Evidence of the Gluten-Free and Casein-Free Diet in Autism Spectrum Disorders: A Systematic Review
Open accessAbstract
In autism spectrum disorders, many parents resort to alternative treatments and these are generally perceived as risk free. Among these, the most commonly used is the gluten-free, casein-free diet. The objective of this work was to conduct a systematic review of studies published from 1970 to date related to the gluten-free, casein-free diet in autism spectrum disorder patients. Few studies can be regarded as providing sound scientific evidence since they were blinded randomized controlled trials, and even these were based on small sample sizes, reducing their validity. We observed that the evidence on this topic is currently limited and weak. We recommend that it should be only used after the diagnosis of an intolerance or allergy to foods containing the allergens excluded in gluten-free, casein-free diets. Future research should be based on this type of design, but with larger sample sizes.
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Other studies highlighted that adoption of an elimination diet could decrease fiber intake, probably aggravating GI problems.
“while other studies highlighted that the adoption of this elimination diet could decrease fiber intake [103], thus probably aggravating the GI problems.”
From Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions (2019) · cites this paper as [103]
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BackgroundInfluentialNutritional Impact of a Gluten-Free Casein-Free Diet in Children with Autism Spectrum Disorder
Marí-Bauset, S., Llopis-González, A., Zazpe, I., Marí-Sanchis, A., & Suárez-Varela, M. M. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2582-7 · Cited by 75 · see citing works
“Research to date has not confirmed the effectiveness of the GFCF diet but the evidence available remains limited and weak (Marı́-Bauset et al. 2014).”
BackgroundSelf-citationBaşpınar, B., & Yardımcı, H. (2020) · Eurasian Journal of Medicine · doi:10.5152/eurasianjmed.2020.19230 · Cited by 74 · see citing works
“In a systematic review, elimination diets were recommended only when there was intolerance or sensitivity to food containing gluten or casein [47].”
BackgroundInfluentialRestriction and Elimination Diets in ADHD Treatment
Nigg, J. T., & Holton, K. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.05.010 · Cited by 60 · see citing works
Plaza-Diaz, J., Flores-Rojas, K., Torre-Aguilar, M. J. D. L., Gomez-Fernández, A. R., Martín-Borreguero, P., Perez-Navero, J. L., Gil, A., & Gil-Campos, M. (2021) · Nutrients · doi:10.3390/nu13103551 · Cited by 56 · see citing works
Lamy, M., & Erickson, C. A. (2018) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2018.08.015 · Cited by 58 · see citing works
Nutritional management of (some) autism: a case for gluten- and casein-free diets?
Whiteley, P. (2015) · Proceedings of The Nutrition Society · doi:10.1017/s0029665114001475 · Cited by 52 · see citing works
Daulay, N. (2021) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2021.103954 · Cited by 53 · see citing works
The Gut-Brain-Immune Axis in Autism Spectrum Disorders: A State-of-Art Report
Puricelli, C., Rolla, R., Gigliotti, C. L., Boggio, E. M., Beltrami, E., Dianzani, U., & Keller, R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.755171 · Cited by 58 · see citing works
Dietary Patterns and Anthropometric Measures of Indian Children with Autism Spectrum Disorder
Siddiqi, S., Urooj, A., & D’Souza, M. J. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3850-0 · Cited by 52 · see citing works
Dietary interventions for autism spectrum disorder: New perspectives from the gut-brain axis
Doenyas, C. (2018) · Physiology & Behavior · doi:10.1016/j.physbeh.2018.07.014 · Cited by 46 · see citing works
Evidence-Based Treatments for Autism Spectrum Disorder
Politte, L. C., Howe, Y. J., Nowinski, L. A., Palumbo, M., & McDougle, C. J. (2015) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-015-0031-z · Cited by 48 · see citing works
Integrative Approaches to Caring for Children with Autism
Klein, N., & Kemper, K. J. (2016) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2015.12.004 · Cited by 45 · see citing works
“A GFCF diet should be implemented only with the help of a registered dietitian, and only for individuals who have sensitivities or allergies to the foods that are being eliminated.(19)”
BackgroundVaresio, C., Grumi, S., Zanaboni, M. P., Mensi, M. M., Chiappedi, M. A., Pasca, L., Ferraris, C., Tagliabue, A., Borgatti, R., & GIORGIS, V. D. (2021) · Nutrients · doi:10.3390/nu13062057 · Cited by 43 · see citing works
“To date, dietary interventions have been mainly based on an “elimination diet,” such as gluten-free and casein-free diets [8], but their level of evidence is limited [9].”
