol Myer Squibb, Johnson and Johnson, Neuropharm, and Curemark. Dr. Cynthia Johnson reported no biomedical financial interest or potential conflicts of interest. Dr. Michelle Zimmer reported no biomedical financial interest or potential conflicts of interest. Kelley Sacco and Kylan Turner also have no financial interests or potential conflicts of interest.


  1. Achenbach, T. M. (2002). Child behavior checklist 1 1/2–5. University of Vermont Department of Psychiatry Vermont.Google Scholar
  2. Aman, M. G., McDougle, C. J., Scahill, L., Handen, B. L., Arnold, L. E., Johnson, C. R., et al. (2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1143–1154.PubMedCrossRefGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4 th ed.), Text Revision (DSM-IV-TR). Washington, DC: Author.CrossRefGoogle Scholar
  4. Arnold, L. E., Aman, M. G., Martin, A., Collier-Crespin, A., Vitiello, B., Tierney, E., et al. (2000). Assessment in autism multisite randomized clinical trials (RCTs). Journal of Autism Developmental Disorder, 30, 99–111.CrossRefGoogle Scholar
  5. Arnold, G., Hyman, S. L., Mooney, R. A., & Kilby, R. S. (2003). Plasma amino acids profiles in children with Autism: potential risk of nutritional deficiencies. Journal of Autism & Developmental Disorders, 33, 449–454.CrossRefGoogle Scholar
  6. Brudnak, M. A., Rimland, B., Kerry, R. E., Dailey, M., Taylor, R., Stayton, B., et al. (2002). Enzyme-based therapy for autism spectrum disorders—is it worth another look? Medical Hypotheses, 58(5), 422–428.PubMedCrossRefGoogle Scholar
  7. Centers for Disease Control and Prevention. Retrieved: September 29, 2008. Autism Information Center: Frequently Asked Questions.
  8. Elder, J. H., Shankar, M., Shuster, J., Theriaque, D., Burns, S., & Sherrill, L. (2006). The gluten-free casein-free diet in autism: results of a preliminary double-blind clinical trial. Journal of Autism and Developmental Disorders, 36(3), 413–420.PubMedCrossRefGoogle Scholar
  9. Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: an update. Journal of Autism & Developmental Disorders, 4, 365–382.CrossRefGoogle Scholar
  10. Food Processor (Nutrition and Fitness Software) version 8.5, 2005. ESHA Research, Inc.Google Scholar
  11. Goday, P. (2008). Whey watchers and wheat watchers: the case against gluten and casein in autism. Nutritional Clinical Practices, 23, 581–582.CrossRefGoogle Scholar
  12. Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37, 613–627.CrossRefGoogle Scholar
  13. Guy, W. (1976). ECDEU Assessment Manual of Psychopharmacology. Rockville, Md.: National Institute of Mental Health US Dept. of Health, Education, and Welfare publication (ADM), Psychopharmacology Research Branch, 76–338.Google Scholar
  14. Hediger, M. L., England, L. J., Molloy, C. A., Yu, K. F., Manning-Courtney, P., & Mills, J. L. (2008). Reduced bone cortical thickness in boys with autism or autism spectrum disorder. Journal of Autism and Developmental Disorders, 38, 848–856.PubMedCrossRefGoogle Scholar
  15. Johnson, S. B., Silverstein, J., Rosenbloom, A., Carter, R., & Cunningham, W. (1986). Assessing daily management in childhood diabetes. Health Psychology, 5, 545–564.PubMedCrossRefGoogle Scholar
  16. Knivsberg, A. M., Reichelt, K. L., Nodland, M., & Hoien, T. (1995). Autistic syndromes and diet: a follow-up study. Scandinavian Journal of Educational Research, 39, 222–236.CrossRefGoogle Scholar
  17. Knivsberg, A. M., Reichelt, K. L., Hoien, T., & Nodland, M. (2002). A randomized, controlled study of dietary interventions in autistic syndromes. Nutritional Neuroscience, 5(4), 251–261.PubMedCrossRefGoogle Scholar
  18. Levy, S. E., & Hyman, S. L. (2003). Use of complementary and alternative treatments for children with autistic spectrum disorders is increasing. Pediatric Annals, 32(10), 685–691.PubMedGoogle Scholar
  19. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2002). Autism diagnostic observation schedule: A standardized observation of communicative and social behavior. Los Angeles, Western Psychological Services. developmental disorders.Google Scholar
  20. Millward, C., Ferriter, M., Calver, S., & Connell-Jones, G. (2008). Gluten- and casein-free diets for autistic spectrum disorder (Review). The Cochran Library, 1(4), 1–21.Google Scholar
  21. Mullen, E. (1995). Mullen scales of early learning. Circle Pines: American Guidance Service.Google Scholar
  22. National Research Council. (2001). Educating children with Autism. Committee on educational interventions for children with Autism. In C. Lord & J. P. McGee (Eds.), Division of behavioral and social sciences and education. Washington, DC: National Academy Press.Google Scholar
  23. Newscaffer, C. J., & Curran, L. K. (2003). Autism: an emerging public health problem. Public Health Reports, 118, 393–399.Google Scholar
  24. Rutter, M. Bailey, A. & Lord, C. Social Communication Questionnaire (SCQ). Western Psychological Services, 2003.Google Scholar
  25. Seung, H. K., Rogalski, Y., Shankar, M., & Elder, J. (2007). The gluten- and casein-free diet and autism: communication outcomes from a preliminary double-blind clinical trial. Journal of Medical Speech-Language Pathology, 15(4), 337–339.Google Scholar
  26. SPSS for Windows. (2007). Chicago: SPSS Inc.Google Scholar
  27. Tapp, J. (2003). Procoder for digital video. Kennedy Center: Vanderbilt University.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Cynthia R. Johnson
    • 1
    Email author
  • Benjamin L. Handen
    • 2
  • Michelle Zimmer
    • 3
  • Kelley Sacco
    • 4
  • Kylan Turner
    • 5
  1. 1.Children’s Hospital of Pittsburgh, Autism CenterUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.University of Pittsburgh School of MedicinePittsburghUSA
  3. 3.University of CincinnatiCincinnatiUSA
  4. 4.Children’s Hospital of PittsburghPittsburghUSA
  5. 5.University of Pittsburgh School of EducationPittsburghUSA

Personalised recommendations