Autism Spectrum Disorders (ASD)

Every child with autism can be treated effectively

Autism is a complex disorder, requiring a comprehensive treatment plan, for an optimal outcome.

No ASD child or adult should be denied the best medical care possible.

Let’s start to help your child achieve their full potential?

If you have been told that there is no evidence to show that correcting nutritional and biocemical deficiencies, dietary modification or supplements can benefit your child, nothing can be further from the truth.

Treat the child NOT the autism diagnosis!

Together we can help your child achieve a better outcome

As a Medical Scientist, Naturopath and father of an ASD child, I know the frustration and challenges of finding the best treatment for your child. Often parents just know that it is not just ASD that is an issue. Something else may be making your child unhappy. If you don’t know what you are dealing with, then it is harder to treat your child successfully.

As a parent you need to do your own research, question everything and commit to helping your child. There is no “magic potion” or protocol, it is treating many issues well, that ultimately help your child make gains. This starts with improving four fundamental areas that form the foundation of helping any ASD child:

  1. dietary issues
  2. sleep disturbances
  3. gastrointestinal problems
  4. anxiety

What improvements would you expect to see in in your child?

By correcting these four fundamental issues, your child will be much happier and life is a little less stressful for you and your family. Especially if all are able to get a good night’s sleep! It also builds a good foundation for other supportive therapies like behavioural, speech, occupational therapy, etc.

By correcting a child’s underlying issues, I have yet to see a child not benefit by becoming happier, calmer and ultimately benefiting more from any additional therapies. They are able to concentrate, learn and hopefully develop the skills to become independent. As a parent of an ASD child, this is what I wanted most for my child. Was it easy? No, but I made the commitment, and now he is independent and making his mark on the world. Together, we can do the same for your child.

Dietary Modification for ASD Children

The Gut – Why is it so important in ASD?

The Importance of Sleep

Beyond the Basics – The future direction of ASD treatment

What are the current outcomes of conventional autism treatment

Additional autism articles of interest

Current Autism Research – Selected research articles of interest

Autism is treatable!

Research is useless unless it is read, shared and implemented into clinical practice.

November 2019

Incidence of Clostridium perfringens and their toxin genes in the gut of children with autism spectrum disorder. Full article. “This study was designed to determine the incidence of Clostridium perfringens and their toxin genes in children with autism spectrum disorder (ASD), and determine the antimicrobial susceptibility of C. perfringens isolates. The highest incidence of C. perfringens was found in the ASD group with GI symptoms, 53.8%. Our findings suggests that a high incidence of C. perfringens and its toxin gene (Cpb2) are associated with the GI complications in ASD which may affect the severity of the disease.”

The neural stem cell/carnitine malnutrition hypothesis: New prospects for effective reduction of autism risk? Full article. “We explore the idea, described in terms of the NSC/carnitine malnutrition hypothesis, that an unappreciated risk factor for ASD is diminished capacity for carnitine-dependent long-chain fatty acid β-oxidation (FAO) in neural stem cells (NSCs) of the developing mammalian brain. The basic premise is that fetal carnitine status is a significant metabolic component in determining NSC vulnerability to derangements in their self-renewal program, and therefore to fetal ASD risk. As fetal carnitine status exhibits a genetic component that relates to de novo carnitine biosynthesis, and is sensitive to environmental and behavioral factors that affect maternal circulating carnitine levels to which the fetus is exposed, we propose reduced carnitine availability during gestation is a common risk factor that lurks beneath the genetically complex ASD horizon.”

Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood. “Cord biomarkers of fetal exposure to acetaminophen were associated with significantly increased risk of childhood ADHD and ASD in a dose-response fashion. Our findings support previous studies regarding the association between prenatal and perinatal acetaminophen exposure and childhood neurodevelopmental risk and warrant additional investigations.”


October 2019

Anxiety, Depression, and the Interpersonal Theory of Suicide in a Community Sample of Adults with Autism Spectrum Disorder.The present study examines occurrence of depression, anxiety, and suicidality in adults with autism spectrum disorder (ASD), relationships between social difficulties and mental health, and application of the Interpersonal Theory of Suicide in this population. A substantial proportion reported a lifetime history of anxiety (63%), depression (55%), and suicide attempts (19%), as well as recent suicidal ideation (12%). Social difficulty was associated with higher psychiatric concerns.”

Prevalence and Risk-Markers of Self-Harm in Autistic Children and Adults. “Self-harm is purportedly common in autistic individuals, but under-researched, particularly in younger samples and those without intellectual disability. This study aimed to describe prevalence, profile and correlates of self-harm in autistic individuals without impairments in adaptive functioning. 24.10% of participants engaged in self-harm. Self-harm was associated with significantly higher levels of impulsivity, over-activity, negative affect, compulsive behaviour and insistence on sameness. Low mood and overactivity/impulsivity predicted the presence of self-harm, with the model correctly classifying 82.9% of cases. Findings highlight a role for impaired behavioural inhibition and low mood in the aetiological mechanisms underpinning self-harm in autism.”

The Association between Autism Spectrum Disorder and Pre- and Postnatal Antibiotic Exposure in Childhood-A Systematic Review with Meta-Analysis. “We found that early antibiotic exposure, including pre- and postnatal, significantly increased the ASD risk in children. Furthermore, early antibiotic exposure, including pre- and postnatal, was significantly increased in children with ASD. Specifically, prenatal antibiotic exposure was significantly increased in children with ASD; however, postnatal antibiotic exposure was not. Our results indicate an association between ASD and early antibiotic exposure; specifically, that prenatal antibiotic exposure is an important risk factor of ASD in children.”

Investigating Mental Health Crisis in Youth with Autism Spectrum Disorder. “Evidence suggests that youth with autism spectrum disorder (ASD) are at increased risk for experiencing a mental health crisis. This study examines the prevalence and characteristics of mental health crisis in children, adolescents, and young adults with autism spectrum disorder. We found that 32% of individuals in our study had experienced a mental health crisis within the last 3 months. Younger age, increased parental depression, and lower quality of life were associated with crisis. These findings emphasize the importance of developing child and family-based interventions to prevent and treat the mental health crisis in this population.”

Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. “Links between eating disorders (EDs) [e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)] and the major neurodevelopmental disorders of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN. The prevalence of ADHD in EDs ranged between 1.6% and 18%.”

Discrepancies between parent and child ratings of anxiety in children with autism spectrum disorder. “Children with autism spectrum disorder (ASD) commonly experience anxiety; yet, their perceptions of their anxiety might differ from their parents’ perceptions. This study found that, while children with ASD and anxiety disorders acknowledge some anxiety, their parents report them as having higher levels of anxiety. Also, child and parent perceptions of anxiety may differ more for children with more severe ASD symptoms.”

Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder. “Behavior-analytic interventions have the most empirical support for feeding disorders. However, there are no randomized controlled trials that have evaluated its effects with a well-defined cohort of children with ASD. The percentage of independent acceptance and mouth clean increased for the applied behavior analytic intervention group, but not for the wait-list control group until we implemented the intervention.”

Propionic acid induced behavioural effects of relevance to autism spectrum disorder evaluated in the hole board test with rats. “Propionic acid (PPA), produced by enteric gut bacteria, crosses both the gut-blood and the blood-brain barrier. Previous research has demonstrated that repeated intracerebroventricular (ICV) infusions of PPA in adult rats produce behavioural and neuropathological changes similar to those seen in ASD patients, including hyperactivity, stereotypy, and repetitive movements. In a dose dependent manner PPA infused rats displayed significantly more locomotor activity, stereotypic behaviour and nose-pokes than PBS infused rats. Low-dose PPA animals showed locomotor activity levels similar to those of PBS animals at the start of the infusion schedule, but gradually increased to levels comparable to those of high-dose PPA animals by the end of the infusion schedule, demonstrating a dose and time dependent effect of the PPA treatments.”

Is Autism Inborn And Lifelong For Everyone? Full article. “Autism or autism spectrum disorder (ASD) is described as a lifelong condition with core behavioural symptoms appearing during infancy or early childhood. Genetic and other effects occurring during the earliest times of life are thought to play a significant contributory role to the presentation of autism, denoting that autism is typically seen as an innate or inborn condition. Such descriptions have, and continue to, define autism research and clinical practice. Inspection of the existing research literature, however, suggests that within the vast heterogeneity of autism, not everyone experiences autism in such a prescribed way. Various reports have observed the presentation of “acquired autism” following a period of typical development. Other findings have documented an abatement of clinically relevant autistic features and related comorbid pathology for some. Such reports offer important insights into the heterogeneity and complexity of autism.”

Metal and essential element levels in hair and association with autism severity. “A significant and positive correlation was found between hair metal burden (lead, aluminum, arsenic and cadmium levels) and severity of ASD symptoms (social communication deficits and repetitive, restrictive behaviors). Hair zinc level were inversely related with age while there was a negative, significant association between hair zinc level and severity of autistic symptoms (defective functional play and creativity and increase of stereotyped behavior). Lead, molybdenum and manganese hair levels were inversely correlated with cognitive level (full intelligence quotient) in ASD individuals.”

Autistic traits in synaesthesia: atypical sensory sensitivity and enhanced perception of details. Full article. “Synaesthesia is a mixing of the senses: specific sensory stimuli evoke unusual, additional experiences. For instance, ‘A’ evokes the colour red; music elicits colours; or the word ‘parents’ tastes like apple. The prevalence of synaesthesia is substantially higher (approx. 20%) among individuals with autism spectrum disorder (ASD). The remarkably high co-occurrence of synaesthesia and autism—both relatively rare conditions—suggests that the two conditions are related, but the exact nature of the relationship is unknown.”

Prenatal exposure to air pollution as a potential risk factor for autism and ADHD. Full article.  “This study contributes to the growing evidence of a link between prenatal exposure to air pollution and autism spectrum disorders, suggesting that prenatal exposure even below current WHO air quality guidelines may increase the risk of autism spectrum disorders.”

Children with an Autism Spectrum Disorder and Their Caregivers: Capturing Health-Related and Care-Related Quality of Life. Full article. “This study investigated health-related QoL (HRQoL) and care-related quality of life (CarerQol) in clinically referred children with an autism spectrum disorder (ASD), and their primary and secondary caregivers. The EuroQol five-dimensional (EQ-5D) and the CarerQol questionnaires were used to respectively measure health-related QoL and care-related QoL. Primary caregivers reported pain/discomfort (42%) and anxiety/depression (40%). In caring, they mostly experienced problems in the relationship with the child (84%), and in combining care with daily activities (51%). Children with ASD had a relevantly lower QoL. Despite negative effects, almost all caregivers (96%) derived fulfillment from caring for their affected children.”

Temperament and Character as Risk Factor for Suicide Ideation and Attempts in Adults with Autism Spectrum Disorders. “Temperament and character can probably not be used for predicting suicide ideation and attempts, based on results from the current sample. Clinicians must take note of the high prevalence and risk of depression among persons with ASD, which may be under-reported.”

Anxiety Disorders in Adults with Autism Spectrum Disorder: A Population-Based Study.  Full article”Anxiety is common in children with ASD; however, the burden of specific anxiety disorders for adults with ASD is under-researched. Using the Stockholm Youth Cohort, we compared anxiety disorder diagnoses among autistic adults (n = 4049), with or without intellectual disability, and population controls (n = 217,645). We conducted additional sibling analyses. Anxiety disorders were diagnosed in 20.1% of adults with ASD compared with 8.7% of controls (RR = 2.62 [95% CI 2.47-2.79]), with greatest risk for autistic people without intellectual disability. Rates of almost all individual anxiety disorders were raised, notably obsessive-compulsive disorder and phobic anxiety disorders. Anxiety disorders were more common in full siblings and half-siblings of people with ASD.”

The Endocannabinoid System as a Window Into Microglial Biology and Its Relationship to Autism. Full article. “Control of microglial activity is in part overseen by small, lipid-derived molecules known as endogenous cannabinoids (endocannabinoids). Endocannabinoids are one component of the endocannabinoid system (ECS), which also includes the enzymes that metabolize these ligands, in addition to cannabinoid receptor 1 (CB1) and 2 (CB2). Interestingly, increased ECS signaling leads to an anti-inflammatory, neuroprotective phenotype in microglia. Here, we review the literature and propose that ECS signaling represents a largely untapped area for understanding microglial biology and its relationship to ASD, with special attention paid to issues surrounding the use of recreational cannabis (marijuana). We also discuss major questions within the field and suggest directions for future research.”

Treatment Gains from Early and Intensive Behavioral Intervention (EIBI) are Maintained 10 Years Later.This study reports outcome in adolescents with autism who in their childhood received Early and Intensive Behavioral Intervention (EIBI). Nineteen children (16 boys) who had received two years of EIBI starting at a mean age of 2-years-and-11-months were followed up, on average, 12 years later. Results showed the participants significantly increased their cognitive and adaptive standard scores during the two years of EIBI, and that these gains were maintained at follow-up, 10 years after the EIBI had ended. Participants also showed a significant reduction in autism symptoms between intake and follow-up. At follow-up, none of the participants had received any additional psychiatric diagnoses, and none were taking any psychotropic medication. Results indicate that treatment gains achieved in EIBI are maintained into adolescence.”

Comorbidity Burden in Adults With Autism Spectrum Disorders and Intellectual Disabilities-A Report From the EFAAR (Frailty Assessment in Ageing Adults With Autism Spectrum and Intellectual Disabilities) Study. Full article. “Although emerging studies suggest that ASD is associated with premature ageing and various medical comorbidities, as described for ID, data are scarce. We found a large range of comorbidities, including gastrointestinal disorders and mental and neurological diseases. Overall, 25% of our ASD-ID sample had chronic kidney disease with the associated increased cardiovascular risk factors. The comorbidity burden was high (mean CIRS-G total score of 10.6 ± 4.8), comparable with that observed among patients older than those in our population hospitalized in geriatric departments. Furthermore, the comorbidity burden positively correlated with age, decreased autonomy, and polypharmacy.”

A Prospective Open-Label Trial of Long-Acting Liquid Methylphenidate for the Treatment of Attention Deficit/Hyperactivity Disorder in Intellectually Capable Adults with Autism Spectrum Disorder. “This treatment trial is aimed at assessing the short-term tolerability and efficacy of liquid-formulation extended-release methylphenidate (MPH-ER) for the treatment of ADHD in adults with high-functioning autism spectrum disorder (HF-ASD). Short-term MPH-ER treatment was associated with significant improvement in ADHD severity. Twelve (80%) participants were deemed responders.  AEs were transient and experienced by 13/15 (87%) participants at mild to moderate severity. Frequently reported AEs were as typically expected (headache [53%], insomnia [33%], anxiety [33%], decreased appetite [27%]).”

Allergic Disease and low ASQ Communication Score in Children.Previous investigations have revealed associations between allergic disease and ASD, which are characterized by impaired communication skills. In this study we observed an association between allergic disease and communication skills development as assessed by the Ages and Stages Questionnaire (ASQ) communication score, as a proxy for ASD. Plasma metabolomics analyses suggest that dysregulated tryptophan metabolism may contribute to the pathogenesis of these co-morbidities.”

The risk of overweight and obesity in children with autism spectrum disorders: A systematic review and meta-analysis. “Autism spectrum disorders seem to increase the risk of childhood obesity. Increased awareness of this association may allow the implementation of early interventions to reduce obesity and prevent potential deterioration of quality-of-life in this population.”

Early Life Exposure to Air Pollution and Autism Spectrum Disorder: Findings from a Multisite Case-Control Study. “Our study corroborates previous findings of a positive association between early life air pollution exposure and ASD, and identifies a potential critical window of exposure during the late prenatal and early postnatal periods.”


September 2019

Chronic Fluoride Exposure and the Risk of Autism Spectrum Disorder. Full article. “We show that F [Flouride] in synergistic interactions with aluminum’s free metal cation (Al3+) can reinforce the pathological symptoms of ASD. This reinforcement takes place at concentrations several times lower than when acting alone. A high ASD prevalence has been reported from countries with water fluoridation as well as from endemic fluorosis areas. We suggest focusing the ASD prevention on the reduction of the F and Al3+ burdens from daily life.”

Early exposure to a methyl donor supplemented diet and the development of repetitive motor behavior in a mouse model.Early exposure to methyl donor supplementation not only affected the frequency of repetitive behavior but also its temporal structure, resulting in more variable patterns of repetitive behavior. Early exposure to the diet was also shown to induce long-lasting increases in DNA methylation in brain tissue of female mice. The role for alterations in DNA methylation in this model may be one mechanism accounting for the robust effects of the environment on the development of repetitive behavior.”

New and Preliminary Evidence on Altered Oral and Gut Microbiota in Individuals with Autism Spectrum Disorder (ASD): Implications for ASD Diagnosis and Subtyping Based on Microbial Biomarkers. Full article. “The diagnosis of ASD currently relies on psychological testing with potentially high subjectivity. Given the emerging role that the oral and gut microbiome plays in systemic diseases, our study will provide preliminary evidence for developing microbial markers that can be used to diagnose or guide treatment of ASD and comorbid conditions. These preliminary results also serve as a starting point to test whether altering the oral and gut microbiome could improve co-morbid conditions in patients with ASD and further modify the core symptoms of ASD.”

Urinary and bowel disfunction in autism spectrum disorder: a prospective, observational study. Full article. “Young and adult patients with ASD present with a high prevalence of BBD [Bowel and Bladder Dysfunction] and concomitant antipsychotic medications could to play a contribution in induction and/or maintaining of BBD.”


August 2019

Aluminium in human brain tissue: how much is too much? Full article. “The presence of aluminium in brain tissue is an intoxication. It will inevitably exert toxicity at a local level. Future research is required to ascertain the significance of discrete aluminium-related neurotoxicity and how the additive effects of such neuropathologies may eventually contribute towards recognised global neurodegenerative disease characteristic of conditions such as AD, MS, epilepsy and ASD.”

Eating as an autistic adult: An exploratory qualitative study. Full article. “Certain traits associated with autism, such as cognitive rigidity and sensory sensitivity, could potentially continue to influence the eating behaviours of autistic adults. These traits are typically experienced as differences which can be adapted around and managed, rather than specific problems. However, these traits can potentially contribute to difficulties such as disordered eating and weight gain, and the implications of these should be explored by future research.”

Prenatal antibiotics exposure and the risk of autism spectrum disorders: A population-based cohort study. Full article. “Prenatal antibiotic exposure is associated with a small increase in the risk of ASD. Given the potential of residual confounding beyond what it was controlled through our study design and because of possible confounding by indication, such a small risk increase in the population is not expected to be clinically significant.”

Characterising the Sexuality and Sexual Experiences of Autistic Females. “Results indicate that due to a mismatch between less sexual interest, yet increased sexual behaviours, autistic women are at greater risk of negative sexual experiences including victimisation and abuse than autistic men.”

Maternal exposure to triclosan constitutes a yet unrecognized risk factor for autism spectrum disorders. Full article. “Our findings presented above have, unexpectedly, revealed a yet unrecognized impact of TCS on behavioral traits of mammalian pups, thus establishing it as a novel environmental factor that could significantly contribute to the etiology of ASD.”

Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring: A Systematic Review and Meta-analysis. Full article. “The findings suggest that cesarean delivery births are associated with an increased risk of autism spectrum disorder and attention-deficit/hyperactivity disorder, irrespective of cesarean delivery modality, compared with vaginal delivery. Future studies on the mechanisms behind these associations appear to be warranted.”

Novel Personalized Dietary Treatment for Autism Based on the Gut-Immune-Endocrine-Brain Axis. Full article. “Not all children with ASD show immune reactivity to dietary proteins in wheat and milk, and wheat and milk may not be the only dietary elements to which reactivity is exhibited, where dietary aquaporins that resemble human aquaporins may elicit antibody reactivity in genetically susceptible individuals, which may include individuals with ASD. These observations are utilized to formulate a three-step plan to create effective, targeted, personalized treatments with as few side effects as possible, enabled by a systems approach connecting the various findings for dietary, immune, and neuroautoimmune reactivity in individuals with ASD.”

Rickets treatment improves more than bone health in toddler with autism spectrum disorder: A brief report. Full article. “Given multiple studies above suggesting that low vitamin D is one factor contributing to the pathogenesis of ASD, it is prudent that clinician’s obtain levels of this vitamin when concerned for developmental delay or early autism to determine whether this level may in part explain symptoms being observed. Pending further clinical trials, supplementation with vitamin D may be an effective treatment to at least in part ameliorate the severity of ASD. In addition, clinician’s should be familiar with the signs and symptoms of rickets disorder when treating a population of patients with ASD. While rickets is more common in developing countries, restrictive eating related in the setting of ASD and other developmental disorders may put patients at a higher risk of this uncommon complication in any location.”

