Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by

impairments in two core domains: social communication and restricted and repetitive patterns
of behavior, interests, or activities (American Psychiatric Association, 2013). According to
the Diagnostic and Statistical Manual of mental disorders- 5th edition (DSM-5) criteria,
people with ASD fall on a continuum with individuals characterized by the severity of their
symptoms in the two core domains. Furthermore, intellectual disability and/ or language
impairment contribute to the heterogeneous presentation of ASD.

Behavioral problems, such as tantrums, comorbidity with other psychiatric disorders,

abnormal sleep patterns and unusual feeding behaviors, are often present in children with
ASD and the everyday management of these problems is a challenge for clinicians and
families (Dominick, Davis, Lainhart, Tager-Flusberg, & Folstein, 2007). Although not a
diagnostic feature of ASD, feeding problems are common in this clinical population, and
food selectivity is the most frequent one.

Many theories explain that autism occurs due to gene mutations, neurological disorders,
and biology. Whiteley et al., (2013) stated that biological problems in autistic children occur
due to digestive disorders. A research has been carried out by Ratnawati in 2013 found that
about 60% of autistic patients have an imperfect digestive system, including the presence of
leaky gut syndrome or the appearance of small holes in the intestinal mucosa. This situation
results in the production of digestive enzymes from the pancreas that are used to break down
peptide proteins are inhibited, and resulting in the breakdown of incomplete peptide proteins.
This type of protein peptide is found in foods and drinks that contain gluten and casein.

Gluten Free Casein Free (GFCF) is a diet recommendation to reduce hyperactivity in

children with autism. GFCF diet is a therapy that is carried out by removing food sources
containing gluten and casein proteins, parents are not allowed to give, and serve foods that
contain gluten and casein. Kawicka and Regulska-Ilow (2011) mention the GFCF diet is a
food therapy that is processed directly in the body. If done with other therapies, such as
behavior therapy, speech therapy, and physical occupational therapy, it will have a better
effect on autistic children.

Gluten and casein are part of short-chain amino acids commonly called peptides.
According to Whiteley et al., (2010) in normal conditions, peptide is only slightly absorbed
by the body and is mostly discharged through feces. However, in people with autism it does
not happen, some of the peptides are absorbed into the blood circulation and some are
towards the brain. The peptide leading to the brain attaches to the opioid receptor and
changes its function like morphine. Opioid peptides that attach to the brain of an autistic child
will affect the central nervous system so that influence the cognitive abilities, speech ability,
pain threshold disorders, sleep disorders and cause behavioral disorders such as more
hyperactive. The hiperactive is not only movements but also emotions such as anger or go
berserk (Fadhli, 2010; Murdiyanta, Ramani, & Sulistiyani, 2015; Nugraheni, 2008). It can be
concluded that gluten and casein cause some behavioral disorders in autistic children.

Parents are one of factors that greatly influence the implementation of the GFCF diet
(Koka, 2011). This is because the diet in autistic children is inseparable from the role of
parents in providing and conducting good and nutritious. Parents do food supervision
according to their children’s needs. So, their children food will be fulfilled if parents
understand the condition of children with autism. Parents’ understanding of the GFCF diet
have an impact on the success of therapy. The negative impact that will arise if parents do not
implement the GFCF diet properly and obediently, it will cause a buildup of opioid peptides
in the brain of autistic children so that there is an increase in hyperactive behavior, and
children become difficult to develop (Hurwitz, 2013).

Gluten and casein are part of short-chain amino acids commonly called peptides.
According to Whiteley et al., (2010) in normal conditions, peptide is only slightly absorbed
by the body and is mostly discharged through feces. However, in people with autism it does
not happen, some of the peptides are absorbed into the blood circulation and some are
towards the brain. The peptide leading to the brain attaches to the opioid receptor and
changes its function like morphine. Opioid peptides that attach to the brain of an autistic child
will affect the central nervous system so that influence the cognitive abilities, speech ability,
pain threshold disorders, sleep disorders and cause behavioral disorders such as more
hyperactive. The hiperactive is not only movements but also emotions such as anger or go
berserk (Fadhli, 2010; Murdiyanta, Ramani, & Sulistiyani, 2015; Nugraheni, 2008). It can be
concluded that gluten and casein cause some behavioral disorders in autistic children.
Therefore, autistic children are encouraged to go on a GFCF diet (Gluten Free Casein Free).

