A landmark study conducted by Children's Hospital & Research Center Oakland is the first to reveal a new syndrome in children that presents with a combination of allergy, apraxia and malabsorption. Autism spectrum disorders were variably present. Verbal apraxia has until now been understood to be a neurologically based speech disorder, although hints of other neurological soft signs have been described.

A new study, led by Children's Hospital and Research Center Oakland scientist and pediatric emergency medicine physician, Dr Claudia Morris and Dr Marilyn Agin, a neurodevelopmental pediatrician at Saint Vincent Medical Center in New York suggests that the symptoms of verbal apraxia, until now understood to be a neurologically based speech disorder, are, at least for a sub-group of children, part of a larger, multifactorial, neurologic syndrome involving food allergies/gluten-sensitivity and nutritional malabsorption.

In the study, Dr Morris collected information from nearly 200 families with children who suffered from verbal apraxia. The data showed a common cluster of allergy, apraxia and malabsorption, along with low muscle tone, poor coordination and sensory integration abnormalities.

Dr Morris also gathered laboratory analyses for 26 of the children, which revealed low carnitine levels, gluten sensitivity, and vitamin D deficiency among others. All children genetically screened carried an HLA gene associated with gluten sensitivity and coeliac disease.

"The sample size is still small and should be interpreted with caution," says Dr Morris. "However this is of particular interest given the recent publication by Eaton and colleagues in the July 6 online edition of Pediatrics demonstrating a greater than 3-fold risk of autism in children born to mothers diagnosed with coeliac disease. This brings some credibility to the anecdotal reports of gastrointestinal and behavioral improvements in children with autism spectrum disorders and/or verbal apraxia when eliminating gluten from their diets. Although the implications of these observations remain to be determined, this association and the utility of dietary modifications warrant further investigation, particularly if we can identify a genetically vulnerable group".

Vitamin E deficiency and Omega 3s

Most significantly, the data suggests that the apraxia overlaps the symptoms of vitamin E deficiency. While there may be many causes for low vitamin E levels, the neurological consequences are symptoms are similar, regardless of the cause. It is possible therefore that vitamin E supplementation could be safely used to the benefit of at least soem children.

Growing evidence support the benefits of omega 3 fatty acid supplementation in a number of neurodevelopmental disorders. Anecdotally the speech of children with verbal apraxia will often improve dramatically when they take high-quality fish oil. According to their parents, the addition of vitamin E to omega 3 fatty acid supplements resulted in improvements inthe speech of these childen which were significantly greater than those resulting from speech therapy alone.

Dr Morris suggests that it is really important that children diagnosed with apraxia should be comprehensively nutritionally and metabolically assesed. Many nutritional deficiencies like low carnitine, zinc and vitamin D are easily treated. By not addressing the nutritional deficiencies, the child will continue to suffer from significant medical consequences of those deficiencies. However, Dr Morris does advise families to work closely with a physician rather than trying promising but unproven interventions on their own.

Published in the July/August issue of Alternative Therapies in Health and Medicine

For more research reports

First Published in July 2009

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