BackgroundZiats, M. N., Comeaux, M. S., Yang, Y., et al. (2015) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.37144 · Cited by 43 · see citing works
“Recent work suggests that there is only weak evidence that dietary modifications improve core autistic symptoms [Mari-Bauset et al., 2014].”
BackgroundDietary status and nutrient intake of children with autism spectrum disorder: A case-control study
Barnhill, K. M., Gutierrez, A., Ghossainy, M. E., Marediya, Z., Devlin, M., Sachdev, P. K., Marti, C. N., & Hewitson, L. C. (2018) · Research in Autism · doi:10.1016/j.rasd.2018.03.002 · Cited by 43 · see citing works
Li, Y., Ou, J., Li, Y., & Xiang, D.-X. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00155 · Cited by 43 · see citing works
“The opioid theory was the most cited theory for adopting of a CFGF diet for the treatment of ASD (67, 68).”
MethodAre therapeutic diets an emerging additional choice in autism spectrum disorder management?
Γώγου, Μ., & Kolios, G. C. (2018) · World Journal of Pediatrics · doi:10.1007/s12519-018-0164-4 · Cited by 42 · see citing works
Gluten-related disorders: certainties, questions and doubts
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“dence on the efficacy of gluten in an exclusion diet in the improvement of autistic spectrum disorder symptoms [100,101].”
BackgroundThe prevalence of gluten free diet use among preschool children with autism spectrum disorder
Rubenstein, E., Schieve, L. A., Bradley, C., DiGuiseppi, C. G., Moody, E. J., Thomas, K. C., & Daniels, J. L. (2017) · Autism Research · doi:10.1002/aur.1896 · Cited by 36 · see citing works
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“Parents who can identify and show concern of their child’s unhealthy weight have been associated with higher readiness in improving the family’s diet quality and effectively manage the child’s eating and exercise behaviours [57].”
BackgroundNutritional management and autism spectrum disorder: A systematic review
Al‐Beltagi, M. (2024) · World Journal of Clinical Pediatrics · doi:10.5409/wjcp.v13.i4.99649 · Cited by 36 · see citing works
Dietary Approaches to the Management of Autism Spectrum Disorders
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A review of gluten- and casein-free diets for treatment of autism: 2005–2015
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“14 However, as Kanner 2 noted in his case report, a thorough review must address case studies as well as reports of clinical trials to produce a “full view of the landscape” of what is currently known about the GFCF diet.”
InfluentialCanals-Sans, J., Esteban-Figuerola, P., Morales-Hidalgo, P., & Arija, V. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-04928-7 · Cited by 33 · see citing works
Dietary interventions for autism spectrum disorder: An updated systematic review of human studies
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Fad, Pseudoscientific, and Controversial Interventions
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Luisier, A.-C., Petitpierre, G., Bérod, A. C., García‐Burgos, D., & Bensafi, M. (2018) · Autism · doi:10.1177/1362361318815252 · Cited by 28 · see citing works
“Interestingly, previous works have shown that children who have the most sensory particularities are also those who have the greatest problems with food (Cermak et al., 2010, 2014; Marí-Bauset et al., 2014; Nadon et al., 2011; Suarez et al., 2012).”
BackgroundWhat Is Autism Spectrum Disorder?