The leaky gut was believed to allow for the entry of gluten- and casein-based peptides
into the circulatory system and then into the central nervous system, where they were
hypothesized to bind to opioid receptors (Horvath et al. 1999; Reichelt et al. 1991; Reichelt
and Landmark 1995). Proponents of the diet propose that the resulting change in brain
chemistry interferes with neural development, cognitive functioning, attention, and learning
in children with ASD (Knivsberg et al. 1995). As evidence for the leaky gut hypothesis, some
studies reported abnormal levels of peptides from gluten and casein in the urine (Reichelt et
al. 1994; Whiteley et al. 1999) and abnormal intestinal permeability (Horvath and Perman
2002). However, other studies have not replicated these findings (Kemperman et al. 2008;
Robertson et al. 2008; Williams and Marshall 1992). Children with ASD frequently are
reported to have gastrointestinal symptoms such as diarrhea or constipation, but ASD-specific
gastrointestinal pathology has not been documented (Buie et al. 2010).

Parents do food supervision according to their children’s needs. So, their children
food will be fulfilled if parents understand the condition of children with autism. Parents’
understanding of the GFCF diet have an impact on the success of therapy. The negative
impact that will arise if parents do not implement the GFCF diet properly and obediently, it
will cause a buildup of opioid peptides in the brain of autistic children so that there is an
increase in hyperactive behavior, and children become difficult to develop (Hurwitz, 2013).
From the results of these studies it can be concluded that parental compliance has an
important role in increasing the effectiveness of the GFCF diet.
 Food containing gluten is found in wheat products, taro and banana noodle and food
containing casein found in animal milk products (Marí-Bauset, Llopis-González, Zazpe,
Marí-Sanchis, & Suárez-Varela, 2016).
Autism Spectrum Disorder (ASD) adalah gangguan perkembangan saraf dicirikan oleh
gangguan pada dua domain inti: social komunikasi dan pola perilaku yang terbatas dan
berulang, minat, atau kegiatan (American Psychiatric Association, 2013). Menurut untuk
Manual Diagnostik dan Statistik gangguan mental-Kriteria edisi 5 (DSM-5), orang dengan
ASD jatuh pada sebuah kontinum dengan individu yang ditandai oleh keparahan gejala
mereka di dua domain inti. Selanjutnya, kecacatan intelektual dan / atau gangguan bahasa
berkontribusi pada heterogen presentasi ASD. (Clinical differences in children with autism
spectrum disorder with and without food selectivity)

Masalah perilaku, seperti amukan, komorbiditas dengan yang lain gangguan kejiwaan, pola
tidur abnormal dan pemberian makanan yang tidak biasa perilaku, sering hadir pada anak-
anak dengan ASD dan sehari-hari manajemen masalah ini merupakan tantangan bagi dokter
dan keluarga (Dominick, Davis, Lainhart, Tager-Flusberg, & Folstein, 2007). Meskipun
bukan fitur diagnostik ASD, masalah makan adalah umum dalam populasi klinis ini, dan
selektivitas makanan adalah yang paling banyak sering. (Clinical differences in children
with autism spectrum disorder with and without food selectivity)

Banyak teori menjelaskan bahwa autisme terjadi karena mutasi gen, gangguan neurologis,
dan biologi. Whiteley et al., (2013) menyatakan bahwa masalah biologis pada anak autis
terjadi karena gangguan pencernaan. Sebuah penelitian yang telah dilakukan oleh Ratnawati
pada 2013 menemukan bahwa sekitar 60% pasien autis memiliki sistem pencernaan yang
tidak sempurna, termasuk adanya sindrom usus bocor atau munculnya lubang kecil di
mukosa usus. Situasi ini menghasilkan produksi enzim pencernaan dari pankreas yang
digunakan untuk memecah protein peptida dihambat, dan mengakibatkan pemecahan protein
peptida tidak lengkap. Protein peptida jenis ini ditemukan dalam makanan dan minuman yang
mengandung gluten dan kasein. (Knowledge and Perception of Parents Towards Diet in
Children with Autism)