Prevalence of Non-Affective Psychoses in Individuals with Autism Spectrum Disorders: A Systematic Review. Full article. “Autism spectrum disorders (ASD) and non-affective psychoses such as schizophrenia are commonly acknowledged as discrete entities. Previous research has revealed evidence of high comorbidity between these conditions, but their differential diagnosis proves difficult in routine clinical practice due to the similarities between core symptoms of each disorder. The prevalence of comorbid non-affective psychoses in individuals with ASD is uncertain, with studies reporting rates ranging from 0% to 61.5%.”

Autism, ADHD and parent-reported behavioural difficulties in young children with epilepsy. “Young children with epilepsy had a very high level of parent reported behavioural difficulties and a high risk for ADHD and ASD highlighting the need for comprehensive multidisciplinary assessment. Behavioural concerns were not greater than for other children with non-epilepsy related neurodisability with the exception of attention and mood. Epilepsy related factors were not associated with child behaviour, suggesting that seizures per se do not confer a unique risk for behavioural difficulties.”

Association Between Gut Microbiota and Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Full article. “Gastrointestinal (GI) dysfunction is an ASD-associated comorbidity, implying a potential role of the gut microbiota in ASD GI pathophysiology. Several recent studies found that autistic individuals harbor an altered bacterial gut microbiota.  This meta-analysis suggests an association between ASD and alteration of microbiota composition and warrants additional prospective cohort studies to evaluate the association of bacterial changes with ASD symptoms, which would provide further evidence for the precise microbiological treatment of ASD.”

The co-occurrence of epilepsy and autism: A systematic review. “The period prevalence of epilepsy in people with autism, and vice versa, was consistently higher than previously reported estimates of the occurrence of these disorders in the general population. These findings highlight the importance of screening for autism in people who have epilepsy and epilepsy in people who have autism and may help shed light on shared pathogenesis between these conditions.”

Anxiety in 3- to 7-year-old children with autism spectrum disorder seeking treatment for disruptive behavior.Anxiety is a common and impairing problem in children with autism spectrum disorder, but little is known about it in preschool children with autism spectrum disorder. Higher levels of anxiety were associated with severity of oppositional defiant behavior and social disability. Anxiety symptoms are common in preschoolers with autism spectrum disorder. These findings are consistent with earlier work in school-age children with autism spectrum disorder. There were no differences in anxiety between children with IQ below 70 and those with IQ of 70 and above. Social withdrawal and oppositional behavior were associated with anxiety in young children with autism spectrum disorder.”

Implication of hypocholesterolemia in autism spectrum disorder and its associated comorbidities: A retrospective case–control study. “Association of autism spectrum disorder (ASD) with abnormally low levels of cholesterol (hypocholesterolemia) has been documented before. We observed four times more hypocholesterolemia in ASD than in the general population. Furthermore, low TC in ASD was associated with higher rates of ASD‐associated intellectual disability and anxiety/depression. Our results support an association between hypocholesterolemia and ASD and open novel opportunities for the diagnosis and treatment of specific forms of ASD.”

Dietary and Supplement-Based Complementary and Alternative Medicine Use in Pediatric Autism Spectrum Disorder. Full article. “Previous literature has shown that complementary and alternative medicine (CAM) is steadily increasing in autism spectrum disorder (ASD). Seventy-five percent of children with ASD consumed supplements with multivitamins (77.8%), vitamin D (44.9%), omega 3 (42.5%), probiotics (36.5%), and magnesium (28.1%) as the most prevalent. Several supplements, such as adrenal cortex extract, where product safety has not yet been demonstrated, were also reported. A gluten free diet was the most common specialty diet followed amongst those with restrictions (14.8%). Health care professionals were the most frequent information source regarding supplements; however, 33% of parents reported not disclosing all their child’s supplements to their physician.”


July 2019

Problem Behavior in Autism Spectrum Disorder: Considering Core Symptom Severity and Accompanying Sleep Disturbance. Full article. “Results indicated that the relationship between ASD symptom severity and problem behavior differed among individuals with ASD depending on the degree of sleep disturbance they experienced. Specifically, there was a significant positive relationship between ASD symptom severity and problem behavior for individuals with no sleep disturbance or milder sleep disturbance (i.e., in these cases, individuals with severe ASD symptoms experienced clinically elevated problem behavior, while those with milder ASD symptoms experienced milder problem behavior).”

Mast Cells, Stress, Fear and Autism Spectrum Disorder. Full article. “Prenatal stress has been associated with higher risk of developing ASD in the offspring. Moreover, children with ASD cannot handle anxiety and respond disproportionately even to otherwise benign triggers. Stress and environmental stimuli trigger the unique immune cells, mast cells, which could then trigger microglia leading to abnormal synaptic pruning and dysfunctional neuronal connectivity. This process could alter the “fear threshold” in the amygdala and lead to an exaggerated “fight-or-flight” reaction. The combination of corticotropin-releasing hormone (CRH), secreted under stress, together with environmental stimuli could be major contributors to the pathogenesis of ASD. Recognizing these associations and preventing stimulation of mast cells and/or microglia could greatly benefit ASD patients.”

Neuropsychiatric “Comorbidity” as Causal Influence in Autism. “Behavioral comorbidity is the rule rather than the exception in autism spectrum disorder (ASD), and the co-occurrence of autistic traits with subclinical manifestations of other psychiatric syndromes (e.g. anxiety, developmental coordination disorder) extends to the general population, where there is strong evidence for overlap in the respective genetic causes.”

The neuroprotective mechanisms and effects of sulforaphane. Full article. “Sulforaphane (SFN) is a phytochemical found in cruciferous vegetables. A substantial amount of preclinical research regarding the ability of SFN to protect the nervous system from many diseases and toxins has been done, but only a few small human trials have been completed. Preclinical data suggest that SFN protects the nervous system through multiple mechanisms and may help reduce the risk of many diseases and reduce the burden of symptoms in existing conditions. This review focuses on the literature regarding the protective effects of SFN on the nervous system. A discussion of neuroprotective mechanisms is followed by a discussion of the protective effects elicited by SFN administration in a multitude of neurological diseases and toxin exposures. SFN is a promising neuroprotective phytochemical which needs further human trials to evaluate its efficacy in preventing and decreasing the burden of many neurological diseases.”

Vasopressin in the Amelioration of Social Functioning in Autism Spectrum Disorder. Full article. “Many preclinical studies show the importance of arginine vasopressin (AVP) physiology in social functioning in several mammalian species. The pharmacologic aspects of the drug as well as its potential to ameliorate social functioning characteristics in human and animal studies are described in this manuscript. AVP, especially in its inhaled form, seems to be safe and beneficial in improving social functioning including in children with autism.”

Psychobiotics in mental health, neurodegenerative and neurodevelopmental disorders. Full article. “Psychobiotics are efficacious in improving neurodegenerative and neurodevelopmental disorders, including autism spectrum disorder (ASD), Parkinson’s disease (PD) and Alzheimer’s disease (AD). Use of psychobiotics can improve GI function, ASD symptoms, motor functions of patients with PD and cognition in patients with AD.”

Nutritional Supplements During Gestation and Autism Spectrum Disorder: What Do We Really Know and How Far Have We Gone? “Nutritional interventions are gaining remarkable attention as complementary management options for autism. Multivitamins use during pregnancy can exert a protective effect on the risk of autism, although depending on the frequency of use. Nevertheless, prenatal iron and folate were not shown to have any significant impact. Research based on animal models showed that choline and folic acid can have a significant impact on the expression of autism-related genes in a sex-specific manner. Furthermore, the use of vitamin D and docosahexaenoic acid during gestation seem to decrease the incidence of autism in animal offspring.”

Improving Outcome in Infantile Autism with Folate Receptor Autoimmunity and Nutritional Derangements: A Self-Controlled Trial. Full article. “Correction of nutritional deficiencies combined with high-dose folinic acid improved outcome for autism, although the trend of a poor prognosis due to maternal FRα antibodies or FRα antibodies in both parents may warrant folinic acid intervention before conception and during pregnancy.”

[Correlation between gut microbiota and behavior symptoms in children with autism spectrum disorder]. [Article in Chinese]. “The development of ASD and the severity of behavior symptoms are closely associated with the composition of gut microbiota.”

Effects of Therapeutic Horseback Riding on Cognition and Language in Children With Autism Spectrum Disorder or Intellectual Disability: A Preliminary Study. Full article. “To investigate if therapeutic horseback riding (THR) can improve language and cognitive function in children with autism spectrum disorder (ASD) or intellectual disability (ID). These results suggest that THR might improve language and cognitive abilities. Although the mechanisms and pathways involved in such improvements are currently unclear based on our findings, THR might have potential to optimize language and cognitive abilities of children with ASD and ID.”

Revisiting Lithium: Utility for Behavioral Stabilization in Adolescents and Adults with Autism Spectrum Disorder. “To examine the efficacy of lithium as a mood stabilizer for patients with autism spectrum disorder (ASD). A retrospective chart review was performed that examined the use of both extended and immediate release lithium carbonate in patients with ASD that were treated at a single clinical center (CNNH NeuroHealth). Our retrospective chart review found that 73.7% of patients with ASD and concomitant maladaptive behaviors experienced “improvement” with the addition of lithium to their treatment regimen. Those with comorbid “ADHD” phenotype were most predictive of an efficacious response.”

The role of zinc supplementation on the metallothionein system in children with autism spectrum disorder. “The data of the present study showed an increase in cognitive-motor performance and an increased serum metallothionein concentration, as well as a significant lowering in the circulating serum levels of copper (Cu) following Zn supplementation. In the cohort of ASD patients, the genetic expression of MT-1 was higher after Zn therapy than before the treatment. In conclusion, Zn supplementation might be an important factor in the treatment of children with ASD.”

Age at identification, prevalence and general health of children with autism: observational study of a whole country population. Full article. “22.0% of children and 25.5% of young people with autism reported poor health, compared with 2.0% and 4.4% without autism. Autism had OR=11.3 (11.0 to 11.7) in predicting poor health. Autistic females had poorer health than autistic males, OR=1.6 (1.5 to 1.8).”

Is Synaesthesia More Prevalent in Autism Spectrum Conditions? Only Where There Is Prodigious Talent. Full article. “Results show a significantly higher prevalence of synaesthesia in people with ASC, but only those who also have savant skills. This suggests that synaesthesia in autism is linked to those with savant abilities rather than autism per se. We discuss the role of synaesthesia in the development of prodigious talent.”

Bladder and bowel dysfunction, adaptive behaviour and psychiatric profiles in adults affected by autism spectrum disorders. “In adults, any type of incontinence was observed in 81.8% of cases, and NE [nocturnal enuresis] and intermittent UI [urinary incontinence] in 59.0% and 36.3% of patients, respectively. Faecal incontinence and constipation were detected 36.3% and in 68.1% of cases, respectively. ID [intellectual disability] was severe in 2 cases and profound in 18; NPI and Vineland-II items most affected were “Irritability/Lability,” “Motor Activity,” and “Agitation,” and IQ-Socialization and IQ-Communication. Significant relationships were identified between intermittent UI and greater ID and high “anxiety”, and between NE and high “euphoria/elevated mood”. These results were similar to those observed in children/teens.”

The association between levels of inflammatory markers in autistic children compared to their unaffected siblings and unrelated healthy controls. “We found that interleukin-8 and TNF-α were exclusively elevated in autistic Jordanian children, while interleukin-6 was elevated in both autistic children and their siblings, potentially dismissing its significance.”


June 2019

Are touch screen technologies more effective than traditional educational methods in children with autism spectrum disorders? A pilot study. Full article. “Overall, our data do not confirm the hypothesis that touch screen presentation improves activity completion and behavioural performance for each individual with ASD. Data discourage an indiscriminate use of these devices and suggest analysing with more attention the core ingredients that should shape digital devices when used for people on ASD.”

Individual risk and familial liability for suicide attempt and suicide in autism: a population-based study. “Clinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.”

HLA-DQ Genotyping, Duodenal Histology, and Response to Exclusion Diet in Autistic Children With Gastrointestinal Symptoms. Full article. “Our data suggest that children with ASD with GI symptoms have a high prevalence of duodenal intraepithelial lymphocytic infiltration, which seems to be linked to a mechanism other than autoimmune response to gluten consumption. Alteration of duodenal histology, but not the HLA-DQ2/DQ8 status, was associated with clinical response to the diet.”

Anti-inflammatory cytokines in autism spectrum disorders: A systematic review and meta-analysis. “This meta-analysis provides evidence for the lower concentration of anti-inflammatory cytokines IL-10 and IL-1Ra in autistic patients compared with control subjects. Also, meta-regression analyses point to the interaction of latitude, age, and gender with peripheral alterations of associated anti-inflammatory cytokines.”

Effect of stress on learning and motivation-relevance to autism spectrum disorder. Full article.Patients with ASD have aggrevated tresponses to stress, especially fear response. There is extensive literature connecting the amygdala to social behavior and to pathophysiologic responses to stress. The amygdala regulate the responses to stress, and anatomical changes in amygdala have been reported in ASD. In particular, corticotropin-releasing hormone (CRH), which is secreted under stress, is high in children with ASD and stimulates both mast cells and microglia, thus providing possible targets for therapy. Factors and/or circumstances that could interfere with the neurodevelopmental pathways involved in learning and motivation are clearly important and should be recognized early.”

Possible Effects of Nutraceuticals in the Management of Some Neurodevelopmental Disorders in Nigerian Children. Full article. “Here we describe a case series of some of the children managed at our center using nutraceuticals and other supportive care. Details of the observed effects are described in this report. Globally, there is rising evidence of improved treatment outcomes with use of nutraceuticals. Our experience in the management of Nigerian children with neurodevelopmental disorders suggests that they may be beneficial and are deserving of well-controlled studies. We hope that this case series will raise interest of researchers in Nigeria in designing observational studies and clinical trials aimed at generating evidence for or against their use.”

Increased psychiatric symptoms in university students with autism spectrum disorder are associated with reduced adaptive behavior. “Significantly higher scores for the ASD group were found for social anxiety, trait anxiety, obsessive-compulsive symptoms, and depression symptoms. The level of adaptive skills correlated negatively and significantly with the severity of social anxiety symptoms in both groups and with severity of obsessive-compulsive symptoms only in the ASD group. Additionally, in a regression model, significant contributions of having an ASD diagnosis and severity of social anxiety explained 41.7% of the variance in adaptive skills. Adequate evaluation and treatment, if needed, are recommended in this population.”

Using self-report to explore the relationship between anxiety and quality of life in children on the autism spectrum. “Anxiety is now recognized as one of the most common conditions that co-occur with autism. Research has shown us that individuals on the autism spectrum are more likely to have poor “quality of life” or general well-being. Because many individuals with a diagnosis on the autism spectrum also receive a diagnosis of anxiety, this study looked at whether a child’s autism symptoms or their anxiety have a bigger impact on their quality of life. Children on the autism spectrum completed questionnaires and the results showed us that one factor, difficulty with uncertainty, had the biggest impact on the child’s quality of life.”

Effectiveness of community-based early intervention for children with autism spectrum disorder: a meta-analysis. Studies of community-based EI for children with ASD were identified through a systematic search. Changes in cognitive, communication, social, and adaptive functioning from pre-treatment to post-treatment were assessed using standardized mean gain scores. There were small but statistically significant gains in each of the four domains. These results indicate that there remains a large gap between outcomes observed in community settings and those reported in efficacy trials.”

The social ecology of aggression in youths with autism spectrum disorder. “The present study demonstrated that youths with autism spectrum disorder may be classified by the types of aggressive behaviors that they exhibit: youths who are verbally and physically aggressive, physically aggressive only, or not aggressive. Compared to the nonaggressive group, both groups of youths who were aggressive experienced difficulties in their individual, family, peer, and academic functioning. Youths with both verbal and physical aggression showed the most problems in their functioning.”

Autistic traits in adults who have attempted suicide. Full article. “The findings suggest that high levels of autistic traits may frequently be present in adults who have attempted suicide, and that AQ scores are higher in those with a history of more than one suicide attempt. It may be possible to better identify suicide risk by screening autistic adults with mental health conditions for suicidal thoughts and behaviours, and by screening people with suicidal thoughts and/or behaviours for autism.”

The phenolic interactome and gut microbiota: opportunities and challenges in developing applications for schizophrenia and autism. “Schizophrenia and autism spectrum disorder have long been associated with elevated levels of various small phenolic molecules (SPMs). In turn, the gut microbiota (GMB) has been implicated in the kinetics of many of these analytes. Heterotypical excretion of various SPMs in association with schizophrenia or autism continues to be reported in independent samples. Recent studies in human cerebrospinal fluid demonstrate the presence of many SPMs A large number of these are bioactive in experimental models. Whether such mechanisms are relevant to the human brain in health or disease is not known. Systematic metabolomic and microbiome studies of well-characterized populations, an appreciation of multiple confounds, and implementation of standardized approaches across platforms and sites are needed to delineate the potential utility of the phenolic interactome in neuropsychiatry.”

Maternal Antibody and ASD: Clinical Data and Animal Models. Full article. “Epidemiologic studies have shifted from an exclusive focus on the identification of genetic risk alleles for such disorders to recognizing and understanding the contribution of xenobiotic exposures, infections, and the maternal immune system during the prenatal and early post-natal periods. In this review we discuss the growing literature regarding the effects of maternal brain-reactive antibodies on fetal brain development and their contribution to the development of neuropsychiatric and neurodevelopmental disorders. Autoimmune diseases primarily affect women and are more prevalent in mothers of children with neurodevelopmental disorders. For example, mothers of children with Autism Spectrum Disorder (ASD) are significantly more likely to have an autoimmune disease than women of neurotypically developing children. Moreover, they are four to five times more likely to harbor brain-reactive antibodies than unselected women of childbearing age. Many of these women exhibit no apparent clinical consequence of harboring these antibodies, presumably because the antibodies never access brain tissue. Nevertheless, these maternal brain-reactive antibodies can access the fetal brain, and some may be capable of altering brain development when present during pregnancy.”

Anxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder. This study examined age trends in anxious and depressive symptoms, from older adolescence to old age, and explored the association between anxious and depressive symptoms with gender, ASD severity, and socio-economic factors. More than one-third of participants reported clinically significant anxiety (38.4%) or depression (38%). A slight trend for an increase in the severity of both anxiety and depression from adolescence to middle adulthood, and then a slight decline in older adulthood was found. Female gender and higher ASD severity predicted more anxiety and depression symptoms. Our findings emphasise the need to provide timely assessment and treatment of anxiety and depression in ASD.”


May 2019

Human Gut Microbiota from Autism Spectrum Disorder Promote Behavioral Symptoms in Mice. Full article. “We transplanted gut microbiota from human donors with ASD or TD controls into germ-free mice and reveal that colonization with ASD microbiota is sufficient to induce hallmark autistic behaviors. The brains of mice colonized with ASD microbiota display alternative splicing of ASD-relevant genes. Microbiome and metabolome profiles of mice harboring human microbiota predict that specific bacterial taxa and their metabolites modulate ASD behaviors. Indeed, treatment of an ASD mouse model with candidate microbial metabolites improves behavioral abnormalities and modulates neuronal excitability in the brain. We propose that the gut microbiota regulates behaviors in mice via production of neuroactive metabolites, suggesting that gut-brain connections contribute to the pathophysiology of ASD.”

Beyond the brain: A multi-system inflammatory subtype of autism spectrum disorder. “An immune-mediated subtype of autism spectrum disorder (ASD) has long been hypothesized. This article reviews evidence from family history studies of autoimmunity, immunogenetics, maternal immune activation, neuroinflammation, and systemic inflammation, which suggests immune dysfunction in ASD. Individuals with ASD have higher rates of co-morbid medical illness than the general population. We conclude by proposing the hypothesis of an immune-mediated subtype of ASD which is characterized by systemic, multi-organ inflammation or immune dysregulation with shared mechanisms that drive both the behavioral and physical illnesses associated with ASD.