Rea, H. M., LaMotte, K., & Burrell, T. L. (2018) · Springer eBooks · doi:10.1007/978-3-030-03213-5_1 · Cited by 29 · see citing works
Nutrient intake and adequacy in children with autism spectrum disorder: EPINED epidemiological study
Arija, V., Esteban-Figuerola, P., Morales‐Hidalgo, P., Jardí, C., & Canals, J. (2022) · Autism · doi:10.1177/13623613221098237 · Cited by 29 · see citing works
“…that of children with TD, which reported lower protein intakes in children with ASD (Barnhill et al., 2018; Hyman et al., 2012; Malhi et al., 2017; Marí-Bauset et al., 2014; Munira et al., 2020; Neumeyer et al., 2018; Shmaya et al., 2014; Tsujiguchi et al., 2020) or similar protein intakes in…”
BackgroundResultInfluentialMarí-Bauset, S., Zazpe, I., Marí-Sanchis, A., González, A. L., & Morales‐Suárez‐Varela, M. (2014) · Research in Autism · doi:10.1016/j.rasd.2014.08.012 · Cited by 25 · see citing works
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Długosz, A., Wróblewski, M., Błaszak, B., & Szulc, J. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26020808 · Cited by 29 · see citing works
Autism - A Comprehensive Array of Prominent Signs and Symptoms
Nadeem, M. S., Murtaza, B. N., Al-Ghamdi, M. A., Ali, A., Zamzami, M. A., Khan, J. A., Ahmad, A., Rehman, M. U., & Kazmi, I. A. (2021) · Current Pharmaceutical Design · doi:10.2174/1381612827666210120095829 · Cited by 25 · see citing works
Anthropometric measures of Spanish children with autism spectrum disorder
Marí-Bauset, S., González, A. L., Zazpe, I., Marí-Sanchis, A., & Morales‐Suárez‐Varela, M. (2014) · Research in Autism · doi:10.1016/j.rasd.2014.09.013 · Cited by 21 · see citing works
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Sensory Snack Time: A School-Based Intervention Addressing Food Selectivity in Autistic Children
Galpin, J., Osman, L., & Paramore, C. (2018) · Frontiers in Education · doi:10.3389/feduc.2018.00077 · Cited by 21 · see citing works
“Feeding or eating difficulties are widely recognized as problematic for autistic children (Schreck et al., 2004; Schreck andWilliams, 2006; Provost et al., 2010; Nadon et al., 2011a,b; Kral et al., 2013; Sharp et al., 2013; Hubbard et al., 2014; Marí-Bauset et al., 2014; Suarez et al., 2014b) and are often compounded…”
BackgroundA Spectrum of Solutions: Unveiling Non-Pharmacological Approaches to Manage Autism Spectrum Disorder
Mondal, A., Sharma, R., Abiha, U., Ahmad, F., Karan, A., Jayaraj, R. L., & Sundar, V. (2023) · Medicina · doi:10.3390/medicina59091584 · Cited by 17 · see citing works
“People with ASD, on the other hand, have higher intestinal permeability to such compounds, resulting in inflammation [48–52].”
BackgroundFolic acid and autism: updated evidences
Vasconcelos, C., Perry, I. D. S., Gottfried, C., Riesgo, R. D. S., & Castro, K. (2024) · Nutritional Neuroscience · doi:10.1080/1028415x.2024.2367855 · Cited by 19 · see citing works
“Moreover, the high cost of food adaptations in these diets could divert resources that should be earmarked for therapies proven to be effective in treating ASD [125].”
Noğay, N. H., & Nahikian-Nelms, M. L. (2022) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2022.2036921 · Cited by 15 · see citing works
Fat intake in children with autism spectrum disorder in the Mediterranean region (Valencia, Spain)
Marí-Bauset, S., González, A. L., Zazpe, I., Marí-Sanchis, A., & Morales‐Suárez‐Varela, M. (2015) · Nutritional Neuroscience · doi:10.1179/1476830515y.0000000029 · Cited by 16 · see citing works
Self-citationGonzález-Domenech, P., Atienza, F. D., Pablos, C. G., Nieto, S. M. S., Rodríguez, Ó. H., Gutiérrez-Rojas, L., & Martínez-Ortega, J. M. (2019) · Journal of Mental Health Research in Intellectual Disabilities · doi:10.1080/19315864.2019.1654574 · Cited by 14 · see citing works
“Another study reports results from even shorter time periods; indeed, meta-reviews (Dosman et al., 2013; Marí-Bauset et al., 2014; Millward et al., 2008; Mulloy et al., 2010; Sathe et al., 2017; Whiteley et al., 2010b) point to this as one of the main limitations for this type of studies.”
BackgroundResultInfluentialPediatric Integrative Medicine Approaches to Attention Deficit Hyperactivity Disorder (ADHD)
Esparham, A. E., Evans, R., Wagner, L. E., & Drisko, J. (2014) · Children · doi:10.3390/children1020186 · Cited by 14 · see citing works
Tan, W. Y., Hamzaid, N. H., & Ibrahim, N. (2023) · Nutrients · doi:10.3390/nu15071608 · Cited by 17 · see citing works
Zhukova, M., Talantseva, O. I., Logvinenko, T. I., Titova, O. S., & Grigorenko, E. L. (2020) · Clinical Psychology and Special Education · doi:10.17759/cpse.2020090310 · Cited by 12 · see citing works
Güner, Ü. Ç., Günay, U., & Acar, M. D. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101847 · Cited by 11 · see citing works
A Narrative Review about Autism Spectrum Disorders and Exclusion of Gluten and Casein from the Diet
González-Domenech, P., Díaz-Atienza, F., Gutiérrez-Rojas, L., Fernández‐Soto, M. L., & González-Domenech, C. M. (2022) · Nutrients · doi:10.3390/nu14091797 · Cited by 11 · see citing works
“Nevertheless, a placebo design and monitoring concomitant treatments are absent, determining a lack of scientific robustness and the chance of being a recommendation in the field [48].”