Bahasa Indonesia punya rissa no 5

Gluten dan kasein adalah bagian dari asam amino rantai pendek yang biasa disebut
peptida. Menurut Whiteley et al., (2010) dalam kondisi normal, peptida hanya sedikit terserap
oleh tubuh dan sebagian besar dibuang melalui kotoran. Namun, pada orang autis hal itu tidak
terjadi, beberapa peptida diserap ke dalam sirkulasi darah dan sebagian lagi ke otak. Peptida
yang mengarah ke otak menempel pada reseptor opioid dan mengubah fungsinya seperti
morfin. Peptida opioid yang menempel pada otak anak autis akan memengaruhi sistem saraf
pusat sehingga memengaruhi kemampuan kognitif, kemampuan bicara, gangguan ambang
nyeri, gangguan tidur dan menyebabkan gangguan perilaku seperti lebih hiperaktif.
Hiperaktif bukan hanya gerakan tetapi juga emosi seperti kemarahan atau mengamuk (Fadhli,
2010; Murdiyanta, Ramani, & Sulistiyani, 2015; Nugraheni, 2008). Dapat disimpulkan
bahwa gluten dan kasein menyebabkan beberapa gangguan perilaku pada anak autis. Oleh
karena itu, anak-anak autis didorong untuk melakukan diet GFCF (Gluten Free Casein Free).
(Knowledge and Perception of Parents Towards Diet in Children with Autism)

Usus bocor diyakini memungkinkan masuknya peptida berbasis gluten dan kasein ke
dalam sistem peredaran darah dan kemudian ke sistem saraf pusat, di mana mereka
dihipotesiskan untuk mengikat reseptor opioid (Horvath et al. 1999; Reichelt et al. 1991;
Reichelt dan Landmark 1995). Pendukung diet mengusulkan bahwa perubahan yang
dihasilkan dalam kimia otak mengganggu perkembangan saraf, fungsi kognitif, perhatian,
dan pembelajaran pada anak-anak dengan ASD (Knivsberg et al. 1995). Sebagai bukti untuk
hipotesis usus bocor, beberapa penelitian melaporkan kadar peptida abnormal dari gluten dan
kasein dalam urin (Reichelt et al. 1994; Whiteley et al. 1999) dan permeabilitas usus
abnormal (Horvath dan Perman 2002). Namun, penelitian lain belum mereplikasi temuan ini
(Kemperman et al. 2008; Robertson et al. 2008; Williams dan Marshall 1992). Anak-anak
dengan ASD sering dilaporkan memiliki gejala gastrointestinal seperti diare atau sembelit,
tetapi patologi gastrointestinal spesifik ASD belum didokumentasikan (Buie et al. 2010).
(The Gluten-Free/Casein-Free Diet: A Double-Blind Challenge Trial in Children with
Autism)

Orang tua melakukan pengawasan makanan sesuai dengan kebutuhan anak-anak

mereka. Jadi, makanan anak-anak mereka akan terpenuhi jika orangtua memahami kondisi
anak autis. Pemahaman orang tua tentang diet GFCF berdampak pada keberhasilan terapi.
Dampak negatif yang akan muncul jika orang tua tidak menerapkan diet GFCF dengan benar
dan patuh, itu akan menyebabkan penumpukan peptida opioid di otak anak autis sehingga ada
peningkatan perilaku hiperaktif, dan anak menjadi sulit berkembang (Hurwitz , 2013). Dari
hasil penelitian ini dapat disimpulkan bahwa kepatuhan orang tua memiliki peran penting
dalam meningkatkan efektivitas diet GFCF. (Knowledge and Perception of Parents
Towards Diet in Children with Autism)