Dietary supplementation with partially hydrolyzed guar gum helps improve constipation and gut dysbiosis symptoms and behavioral irritability in children with autism spectrum disorder. Full article. “Prebiotic dietary water-soluble fiber obtained from partially hydrolyzed guar gum was added to diets of children with autism spectrum disorders who presented constipation symptoms. Supplementation with partially hydrolyzed guar gum altered gut microbiota and significantly increased the frequency of defecation per week and altered the gut microbiota. In addition, supplementation with partially hydrolyzed guar gum significantly decreased and tended to decrease the concentrations of serum interleukin-1β and tumor necrosis factor-α, respectively. More importantly, supplementation with partially hydrolyzed guar gum significantly ameliorated behavioral irritability as per the Aberrant Behavior Checklist, Japanese Version. The present study demonstrated that supplementation with partially hydrolyzed guar gum to diets of constipated autism spectrum disorders children helped improve constipation and gut dysbiosis symptoms, which in turn helped attenuate the level of serum inflammation cytokines and behavioral irritability.”

Developmental Vitamin D Deficiency Produces Behavioral Phenotypes of Relevance to Autism in an Animal Model. Full article. “Emerging evidence suggests that gestational or developmental vitamin D (DVD) deficiency is associated with an increased risk of autism spectrum disorder (ASD). Here we investigate these features in an animal model related to ASD-the DVD-deficient rat. Compared to controls, both DVD-deficient male and female pups show altered ultrasonic vocalizations and stereotyped repetitive behavior. Further, the DVD-deficient animals had delayed motor development and impaired motor control. Adolescent DVD-deficient animals had impaired reciprocal social interaction, while as adults, these animals were hyperactive. The DVD-deficient model is associated with a range of behavioral features of interest to ASD.”

Human Gut Microbiota from Autism Spectrum Disorder Promote Behavioral Symptoms in Mice. Full article. “The brains of mice colonized with ASD microbiota display alternative splicing of ASD-relevant genes. Microbiome and metabolome profiles of mice harboring human microbiota predict that specific bacterial taxa and their metabolites modulate ASD behaviors. Indeed, treatment of an ASD mouse model with candidate microbial metabolites improves behavioral abnormalities and modulates neuronal excitability in the brain. We propose that the gut microbiota regulates behaviors in mice via production of neuroactive metabolites, suggesting that gut-brain connections contribute to the pathophysiology of ASD.”

Urine Organic Acids as Potential Biomarkers for Autism-Spectrum Disorder in Chinese Children. Full article. “Urine organic acids detection with GC/MS combined with XGBoost algorithm could represent a novel, non-invasive and accurate strategy for diagnosis of autism and the discovered potential biomarkers could be valuable for future research on the pathogenesis of autism and possible interventions, and have a range of clinical applications.”

The potential role of rhythmic entrainment and music therapy intervention for individuals with autism spectrum disorders. Full article. “Music and rhythm have shown a significant potential in improving the oral-motor activities of people affected by ASD. Music based interventions are being used for children diagnosed with ASDs to improve their social communication and motor skills. This article represents the possible role of rhythmic cueing for sensorimotor regulation in ASD individuals. This can serve as a base for further research for the impact of musical therapy on coordination and oral-motor synchronization of individuals diagnosed with ASD.”

Prevalence of comorbid depressive symptoms and suicidal ideation in children with autism spectrum disorder and elevated anxiety symptoms. “Children with autism spectrum disorder (ASD) often have comorbid depressive symptoms and suicidal ideation. The aim of this study was to examine levels of depressive symptoms and suicidal ideation in a sample of children with ASD, normal cognitive functioning and elevated anxiety. More than 35% of the children with ASD reported clinical levels of depressive symptoms while, according to parents, even more than 75% of these children showed clinical levels of depressive symptoms. Girls reported significantly higher levels of depressive symptoms than boys. Moreover, 32.2% of the children with ASD and anxiety had suicidal thoughts and 2.2% of the children showed active suicidal ideation. No gender differences were found in suicidal ideation.”

A Pilot Evaluation of a Treatment Package to Teach Social Conversation via Video-Chat. By engaging with family members through video-chat technology, children with autism spectrum disorder (ASD) may access additional opportunities to develop social connections to build familial cohesion and access emotional support. The purpose of this study was to evaluate a behavioral intervention package in teaching social conversation via video-chat. Using a non-concurrent multiple-baseline across participants with an embedded alternating treatments design, three seven-year-old males with ASD were taught two variations of a social conversation. Their conversation skills generalized to unfamiliar adults, some of whom had no prior experience with children with ASD. When visual supports were removed, participants appropriately varied their social conversations. Social conversations continued to occur 2 weeks following the completion of the study.”

Humanism in medicine: The critical role of pediatricians in autism spectrum disorder. Full article.In this article, we describe the importance of coexisting medical problems in the diagnosis of autism spectrum disorder (ASD). It is worth noting the role of pediatricians as health care providers trained to assess, test, diagnose, and treat such conditions during childhood. The population diagnosed with ASD is systemically vulnerable. ASD is the name given to a group of symptoms resulting from a systemic, dynamic, chronic encephalopathy according to the model proposed by Martha Herbert, M.D. (Harvard, USA). Based on this model, we may describe the circumstances of patients’ families who, in Argentina, are unable to find answers on the coexisting medical problems in the diagnosis of ASD according to the psychoanalytic, genetic, and neurodiversity models. It is necessary to review current models in the setting of humanism in medicine because, so far, results have not been as expected.”

Microbiota and Autism Spectrum Disorder. Full article. “The fact that diet has a huge influence on our health should be common knowledge by now. But what research has been showing us in recent years is just how fundamental the influence of diet on our health can be. Surprising links between diet and a number of previously unsuspected diseases are being continuously established. But food does not affect us only after we are born, it actually starts to shape our health during pre-natal development. Many of these associations between diet and disease, including neurological diseases, are now known to be modulated by the gut microbiota. Research on the gut-brain axis is a blooming field where new and important findings keep streaming. Individuals with ASD often also have gastrointestinal problems and dysbiosis of the gut microbiota, being unclear whether an altered gut flora is a cause of a comorbidity of ASD. It has been suggested that changes in the gut microbiota may indeed play a role in the development of the behavioral symptoms associated with ASD, but the possible mechanisms of this link remain unknown 6.  As for autism, this link may come down to a particular molecule called interleukin-17a (or IL-17a), which is produced by the immune system. The molecule has already been associated with conditions like rheumatoid arthritis, multiple sclerosis, and psoriasis, and has been shown to serve an important role in preventing infections, notably those of the fungal kind. Importantly, it can also influence the way the brain develops in the womb.”


April 2019

Mapping the Autistic Advantage from the Accounts of Adults Diagnosed with Autism: A Qualitative Study. Full article. “Autism has been associated with specific cognitive strengths. Strengths and weaknesses have traditionally been conceptualized as dichotomous. The ability to hyperfocus, attention to detail, good memory, and creativity were the most frequently described traits. Participants also described specific qualities relating to social interaction, such as honesty, loyalty, and empathy for animals or for other autistic people. In thematic analysis we found that traits associated with autism could be experienced either as advantageous or disadvantageous dependent on moderating influences. Moderating influences included the social context in which behaviors occurred, the ability to control behaviors, and the extent to which traits were expressed. Separating autistic strengths from weaknesses may be a false dichotomy if traits cannot be isolated as separate constructs of strengths or deficits. If attempts to isolate problematic traits from advantageous traits are ill conceived, there may be implications for interventions that have reduction in autistic traits as a primary outcome measure.”

Gut Microbiota and Fecal Metabolome Perturbation in Children with Autism Spectrum Disorder. Full article. “The brain-intestinal axis concept describes the communication between the intestinal microbiota as an ecosystem of a number of dynamic microorganisms and the brain. The composition of the microbial community of the human gut is important for human health by influencing the total metabolomic profile. In children with autism spectrum disorder (ASD), the composition of the fecal microbiota and their metabolic products has a different configuration of the healthy child. An imbalance in the metabolite derived from the microbiota in children with ASD affect brain development and social behavior. In this article, we review recent discoveries about intestinal metabolites derived from microbiota based on high-yield molecular studies in children with ASD as part of the “intestinal brain axis“.

Reduction in Obsessive Compulsive Disorder and Self-Injurious Behavior With Saccharomyces boulardii in a Child with Autism: A Case Report. This case report describes the effective use of Saccharomyces boulardii in a boy with autism spectrum disorder, obsessive compulsive disorder (OCD), and self-injurious behavior (SIB). Gastrointestinal dysfunction and OCD are frequent comorbidities in autism, which may share a common etiology resulting from a disturbance in normal gut microbiota. Alterations in microbial diversity influence neuroinflammation and are linked to mood disorders, abdominal pain, and SIB. S boulardii is a nonpathogenic probiotic yeast that supports a healthy microbiome, enhances immune function, and reduces diarrhea. Treatment with S boulardii successfully reduced OCD and SIB symptoms in this child.”

A Pilot Study: Parent Perceptions of Behavior Change in Their Child With Autism Spectrum Disorder Following High Antioxidant Cacao Consumption. Children with ASD tend to have higher free radicals than antioxidants compared with their matched controls. This disequilibrium of oxidative stress has been associated with the pathogenesis of this neurocognitive disorder. The aim of this pilot feasibility study was to examine the effect of high antioxidant cacao consumption on behavior in children with ASD. This was a 4-wk repeated measures experimental pilot study of high antioxidant cacao and children with ASD. Participants consumed 8 squares (or 16 g) per day of the dark chocolate that had a concentration of 70% cacao and 30% organic cane sugar (total antioxidant activity was 8320 μmoles TE/100 g). Results from this study support previous literature on antioxidant intake as an adjunct therapy to improve behaviors of children with ASD.”

A randomized placebo-controlled pilot trial shows that intranasal vasopressin improves social deficits in children with autism. “Preclinical research suggests that arginine vasopressin (AVP), a neuropeptide involved in promoting mammalian social behaviors, may be a possible treatment for ASD. Using a double-blind, randomized, placebo-controlled, parallel study design, we tested the efficacy and tolerability of a 4-week intranasal AVP daily treatment in 30 children with ASD. Intranasal AVP treatment compared to placebo enhanced social abilities as assessed by change from baseline in this phase 2 trial’s primary outcome measure. AVP treatment also diminished anxiety symptoms and some repetitive behaviors.”

A phase 2 clinical trial of a vasopressin V1a receptor antagonist shows improved adaptive behaviors in men with autism spectrum disorder. “The neuropeptide vasopressin has been implicated in the regulation of social behaviors, and its modulation has emerged as a therapeutic target for ASD. The phase 2 VANILLA clinical trial reported here evaluated balovaptan, an orally administered selective vasopressin V1a receptor antagonist, in 223 men with ASD. Balovaptan was well tolerated across all doses, and no drug-related safety concerns were identified.”

Effects of MDMA on attention to positive social cues and pleasantness of affective touch. The psychostimulant drug ±3,4-methylenedioxymethamphetamine (MDMA) reportedly produces distinctive feelings of empathy and closeness with others. MDMA increases social behavior in animal models and has shown promise in psychiatric disorders, such as autism spectrum disorder (ASD) and post-traumatic stress disorder (PTSD). How it produces these prosocial effects is not known. This behavioral and psychophysiological study examined the effects of MDMA, compared with the prototypical stimulant methamphetamine (MA). We found that MDMA, but not MA, selectively enhanced ratings of pleasantness of experienced affective touch. These results provide new evidence that MDMA can enhance the experience of positive social interactions, in this case, pleasantness of physical touch and attentional bias toward positive facial expressions. The findings are consistent with evidence that the prosocial effects are unique to MDMA relative to another stimulant.”

De novo Blood Biomarkers in Autism: Autoantibodies against Neuronal and Glial Proteins. Full article. “Our data show that the levels of circulating IgG class autoantibodies against the nine proteins were significantly elevated in ASD children. Mothers of ASD children exhibited increased levels of autoantibodies against all panel of tested proteins except for S100B and tubulin compared to age-matched healthy control children and their mothers. Control children and their mothers showed low and insignificant levels of autoantibodies to neuronal and glial proteins. These results strongly support the importance of anti-neuronal and glial protein autoantibodies biomarker in screening for ASD children and further confirm the importance of the involvement of the maternal immune system as an index that should be considered in fetal in utero environmental exposures.”

The Possible Role of the Microbiota-Gut-Brain-Axis in Autism Spectrum Disorder. Full article. “New research points to a possible link between autism spectrum disorder (ASD) and the gut microbiota as many autistic children have co-occurring gastrointestinal problems. This review focuses on specific alterations of gut microbiota mostly observed in autistic patients. Particularly, the mechanisms through which such alterations may trigger the production of the bacterial metabolites, or leaky gut in autistic people are described. A less integrative gut-blood-barrier is abundant in autistic individuals. This explains the leakage of bacterial metabolites into the patients, triggering new body responses or an altered metabolism. Some other co-occurring symptoms such as mitochondrial dysfunction, oxidative stress in cells, altered tight junctions in the blood-brain barrier and structural changes in the cortex, hippocampus, amygdala and cerebellum were also detected. Moreover, this paper suggests that ASD is associated with an unbalanced gut microbiota (dysbiosis). Although the cause-effect relationship between ASD and gut microbiota is not yet well established, the consumption of specific probiotics may represent a side-effect free tool to re-establish gut homeostasis and promote gut health. The diagnostic and therapeutic value of bacterial-derived compounds as new possible biomarkers, associated with perturbation in the phenylalanine metabolism, as well as potential therapeutic strategies will be discussed.”

The influence of neuroinflammation in Autism Spectrum Disorder. “The potential involvement of microglia and astrocytes reactive to inflammatory stimuli in ASD has generated much interest due to their varied roles including in mounting an immune response and regulating synaptic function. Increased numbers of reactive microglial and astrocytes in both ASD postmortem tissue and animal models have been reported. Whether dysregulation of glial subtypes exacerbates alterations in neural connectivity in the brain of autistic patients is not well explored.”

A case study of suicidality presenting as a restricted interest in autism Spectrum disorder. Full article. “Suicidality has been under-researched in autism spectrum disorders (ASD). Most studies have linked increased suicidality in ASD to psychiatric comorbidities such as depression. Here we investigated, from a neuropsychological and clinical standpoint, the relationship between core ASD symptoms, i.e., restricted behaviors and social and communication impairments, and the suicidal behaviors in an adult male individual with ASD, with no psychiatric comorbidities. Our case-study suggests that specific clinical and neuropsychological dimensions might be related to suicidal behaviors in ASD. Clinically, the repetitive and rigid suicide-oriented thinking of our patient was not part of a depressive episode. Instead, it followed a purely logical, inflexible, and pervasive reasoning pattern focused on a topic that fascinated him – i.e., suicide –, akin to restricted behaviors.”

Mood Disorders in High-Functioning Autism: The Importance of Alexithymia and Emotional Regulation. Individuals with autism spectrum disorder (ASD) often have co-morbid anxiety and depression. Alexithymia and emotion regulation difficulties are commonly seen in individuals with ASD and in mood disorders. The serial relationship between alexithymia and emotional regulation mediated associations between autistic features and depression and anxiety, separately. The findings suggest that targeting alexithymia may benefit therapies designed to alleviate mood disorders in ASD.”

Perceived Stress among Caregivers of Children with Autism Spectrum Disorder: A State-Wide Study. Full article. “Caregivers of children with autism spectrum disorder (ASD) experience increased stress and more significant negative caregiving consequences than those with typically developing children. There is a lack of studies specifically focusing on stress among caregivers with ASD children in Asian countries. The current study examines levels of perceived stress and factors associated with it among caregivers in Kelantan, Malaysia. Caregivers of an ASD child perceived significant stress while taking care of their children. Institutions should alleviate the factors that were predicted to increase the caregivers’ perceived stress to improve the quality of the lives of children and ASD families as a whole.”

The Relationship Among Gastrointestinal Symptoms, Problem Behaviors, and Internalizing Symptoms in Children and Adolescents With Autism Spectrum Disorder. Full article. “Many individuals with autism spectrum disorder (ASD) have co-occurring gastrointestinal (GI) symptoms, but the etiology is poorly understood. These GI symptoms often coincide with problem behaviors and internalizing symptoms, which reduces the quality of life for these individuals. The majority of patients experienced constipation (65%), about half experienced stomachaches or stomach pain (47.9%), and others experienced nausea (23.2%) or diarrhea (29.7%). Young children with aggressive problem behaviors were 11.2% more likely to have co-occurring nausea; whereas, older children showed more complex relationships between internalizing symptoms and GI symptoms. Older children with greater anxiety symptoms were 11% more likely to experience constipation, but 9% less likely to experience stomachaches. Older children with greater withdrawn behavior were 10.9% more likely to experience stomachaches, but 8.7% less likely to experience constipation. Older children with greater somatic complaints were 11.4% more likely to experience nausea and 11.5% more likely to experience stomachaches.”

Functional Gastrointestinal Disease in Autism Spectrum Disorder: A Retrospective Descriptive Study in a Clinical Sample. Full article. “Medical comorbidities are common in ASD and include functional gastrointestinal disorders (fGID), which are reported in 30-70% of patients. In this research study, we aimed to systematically assess the prevalence of gastrointestinal problems in ASD and describe their clinical correlates. Almost one-third of ASD patients in our sample had at least one fGID. The presence of fGID was associated with ID, sleep problems and with behavioral problems (as measured by the prescription of psychotropic drugs). This subsample of ASD patients with fGID deserves particular attention in future research projects, focusing on specific phenotypic characteristics and overlapping biological markers that may underlie both pathologies.”

Lifesaving Electroconvulsive Therapy for a Child With Autism Spectrum Disorder, Severe Self-Injurious Behavior, and Neuroleptic Malignant Syndrome. We present a case of a preteen with autism spectrum disorder and severe self-injurious behavior who developed neuroleptic malignant syndrome on antipsychotics and required urgent electroconvulsive therapy and continued maintenance electroconvulsive therapy for ongoing clinical stability.”

Prevalence and Risk Factors of Hypovitaminosis-D in Children with Cognitive and Movement Disorders. To document the prevalence of hypovitaminosis-D in children with intellectual and movement disorders and to identify the risk factors in vitamin D deficient children. Of the 90 children, 86 (95.5%) had at least one sign of vitamin D deficiency. Lowest levels of vitamin D were seen in autistic spectrum disorder and learning disabilities in the Cognitive Disability group and hemiplegia in the Movement Disability group. The prevalence of vitamin D deficiency in children with neurodevelopmental disabilities was 72.2%, with 76.1% in the cognitive disability group and 68.2% in the movement disability group. The risk factors were more common in vitamin D deficient children.”

[Clinical effect of vitamin D3 combined with the Early Start Denver Model in the treatment of autism spectrum disorder in toddlers]. “Early Start Denver Model (ESDM) can effectively improve the clinical symptoms of toddlers with ASD, with a significantly better clinical effect in improving social interaction and somatic movement than conventional rehabilitation. ESDM combined with VitD3 has a significantly better clinical effect in improving social communication skills and may be one of the best strategies for improving the clinical symptoms of toddlers with ASD.”

Air pollution and Autism in Denmark. “Previous autism spectrum disorder (ASD) and air pollution studies focused on pregnancy exposures, but another vulnerable period is immediate postnatally. Here, we examined early life exposures to air pollution from the pre- to the postnatal period and ASD/ASD subtypes in the Danish population. Our data suggest that air pollutant exposure in early infancy but not during pregnancy increases the risk of being diagnosed with autism and Asperger among children born in Denmark.”

A ‘choice’, an ‘addiction’, a way ‘out of the lost’: exploring self-injury in autistic people without intellectual disability. Full article. “Non-suicidal self-injury (NSSI) describes a phenomenon where individuals inflict deliberate pain and tissue damage to their bodies. Self-injurious behaviour is especially prevalent across the autism spectrum, but little is understood about the features and functions of self-injury for autistic individuals without intellectual disability, or about the risk factors that might be valuable for clinical usage in this group. Alexithymia, depression, anxiety and sensory differences may place some autistic individuals at especial risk of self-injury. Investigating the involvement of these variables and their utility for identification and treatment is of high importance, and the voices of participants offer guidance to practitioners confronted with NSSI in their autistic clients.”

Mood symptoms and suicidality across the autism spectrum. Full article. “The aim of this study was to investigate the presence of mood symptoms and suicidal ideation and behaviors in patients with full-blown ASD and in subjects with AT, as well in a healthy control (HC) group, with a specific focus on which of the autistic features may be predictive of suicidal ideation and behaviors. Our results highlight a correlation between autism and mood spectrum, as well as between suicidality and both ASD and AT. Subthreshold forms of ASD should be accurately investigated due to their relationship with suicidal thoughts and behaviors.”

