Online resource 2. Gluten- and Casein-free diet and autism spectrum disorders in children:

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1 European Journal of Nutrition. Gluten- and Casein-free diet and autism spectrum disorders in children: a systematic review. Authors: Anna Piwowarczyk, Andrea Horvath, Jan Łukasik, Ewa Pisula, Hania Szajewska. Corresponding author: Andrea Horvath, The Medical University of Warsaw, Department of Paediatrics, andrea.hania@gmail.com Online resource 2. Gluten- and Casein-free diet and autism spectrum disorders in children: overview of scales used to assess autism spectrum disorder symptoms in the included trials. Scale ABC (Aberrant Behavior Checklist) ADHD-IV (Attention- Deficit Hyperactivity Disorder IV Rating Scale) ADOS (Autism Diagnostic Observation Schedule) AWPC-score (Approach Withdrawal Problems Composite) Study in which the scale was used al [3] Pusponegoro et al.[6] Description A standardized, 58-item rating scale originally designed to assess treatment effects in individuals living in residential facilities. It consists of five subscales: (I) irritability, agitation, crying, (II) lethargy, social withdrawal, (III) stereotypic behavior, (IV) hyperactivity, noncompliance, and (V) inappropriate speech. [2] Scale for the evaluation of inattention and hyperactivityimpulsivity based on the DSM-IV criteria for ADHD. Assessment is based on parents reports. [4] A tool for the assessment of core autism behaviors, with four modules suited for language capability of the subject. It generates an algorithm score for the three core areas of autism - communication, social interaction and repetitive behaviors. [5] Score for evaluation of maladaptive behavior. It is a subtest of the Pervasive Developmental Disorder Behavior Inventory (PDDBI). The AWPC measures seven categories of maladaptive behavior, including: sensory/perceptual approach behaviors, ritualism/resistance to change, social/pragmatic problems, semantic/pragmatic problems, arousal/regulation problems, specific fears, and aggressiveness. [7]

2 CARS (Childhood Autism Rating Scale) CBCL (Child Behavior Checklist) CPRS-R (Conners Parent Rating Scale- Revised) DIPAB Direct Behavior Observation Measure ECO Scales (Ecological Communication Orientation) GARS (Gilliam Autism Rating Scale) In-home observation of child behaviors [8] [5] [5] Scale used to identify children with autism and evaluate severity of autistic features. CARS includes rating of the following behaviors: relationships with others; imitation, emotional expression, body use, peculiarities in object use; resistance to change; visual, auditory, and tactile responsiveness; anxiety; verbal and nonverbal communication; activity level; and intellectual ability. [9] A questionnaire used to assess emotional, behavioral, and social problems of a child, filled out by caregiver. It is divided into the following categories: anxiety/depression, withdrawal/depression, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, and aggressive behavior. A tool that enables collecting parental reports of their children s behavior abnormalities. It comprises seven subscales: Cognitive Problems, Oppositional, Hyperactivity-Impulsivity, Anxious-Shy, Perfectionism, Social Problems, and Psychosomatic. [11] A standardized Danish tool used for assessment of autistic behavior and function of language, communication and social contact and motor skills. [13] Additional analysis of video material shot during testing of the children with the ADOS (Autism Diagnostic Observation Schedule) for: positive vocalizations, attending to task/activity, social initiations. Used to assess the quality of the child and parent interaction. [14] A questionnaire identifying and diagnosing autism, as well as estimating the severity of the individual's disorder. Tool is comprised of 56 items grouped into four scales evaluating symptoms of ASD: social interaction, communication, stereotyped behaviors, and developmental disturbances. Scores in each scale are summed and converted to standard scores based on reference samples. [15] Each child s interaction with primary care-taking parents was videotaped for 15 minutes during unstructured sessions that were a part of house visits. Behaviors that were assessed included: child initiating, child 2

