The Relative and Combined Effects of a Diet and a Behavioural Intervention for Behaviour and Sleep Problems in Four Boys with Asperger's Disorder

Background: Sleep and behaviour problems are common in children with an autism spectrum disorder (ASD) and are often related. Although behavioural interventions, including Behavioural Parent Training (BPT) programs, can be effective in alleviating both problems, parents often try alternative treatments such as diets. Thus accurate information regarding the effectiveness of dietary interventions for behaviour and sleep problems, both relative to, and compared with, behavioural interventions is needed. There is some evidence that various elimination diets can improve behaviour and sleep, however the relative impact of a BPT and diet on behaviour in general and the impact of diet on sleep problems is unknown. Objectives: To investigate the relative and combined effects of a BPT program and the Simplified Elimination Diet (SED) on daytime behaviour and sleep in children with a range of challenging behaviours, including sleep problems. The SED excludes food additives, salicylates, amines, and glutamates, while the BPT teaches parents standard behavioural principles to manage their child's difficult behaviours. Methods: Four boys with Asperger's Disorder aged 4:6, 6:8, 7:11, and 10:5 years participated in this study. They had an IQ > 85 and challenging behaviour, defined by a score ≥ 85th percentile on the Rowe Behaviour Rating Inventory (RBRI). Participants were randomly allocated to the BPT (Boys 1 and 2) or the SED (Boys 3 and 4) group (Phase 2). Children from the BPT group then completed the SED and those from the SED completed the BPT program (Phase 3); participants maintained the Phase 2 intervention. Measures were taken before (Phase 1) and following Phase 2, and following Phase 3. Children's general challenging behaviour and compliance and the RBRI were also measured weekly throughout the study. As well as the RBRI, which includes a sleep subscale, the Children's Sleep-Wake Scale, Conners Parent Rating Scale, Child Behavior Checklist, Home Situations Questionnaire and Social Skills Rating Scale were completed. Results: There were no changes in Boy 1's behaviour or sleep following the BPT intervention, however Boy 2 showed some positive behaviour changes and his sleep problems reduced to zero. There were significant improvements in behaviour following the SED for Boys 1 and 2 and sleep problems for Boy 1 reduced to zero. Behaviour problems improved significantly with the SED for Boys 3 and 4 and sleep problems reduced to zero. After the BPT program Boy 4 showed further improvement in some behaviours. Two of the four boys completed an open food challenge and both behaviour and sleep problems returned during the challenge phase. Conclusions: The SED was more effective than a BPT in reducing both sleep and behaviour problems in 3 of 4 boys with AD. The fourth boy's sleep problems responded to the BPT but the SED was more effective in dealing with his challenging behaviour in general. Thus, this study provides evidence that, at least some in children with AD both sleep and behaviour problems may be related to diet. This requires further investigation, including determining which dietary constituents are responsible for these effects.