Burden of care and Suicidal Ideation among Mothers of Children with Autism Spectrum Disorder: Perceived Social Support as a Moderator. Full article. “To examine the moderation effect of perceived social support between burden of care and suicidal ideation among mothers of children suffering from Autism Spectrum Disorder. Social support provided by the significant others lowered the burden of care and suicidal ideation among mothers of children with Autism Spectrum Disorder.”

Nuclear Peroxisome Proliferator-Activated Receptors (PPARs) as Therapeutic Targets of Resveratrol for Autism Spectrum Disorder. Full article. “Clinical evidence and molecular data support the role of impaired mitochondrial fatty acid oxidation (FAO) in ASD. The recognition of defects in energy metabolism in ASD may be important for better understanding ASD and developing therapeutic intervention. The nuclear peroxisome proliferator-activated receptors (PPAR) α, δ, and γ are ligand-activated receptors with distinct physiological functions in regulating lipid and glucose metabolism, as well as inflammatory response. PPAR activation allows a coordinated up-regulation of numerous FAO enzymes, resulting in significant PPAR-driven increases in mitochondrial FAO flux. Resveratrol (RSV) is a polyphenolic compound which exhibits metabolic, antioxidant, and anti-inflammatory properties, pointing to possible applications in ASD therapeutics. In this study, we review the evidence for the existing links between ASD and impaired mitochondrial FAO and review the potential implications for regulation of mitochondrial FAO in ASD by PPAR activators, including RSV.”

The Association Between Serum Vitamin D3 Levels and Autism Among Jordanian Boys. “This study assesses the correlation between vitamin-D deficiency and autism spectrum disorder (ASD) in Jordan. We performed a case-controlled cross-sectional analysis to assess vitamin D levels in 83 children with ASD aged less than 8 years old compared to 106 healthy controls. In addition, the association between vitamin D deficiencies and gastrointestinal (GI) complains and electroencephalogram (EEG) abnormalities commonly found in children with ASD was investigated. Vitamin D levels in ASD patients were significantly lower. Also, Vitamin D levels in ASD patients had significant correlation with GI complains, but no correlation between vitamin D levels and Ca2+or EEG abnormalities was detected. These data suggest a possible role for vitamin D deficiency in the pathophysiology of ASD.”

A molecular biomarker for prediction of clinical outcome in children with ASD, constipation, and intestinal inflammation. Full article. “In children with autism spectrum disorder (ASD) who present to the gastroenterologist with chronic constipation on a background of colonic inflammation, we have identified two distinct clinical subtypes: (1) patients who experience a sustained state of GI symptomatic remission while on maintenance anti-inflammatory therapy (fast responders) and, (2) those with recurrent right-sided fecal loading requiring regular colon cleanouts during treatment for enterocolitis (slow responders). We hypothesized that a detailed molecular analysis of tissue from the affected region of the colon would provide mechanistic insights regarding the fast versus slow response to anti-inflammatory therapy. Significant differences were found between the two clusters with fast responder-predominant cluster showing an upregulation of transcripts involved in the activation of immune and inflammatory response and the slow responder-predominant cluster showing significant over-representation of pathways impacting colonic motility (e.g. genes involved in tryptophan and serotonin degradation and mitochondrial dysfunction).”

Effects of Lactobacillus plantarum PS128 on Children with Autism Spectrum Disorder in Taiwan: A Randomized, Double-Blind, Placebo-Controlled Trial. Full article. “This four-week, randomized, double-blind, placebo-controlled study investigated the effects of Lactobacillus plantarum PS128 (PS128) on boys with autism spectrum disorder (ASD) aged 7-15 in Taiwan. The results showed that PS128 ameliorated opposition/defiance behaviors, and that the total score of SNAP-IV for younger children (aged 712) improved significantly compared with the placebo group. Additionally, several elements were also notably improved in the PS128 group after 28-day consumption of PS128. Further studies are needed to better clarify the effects of PS128 for younger children with ASD on broader symptoms.

Sleep determines quality of life in autistic adults: A longitudinal study. “Many individuals with autism report generally low quality of life (QoL). Identifying predictors for pathways underlying this outcome is an urgent priority. In this study, we looked at factors that predict long-term QoL and found that sleep problems are highly influential. Our results additionally suggest that social satisfaction can buffer this influence. These findings suggest that sleep and social satisfaction could be monitored to increase QoL in autistic adults.”

Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota. Full article. “Many studies have reported abnormal gut microbiota in individuals with Autism Spectrum Disorders (ASD), suggesting a link between gut microbiome and autism-like behaviors. Modifying the gut microbiome is a potential route to improve gastrointestinal (GI) and behavioral symptoms in children with ASD, and fecal microbiota transplant could transform the dysbiotic gut microbiome toward a healthy one by delivering a large number of commensal microbes from a healthy donor. We previously performed an open-label trial of Microbiota Transfer Therapy (MTT) that combined antibiotics, a bowel cleanse, a stomach-acid suppressant, and fecal microbiota transplant, and observed significant improvements in GI symptoms, autism-related symptoms, and gut microbiota. Here, we report on a follow-up with the same 18 participants two years after treatment was completed. Notably, most improvements in GI symptoms were maintained, and autism-related symptoms improved even more after the end of treatment. Important changes in gut microbiota at the end of treatment remained at follow-up, including significant increases in bacterial diversity and relative abundances of Bifidobacteria and Prevotella. Our observations demonstrate the long-term safety and efficacy of MTT as a potential therapy to treat children with ASD who have GI problems, and warrant a double-blind, placebo-controlled trial in the future.”

Parent-reported prevalence of food allergies in children with autism spectrum disorder: National health interview survey, 2011-2015. “Food allergies are frequently reported to co-occur with autism spectrum disorder (ASD), but the prevalence of this co-occurrence remains uncertain. In the present study, we examined parent-reported prevalence of co-occurring food allergy and ASD in a nationally representative sample of US children ages 2-17 in the National Health Interview Survey, study years 2011-2015. Parent-reported food allergies were nearly 2.5 times more common in children with ASD (13.1%) than in children without ASD (5.4%).”

A Study on the Incidence and Comorbidities of Autism Spectrum Disorders Accompanied by Intellectual Disabilities in Yonago City, Japan. Full article. “Autism spectrum disorders (ASD) with intellectual disabilities may be associated with many factors. This study focused on patients with ASD with intellectual disabilities, defined by a threshold intelligence quotient (IQ) or development quotient (DQ) of 70. We also discuss comorbidities and other factors related to ASD. It is important to treat and support individuals with ASD and intellectual disabilities taking into account the characteristics and prognosis of the comorbidities and related factors.”

Randomized Trial of a Computer-Assisted Intervention for Children With Autism in Schools. “Despite growing enthusiasm for CAI [computer-assisted interventions] in autism treatment, our findings indicate that CAI may not be effective at improving language and cognitive outcomes for children with ASD. The decision to implement CAI in schools should be carefully balanced with the evidence for effectiveness of these programs. Schools may be better served by investing in treatment strategies with established evidence.”


March 2019

A Review of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy. Full article. “This paper provides a brief review of the history, proposed pharmacological mechanisms, safety issues, and clinical applications of the medicine 3,4-methylenedioxymethamphetamine (MDMA). Most clinical MDMA research in patients to date has focused on MDMA-assisted psychotherapy to treat posttraumatic stress disorder (PTSD). In this review paper other potential therapeutic applications for MDMA therapy are described, including contemporary studies treating anxiety associated with autism and the authors’ ongoing study exploring the potential role for MDMA-assisted psychotherapy to treat alcohol use disorder. MDMA therapy for PTSD is now entering the final Phase 3 stage of drug development, with a target set for licensing by the FDA and EMA in 2021. This means that if clinical efficacy criteria are achieved, MDMA would become a medicine.”

Environmental Chemicals and Autism: A Scoping Review of the Human and Animal Research. Full article. “Although research is growing rapidly, wide variability exists in study design and conduct, exposures investigated, and outcomes assessed. Conclusions focus on recommendations to guide development of best practices in epidemiology and toxicology, including greater harmonization across these fields of research to more quickly and efficiently identify chemicals of concern. In particular, we recommend chlorpyrifos, lead, and polychlorinated biphenyls (PCBs) be systematically reviewed in order to assess their relationship with the development of autism. There is a pressing need to move forward quickly and efficiently to understand environmental influences on autism in order to answer current regulatory questions and inform treatment and prevention efforts.”

Parenting Stress in Mothers of Children With Autism Without Intellectual Disability. Mediation of Behavioral Problems and Coping Strategies. Full article. “Correlation analyses revealed that parenting stress was positively correlated with the children’s ASD symptoms and behavioral problems. Correlation analyses revealed that parenting stress was positively correlated with the children’s ASD symptoms and behavioral problems.”

Adverse Events Associated with Risperidone Use in Pediatric Patients: A Retrospective Biobank Study. Full article. “Nearly one in three children treated with risperidone for ≥ 1 month experienced one or more AEs. Particular vigilance is warranted for children with self-injurious behavior.”

Altered Gut Microbiota in Chinese Children With Autism Spectrum Disorders. Full article. “This study provides further evidence of intestinal microbial dysbiosis in ASD and sheds light on the characteristics of the gut microbiome of autistic children in China.”

Prenatal and infant exposure to ambient pesticides and autism spectrum disorder in children: population based case-control study. Full article. “Findings suggest that an offspring’s risk of autism spectrum disorder increases following prenatal exposure to ambient pesticides within 2000 m of their mother’s residence during pregnancy, compared with offspring of women from the same agricultural region without such exposure. Infant exposure could further increase risks for autism spectrum disorder with comorbid intellectual disability.”

Transplacental transport of paracetamol and its phase II metabolites using the ex vivo placenta perfusion model. In Europe, 50-60% of pregnant women uses paracetamol (PCM), also known as acetaminophen. While it was considered to be safe, recent studies have shown an association between prenatal exposure to PCM and increased incidences of autism, cryptorchidism, asthma and ADHD. PCM crosses the placental barrier rapidly via passive diffusion. Differences in flow rate and villous placental structure explain the significantly faster M-F transfer than F-M transfer of PCM. The larger and more hydrophilic molecules PCM-S and PCM-G cross the placenta at a significantly lower rate. Moreover, their F-M transport is about 40% slower than M-F transport, suggesting involvement of a transporter.”

Autistic Symptoms in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analysis. Full article. “Recent studies have examined the association between autism spectrum disorder and schizophrenia spectrum disorders, describing a number of cognitive features common to both conditions (e.g., weak central coherence, difficulties in set-shifting, impairment in theory of mind). Several studies have reported high levels of autistic symptoms in population with schizophrenia spectrum disorders. Current findings support that individuals with schizophrenia spectrum disorders have higher autistic symptoms than healthy controls. Therefore, further studies are needed in order to shed light on the association between these two conditions.”

Prevalence of Overweight and Obesity Among Children and Adolescents With Autism Spectrum Disorder and Associated Risk Factors. Full text. “Prevalence of obesity in Autism Spectrum Disorder (ASD) has been reported to be higher than in the general population. The prevalence of obesity and overweight is high among Malaysian ASD children and adolescents. Older child age, high maternal BMI, older paternal age, low physical activity, low likelihood of food refusal and high likelihood of food selectivity were found to be risk factors for high BMI in these children.”

Variations in Mitochondrial Respiration Differ in IL-1ß/IL-10 Ratio Based Subgroups in Autism Spectrum Disorders. Full article. “Autism spectrum disorder (ASD)7 is associated with multiple physiological abnormalities, including immune dysregulation, and mitochondrial dysfunction. However, an association between these two commonly reported abnormalities in ASD has not been studied in depth. This study assessed the association between previously identified alterations in cytokine profiles by ASD peripheral blood monocytes (PBMo) and mitochondrial dysfunction. Our results indicate for the first time, an association between PBMC mitochondrial function and PBMo cytokine profiles in ASD subjects. This relationship differs across the IL-1ß/IL-10 ratio based ASD subgroups. Changes in mitochondrial function are likely due to adaptive changes or mitochondrial dysfunction, resulting from chronic oxidative stress. These results may indicate alteration in molecular pathways affecting both the immune system and mitochondrial function in some ASD subjects.”

Is cesarean section delivery associated with autism spectrum disorder? To investigate a correlation between birth by caesarean section and autism spectrum disorder (ASD). An association between delivery by cesarean section and ASD was found in this study, in support of the findings of other studies. It is recommended that preventive measures are adopted to avoid unnecessary cesarean sections.


February 2019

Autism Spectrum Disorders and the Gut Microbiota. Full article. “In recent years, there has been an emerging interest in the possible role of the gut microbiota as a co-factor in the development of autism spectrum disorders (ASDs), as many studies have highlighted the bidirectional communication between the gut and brain (the so-called “gut-brain axis”). Accumulating evidence has shown a link between alterations in the composition of the gut microbiota and both gastrointestinal and neurobehavioural symptoms in children with ASD. The aim of this narrative review was to analyse the current knowledge about dysbiosis and gastrointestinal (GI) disorders in ASD and assess the current evidence for the role of probiotics and other non-pharmacological approaches in the treatment of children with ASD. Analysis of the literature showed that gut dysbiosis in ASD has been widely demonstrated; however, there is no single distinctive profile of the composition of the microbiota in people with ASD. Gut dysbiosis could contribute to the low-grade systemic inflammatory state reported in patients with GI comorbidities. The administration of probiotics (mostly a mixture of Bifidobacteria, Streptococci and Lactobacilli) is the most promising treatment for neurobehavioural symptoms and bowel dysfunction, but clinical trials are still limited and heterogeneous. Well-designed, randomized, placebo-controlled clinical trials are required to validate the effectiveness of probiotics in the treatment of ASD and to identify the appropriate strains, dose, and timing of treatment.”

Association of Maternal Prenatal Vitamin Use With Risk for Autism Spectrum Disorder Recurrence in Young Siblings. Most mothers (231 [95.9%]) reported taking prenatal vitamins during pregnancy, but only 87 mothers (36.1%) met the recommendations to take prenatal vitamins in the 6 months before pregnancy. The prevalence of ASD was 14.1% (18) in children whose mothers took prenatal vitamins in the first month of pregnancy compared with 32.7% (37) in children whose mothers did not take prenatal vitamins during that time. Children whose mothers reported taking prenatal vitamins during the first month of pregnancy were less likely to receive an ASD diagnosis. Maternal prenatal vitamin intake during the first month of pregnancy may reduce ASD recurrence in siblings of children with ASD in high-risk families.”

Mortality and cause of death of Australians on the autism spectrum. “Ihe present study used large linked datasets spanning 2001-2015 to report the rates and risk factors for mortality and cause of death in individuals on the autism spectrum (n = 35,929 age range 5-64) with and without concurrent intellectual disability (ID) in New South Wales, Australia. Mortality rates for those on the autism spectrum were 2.06 times that of the general population. Rates of death are higher for autistic individuals compared to the general population. There is higher risk of death for autistic individuals who have additional mental and physical health conditions. The leading causes of death for autistic individuals with and without ID are “nervous system and sense disorders”, which includes epilepsy and “injury and poisoning”, respectively.

Autism prevalence and outcomes in older adults. “Recent studies of mortality, illness, and suicide among autistic adults paint an alarming picture. Autistic people appear to die much earlier than the general population, and they seem to be far more vulnerable to a surprising range of medical problems. Suicide and depression seem far more common than in the general population. If correct, that suggests an older autistic population in silent crisis, with few if any supports.”

Adherence to Antipsychotic Adverse Effect Monitoring Among a Referred Sample of Children with Intellectual Disabilities.Despite frequent use of antipsychotic medications to target severe behavioral problems among children with intellectual disabilities (ID), there is little information as to the extent to which adverse effect monitoring is in place for this population. The most commonly used antipsychotic was risperidone (48%). The extent of adherence to the guidelines was (1) 96% for weight, height, and body mass index; (2) 84% for extrapyramidal symptom screening; (3) 80% for blood pressure; (4) 64% for abdominal girth and liver enzymes; (5) 60% for fasting plasma glucose; and (6) 56% for fasting lipids. Only 20% had all core recommended parameters documented.”

Highly Selective Eating in Autism Spectrum Disorder Leading to Scurvy: A Series of Three Patients. Some children with autism spectrum disorder (ASD) have highly specific food selectivity and therefore are prone to nutritional deficiencies of different kinds. We document three children with ASD who presented with refusal to walk and gingivitis who underwent comprehensive evaluations before establishing the diagnosis of vitamin C deficiency (scurvy). The symptoms resolved after treatment with vitamin C. Prevention of nutritional deficiencies in children with ASD is essential, and providing multivitamin supplementation whenever high food selectivity is noted may prevent significant morbidity.”

Nrf2 activator, sulforaphane ameliorates autism-like symptoms through suppression of Th17 related signaling and rectification of oxidant-antioxidant imbalance in periphery and brain of BTB R T+tf/J mice. Autism is a neurodevelopmental disease which is characterized by its core behavioral symptoms such as impairment in social interaction and stereotyped repetitive behavior. Th17 immune responses and oxidative stress are reported to be elevated in both human autistic subjects and BTBR T + Itpr3tf/J (BTBR) mice. On the other hand, activation of nuclear factor erythroid 2 related factor (Nrf2), a master transcription factor is essential for the management of anti-inflammatory and antioxidant genes. Sulforaphane activates Nrf2 and thus is considered a potential approach to treat several neurological disorders including autism. Our results demonstrate that BTBR treated with sulforaphane had reduced self-grooming/marble burying behavior, and increased social interaction in three chambered sociability test as compared to untreated BTBR mice. Furthermore, sulforaphane-treated BTBR and C57 mice had upregulated enzymatic antioxidant defenses in neutrophils/cerebellum (SOD, GPx and GR expression and activity). We reason that activation of Nrf2 by sulforaphane corrected Th17 immune dysfunction and oxidant-antioxidant imbalance in periphery and brain in BTBR mice. These mechanisms lead to improvement in autism-like symptoms in BTBR mice.”

Sleep Disturbances Increase the Impact of Working Memory Deficits on Learning Problems in Adolescents with High-Functioning Autism Spectrum Disorder. Sleep disturbances (SD) are prevalent in individuals diagnosed with Autism Spectrum Disorder (ASD). Less is known about the effects of SD on cognition and learning in adolescents with high-functioning ASD (HF-ASD). Adolescents with HF-ASD (N = 96) were evaluated for the relationships of SD to working memory and learning problems. Results found SD to modify the relationship between working memory and learning problems. Working memory deficits were associated with learning problems among those with SD, while not among those without SD. SD and working memory deficits should be targeted in interventions for these adolescents with HF-ASD (e.g., cognitive behavior therapy for insomnia, pharmacological treatments). Future studies should examine if improvement in SD reduces the impact of working memory deficits on learning problems.

Autism, spectrum or clusters? An EEG coherence study. Full article. “EEG coherence factors provide evidence of two highly significant separate clusters within the subject population with autism. The establishment of a unitary “Autism Spectrum Disorder” does a disservice to patients and clinicians, hinders much needed scientific exploration, and likely leads to less than optimal educational and/or interventional efforts.”

Autism Spectrum Disorder (ASD) with and without Mental Regression is Associated with Changes in the Fecal Microbiota. Full article. “The aim of the present study was to evaluate the fecal metagenomic profiles in children with ASD and compare them with healthy participants. This comparison allows us to ascertain how mental regression (an important variable in ASD) could influence the intestinal microbiota profile. For this reason, a subclassification in children with ASD by mental regression (AMR) and no mental regression (ANMR) phenotype was performed. Preliminary results, using a principal component analysis, showed differential patterns in children with ASD, ANMR and AMR, compared to healthy group, both for intestinal microbiota and food patterns. In this study, we report, higher levels of Actinobacteria, Proteobacteria and Bacilli, aside from Erysipelotrichi, and Gammaproteobacteria in children with ASD compared to healthy group. Furthermore, AMR children exhibited higher levels of Proteobacteria. Further analysis using these preliminary results and mixing metagenomic and other “omic” technologies are needed in larger cohorts of children with ASD to confirm these intestinal microbiota changes.”