BackgroundA Scoping Literature Review of the Relation between Nutrition and ASD Symptoms in Children
van der Wurff, I. S. M., Oenema, A., de Ruijter, D., Vingerhoets, C., van Amelsvoort, T., Rutten, B. P. F., Mulkens, S., Köhler, S., Schols, A. M. W. J., & de Groot, R. H. M. (2022) · Nutrients · doi:10.3390/nu14071389 · Cited by 11 · see citing works
Ha, V. S., & Whittaker, A. M. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2040613 · Cited by 10 · see citing works
Dietary and Micronutrient Treatments for Children with Neurodevelopment Disorders
Taylor, M. R., Chuang, C.-C., Carrasco, K., Nagatomo, S., & Rucklidge, J. J. (2018) · Current Developmental Disorders Reports · doi:10.1007/s40474-018-0150-5 · Cited by 11 · see citing works
“Existing treatments for these conditions include medication and behavioral treatments [3]; however, many families choose to explore dietary treatments for neurobehavioral disorders [4].”
BackgroundShi, A., Liu, D., Wu, H., Zhu, R., Deng, Y., Yao, L., Xiao, Y., Lorimer, G. H., Ghiladi, R. A., Xu, X., et al. (2024) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2024.116191 · Cited by 9 · see citing works
Parents’ assessments of their child’s autism-related interventions
Shepherd, D., Landon, J., Goedeke, S., Ty, K., & Csákó, R. I. (2018) · Research in Autism · doi:10.1016/j.rasd.2018.02.005 · Cited by 9 · see citing works
Abirami, G. P. P., Radhakrishnan, R. K., Johnson, E., Roshan, S. A., Yesudhas, A., Parveen, S., Biswas, A., Ravichandran, V. R., Anusuyadevi, M., & Kandasamy, M. (2020) · Advances in neurobiology · doi:10.1007/978-3-030-30402-7_8 · Cited by 9 · see citing works
Gastrointestinal Issues in Infants and Children with Autism and Developmental Delays
Jiang, X., Matson, J. L., Cervantes, P. E., Matheis, M., & Burns, C. O. (2017) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-017-9532-6 · Cited by 9 · see citing works
Glutensiz diyet; gerçekten her zaman yararlı mı?
Kutlu, T. (2019) · Türk Pediatri Arşivi · doi:10.14744/turkpediatriars.2019.82609 · Cited by 8 · see citing works
“When 24 articles published on this subject since 1970 were examined, however, a low level of scientific evidence could be observed in only 4 articles (21).”
BackgroundActon, R. K., Imberman, S. A., & Lovenheim, M. (2021) · Journal of Health Economics · doi:10.1016/j.jhealeco.2021.102489 · Cited by 6 · see citing works
The opioid excess theory in autism spectrum disorders - is it worth investigating further?
Tarnowska, K., Gruczyńska–Sękowska, E., Kowalska, D., Majewska, E., Kozłowska, M., & Winkler, R. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2021.1996329 · Cited by 6 · see citing works
Cravero, C., Guinchat, V., Claret, A., Sahnoun, C., Bonniau, B., Bodeau, N., Danion-Grilliat, A., Cohen, D., & Chamak, B. (2017) · Neuropsychiatrie de l Enfance et de l Adolescence · doi:10.1016/j.neurenf.2016.10.002 · Cited by 6 · see citing works
Diet, Microbiome, and Neuropsychiatric Disorders
Javitt, G. A., & Javitt, D. C. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811440-7.00013-2 · Cited by 6 · see citing works
History of Non-Evidence-Based Practices for Individuals Diagnosed with ASD
Kryszak, E. M., & Mulick, J. A. (2022) · Autism and child psychopathology series · doi:10.1007/978-3-030-96478-8_3 · Cited by 5 · see citing works
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Dehghani, E., Karimi, K., Arekhi, S., Ardeshir, M., Rezapour, R., Shayestehfar, M., & Memari, A. H. (2025) · BMC Nutrition · doi:10.1186/s40795-025-01043-z · Cited by 4 · see citing works
The Relationship of Autism Spectrum Disorders and Celiac Disease and Gluten-free Diet
Szaflarska‐Popławska, A. (2016) · International Journal of Celiac Disease · doi:10.12691/ijcd-3-4-1 · Cited by 4 · see citing works
“Moreover, the affinity of exogenous opioids to opioid receptors is low, and in food products there are also peptides of antagonistic action to these receptors [2].”