3 ITPA (Illinois Test of Psycholinguistic Abilities) LIPS (Leiter International Performance Scale) Movement Assessment Battery for Children Mullen Scales of Early Learning AGS Edition Reynells spraktest SCQ (Social Communications Questionnaire) VABS (Vineland Adaptive Behavior Scales) responding, intelligible words spoken and also parent initiating, parent responding and parent expectant waiting. [5] Test assessing psycholinguistic abilities standardized for children between 4 and 10 years of age. It consists of subtests assessing various aspects of the verbal and nonverbal language. [16] Non-verbal test for cognitive skills in children with developmental disorders aged 2-18 years. [17] Used for rating of motor abilities. It consists of a checklist and a test. The checklist is developed for classroom assessment and screening of children with motor function abnormalities. The test is a version of the Tests of Motor Impairment (TOMI). It has been standardized in the US for children between 4 and 12 years, and it is divided into 4 age groups with increasingly difficult tasks. [18] Scales for evaluation of cognitive functioning for infants and preschool children aged 0-68 months. It includes five domains: Visual Reception (nonverbal problem-solving skills), Receptive Language, Expressive Language, Fine Motor skills, and Gross Motor skills (for younger children) [19] Test for psycholinguistic abilities standardized for Norwegian children between 1.5 and 6 years. It includes various subtests covering both impressive and expressive language. [20] A questionnaire for parents to screen for autism spectrum disorders dedicated to evaluating children older than 4 years, also suitable for monitoring. It is based on the ADI-R (Autism Diagnostic Interview Revised) and DSM-IV. [21] A questionnaire for measurement of adaptive behavior from birth to adulthood. For children, it is based on parents reports. It includes evaluation of multiple domains of communication, socialization, and daily living skills. It provides an estimate of a child s adaptive developmental age. [22] 3

4 European Journal of Nutrition. Gluten- and Casein-free diet and autism spectrum disorders in children: a systematic review. Authors: Anna Piwowarczyk, Andrea Horvath, Jan Łukasik, Ewa Pisula, Hania Szajewska. Corresponding author: Andrea Horvath, The Medical University of Warsaw, Department of Paediatrics, andrea.hania@gmail.com References [1] Navarro F, Pearson DA, Fatheree N, Mansour R, Hashmi SS, Rhoads JM (2015) Are 'leaky gut' and behavior associated with gluten and dairy containing diet in children with autism spectrum disorders? Nutr Neurosci 18: [2] Aman MG, Singh NN, Stewart AW, Field CJ (1985) The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. Am J Ment Defic 89: [3] Whiteley P, Haracopos D, Knivsberg AM, et al (2010) The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci 13: [4] DuPaul GJ, Power TJ, Anastopoulos AD (1998) ADHD rating scale-iv. Guilford, New York [5] Lord C, Rutter M, DiLavore P, Risi S (1999) Autism Diagnostic Observation Schedule: Manual. Western Psychological Services, Los Angeles [6] Pusponegoro HD, Ismael S, Firmansyah A, Sastroasmoro S, Vandenplas Y (2015) Gluten and casein supplementation does not increase symptoms in children with autism spectrum disorder. Acta Paediatr 104:e [7] Cohen IL, Sudhalter S (2005) PDD behavior inventory. Professional manual. Psychological Assessment Resources Inc, Odessa [8] Elder JH, Shanker 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. J Autism Dev Disord 36: [9] Schopler E, Reichler RJ, DeVellis RF, Daly K (1980) Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). J Autism Dev Disord 10: [10] Johnson CR, Handen BL, Zimmer M, Sacco K, Turner K (2011) Effects of gluten free/casein free diet in young children with autism: a pilot study. J Dev Phys Disabil 23: [11] Conners CK, Sitarenios G, Parker JD, Epstein JN (1998) The revised Conners Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol 26:

5 [12] Knivsberg AM, Reichelt KL, Høien T, Nødland M (2002) A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci 5: [13] Haracopos D, Kelstrup A (1975) DIPAB observationsskema. Special-peadagogisk forlag a/s Herning. [14] MacDonald JD, Gillette Y, Hutchinson TA (1989) ECO scales manual. Special Press, San Antonio [15] Gilliam JE (1995) Gilliam autism rating scale. Pro-Ed, Austin [16] Kirk SA, McCarthy JJ (1961) The Illinois Test of Psycholinguistic Abilities: An approach to differential diagnosis. J Ment Defic Res 66: [17] Leiter R (1979) Leiter International Performance Scale. Stoelting Co, Wood Dale [18] Henderson S, Sugden D (1992) Movement Assessment Battery for Children. The Psychological Corporation LTD, Sidcup [19] Mullen E (1995) Mullen scales of early learning. American Guidance Service, Circle Pines [20] Hagtvet B, Lillestolen R (1985) Handbook. Reynells spraktest (Reynell Developmental Language Scale). Universitetsforlaget, Oslo [21] Rutter M, Bailey A, Lord C (2003) Social Communication Questionnaire (SCQ). Western Psychological Services, Los Angeles [22] Sparrow SS, Balla DA., Cicchetti DV (1984) Vineland Adaptive Behaviour Scales (Interview Edition), 2nd edition. American Guidance Service, Circle Pines 5