Chronic exposure to xenobiotic pollution leads to significantly higher total glutathione and lower reduced to oxidized glutathione ratio in red blood cells of children with autism. “Analyses of reduced glutathione (GSH), oxidized glutathione (GSSG), and total glutathione (tGSH) in red blood cell samples from 30 children diagnosed with autism and 30 age, gender, and socioeconomic status matched controls were undertaken. Results suggest that exposure to toxic elements may prompt compensatory increases in production of GSH in children with autism in environments higher in toxins. The compensation did not fully correct the anti-oxidant properties of exposure to xenobiotics as demonstrated by the significantly lower GSH/GSSG in children with autism compared to controls. Out of a set of glutathione biomarkers, GSH/GSSG may best determine the degree of compensation for oxidative stress in children with autism.”

A randomised controlled trial of vitamin D and omega-3 long chain polyunsaturated fatty acids in the treatment of irritability and hyperactivity among children with autism spectrum disorder.Irritability and hyperactivity are common in children with Autism Spectrum Disorder (ASD). Because pharmacological treatments may have adverse effects, and despite limited evidence, caregivers/parents often use dietary supplements such as vitamin D and omega-3 fatty acids to address these behavioural symptoms. As a secondary objective of the VIDOMA (Vitamin D and Omega-3 in ASD) trial, we evaluated the efficacy of vitamin D, omega-3 long chain polyunsaturated fatty acid [omega-3 LCPUFA; docosahexaenoic acid (DHA)], or both on irritability and hyperactivity. New Zealand children with ASD (aged 2.5-8 years) participated in a 12-month randomized, double-blind, placebo-controlled trial of vitamin D (2000 IU/day, VID), omega-3 LCPUFA (722 mg/day DHA, OM), or both (2000 IU/day vitamin D + 722 mg/day DHA, VIDOM). The primary outcomes were the Aberrant Behaviour Checklist (ABC) domains of irritability and hyperactivity. Biomarkers (serum 25-hydroxyvitamin D [25(OH)D] and omega-3 index) and primary outcomes were measured at baseline and 12-months. Out of 111 children who completed baseline data collection, 66% completed the study (VID = 19, OM = 23, VIDOM = 15, placebo = 16). After 12 months, children receiving OM (-5.0 ± 5.0, P = 0.001) and VID (-4.0±4.9, P = 0.01) had greater reduction in irritability than placebo (0.8±6.1). Compared to placebo, children on VID also had greater reduction in hyperactivity (-5.2±6.3 vs. -0.8±5.6, P = 0.047). Serum 25(OH)D concentration (nmol/L, mean±SD) increased by 27±14 in VID and by 36±17 in VIDOM groups (P < 0.0001), and omega-3 index (%, median (25th, 75th percentiles)) by 4.4 (3.3, 5.9) in OM and by 4.0 (2.0, 6.0) in VIDOM groups (P < 0.0001), indicating a good compliance rate. The results indicate that vitamin D and omega-3 LCPUFA reduced irritability symptoms in children with ASD. Vitamin D also reduced hyperactivity symptoms in these children.”


January 2019

Impact of Psychoactive Drug Use on Developing Obesity among Children and Adolescents with Autism Spectrum Diagnosis: A Nested Case-Control Study. Longer and higher SGA [second generation antipsychotic] exposure increased the risk of obesity, which has to be considered in relation to the paucity of evidence supporting long-term psychoactive medication use in AS children. Results highlight the need to promote optimal use and interventions to mitigate metabolic side effects of SGAs in this population.”

Altered gut microbiota and short chain fatty acids in Chinese children with autism spectrum disorder. “The results showed that the compositions of the gut microbiota and SCFAs were altered in ASD individuals. We found lower levels of fecal acetic acid and butyrate and a higher level of fecal valeric acid in ASD subjects. We identified decreased abundances of key butyrate-producing taxa (Ruminococcaceae, Eubacterium, Lachnospiraceae and Erysipelotrichaceae) and an increased abundance of valeric acid associated bacteria (Acidobacteria) among autistic individuals. Constipation was the only GI disorder in ASD children in the present study. We also found enriched Fusobacterium, Barnesiella, Coprobacter and valeric acid-associated bacteria (Actinomycetaceae) and reduced butyrate-producing taxa in constipated autistic subjects. It is suggested that the gut microbiota contributes to fecal SCFAs and constipation in autism. Modulating the gut microbiota, especially butyrate-producing bacteria, could be a promising strategy in the search for alternatives for the treatment of autism spectrum disorder.

Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: A randomized controlled trial.The objective of this study was to examine the impact of physical activity on sleep quality and cognition in children with autism spectrum disorder. Results revealed a significant improvement in sleep efficiency, sleep onset latency, and sleep duration in the intervention group but not in the control group during weekdays. Moreover, a significant improvement in inhibitory control was shown in the intervention group but not in the control group. No significant improvement in working memory capacity was documented in either group. Our findings highlight the value of physical activity in improving sleep quality and cognition among children with autism spectrum disorder, but specific physical activity may be required to benefit individual executive functions.”

A 20-year study of suicide death in a statewide autism population.This study examined suicide risk among individuals with autism spectrum disorder (ASD) in Utah over a 20-year period. Risk of suicide death in individuals with ASD was found to have increased over time and to be greater than in individuals without ASD between 2013 and 2017. Females with ASD were over three times as likely to die from suicide as females without ASD. Young people with ASD were at over twice the risk of suicide than young people without ASD. Individuals with ASD were less likely than others to die from firearm-related suicides.”

Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy. Full Article. “Recently anecdotal evidence of possible therapeutic effects of cannabis products has emerged. The aim of this study is to characterize the epidemiology of ASD patients receiving medical cannabis treatment and to describe its safety and efficacy. After six months of treatment 82.4% of patients (155) were in active treatment and 60.0% (93) have been assessed; 28 patients (30.1%) reported a significant improvement, 50 (53.7%) moderate, 6 (6.4%) slight and 8 (8.6%) had no change in their condition. Twenty-three patients (25.2%) experienced at least one side effect; the most common was restlessness (6.6%). Cannabis in ASD patients appears to be well tolerated, safe and effective option to relieve symptoms associated with ASD.”

Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children. Full article. “To examine the association of food allergy and other allergic conditions with ASD in US children. In a nationally representative sample of US children, a significant and positive association of common allergic conditions, in particular food allergy, with ASD was found. Further investigation is warranted to elucidate the causality and underlying mechanisms.”

Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms. Full article. “The study objective was to assess tolerability of a probiotic (Bifidobacterium infantis) in combination with a bovine colostrum product (BCP) as a source of prebiotic oligosaccharides and to evaluate GI, microbiome and immune factors in children with ASD and GI co-morbidities. Some participants on both treatments saw a reduction in the frequency of certain GI symptoms, as well as reduced occurrence of particular aberrant behaviors. Improvement may be explained by a reduction in IL-13 and TNF-α production in some participants. Although limited conclusions can be drawn from this small pilot study, the results support the need for further research into the efficacy of these treatments.”

Autism and carnitine: A possible link. Full article. “Autism onset can be connected with various factors such as metabolic disorders: including carnitine deficiency. Carnitine is a derivative of two amino acid lysine and methionine. Carnitine is a cofactor for a large family of enzymes: the carnitine acyltransferases. Through their action these enzymes (and L-carnitine) are involved in energy production and metabolic homeostasis. Some people with autism (less than 20%) seem to have L-carnitine metabolism disorders and for these patients, a dietary supplementation with L-carnitine is beneficial. This review summarizes the available information on this topic.”

Role of Milk-Derived Opioid Peptides and Proline Dipeptidyl Peptidase-4 in Autism Spectrum Disorders. Full article. “Opioid peptides released during digestion of dietary proteins such as casein, were suggested to contribute to autism development, leading to the announcement of opioid excess hypothesis of autism. This paper examines role of enzyme proline dipeptidyl peptidase-4 (DPPIV; EC and it is exogenous substrate, β-casomorphin-7 (BCM7) in autism etiology. The inspiration for this study emanated from clinical experience of the daily diet role in relieving the symptoms of autism. Despite this, we have concluded that milk-derived opioid peptides and DPPIV are potentially factors in determining the pathogenesis of autism; conducted studies are still limited and require further research.”


December 2018

Modeling Inflammation in Autism Spectrum Disorders Using Stem Cells. Full article. “Induced pluripotent stem cell (iPSC) technology offers a groundbreaking platform for the study of polygenic neurodevelopmental disorders in live cells. Robust inflammation states and immune system dysfunctions are associated with ASD and several cell types participate on triggering and sustaining these processes. In this review, we will examine the contribution of neuroinflammation to the development of autistic features and discuss potential therapeutic approaches.”

Gut Microbiota Features in Young Children With Autism Spectrum Disorders. Full article. “Proliferation and/or depletion of clusters of specific bacteria regulate intestinal functions and may interfere with neuro-immune communication and behavior in patients with autism spectrum disorder (ASD). Consistently, qualitative and quantitative alteration of bacterial metabolites may functionally affect ASD pathophysiology.”

The Presence of Comorbid ADHD and Anxiety Symptoms in Autism Spectrum Disorder: Clinical Presentation and Predictors. Full article. “High rates of attention deficit/hyperactivity disorder (ADHD) and anxiety symptoms have been documented in autism spectrum disorder (ASD), and have been associated with social and adaptive impairments. The study examined the frequency of clinically elevated ADHD and anxiety symptoms in an ASD group in comparison to a non-clinical group, compared the clinical presentation in the ASD group with and without ADHD and anxiety, assessed which child and familial variables add to the severity of Inattention, Hyperactivity/Impulsivity (HI), and anxiety symptoms, and evaluated whether having clinically elevated ADHD and/or anxiety symptoms adds to the prediction of adaptive functioning in ASD.”

Autism Spectrum Disorder and Cannabidiol: Have We Seen This Movie Before? Full article. “The use of CBD for clinical applications has gained increasing attention given its lack of psychoactive properties and potential benefits that have been noted in certain disease states, such as pediatric epilepsy and adult disorders. There is a paucity of literature supporting the clinical evidence for use of CBD in ASD. CBD and similar products remain a promising yet unproven intervention in the treatment of children with ASD. Instead, many questions remain unanswered. Will CBD be effective in the treatment of certain target symptoms in children with ASD? Will the selection of individuals who are candidates for this treatment be an important factor? What is the most appropriate ratio of CBD to THC for the beneficial effects, if any? Well-designed research studies are being planned and underway, but results have yet to emerge.”

Fragranced consumer products: effects on autistic adults in the United States, Australia, and United Kingdom. Full article. “Fragranced consumer products, such as cleaning supplies, air fresheners, and personal care products, can have adverse effects on both air quality and health. This study investigates the effects of fragranced products on autistic individuals ages 18-65 in the United States, Australia, and United Kingdom. Autistic adults, 83.7% report adverse health effects from fragranced products, including migraine headaches (42.9%), neurological problems (34.3%), respiratory problems (44.7%), and asthma attacks (35.9%). In particular, 62.9% of autistic adults report health problems from air fresheners or deodorizers, 57.5% from the scent of laundry products coming from a dryer vent, 65.9% from being in a room cleaned with scented products, and 60.5% from being near someone wearing a fragranced product. Further, 59.4% of autistic adults have lost workdays or lost a job, in the past year, due to fragranced product exposure in the workplace. More than twice as many autistic as well as non-autistic individuals would prefer that workplaces, health care facilities, and health care professionals were fragrance-free rather than fragranced. Results show that vulnerable individuals, such as those with autism or autism spectrum disorders, can be profoundly, adversely, and disproportionately affected by exposure to fragranced consumer products.”

Omega-3 PUFAs and vitamin D co-supplementation as a safe-effective therapeutic approach for core symptoms of autism spectrum disorder: case report and literature review.We report the case of a 23-year-old young adult male with autism who was referred to our Unit due to a 12-month history of cyclic episodes of restlessness, agitation, irritability, oppositional and self-injurious behaviours. Laboratory tests documented a markedly altered omega-6/omega-3 balance, along with a vitamin D deficiency, as assessed by serum levels of 25-hydroxyvitamin D. Omega-3 and vitamin D co-supplementation was therefore started, with remarkable improvements in ASD symptoms throughout a 24-month follow-up period. A brief review of the literature for interventional studies evaluating the efficacy of omega-3 or vitamin D supplementation for the treatment of ASD-related symptoms is also provided.”

Anti-Candida albicans IgG Antibodies in Children With Autism Spectrum Disorders. Full article. “A growing body of evidence suggests that individuals with ASD have significant aberrations in the composition of their gut microbiota, known as dysbiosis. However, these studies have focused on the bacterial components of the microbiota, leaving the fungal microbiota in ASD poorly studied. Increases in fungal species such as Candida albicans are associated with inflammatory bowel disorders, and have recently been implicated in several neurological disorders including schizophrenia. We aimed to determine if children with ASD exhibit elevations in antibodies that target C. albicans, indicating current or previous overgrowth of this fungal species. Overall, ASD children had a higher rate of high-positive values compared to typically developed children with an unadjusted odds ratio of 3.45. GI dysfunction was found in about half of the ASD children who were positive for anti-Candida IgG.”

Procedural sedation in children with autism spectrum disorders in the emergency department.Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED. Children with autism in the ED commonly received sedation; one in four of which were for non-painful diagnostic procedures or physical examination. Over one-third received sedation via a non-parenteral route for intended minimal sedation. Sedative medication dosing and observed adverse events were similar to those reported previously in children without ASD. Emergency providers must be prepared to meet the unique sedation needs of children with ASD.

An exploration of concomitant psychiatric disorders in children with autism spectrum disorder. Full article. “We explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD). Participants were 658 children with ASD (age 3-17 years). The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder.”

November 2018

Immune Dysfunction and Autoimmunity as Pathological Mechanisms in Autism Spectrum Disorders. Full article. “Many current studies focus on the combined effects of genetics and environment. Strikingly, a distinct picture of immune dysfunction has emerged and been supported by many independent studies over the past decade. Many players in the immune-ASD puzzle may be mechanistically contributing to pathogenesis of these disorders, including skewed cytokine responses, differences in total numbers and frequencies of immune cells and their subsets, neuroinflammation, and adaptive and innate immune dysfunction, as well as altered levels of immunoglobulin and the presence of autoantibodies which have been found in a substantial number of individuals with ASD. This review summarizes the latest research linking ASD, autoimmunity and immune dysfunction, and discusses evidence of a potential autoimmune component of ASD.”

Maternal depression and antidepressant use during pregnancy and the risk of autism spectrum disorder in offspring. Full article. “Results of prior studies suggest that antidepressant exposure during pregnancy increases the risk of having a child with autism spectrum disorder (ASD), while results of other studies suggest that depression itself increases the chance of having a child with ASD. This study, using the UK Clinical Practice Research Datalink (CPRD), was conducted to estimate the risk of ASD in children of women who took antidepressants and/or had depression during pregnancy compared to unexposed women. The results of this study suggest that women with depression during pregnancy, regardless of antidepressant use, have an increased risk of having a child with ASD compared to women who do not have depression.”

Social difficulties in youth with autism with and without anxiety and ADHD symptoms. Anxiety and attention deficit hyperactivity disorder (ADHD) symptoms are related to greater social challenges for adolescents with autism spectrum disorder. The present study found that autism with anxiety and autism with anxiety and ADHD, was related to greater social difficulties than autism alone. Findings provide further support for the intertwined nature of anxiety and ADHD symptoms in autism. What this may mean for research and clinical practice is considered and recommendations are suggested.”

Infections in children with autism spectrum disorder: Study to Explore Early Development (SEED). Immune system abnormalities have been widely reported among children with autism spectrum disorder (ASD), which may increase the risk of childhood infections. Children with ASD had greater odds of neonatal and early childhood infection compared to POP children, and greater odds of neonatal infection compared to DD children. Cases with regression had 1.6 times the odds of caregiver-reported infection during the first year of life compared to cases without regression, but neonatal infection risk and overall early childhood infection risk did not differ. Our results support the hypothesis that children with ASD are more likely to have infection early in life compared to the general population and to children with other developmental conditions.”

Regression in autism spectrum disorder: Reconciling findings from retrospective and prospective research. Regression-a loss of previously established skills-occurs in a subset of children with ASD. Parental recall is not always accurate but studying younger siblings of children with ASD, 10-20% of whom will develop ASD, should make it possible to measure regression as it occurs. Clear-cut regression, like loss of language, has not often been reported in infant sibling studies, but recent research suggests that gradual loss of social engagement might be more common. This review looks at the evidence for regression from infant sibling studies and asks how study design affects the likelihood of capturing regression.”

Aluminium in brain tissue in autism. Full article.

Leisure time and family functioning in families living with autism spectrum disorder.Low leisure satisfaction was related to less effective family communication, which in turn led to poorer family functioning and less satisfaction with family life. Amount of time spent in leisure made relatively small contributions to predicting other family variables. These results suggest that leisure-focused interventions for families of children with autism spectrum disorder should focus on improving quality, rather than quantity, of family leisure time.”

The Levels of Vitamin D, Vitamin D Receptor, Homocysteine and Complex B Vitamin in Children with Autism Spectrum Disorders.Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome with an increasingly prevalent etiology, yet not fully understood. It has been thought that vitamin D, complex B vitamin levels and homocysteine are associated with environmental factors and are important in ASD. The aim of this study was to examine serum vitamin D, vitamin D receptor (VDR), homocysteine, vitamin B6, vitamin B12 and folate levels in ASD. This comprehensive study, which examines many parameters has shown that low serum levels of vitamins D, B6, B12, folate and VDR as well as high homocysteine are important in the etiopathogenesis of ASD.”

Sleep Problems and Their Correlates in Children with Autism Spectrum Disorder: An Indian Study.Seventy-three children with ASD and their age and sex matched TD controls in age group of 3-12 years were enrolled in the study. Higher sleep problems were found in children with ASD than TD children. Most common sleep problem reported in children with ASD was Sleep Wake Transition Disorders, followed by Disorder of Initiation and Maintenance; while in TD controls, it was Sleep Breathing Disorders. Apart from severity of Autism; hyperactivity, sensory issues and poor motor skills were significantly associated with sleep problems, which may be important targets for intervention in children with sleep problems.”

Stem cell therapy in autism: recent insights. Full article. “Due to neurobiologic changes underlying ASD development, cell-based therapies have been proposed and applied to ASDs. Indeed, stem cells show specific immunologic properties, which make them promising candidates in ASD treatment. This comprehensive up-to-date review focuses on ASD cellular/molecular abnormalities, potentially useful stem cell types, animal models, and current clinical trials on the use of stem cells in treating autism. Limitations are also discussed.”

Early life exposure to particulate matter air pollution (PM1, PM2.5 and PM10) and autism in Shanghai, China: A case-control study.The evidence for adverse effects of ambient particulate matter (PM) pollution on mental health is limited. Studies in Western countries suggested higher risk of autism spectrum disorder (ASD) associated with PM air pollution, but no such study has been done in developing countries. Exposures to PM1, PM2.5 and PM10 during the first three years of life were associated with the increased risk of ASD and there appeared to be stronger effects of ambient PM pollution on ASD in the second and the third years after birth.”

Gastrointestinal and Psychiatric Symptoms Among Children and Adolescents With Autism Spectrum Disorder. Full article. “Individuals with autism spectrum disorder (ASD) are at heightened risk of psychiatric comorbidities across the lifespan, including elevated rates of internalizing, externalizing, and self-injurious behaviors. Identification of medical comorbidities that contribute to these concerns may elucidate mechanisms through which psychiatric concerns arise, as well as offer additional avenues for intervention. Gastrointestinal (GI) conditions are of particular interest, as they are prevalent among those with ASD, may share genetic or neurobiological etiologies with the core features of ASD, and are linked with psychiatric difficulties in the general population. Results indicate that the presence and quantity of GI symptoms should be considered when evaluating psychiatric and behavioral concerns among children with ASD, and that treatment of GI conditions may be an important component in alleviating a broad array of mental health concerns in this group.”

Alteration of gut microbiota-associated epitopes in children with autism spectrum disorders.Gastrointestinal (GI) problems are common in children with ASD, and although gut microbiota is known to play an important role in ASD through the gut-brain axis, the specific mechanism is unknown. Recent evidence suggests that gut microbiota may participate in the pathogenesis of ASD through immune- and inflammation-mediated pathways. Here, we identified potentially immunogenic epitopes derived from gut microbiota in stool samples from ASD children with and without GI problems and typically developing (TD) children. Our findings demonstrate the abnormal of MEs composition in the gut of children with ASD, moreover, the abnormality in MEs composition was associated with abnormal gut IgA levels and altered gut microbiota composition, this abnormality also suggests that there may be abnormalities in intestinal immunity in children with ASD; In all, thirty-four MEs identified were potential biomarker of ASD, andalterations in MEs may contribute to abnormalities in gut immunity and/or homeostasis in ASD children.”