BackgroundMethodInfluentialAutism Spectrum Disorders and Gluten/Casein Free Diet Treatment: A Systematic Review (1990-2016)
Çöpür, M., & Çöpür, S. (2017) · International Journal Of Nutrition · doi:10.14302/issn.2379-7835.ijn-17-1710 · Cited by 4 · see citing works
“…Hurwitz et al, 2013 39 1 Systematic review Journal of Early Intervention Herbert and Buckley, 2013 40 6 1 The Journal of Child Neurology Mar ı ´-Bauset et al, 2014 41 1 Systematic review Journal of Child Neurology Elder et al, 2015 42 1 Systematic review Nutrition and Dietary Supplements…”
Harrington, J. W., & Bora, S. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-35868-2.00008-6 · Cited by 4 · see citing works
Bicer, A. H., & Alsaffar, A. A. (2016) · Integrative Food Nutrition and Metabolism · doi:10.15761/ifnm.1000135 · Cited by 4 · see citing works
“Although adopted by many families, systematic reviews of GFCF diets could not support the use of such diets in the treatment of ASD [50,51].”
BackgroundAngelopoulou, M., Siaperas, P., Livadas, S., Karantana, E., Papadimitriou, D. T., & Angelopoulos, N. (2025) · Neuroscience · doi:10.1016/j.neuroscience.2025.09.009 · Cited by 4 · see citing works
Autismo: aspectos nutrológicos das dietas e possível etiologia
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Comorbidity and the Need for Interdisciplinary Treatments
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Substantiated and Unsubstantiated Interventions for Individuals with ASD
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The cost of being gluten-free: a hedonic pricing analysis of food products for celiac patients
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Differential Hallmarks of Celiac Versus Non-Celiac Gluten Sensitivity
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Gluten-free diet among school-age children in Olmsted County, Minnesota
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“Despite the lack of strong medical evidence to support GFD in children with autism spectrum disorders, many families elect to eliminate gluten because of autism or behavioral concerns.[16,17]”
BackgroundAutism in Children Connected with Gastrointestinal Symptoms
Walecki, P. K., Kawala‐Sterniuk, A., & Siwek, J. (2018) · IntechOpen eBooks · doi:10.5772/intechopen.79863 · Cited by 2 · see citing works
“Many studies on the GFCF diet focus on the safety of the intervention [31].”
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Gluten: do only celiac patients benefit from its removal from the diet?
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A Qualitative Assessment Of Eating Behaviors In Adults With Autism
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- Authors
- Marí-Bauset, S., Zazpe, I., Mari-Sanchis, A., Llopis-González, A., & Morales-Suárez-Varela, M.
- Affiliations
- Universitat de València (ES)
- Department of Nutrition and Food Sciences and Physiology, University of Navarra, Navarra, Spain
- Clinical Nutrition and Dietetics Unit, Navarra Hospital Complex, Navarra, Spain
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
- Venue
- Journal of Child Neurology
- Publisher
- SAGE Publications
- Published
- 2014-04-30
- Volume
- 29
- Issue
- 12
- Pages
- 1718-1727
- ISSN
- 0883-0738 (ISSN-L)
- 1708-8283
- OpenAlex
- W2011447176
- Semantic Scholar
- 1d7091aa87f7bd44dce0d3436ece1b2ebd569bc0
- Cited by
- 136
- References
- 67
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 8 · 2023: 4 · 2022: 10 · 2021: 17 · 2020: 11 · 2019: 12 · 2018: 15 · 2017: 18 · 2016: 9 · 2015: 12 · 2014: 8
- FWCI
- 11.96
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Child Neurology (publishedVersion)
- PubMed (publishedVersion)
- Deposito Adademico Digital Universidad De Navarra (University of Navarra) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- gluten-free diet, casein-free diet, autism spectrum disorder, dietary intervention, food intolerance, food allergy, alternative treatment, quality of evidence
- MeSH terms
- Caseins, Child Development Disorders, Pervasive, Diet Therapy, Humans, Diet, Gluten-Free
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