Meet the AIR-P Researchers
Susan L. Hyman, M.D.
Dr. Hyman is Principle Investigator for the HRSA AIR-P research project "Diet and Nutrition in Children with Autism Spectrum Disorders: An Autism Treatment Network Collaborative Study".
Susan L. Hyman, M.D. is the Chief of Neurodevelopmental and Behavioral Pediatrics and an Associate Professor of Pediatrics at the Golisano Children's Hospital at Strong of the University of Rochester School of Medicine. She is Board Certified in Developmental Disabilities and in Developmental and Behavioral Pediatrics.
She received her undergraduate and medical degrees from Brown University and completed a pediatric residency at the North Carolina Memorial Hospital in Chapel Hill. She remained on the faculty at Kennedy Krieger Institute/Johns Hopkins Medical Center after her Fellowship there in Developmental Pediatrics. She is the chair of the Autism Subcommittee of the Committee on Children with Disabilities for the American Academy of Pediatrics. Her research interests in interventions for autism include medication management, diet and nutrition, early education, and medical assessment and treatment. Dr. Hyman has served on the Scientific Advisory Committees of both NAAR and Autism Speaks. She is co-PI of the Autism Treatment Network site at the University of Rochester.
1. How did you become interested in the area of diet and nutrition as it relates to children with Autism Spectrum Disorder (ASD)?
Questions about diet and nutrition come up at every clinical visit with families of children with ASD. My research interest in this area emerged to answer the questions that families needed answered: How does nutrition affect behavior? How does it affect health and wellness? What are the beneficial and potentially harmful effects of dietary interventions? and lastly, How can I get him/her to eat more (or less!)?
2. In your work have you seen differences between the diet and nutrition of children with ASD and those of typically developing children which you feel may be significant to the health and overall wellbeing of children with ASD?
I have concerns about the nutrition of all children related to health and well being, not just children with ASD. Our American diet provides too many calories. Foods are fortified and supplements provided without the data to understand how we may be affecting health and wellness into the future. Children with ASD may be at particular risk for nutritional insufficiency or excess because of the food aversions and habits that are often reported. In addition, when the diet is altered, care must be taken to provide the necessary nutrients that are removed. For example, when dairy products are removed, attention to the protein, calcium, and vitamin D that is typically ingested through milk products must be provided through alternative products.
3. What previous work undertaken either by you or others has led to this particular study?
There is a modest literature examining food aversions and nutritional status of children with ASD.
- Over the past 5 years Drs. Patricia A. Stewart, Tristram Smith and I performed a double blind placebo controlled challenge study of the gluten-free and casein-free diet in young children with autism at the University of Rochester. We are still in the process of analyzing the data. This project allowed my collaborators and I to intensely experience the range of eating and nutritional issues experienced by families of children with ASD. Each child brought up new research questions.
- Dr. Cynthia Johnson and her colleagues at Pittsburgh and Dr. Reynolds and Rosenberg at Colorado both examined nutritional intake in cohorts of young children with ASD at their centers. Different patterns of nutritional insufficiency were noted. Clearly, a larger sample and additional data is necessary to further examine the intake of fiber, vitamins, and minerals and have the power to examine the relationship of intake with bowel habits and behaviors.
- Dr. Cynthia Molloy and her colleagues in Cincinnati has demonstrated that children with ASD have decreased cortical bone density. Children with less dairy intake seem to have additional compromise.
- Dr. Jill James and collaborators in Arkansas have demonstrated metabolic abnormalities in a group of children with ASD related to oxidative stress. She has been pursuing nutritional interventions to correct this observed biochemical abnormality and is studying the response to nutritional supplements.
Examples of other studies include the relationship of iron status and sleep problems (Dosman et al), taste and smell differences and eating behaviors (Bennetto et al), and eating behaviors and food choice (Shreck and Williams). The studies to date have all been too small and too limited to answer the questions related to diet and feeding behavior in children with ASD.
4. Would you briefly describe the AIR-P study, the participating institutions and how the study will work?
Five ATN sites with prior work in the area of diet, nutrition, and ASD will collaborate in the collection of a large cohort of children with ASD. Data related to dietary intake, laboratory tests for iron and vitamin D status, and feeding behaviors will be collected on ATN participants at these sites: Arkansas, Cincinnati, Colorado, Pittsburgh, and Rochester. We will use the rich ATN protocol to examine whether dietary insufficiency or the laboratory markers are associated with specific behaviors related to sleep, activity, perseveration, and eating. It will provide valuable information to guide the development of trials addressing the behavioral correlates of dietary interventions, feeding behaviors, and will inform the development of guidelines related to diet and nutrition that can be used by health care providers and families.
5. What is the age range of the children you will be studying?
ATN participants ages 2-11 years.
6. Why is this work important to families with a child with ASD? How will it help them?
Although I think there are many things that that will be important in shaping the future of autism research there are some that come immediately to mind:
- Making certain we have a constant influx of young and well-trained researchers
- Advocacy by the stakeholders so that adequate funds remain available
- A focus on translational research that will permit biological and clinical understanding and intervention to be tested simultaneously to inform evidence based interventions