Predicting sleep problems in children with autism spectrum disorders.Sleep difficulties in children with autism spectrum disorders (ASD) have been well-established. Among children with ASD aggressive behavior independently predicts sleep problems.”

A perspective on pre-eclampsia and neurodevelopmental outcomes in the offspring: does maternal inflammation play a role?While the adverse effects of pre-eclampsia on maternal and fetal health in pregnancy is well-recognised, the long-term impact of pre-eclampsia exposure on the risk of autism spectrum disorder (ASD) in exposed offspring is a topic of on-going debate. In particular, a recent systematic review has reported an association between exposure to pre-eclampsia and increased risk of ASD, however the molecular basis of this association is unknown. Here we review recent evidence for; 1) maternal inflammation in pre-eclampsia; 2) epidemiological evidence for alterations in neurodevelopmental outcomes in offspring exposed to pre-eclampsia; 3) long-term changes in the brains of offspring exposed to pre-eclampsia; and 4) how maternal inflammation may lead to altered neurodevelopmental outcomes in pre-eclampsia exposed offspring.”

October 2018

First episode psychosis and comorbid ADHD, autism and intellectual disability.Psychosis with comorbid ADHD is associated with high risks for substance use disorders and for self-harm, while psychosis with comorbid autism and intellectual disability is associated with longer treatment and higher doses of antipsychotic medication.”

Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample.Children with developmental disabilities are at heightened risk for maltreatment. However, little is known regarding the prevalence of maltreatment among specific groups, such as autism spectrum disorder (ASD) and/or intellectual disability (ID). Children with ASD+ID and ID-only were between two and three times more likely to experience maltreatment. All groups were more likely to experience physical neglect, and children in the ASD+ID and ID-only groups were more likely to experience all forms of abuse. Children in the ASD-only group were more likely to experience physical abuse. Maltreated children in the ASD-only and ID-only groups experienced more cases of physical abuse and neglect, and were victimized by more perpetrators compared to other maltreated youth. Maltreatment was associated with higher likelihood of aggression, hyperactivity, and tantrums for children with ASD.”

Autism spectrum disorder (ASD) in girls. Co-occurring psychopathology. Sex differences in clinical manifestation. Full article. “Clinical data suggests that ASD girls present more abnormalities in sensory profile. ASD girls are at greater risk for developing anxiety, depression, suicidal ideation, and for psychiatric hospitalization. ASD boys appear to be at greater risk for co-occurring ADHD, OCD and tics.”

Differences in food consumption and nutritional intake between children with autism spectrum disorders and typically developing children: A meta-analysis.Children with autism spectrum disorders show higher food selectivity, which restricts consumption of some foods and may cause nutritional deficiencies. The aims of this meta-analysis are to determine the overall differences in nutritional intake and food consumption between children with autism spectrum disorder and control (typical development) children, as well as determine the extent to which the nutritional intake and food consumption of autistic children comply with the dietary recommendations. Children with autism spectrum disorder consume less protein, calcium, phosphorus, selenium, vitamin D, thiamine, riboflavin and vitamin B12 and more polyunsaturated fat acid and vitamin E than controls. Autistic children also consume less omega-3 and more fruit and vegetables than control children. The results also suggest a lower intake of calcium, vitamin D and dairy and a higher intake of fruit, vegetables, protein, phosphorus, selenium, thiamine, riboflavin and vitamin B12 than recommended.”

Savant syndrome has a distinct psychological profile in autism. Full article. “Savant syndrome is a condition where prodigious talent can co-occur with developmental conditions such as autism spectrum conditions (autism). Heightened sensory sensitivity, obsessional behaviours, technical/spatial abilities, and systemising were all key aspects in defining the savant profile distinct from autism alone, along with a different approach to task learning. These results reveal a unique cognitive and behavioural profile in autistic adults with savant syndrome that is distinct from autistic adults without a savant skill.”

EEG endophenotypes in autism spectrum disorder.The association between autism spectrum disorder (ASD) and epilepsy is well-known. Abnormalities on electroencephalography (EEG) results have been reported in patients with ASD without a history of seizures. However, little is known about the relationship between abnormalities on EEG results and the core features of ASD. The presence of an abnormal EEG result or epilepsy in the setting of ASD suggests worse developmental and adaptive functioning. Further analysis will help to clarify associations and offer insight into treatment for this subpopulation without epilepsy but with abnormal EEG results.”

Autism and Caregiver Burden, Anxiety and Depression Levels.The purpose of this study was to examine relations between the clinical characteristics of children diagnosed with autism spectrum disorder (ASD) and caregiver burden, and anxiety and depression levels. Our findings show that ASD symptom severity and depressive symptoms in the caregiver are the most important factors giving rise to the caregiver burden, and that the main ASD symptom cluster affecting the caregiver burden was problems associated with language development.

Quality of live among parents of children with autism spectrum disorders in Tunisia.Studies on parents of children with autistic spectrum disorders’ (ASD) quality of life (QOL) agree on its alteration and seek to identify risk factors in order to target interventions. The proportion of parents with impaired QOL was 64%. This study illustrates the importance of clinical factors in influencing parents’ quality of life in order to advocate for measures to support them and to promote their quality of life, which in turn has positive impacts on the family climate.”

Efficacy of Memantine as Adjunct Therapy for Autism Spectrum Disorder in Children Aged <14 Years. Full article. “The aim of this study was to evaluate the efficacy of memantine as adjunct therapy in children with ASD. Memantine administration as adjunct therapy can be more effective in improvement of ASD symptoms in children than ABA alone. Thus, it can be considered as a new selective adjunct therapy.”

Psychiatric comorbidity in persons with high-functioning autism spectrum disorders: Findings from a tertiary care neuropsychiatric hospital.The literature on co-morbid psychiatric illnesses in adults with high-functioning autism (HFA) spectrum disorder is sparse. Individuals with HFA spectrum disorders suffer from multiple psychiatric comorbidities. OCD is the most common type of psychiatric comorbidity followed by BD and psychotic spectrum disorders. Comorbid psychiatric illnesses in individuals with HFA show poor response to treatment.”

Autism spectrum disorder and food neophobia: clinical and subclinical links. Full article. “Autism spectrum disorder (ASD) has been linked with eating- and feeding-related atypicalities, including food neophobia (FN) (refusal to try unfamiliar foods), since its earliest description. Children with ASD were rated as more food neophobic than their same-age non-ASD peers, and there were subclinical associations between FN and ASD traits (social, communication, and restricted/repetitive behavior) in this community-based sample of children. Moreover, whereas FN alone predicted lower BMI, the interaction of FN and ASD traits predicted higher BMI.”

Use of Psychotropic Drugs among Children and Adolescents with Autism Spectrum Disorders in Denmark: A Nationwide Drug Utilization Study. Full article. “Children with autism spectrum disorder (ASD) have a considerable use of psychotropics. Leveraging nationwide registry data, we aimed to describe the use of psychotropics among children and adolescents with ASD in Denmark. Thirty percent of the identified children used psychotropics in 2017 most commonly ADHD medication (17%) and melatonin (13%). Methylphenidate, sertraline and risperidone were most often prescribed. Most children filled more than one prescription and, across drug classes, at least 38% received treatment two years after treatment initiation. Use of psychotropics followed psychiatric comorbidities. In summary, psychotropic drug use has increased in children with ASD mainly due to an increase in the use of ADHD medication and melatonin. In accordance with previous studies, use seems to follow comorbidities. The long treatment duration underlines the need to investigate long-term effects of psychotropic drug use in children with ASD.”

Blunted serum 25(OH)D response to vitamin D3 supplementation in children with autism.Data suggest a potential role for vitamin D in autism spectrum disorder (ASD) prevention and treatment. It is likely that the serum response to vitamin D supplementation contributes to its effectiveness. Multiple factors affect serum vitamin D 25(OH)D response to supplementation. Children with ASD had a lower increase in 25(OH)D levels with supplementation. Potential mechanisms include altered absorption/metabolism as well as well genetic factors. Clinical and research work relating to vitamin D in ASD should measure 25(OHO)D response to supplementation to assess therapeutic doses.”

September 2018

Temperament and character in men with autism spectrum disorder: A reanalysis of scores on the Temperament and Character Inventory by individual case matching. Full text. “Interest in autism spectrum disorders (ASD) in adulthood is increasing. Although a person may be diagnosed with ASD, the diagnosis reveals little about the individual’s temperament, character, and personality. Also, relatively little is known about the personality of adults with ASD. Compared to the comparison group, men with ASD scored significantly higher on the scale for Harm Avoidance, and lower on Novelty Seeking, Reward Dependence, Self-Directedness, and Cooperativeness.”

Impaired neurite development associated with mitochondrial dysfunction in dopaminergic neurons differentiated from exfoliated deciduous tooth-derived pulp stem cells of children with autism spectrum disorder. Full text. “Among the various mechanisms underlying the pathogenesis of ASD, dysfunctions of dopaminergic signaling and mitochondria have been hypothesized to explain the core symptoms of children with ASD. However, only a few studies focusing on the pathological association between dopaminergic neurons (DN) and mitochondria in ASD have been performed using patient-derived stem cells and in vitro differentiated neurons. Stem cells from human exfoliated deciduous teeth (SHED) are neural crest-derived mesenchymal stem cells present in the dental pulp of exfoliated deciduous teeth; these cells can differentiate into dopaminergic neurons (DN) in vitro. This study aimed to investigate the pathological association between development of DN and mitochondria in ASD by using SHED as a disease- or patient-specific cellular model. The SHED obtained from three children with ASD and three typically developing children were differentiated into DN, and the neurobiology of these cells was examined. The DN derived from children with ASD showed impaired neurite outgrowth and branching, associated with decreased mitochondrial membrane potential, ATP production, number of mitochondria within the neurites, amount of mitochondria per cell area and intracellular calcium level. In addition, impaired neurite outgrowth and branching of ASD-derived DN were not improved by brain-derived neurotrophic factor (BDNF), suggesting impairment of the BDNF signaling pathway in ASD. These results imply that intracerebral dopamine production may have decreased in these children.”

Autism & Gluten: The Proof By Regression! Full text. “Through a case control design, they looked for the distribution of HLA class II alleles, genotypes and haplotypes in Autism Spectrum Disorders (ASD) patients meeting DSM-IV TR criteria versus healthy controls (HC). Subsequent comparisons of the HLA genotypes from these ASD patients and healthy controls (474 and 350 respectively) were conducted. A particluar HLA haplotype (HLA-DRB1 *11-DQB1*07), stongly associated to celiac disease was more prevalent in ASD patients, versus HC (p = 0.001). Another haplotype (HLA-DRB1 *17-DQB1*02 ) was higher in HC and thus considered as protective. The authors concluded that these finding would support previous works linking gluten to autism and could open a new window of opportunity to a better understanding of ASD.”

Genetic risk for schizophrenia and autism, social impairment and developmental pathways to psychosis. Full text. “While psychotic experiences (PEs) are assumed to represent psychosis liability, general population studies have not been able to establish significant associations between polygenic risk scores (PRS) and PEs. Previous work suggests that PEs may only represent significant risk when accompanied by social impairment. The pathway between polygenic risk for autism spectrum disorder and PEs was mediated by social impairments in late adolescence. These findings point to multiple direct and indirect pathways to PEs, suggesting that different processes are in play, depending on genetic loading, and environment. Our results suggest that treatments targeting prevention of social impairment may be particularly promising for individuals at genetic risk for autism in order to minimize risk for psychosis.”

Emerging Developments in Microbiome and Microglia Research: Implications for Neurodevelopmental Disorders. Full text. “Recent studies on neurodevelopmental disorders, such as autism spectrum disorders (ASD), Rett syndrome, and schizophrenia, whose complex pathologies include neuronal and synaptic dysfunction, suggest improper microglial activity as a contributor to these disorders’ neurobiological and behavioral outcomes. Interestingly, additional studies suggest that microglia, not unlike peripheral macrophages, may be susceptible to microbiome changes. Altogether, the demonstration of microbial influence on brain function via microglial mediators raises the possibility that manipulation of microbe-immune crosstalk represents a promising strategy for treating neurological diseases.”

Randomized Crossover Feasibility Trial of Helminthic Trichuris Suis Ova vs. Placebo for Repetitive Behaviors in Adult Autism Spectrum Disorder.Inflammatory mechanisms are implicated in the etiology of Autism Spectrum Disorder (ASD), and use of the immunomodulator Trichuris Suis Ova (TSO) is a novel treatment approach. This pilot study determined the effect sizes for TSO vs. placebo on repetitive behaviors, irritability and global functioning in adults with ASD. Large effect sizes for improvement in repetitive behaviors, restricted interests, rigidity, and irritability were observed after 12 weeks of treatment. No changes were observed in the social-communication domain. TSO had only minimal, non-serious side effects.”

Role of Probiotics in Managing Gastrointestinal Dysfunction in Children with Autism Spectrum Disorder: An Update for Practitioners.Children with autism spectrum disorder (ASD) are 4 times as likely to experience gastrointestinal symptoms as children without ASD. The gut microbiota has increasingly been the subject of investigation as a contributing factor to these symptoms in this population because there is evidence to suggest that alterations in the intestinal microflora are correlated with gastrointestinal and ASD symptom severity. Probiotic therapy has been proposed as a treatment for augmented gastrointestinal symptom severity in children with ASD. This narrative review systematically searched the literature to provide an update for practitioners on the state of the evidence surrounding probiotic therapy in children with ASD as a treatment option for reducing gastrointestinal symptoms. A total of 186 articles were screened and 5 articles met the inclusion criteria. A collective sample of 117 children with ASD is represented and outcomes addressed include improvement in gastrointestinal symptoms as well as influence of probiotic supplementation on the gut microbiota and ASD symptoms and behavior. There is promising evidence to suggest that probiotic therapy may improve gastrointestinal dysfunction, beneficially alter fecal microbiota, and reduce the severity of ASD symptoms in children with ASD. Future research is still warranted in this area because there are methodologic flaws in the available literature and optimal species, strains, dosages, and duration of treatment have not been identified.”

Gestational Diabetes Alters the Metabolomic Profile in 2nd Trimester Amniotic Fluid in a Sex-Specific Manner. Full article. “Maternal diabetes and obesity induce marked abnormalities in glucose homeostasis and insulin secretion in the fetus, and are linked to obesity, diabetes, and metabolic disease in the offspring, with specific metabolic characterization based on offspring sex. Gestational diabetes (GDM) has profound effects on the intrauterine milieu, which may reflect and/or modulate the function of the maternal⁻fetal unit. Using a nested case-control study design, we identified 69 total biochemicals altered by GDM exposure, while sex-specific analysis identified 44 and 58 metabolites in male and female offspring, respectively. The most significant changes were in glucose, amino acid, glutathione, fatty acid, sphingolipid, and bile acid metabolism with specific changes identified based on the offspring sex. Targeted isotope dilution LC/MS confirmatory assays measured significant changes in docosahexaenoic acid and arachidonic acid.”

Saliva oxytocin, cortisol, and testosterone levels in adolescent boys with autism spectrum disorder, oppositional defiant disorder/conduct disorder and typically developing individuals.The aim of the current study was to compare levels of oxytocin, cortisol, and testosterone in adolescents with either autism spectrum disorder (ASD), or oppositional defiant disorder (ODD)/conduct disorder (CD), and in typically developing individuals (TDI), and relate hormone levels to severity and subtype of aggression and callous-unemotional (CU) traits. The current findings show that, regardless of cognitive ability or comorbid disorders, the diagnostic groups (ASD, ODD/CD) differ from each other by their hormonal levels, with the ASD group characterized by relative low level of oxytocin, and the ODD/CD group by a relative low level of oxytocin and high level of testosterone. These group effects were partly driven by differences in CU traits between the groups.”

Crucifers and related vegetables and supplements for neurologic disorders: what is the evidence?The weight of evidence supporting prescriptive dietary recommendations to promote or enhance healthspan has been building for decades. Cruciferous vegetables are a key part of the arsenal of nutrition-based approaches for reducing the burden of chronic disease. Much new evidence suggests that neurological disorders are among the potential targets for this approach. This evidence includes at least nine clinical studies of neurodevelopmental conditions like autism spectrum disorder and schizophrenia, and there are a great many studies in animal model systems, of neurodegenerative disorders like Alzheimer’s and Parkinson’s diseases. There is great promise for the regular use of cruciferous vegetables or supplements containing standardized levels of bioactives in the treatment and prevention of neurologic disorders.”

The Prevalence of Autism Spectrum Disorders in Adult Psychiatric Inpatients: A Systematic Review. Full article. “From the limited research data currently available, it appears that the prevalence of autism spectrum disorders is increased in inpatient psychiatric settings relative to the general population. There is a need for further high quality research in this patient group, to add to this limited evidence base, as well as in developing effective strategies to identify patients with a high likelihood of autism spectrum disorders within this setting.”

Decreased levels of serum retinoic acid in chinese children with autism spectrum disorder.Previous studies framed a possible link of retinoic acid (RA) regulation in brain to autism spectrum disorders (ASD) etiology. The aim of this study was to measure serum levels of RA in relation to the degree of the severity of autism. The serum levels of RA in the children with ASD were significantly lower than those of control subjects. At admission, 57 children (70.4%) had a severe autism. In those children, the mean serum RA levels were lower than in those children with mild to moderate autism. The data suggested that serum RA levels were reduced in the group with ASD, and the levels negative correlated significantly with the severity of autism.”

August 2018

Autism Research: An Objective Quantitative Review of Progress and Focus Between 1994 and 2015. Full article. “The nosology and epidemiology of Autism has undergone transformation following consolidation of once disparate disorders under the umbrella diagnostic, autism spectrum disorders. Despite this re-conceptualization, research initiatives, including the NIMH’s Research Domain Criteria and Precision Medicine, highlight the need to bridge psychiatric and psychological classification methodologies with biomedical techniques. Combining traditional bibliometric co-word techniques, with tenets of graph theory and network analysis, this article provides an objective thematic review of research between 1994 and 2015 to consider evolution and focus. Results illustrate growth in Autism research since 2006, with nascent focus on physiology. However, modularity and citation analytics demonstrate dominance of subjective psychological or psychiatric constructs, which may impede progress in the identification and stratification of biomarkers as endorsed by new research initiatives.”

Effectiveness of Earmuffs and Noise-cancelling Headphones for Coping with Hyper-reactivity to Auditory Stimuli in Children with Autism Spectrum Disorder: A Preliminary Study. Full article. “This study demonstrated the effectiveness of standard earmuffs and NC headphones in helping children with ASD to cope with problem behaviours related to hyperreactivity to auditory stimuli, therefore, children with ASD could use earmuffs to help to deal with unpleasant sensory auditory stimuli.”

Immunological Dysfunction in Autism Spectrum Disorder: A Potential Target for Therapy. Full article. “Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with an unknown etiology and currently few effective therapies. Immune system alterations have being demonstrated in ASD, both in humans and via animal models; immune imbalance thus arises as a possible pathway for drug intervention. In this review, the studies were classified into 2 major groups: (1) clinical research whose authors classify therapies with primary anti-inflammatory and immunomodulatory actions, making use of: sulforaphane, celecoxib, lenalidomide, pentoxifylline, spironolactone, flavonoid luteolin, corticosteroids, oral immunoglobulin, intravenous immunoglobulin, cell therapy, dialyzable lymphocyte extracts, minocycline, and pioglitazone; and (2) other ASD therapies already used or currently under study whose initial characteristics were neither anti-inflammatory nor immunomodulatory initially, but displayed a capacity for immunomodulation throughout the treatment: risperidone, vitamin D, omega-3, Ginkgo biloba, L-carnosine, N-acetylcysteine, and microbiome restoration.”

Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis.Adults with autism spectrum disorder (ASD) are thought to be at disproportionate risk of developing mental health comorbidities, with anxiety and depression being considered most prominent amongst these. his systematic review and meta-analysis examined the rates of anxiety and depression in adults with ASD. The pooled estimation of current and lifetime prevalence for adults with ASD were 27% and 42% for any anxiety disorder, and 23% and 37% for depressive disorder.”

Comparative study on the independent and combined effects of omega-3 and vitamin B12 on phospholipids and phospholipase A2 as phospholipid hydrolyzing enzymes in PPA-treated rats as a model for autistic traits. Full article. “Abnormal phospholipid metabolism is a major component of many neurodevelopmental disorders including autism. Oral administration of propionic acid (PPA) can produce behavioral abnormalities and biochemical features in rodents similar to those observed in autism and can thus be used as a model to understand impaired brain fatty acid metabolism in autism. A significant decrease in phospholipid levels and a significant increase in cPLA2 were found in brain tissue of PPA-treated rats; however, both ω-3 and vitamin B12 were efficient in ameliorating the neurotoxic effect of PPA. Both ω-3 and vitamin B12 may play a role in ameliorating impaired phospholipid metabolism in autism.”

Early Disruption of the Microbiome Leading to Decreased Antioxidant Capacity and Epigenetic Changes: Implications for the Rise in Autism. Full article. “In this review article, we examine the connections between early disruption of the developing microbiome and gastrointestinal tract function, with particular regard to susceptibility to autism. The biological mechanisms that accompany individuals with autism are reviewed in this manuscript including immune system dysregulation, inflammation, oxidative stress, metabolic and methylation abnormalities as well as gastrointestinal distress. We propose that these autism-associated biological mechanisms may be caused and/or sustained by dysbiosis, an alteration to the composition of resident commensal communities relative to the community found in healthy individuals and its redox and epigenetic consequences, changes that in part can be due to early use and over-use of antibiotics across generations. A better understanding of the microbiome and gastrointestinal tract in relation to autism will provide promising new opportunities to develop novel treatment modalities.”

Melatonin and Comorbidities in Children with Autism Spectrum Disorder. Full text. “Melatonin is used to treat sleep difficulties associated with autism spectrum disorder (ASD). There are growing evidence that melatonin could have an effect on other symptoms than sleep, such as anxiety, depression, pain, and gastrointestinal dysfunctions. Interestingly, these symptoms frequently are found as comorbid conditions in individuals with ASD. We aimed to highlight the potential effect of melatonin on these symptoms. Melatonin has the potential to act on a wide variety of symptoms associated with ASD. However, other than sleep difficulties, no studies exist on melatonin as a treatment for ASD comorbid conditions. Such investigations should be on the research agenda because melatonin could improve a multitude of ASD comorbidities and, consequently, improve well-being.”

Depression in Children and Adolescents with Autism Spectrum Disorder. Full article. “Autism spectrum disorder (ASD) has a high rate of psychiatric comorbidity. The prevalence of comorbid depression seems to correlate with higher functioning forms of ASD and increasing age. The lack of reliable rating and diagnostic scales for depression in individuals with ASD makes it difficult to accurately measure rates of depression among individuals with more severe verbal deficits. Current evidence will be presented in this review, including prevalence rates of depression in youth with ASD, various risk and protective factors, the use of diagnostic rating scales, and treatment studies. The lack of evidence supporting various treatment approaches will be highlighted, including challenges specific to the treatment of depression in ASD, which are not addressed in the current treatment studies in typically developing youth with depression.”

Long-Term Efficacy and Safety of Pediatric Prolonged-Release Melatonin for Insomnia in Children with Autism Spectrum Disorder.A recent double-blind randomized placebo-controlled study demonstrated 3-month efficacy and safety of a novel pediatric-appropriate prolonged-release melatonin (PedPRM) for insomnia in children and adolescents with autism spectrum disorder (ASD) and neurogenetic disorders (NGD) with/without attention-deficit/hyperactivity disorder comorbidity. Long-term efficacy and safety of PedPRM treatment was studied. PedPRM, an easily swallowed formulation shown to be efficacious versus placebo, is an efficacious and safe option for long-term treatment (up to 52 weeks reported here) of children with ASD and NGD who suffer from insomnia and subsequently improves caregivers’ quality of life.”

Resveratrol ameliorates prenatal progestin exposure-induced autism-like behavior through ERβ activation. Full article. “We conclude that resveratrol ameliorates prenatal progestin exposure-induced autism-like behavior through ERβ activation. Our data suggest that prenatal progestin exposure is a strong risk factor for autism-like behavior. Many potential clinical progestin applications, including oral contraceptive pills, preterm birth drugs, and progestin-contaminated drinking water or seafood, may be risk factors for ASD. In addition, RSV may be a good candidate for clinically rescuing or preventing ASD symptoms in humans, while high doses of resveratrol used in the animals may be a potential limitation for human application.”

Microglia and Autism Spectrum Disorder: Overview of Current Evidence and Novel Immunomodulatory Treatment Options. Full article. “Autism spectrum disorder is a rapidly increasing heterogeneous neurodevelopmental syndrome, remarked by persistent deficit in social communication, and restricted, repetitive patterns of behavior and interest. Lately, maternal immune activation and micgroglial dysfunction in the developing brain have been gaining mounting evidence and leading to studies of various novel agents as potential treatment options. A few immunomodulatory treatment options-luteolin, minocycline, suramin, vitamin D, gut microbiota-are discussed in the current article, regarding the current understanding of their mechanisms and evidence for potential clinical use. More studies are warranted to understand their exact mechanisms of action and to verify efficacy and safety in human subjects.”

Parent descriptions of the presentation and management of anxiousness in children on the autism spectrum.Studies to date have not explored how the presentation of anxiety may differ between settings. Over half (52.6%) felt their child was anxious at home, 77.6% at school and 76.2% in the community. Parents reported differing presentations of anxiety between settings, with the majority of descriptions relating to observable, behavioural changes (e.g. hides/shuts down, repetitive behaviours) rather than cognitive or physiological signs. Parents also reported using different strategies across settings.”

Heart rate mean and variability as a biomarker for phenotypic variation in preschoolers with autism spectrum disorder.Cardiac activity, such as heart rate and heart rate variability, is linked to a wide range of psychological functions. This study shows that there is an association between heart rate and heart rate variability and language skills in young children with autism spectrum disorder (ASD). These results may help us understand what underlies individual differences in developmental abilities in young children with ASD.”

Association of Maternal Insecticide Levels With Autism in Offspring From a National Birth Cohort. “To date, few studies have investigated prenatal exposure to toxins and risk of autism by using maternal biomarkers of exposure. Persistent organic pollutants are lipophilic halogenated organic compounds and include the insecticide dichlorodiphenyltrichloroethane (DDT), as well as its metabolite p,p’-dichlorodiphenyl dichloroethylene (p,p’-DDE), and polychlorinated biphenyls (PCBs). The objective of this study was to test whether elevated maternal levels of persistent organic pollutants are associated with autism among offspring. These findings provide the first biomarker-based evidence that maternal exposure to insecticides is associated with autism among offspring. Although further research is necessary to replicate this finding, this study has implications for the prevention of autism and may provide a better understanding of its pathogenesis.”

Diet Can Impact Microbiota Composition in Children With Autism Spectrum Disorder. Full text. “Diet is one of the most influential environmental factors in determining the composition of the gastrointestinal microbiota. Microbial dysbiosis in children with Autism Spectrum Disorder (ASD) and the impact of some bacterial taxa on symptoms of ASD has been recognized. Diet-associated microbial profiles were related to GI symptoms, but no significant interaction between nutrition and microbiota in predicting social deficit scores were observed. In conclusion, dietary patterns associated with fecal microbiota composition and VFA concentrations in children with ASD were identified.”

Parent Training for Feeding Problems in Children With Autism Spectrum Disorder: Initial Randomized Trial.Many children with autism spectrum disorder (ASD) have feeding and mealtime problems. To address these, we conducted a pilot randomized trial of a new 11-session, individually delivered parent training program that integrated behavioral strategies and nutritional guidance (PT-F). Forty-two young children (age: 2 to 7-11 years) with ASD and feeding problems were assigned to 11 sessions of PT-F intervention over 20 weeks or a waitlist control. Outcomes included attendance, parent satisfaction, therapist fidelity, and preliminary assessments of child and parent outcomes. This trial provides evidence for feasibility, satisfaction, and fidelity of implementation of PT-F for feeding problems in young children with ASD. Feeding outcomes also appeared favorable and lends support for conducting a larger efficacy trial.”

Early childhood antibiotics use and autism spectrum disorders: a population-based cohort study. Full article. “Changes in microbiota composition as a result of antibiotics use in early life has been proposed as a possible contributor in the aetiology of autism spectrum disorders (ASD). We aimed to examine the association between early life antibiotic exposure and risk of ASD. Our findings suggested no clinically significant association between early life antibiotics exposure and risk of autism spectrum disorders, and should provide reassurance to concerned prescribers and parents.”

Autism Spectrum Disorder: The Impact of Stressful and Traumatic Life Events and Implications for Clinical Practice. Full text. “Research findings suggest that behavioral interventions are effective in improving educational outcomes and fostering skill development in people with autism spectrum disorder (ASD). However, high rates of comorbidity between ASD and other psychological disorders, including depression and anxiety, indicate that standard behavioral approaches are not adequately addressing issues related to mental health in this population. Mounting evidence for stress and trauma as a risk factor for comorbidity and the worsening of core ASD symptoms may intimate a shift in the way clinical social workers and other clinical practitioners conceptualize and approach work with this population to include trauma-focused assessment strategies and clinical interventions. Future directions for research to better understand the nature of childhood stress and trauma and improve mental health in this population are also discussed.”

Intravenous immunoglobulin for the treatment of autoimmune encephalopathy in children with autism. Full article. “The identification of brain-targeted autoantibodies in children with autism spectrum disorder (ASD) raises the possibility of autoimmune encephalopathy (AIE). Intravenous immunoglobulin (IVIG) is effective for AIE and for some children with ASD. The majority of parents (90%) reported some improvement with 71% reporting improvements in two or more symptoms. Adverse effects were common (62%) but mostly limited to the infusion period. Only two (6%) patients discontinued IVIG because of adverse effects. Overall, our open-label case series provides support for the possibility that some children with ASD may benefit from IVIG. Given that adverse effects are not uncommon, IVIG treatment needs to be considered cautiously. We identified immune biomarkers in select IVIG responders but larger cohorts are needed to study immune biomarkers in more detail. Our small open-label exploratory trial provides evidence supporting a neuroimmune subgroup in patients with ASD.”

Oxytocin improves animal behaviors and ameliorates oxidative stress and inflammation in autistic mice.Our results showed that oxytocin improved the behaviors of autistic mice, with less anxiety, depression and repetitive behavior, and ameliorated social interaction. Further study showed that the elevated oxidative stress and inflammation in autistic mice were alleviated after treatment of oxytocin.”

Nutritional Rickets Presenting as Chronic Episodic Extremity Pain in a 9-year-old with Autism. Full article. “Rickets due to vitamin D deficiency, typically presenting as bowed legs in toddlers, is uncommon in the modern era. We describe the case of a nine-year-old girl with autism and developmental delay who was evaluated for chronic intermittent extremity pain for more than one year prior to referral to the emergency department for hypocalcemia and increased alkaline phosphatase, which eventually led to the diagnosis of rickets confirmed by radiographic and laboratory findings. This report highlights the importance of the patient’s history of developmental delay and autism in the evaluation and approach to limb pain, and discusses the appropriate diagnostic approach.”

Making the future together: Shaping autism research through meaningful participation. Full article. “Participatory research methods connect researchers with relevant communities to achieve shared goals. These methods can deliver results that are relevant to people’s lives and thus likely to have a positive impact. In the context of a large and growing body of autism research, with continued poor implementation, and some evidence of community dissatisfaction, there is a powerful case for participatory autism research. In order to develop a framework for such collaborative working, a UK seminar series was organised and co-produced by autistic and non-autistic people with academic, practitioner and lived expertise. This article reports on the outcomes from the series, identifying five topics relevant to building a community of practice in participatory research: Respect, Authenticity, Assumptions, Infrastructure and Empathy.”

Family history of immune conditions and autism spectrum and developmental disorders: Findings from the study to explore early development.Using data from a large multi-site study in the US-the Study to Explore Early Development-we found that women with a history of eczema/psoriasis and asthma are more likely to have children with ASD or DD. In addition, children with ASD are more likely to have a history of psoriasis/eczema or allergies than typically developing children. These data support a link between maternal and child immune conditions and adverse neurodevelopmental outcomes.”

The role of cellular phone usage by parents in the increase in ASD occurrence: A hypothetical framework.The biggest environmental change over this decade has been the massive introduction of cellphones. Eye contact is fundamental for infants’ development, and parent-infant eye contact is impaired when parents are pre occupied by cellphones. We speculate that children with a pre-existing vulnerability to autism may be adversely affected by this pattern of parental behavior. As a first step toward exploring our hypothesis, we wished to document the extent of cellular phone usage by parents during their child’s diagnostic developmental assessment. We speculated that, if under these stressful circumstances of awaiting their child’s crucial assessment the parent is not fully engaged with his/her child, then in real daily activities this phenomenon is likely much more pronounced. Of 111 developmental sessions, 73 parents (66%) engaged their phone during the assessment, between 1 and 20 times. Of 62 observations in the waiting room, 52 (83.9%) parents used their phone, 1-19 times. Nine parents (17.3%) used their phone for 10-50% of the time and 16 (30.8%) for more than 50% of the time in the waiting room. In our analysis, the rate of language/motor delays was twice more common among children of cell phone users than among non users as an initial support of our hypothesis. Parents’ focus and full attention toward their cellphones can adversely affect the development of joint attention in infants and may contribute to the development of autistic features among a vulnerable subgroup of infants. While more research is needed to prove causation, it would be reasonable to advise parents to decrease to minimum the usage of cellphones when interacting with their young children.”

Brief Report: Implementation of a Specific Carbohydrate Diet for a Child with Autism Spectrum Disorder and Fragile X Syndrome.This brief report examines the implementation of dietary intervention utilizing the specific carbohydrate diet (SCD) for the management of gastrointestinal issues in a 4 year old boy diagnosed with Autism Spectrum Disorder (ASD) and Fragile X Syndrome (FXS). Data relating to anthropometrics, dietary intake, blood markers, gastrointestinal (GI) symptoms, sleep issues, and behavioral concerns were gathered at baseline and after 4 months of dietary intervention. The dietary intervention was well tolerated. Improvements in nutrient status, GI symptoms, and behavioral domains were reported. The use of the SCD protocol in children with ASD/FXS and GI symptoms warrants further investigation.”

Prevalence of Autism Spectrum Disorder in Preterm Infants: A Meta-analysis. “The prevalence of ASD is significantly high in the preterm population. Adequate resources are needed to improve the outcomes of these children.”

Disparities in Cervical Cancer Screening Among Women With Disabilities: A National Database Study in South Korea.Despite the availability of free screening, a significant disparity was found in cervical cancer screening participation, especially in women with severe disabilities and those with mental disabilities. Screening rates were markedly lower in women with severe disabilities and women with autism, intellectual disability, brain injury, ostomy, or mental disorder.”

July 2018

A prebiotic intervention study in children with autism spectrum disorders (ASDs). Full article. “Different dietary approaches, such as gluten and casein free diets, or the use of probiotics and prebiotics have been suggested in autistic spectrum disorders in order to reduce gastrointestinal (GI) disturbances. GI symptoms are of particular interest in this population due to prevalence and correlation with the severity of behavioural traits. Nowadays, there is lack of strong evidence about the effect of dietary interventions on these problems, particularly prebiotics. Therefore, we assessed the impact of exclusion diets and a 6-week Bimuno® galactooligosaccharide (B-GOS®) prebiotic intervention in 30 autistic children. Following B-GOS® intervention, we observed improvements in anti-social behaviour, significant increase of Lachnospiraceae family, and significant changes in faecal and urine metabolites.”

The Perturbance of Microbiome and Gut-Brain Axis in Autism Spectrum Disorders. Full article. “Gastrointestinal problems have been documented in Autism Spectrum Disorder (ASD). Studies have found that these disturbances may be associated with an altered gut microbiome in ASD. Furthermore, in ASD, these alterations are implicated in increased gut permeability, or “leaky gut”, which allows bacterial metabolites to cross the gut barrier, impacting neurodevelopment during early childhood in susceptible subjects by way of gut-brain axis. In our review, we will discuss the interaction of gut microbiota and brain development in ASD and the signaling mechanisms underlying this interaction. We will also explore the potential for treatment of ASD by targeting the microbiome with probiotics. Finally, this paper will attempt to provide significance to the aggregation of the research in this area of research; providing our interpretations and assessments of future of this field.”

Clinical and Molecular Characteristics of Mitochondrial Dysfunction in Autism Spectrum Disorder.One of these major physiological abnormalities is mitochondrial dysfunction, which may affect a significant subset of children with ASD. Here we systematically review the literature on human studies of mitochondrial dysfunction related to ASD. Clinical aspects of mitochondrial dysfunction in ASD include unusual neurodevelopmental regression, especially if triggered by an inflammatory event, gastrointestinal symptoms, seizures, motor delays, fatigue and lethargy. Several environmental factors, including toxicants, microbiome metabolites and an oxidized microenvironment are shown to modulate mitochondrial function in ASD tissues. Investigations of treatments for mitochondrial dysfunction in ASD are promising but preliminary.”

Dietary interventions for autism spectrum disorder: New perspectives from the gut-brain axis.There is still controversy surrounding the effectiveness of dietary interventions for autism spectrum disorder (ASD), namely the gluten-free/casein free diet and the ketogenic diet. Additionally, as studies mainly investigated their impact on ASD symptoms and behaviors, much remains unknown about their mechanisms of action and physiological effects. Given the recent surge of global interest in the gut-brain axis and its involvement in ASD, we underline the importance of understanding the physiological effects of such restrictive diets that remove certain nutritional items from one’s diet. Some evidence has emerged with findings of the gut-microbial, inflammatory, and neuronal effects of these diets. We propose probiotics as a potential alternative that can serve similar biological purposes as these elimination diets and outline different physiological routes whereby probiotics can lead to improvements for individuals with ASD. We hope that future research can delineate the complete physiological effects of these diets. Such knowledge can guide the creation of more informed interventions, which conserve the components resulting in positive behavioral change while being less restrictive and devoid of the harmful effects of limiting certain nutrients.”

Serum tryptophan, tryptophan catabolites and brain-derived neurotrophic factor in subgroups of youngsters with autism spectrum disorders.There is evidence that changes in neuro-immune responses coupled with dysfunctions in serotonin metabolism underpin the pathophysiology of autism spectrum disorders (ASD). 65 individuals with ASD (diagnosed according to ICD criteria) and 30 healthy control patients were included. Measured were serum levels of tryptophan, kynurenine (KYN), kynurenic acid (KA), quinolinic acid (QA), BDNF and PRO-BDNF and total blood 5-HT and 5-OH-tryptophan (5-HTP). Elevated BDNF levels and lower tryptophan and KA levels were characteristics of both childhood autism and intellectual disability disorder, whilst elevated tryptophan and lower 5-HT synthesis were hallmarks of Asperger syndrome. A pathological MRI was associated with elevated tryptophan and lowered KA. Abnormal EEG results and dysmorphology were both associated with an elevated BDNF/ PRO-BDNF ratio. Any brain pathology and gastro-intestinal symptoms were accompanied by lowered KA.”


Optimal vitamin D spurs serotonin: 1,25-dihydroxyvitamin D represses serotonin reuptake transport (SERT) and degradation (MAO-A) gene expression in cultured rat serotonergic neuronal cell lines. Full text. “Diminished brain levels of two neurohormones, 5-hydroxytryptamine (5-HT; serotonin) and 1,25-dihydroxyvitamin D3 (1,25D; active vitamin D metabolite), are proposed to play a role in the atypical social behaviors associated with psychological conditions including autism spectrum disorders and depression. These results are consistent with the concept that vitamin D maintains extracellular fluid serotonin concentrations in the brain, thereby offering an explanation for how vitamin D could influence the trajectory and development of neuropsychiatric disorders. We conclude that 1,25D acts not only to induce serotonin synthesis, but also functions at an indirect, molecular-genomic stage to mimic SSRIs and MAO inhibitors, likely elevating serotonin in the CNS. These data suggest that optimal vitamin D status may contribute to improving behavioral pathophysiologies resulting from dysregulation of serotonergic neurotransmission.”

Dietary Intake, Nutrient Status, and Growth Parameters in Children with Autism Spectrum Disorder and Severe Food Selectivity: An Electronic Medical Record Review.Criteria for severe food selectivity used in this clinical practice required complete omission of one or more food groups (eg, fruit, vegetable, protein, grain, dairy) or consuming a narrow range of items on a weekly basis (eg, five or fewer total food items). Of the 279 patients evaluated during the 24-month period, 70 children with ASD and severe food selectivity met inclusion criteria. Caregivers reported 67% of the sample omitted vegetables and 27% omitted fruits. Seventy-eight percent consumed a diet at risk for five or more inadequacies. Risk for specific inadequacies included vitamin D (97% of the sample), fiber (91%) vitamin E (83%), and calcium (71%). Children with five or more nutritional inadequacies (n=55) were more likely to make negative statements during meals.”

Leptin and camel milk abate oxidative stress status, genotoxicity induced in valproic acid rat model of autism.These results suggest that CAM is a potential therapeutic candidate for autism via regulation of inflammatory and apoptotic pathways. Leptin plays an essential role in alleviation of autistic behaviour through antioxidant effects.”

A Comparison of Autistic Like Traits in the Relatives of Patients with Autism and Schizophrenia Spectrum Disorder. Full article. “This study aimed to identify autistic like traits in relatives of patients with schizophrenia and autism spectrum disorder. First degree relatives of individuals with autism spectrum disorder got higher scores in deficiency of social skill, deficiency of communication, deficiency of attention, and attention to details. Relatives of individuals with autism spectrum disorder compared to relatives of patients with schizophrenia spectrum disorder showed higher rates of autistic like traits.”

Role of the immune system in autism spectrum disorders (ASD).The evidence base supports that multifactorial and complex immune interactions play a role in autism spectrum disorders (ASD), but contradictory findings are also reported. Several studies have found that the risk of ASD is greater among children whose mothers suffered from autoimmune diseases while pregnant. Moreover, individuals with ASD show increased levels of antibodies that are specific for several specific proteins. Studies also show that mothers of children with ASD have antibodies against fetal brain proteins. There are also reports on associations between increased levels of proinflammatory cytokines and ASD. Finally, infections in mothers during pregnancy are linked to an increased risk of ASD.”

“Life is Much More Difficult to Manage During Periods”: Autistic Experiences of Menstruation.Although menarche and menstruation are perceived to be overwhelmingly negative events for developmentally-disabled women, women’s health issues remain under-researched in autism. Here, we conducted a preliminary investigation of the experiences of post-menarcheal autistic (n = 123) and non-autistic (n = 114) respondents to a brief online survey. Although autistic respondents reported many overlapping issues and experiences with non-autistic respondents, they also highlighted distinct-and sometimes-distressing-issues relating to menstruation, especially a cyclical amplification of autistic-related challenges, including sensory differences and difficulties with regulating emotion and behavior, which had a significant, negative impact on their lives. These initial findings call for systematic research on the potential causes, correlates and consequences of menstrual-related problems in autistic individuals-across the spectrum and the lifespan.”

Copper in depressive disorder: A systematic review and meta-analysis of observational studies.Copper (Cu) has been associated with mental disorders such as autism and epilepsy. So far, publications evaluating copper levels in patients with depressive disorder showed conflicted results. To derive a comprehensive estimation of the relationship between body burden of copper and depressive disorder and explore the possible role of copper in mental health, we performed a systematic review and meta-analysis. This meta-analysis suggests that increased levels of blood copper might be associated with depressive disorder and therefore the possible role of copper as a biomarker of depression.”

June 2018

Blood-brain barrier regulation in psychiatric disorders.The blood-brain barrier (BBB) is a dynamic interface between the peripheral blood supply and the cerebral parenchyma, controlling the transport of material to and from the brain. Tight junctions between the endothelial cells of the cerebral microvasculature limit the passage of large, negatively charged molecules via paracellular diffusion whereas transcellular transportation across the endothelial cell is controlled by a number of mechanisms including transporter proteins, endocytosis, and diffusion. Here, we review the evidence that perturbation of these processes may underlie the development of psychiatric disorders including schizophrenia, autism spectrum disorder (ASD), and affective disorders. Increased permeability of the BBB appears to be a common factor in these disorders, leading to increased infiltration of peripheral material into the brain culminating in neuroinflammation and oxidative stress. However, although there is no common mechanism underpinning BBB dysfunction even within each particular disorder, the tight junction protein claudin-5 may be a clinically relevant target given that both clinical and pre-clinical research has linked it to schizophrenia, ASD, and depression.”

Sleep Dysfunction and Behavioral Daytime Problems in Children with Autism Spectrum Disorders: A Comparative Study.Children with ASD are at a high risk for sleep problems and this is associated with daytime behavior disturbances. Pediatricians should routinely screen ASD children for sleep problems and initiate timely and appropriate interventions.”

Sleep and Challenging Behaviors in the Context of Intensive Behavioral Intervention for Children with Autism.This study examined the associations between sleep and challenging behaviors for average and night-to-night fluctuations in sleep, in 39 children with autism spectrum disorder (ASD) receiving intensive behavioral intervention (IBI). Results indicated that on average, poor sleep was associated with higher rates of repetitive behavior, negative affect, and a composite of overall challenging behaviors. These findings suggest that average sleep patterns are important within the context of IBI (rather than night-to-night fluctuations). Interventions aimed at improving overall patterns of sleep may have important cascading effects on challenging behaviors and developmental outcomes for children with ASD and their families.”

Acetaminophen, antibiotics, ear infection, breastfeeding, vitamin D drops, and autism: an epidemiological study. Full article. “In order to determine whether certain factors are associated with autism spectrum disorder (ASD), we conducted an Internet survey among parents whose children have ASD and parents whose children do not have ASD. Based on the response from this survey, we find that increased use of acetaminophen among children under 2 years, increased use of antibiotics among children under 2 years, increased cases of ear infection among children under 2 years, and early weaning are associated with ASD. These results account for the associations with demographic variables. In addition, we find a weak association between consumption of oral vitamin D drops and ASD when accounting for associations with breastfeeding and demographics.”

Effects of Mycotoxins on Neuropsychiatric Symptoms and Immune Processes.Exposure to molds is most commonly associated with allergies and asthma. However, it is now thought to be associated with many complex health problems, since some molds, especially Trichoderma, Fusarium and Stachybotrys spp, produce mycotoxins that are absorbed from the skin, airways, and intestinal lining. People exposed to molds and mycotoxins present with symptoms affecting multiple organs, including the lungs, musculoskeletal system, as well as the central and peripheral nervous systems. Furthermore, evidence has recently implicated exposure to mycotoxins in the pathogenesis of autism spectrum disorder. The effects of mycotoxins can be mediated via different pathways that include the secretion of pro-inflammatory cytokines, especially from mast cells. The information reviewed indicates that exposure to mold and mycotoxins can affect the nervous system, directly or through immune cell activation, thus contributing to neurodevelopmental disorders such as autism spectrum disorder.”

Antioxidants and Autism: Teachers’ Perceptions of Behavioral Changes.Children with Autism Spectrum Disorder (ASD) demonstrate a physiological imbalance between free radicals, resultant from oxidative stress, and antioxidants. Oxidative stress is linked to the pathogenesis of this neurocognitive disorder. The aim of this pilot feasibility study was to examine the effect of consumption of high concentration antioxidant cacao on behavior of children with ASD. Results from this study support the potential therapeutic benefit of antioxidants in improving social communication, unusual behaviors, and self-regulation behaviors of children with ASD.”

Dietary Considerations in Autism Spectrum Disorders: The Potential Role of Protein Digestion and Microbial Putrefaction in the Gut-Brain Axis. Full article. “Children with autism spectrum disorders (ASD), characterized by a range of behavioral abnormalities and social deficits, display high incidence of gastrointestinal (GI) co-morbidities including chronic constipation and diarrhea. Research is now increasingly able to characterize the “fragile gut” in these children and understand the role that impairment of specific GI functions plays in the GI symptoms associated with ASD. This mechanistic understanding is extending to the interactions between diet and ASD, including food structure and protein digestive capacity in exacerbating autistic symptoms. Children with ASD and gut co-morbidities exhibit low digestive enzyme activity, impaired gut barrier integrity and the presence of antibodies specific for dietary proteins in the peripheral circulation. These findings support the hypothesis that entry of dietary peptides from the gut lumen into the vasculature are associated with an aberrant immune response. Furthermore, a subset of children with ASD exhibit high concentrations of metabolites originating from microbial activity on proteinaceous substrates. Taken together, the combination of specific protein intakes poor digestion, gut barrier integrity, microbiota composition and function all on a background of ASD represents a phenotypic pattern. A potential consequence of this pattern of conditions is that the fragile gut of some children with ASD is at risk for GI symptoms that may be amenable to improvement with specific dietary changes. There is growing evidence that shows an association between gut dysfunction and dysbiosis and ASD symptoms. It is therefore urgent to perform more experimental and clinical research on the “fragile gut” in children with ASD in order to move toward advancements in clinical practice. Identifying those factors that are of clinical value will provide an evidence-based path to individual management and targeted solutions; from real time sensing to the design of diets with personalized protein source/processing, all to improve GI function in children with ASD.”

Inflammation and Neuro-Immune Dysregulations in Autism Spectrum Disorders. Full article.Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication and interaction and restricted-repetitive patterns of behavior, interests, or activities. Strong inflammation states are associated with ASD. This inflammatory condition is often linked to immune system dysfunction. Several cell types are enrolled to trigger and sustain these processes. Neuro-inflammation and neuro-immune abnormalities have now been established in ASD as key factors in its development and maintenance. In this review, we will explore inflammatory conditions, dysfunctions in neuro-immune cross-talk, and immune system treatments in ASD management.”

Constipation in Children with Autism Spectrum Disorder Associated with Increased Emergency Department Visits and Inpatient Admissions.Emergency Department (ED) visits by children with ASD were more likely to be constipation-related compared with visits by children with other chronic conditions or children with no chronic conditions. Constipation is responsible for a large proportion of ED visits and more inpatient admissions resulting from these ED visits. These findings suggest a need for developing more effective outpatient therapies for constipation in children with ASD.”

May 2018

Identification of urinary metabolites that correlate with clinical improvements in children with autism treated with sulforaphane from broccoli. Full article. “Fifteen children completed the 12-week study. Mean scores on both symptom measures showed improvements (decreases) over the study period, but only the change in the SRS was significant. The ABC improved - 7.1 points (95% CI - 17.4 to 3.2), and the SRS improved - 9.7 points (95% CI - 18.7 to - 0.8). We identified 77 urinary metabolites that were correlated with changes in symptoms, and they clustered into pathways of oxidative stress, amino acid/gut microbiome, neurotransmitters, hormones, and sphingomyelin metabolism.”

Are therapeutic diets an emerging additional choice in autism spectrum disorder management?Therapeutic diets that have been used in children with autism include ketogenic and gluten/casein-free diet. We were able to identify 8 studies conducted in animal models of autism demonstrating a beneficial effect on neurophysiological and clinical parameters. Only 1 clinical study was found showing improvement in childhood autism rating scale after implementation of ketogenic diet. With regard to gluten/casein-free diet, 4 clinical studies were totally found with 2 of them showing a favorable outcome in children with autism. Furthermore, a combination of gluten-free and modified ketogenic diet in a study had a positive effect on social affect scores. No serious adverse events have been reported.”

Pioglitazone abolishes autistic-like behaviors via the IL-6 pathway. Full text. “Previous investigations by our group have demonstrated that prenatal exposure to lipopolysaccharide (LPS), which mimics infections by gram-negative bacteria, induces autistic-like behaviors. No effective treatment yet exists for autism. We selected pioglitazone to block or ease the impairments induced by LPS because although this drug was designed as an anti-diabetic drug (it has an insulin effect), it also exerts anti-inflammatory effects. Juvenile offspring were treated daily with pioglitazone, and the main behaviors related to autism, namely, socialization (play behavior) and communication (50-kHz ultrasonic vocalizations), were studied. Biomarkers linked to autism and/or pioglitazone were also studied to attempt to understand the mechanisms involved, namely, IL-6, TNF-alpha, MCP-1, insulin, and leptin. Prenatal LPS exposure induced social deficits and communicational abnormalities in juvenile rat offspring as well as elevated plasma IL-6 levels. Daily postnatal pioglitazone treatment blocked the impairments found in terms of the time spent on social interaction, the number of vocalizations (i.e., autistic-like behaviors) and the elevated plasma IL-6 levels. Thus, pioglitazone appears to be a relevant candidate for the treatment of autism. The present findings may contribute to a better understanding and treatment of autism and associated diseases.”

Pediatric Scurvy: When Contemporary Eating Habits Bring Back the Past. Full text. “We report the case of a 3-years old child developing scurvy as consequence of strict selective diet; extensive and invasive investigations were undertaken before the correct diagnosis was considered. Despite being considered a rare condition, scurvy still exists nowadays, even in children with no apparent risk factors living in wealthy families. The increasing popularity of dietary restriction for children, especially those with allergies, may potentially enhance the occurrence of scurvy in apparently healthy children.”

Could Autism Be Associated With Nutritional Status in the Palestinian population? The Outcomes of the Palestinian Micronutrient Survey. Full article. “The Palestinian Micronutrient Survey was conducted to assess micronutrient status in most vulnerable groups and also micronutrient deficiencies. The data from Palestinian population showed severe anaemia due to iron, Zn, B12, and folic acid deficiencies. One in every 3 Palestinian pregnant women is anaemic. Moreover, 78.2% and 87.1% of lactating mothers from the West Bank and Gaza Strip are Zn deficient. For children from 6 to 59 months old, 1 in every 4 boys and 1 in every 5 girls are considered anaemic. Similar trend was found with respect to vitamins E, D, A, and folic acid. We reviewed the literature that linked micronutrient deficiencies to neurodevelopmental disorders and expected the number of neurodevelopmental disorder cases, including autism, to increase.”

The Relationship between Sleep Problems, Neurobiological Alterations, Core Symptoms of Autism Spectrum Disorder, and Psychiatric Comorbidities. Full article. “Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have also suggested that sleep disturbances may increase behavioral problems in this clinical population. Although understanding the causes of sleep disorders in ASD is a clinical priority, the causal relationship between these two conditions remains unclear. Given the complex nature of ASD, the etiology of sleep problems in this clinical population is probably multi-factorial. In this overview, we discuss in detail three possible etiological explanations of sleep problems in ASD that can all contribute to the high rate of these symptoms in ASD. Specifically, we examine how neurobiological alterations, genetic mutations, and disrupted sleep architecture can cause sleep problems in individuals with ASD. We also discuss how sleep problems may be a direct result of core symptoms of ASD. Finally, a detailed examination of the relationship between sleep problems and associated clinical features and psychiatric comorbidities in individuals with ASD is described.”

Long-term social skills group training for children and adolescents with autism spectrum disorder: a randomized controlled trial. Full article. “The present study suggests that a long-term social skills group training (SSGT) program can result in larger gains in social skills than has previously been reported for shorter SSGT programs. The gains were maintained 3 months after completion of the training. While these preliminary results should be interpreted with caution, they hold promise that continued efforts to fine-tune the content and form of social skills training programs eventually could enable service providers to use their resources more effectively and help young people with ASD to reach their full potential.”

Youth With Autism Spectrum Disorder in the Emergency Department.Youth (aged 0-17 years) with ASD were up to 30 times more likely to present to the ED than youth without ASD. For youth with ASD, up to 13% of visits were for behavioral or psychiatric problems, whereas for youth without ASD less than 2% were for psychiatric problems. ASD youth were more likely to present for externalizing problems or psychotic symptoms. Youth with ASD were also likely to have repeat visits to the ED and more likely to be admitted to a psychiatric unit or medical floor than youth without ASD.”

Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Full article. “Review authors examined and compared the results of all five studies. They found weak evidence that children receiving the EIBI treatment performed better than children in the comparison groups after about two years of treatment on scales of adaptive behavior, intelligence tests, expressive language (spoken language), and receptive language (the ability to understand what is said). Differences were not found for the severity of autism symptoms or a child’s problem behavior. No study reported adverse events (deterioration in adaptive behaviour or autism symptom severity) due to treatment.”

Predictors of quality of life for autistic adults.There has been limited research into the lived experience of autistic adults. Using the World Health Organization quality of life measure, we found that autistic people (370) in the UK reported their quality of life to be lower than that of the general population. Better quality of life was associated with being in a relationship; those with a mental health condition had poorer quality of life. This research suggests some ways in which autistic people can be helped to improve their quality of life.”

Follow-Up of Children With Autism Spectrum Disorder 1 Year After Early Behavioral Intervention. Full article. “The effectiveness of early intensive behavioral intervention (EIBI) for children with autism spectrum disorders (ASDs) has been demonstrated by many studies and meta-analyses. Although it is considered an exemplary practice in several countries, few studies have investigated the maintenance of gains made in EIBI over time. Thirty-two children were assessed at posttreatment and 1-year follow-up after they attended a low-to-moderate-intensity (10 to 20 hr per week) EIBI program delivered by a public rehabilitation center. Between baseline and posttreatment, children showed significant gains in most areas of intellectual functioning and a significant decrease of autism symptom severity, but no change in adaptive behavior. Gains in intellectual functioning were maintained over a 1-year period after treatment termination, but autism symptom severity had increased to approximately pretreatment levels during that interval. Considerable individual variability was noted in the evolution of outcomes.”

Students with Autism Spectrum Disorder and Their Parents in the Transition into Higher Education: Impact on Dynamics in the Parent-Child Relationship.This study examined how 34 senior students and first-year college students with autism spectrum disorder, their mothers (n = 34) and fathers (n = 26) navigate the higher education transition, and how this context impacts on dynamics in the parent-child relationships. Semi-structured interviews were analyzed based on grounded theory and dyadic analysis principles. Both parties were confronted with an abundance of challenges and experienced strong feelings of ambivalence, stress and anxiety. Differences in perspectives occurred regarding the construction of adulthood, the acquisition of autonomy, disclosure and subscribing to support services. These differences caused tensions in the parent-child relationship, hindering the transformation of the relationship into an adult-like mutual relationship. Clinical implications are extrapolated on the basis of these findings.”

Aging Well on the Autism Spectrum: An Examination of the Dominant Model of Successful Aging.Using survey data, a model of “aging well” was operationalised and applied to 92 autistic adults and 60 controls. A very small proportion (3.3%) of autistic adults were found to be aging well. Significantly less autistic adults were “maintaining physical and cognitive functioning” and “actively engaging with life” in comparison to controls.”

Immunoexcitotoxicity as the central mechanism of etiopathology and treatment of autism spectrum disorders: A possible role of fluoride and aluminum. Full article. “Our review suggests that most autism spectrum disorder (ASD) risk factors are connected, either directly or indirectly, to immunoexcitotoxicity. Chronic brain inflammation is known to enhance the sensitivity of glutamate receptors and interfere with glutamate removal from the extraneuronal space, where it can trigger excitotoxicity over a prolonged period. Neuroscience studies have clearly shown that sequential systemic immune stimulation can activate the brain’s immune system, microglia, and astrocytes, and that with initial immune stimulation, there occurs CNS microglial priming. Children are exposed to such sequential immune stimulation via a growing number of environmental excitotoxins, vaccines, and persistent viral infections. We demonstrate that fluoride and aluminum (Al3+) can exacerbate the pathological problems by worsening excitotoxicity and inflammation. While Al3+ appears among the key suspicious factors of ASD, fluoride is rarely recognized as a causative culprit. A long-term burden of these ubiquitous toxins has several health effects with a striking resemblance to the symptoms of ASD. In addition, their synergistic action in molecules of aluminofluoride complexes can affect cell signaling, neurodevelopment, and CNS functions at several times lower concentrations than either Al3+ or fluoride acting alone. Our review opens the door to a number of new treatment modes that naturally reduce excitotoxicity and microglial priming.”

EEG Analytics for Early Detection of Autism Spectrum Disorder: A data-driven approach. Full article.EEG is a relatively easy-to-use, low cost brain measurement tool that is being increasingly explored as a potential clinical tool for monitoring atypical brain development. EEG measurements were collected from 99 infants with an older sibling diagnosed with ASD, and 89 low risk controls, beginning at 3 months of age and continuing until 36 months of age. Prediction of the clinical diagnostic outcome of ASD or not ASD was highly accurate when using EEG measurements from as early as 3 months of age. Specificity, sensitivity and PPV were high, exceeding 95% at some ages. Prediction of ADOS calibrated severity scores for all infants in the study using only EEG data taken as early as 3 months of age was strongly correlated with the actual measured scores. This suggests that useful digital biomarkers might be extracted from EEG measurements.”

Recognizing the Problem of Suicidality in Autism Spectrum Disorder.Until recently, suicidality in autism spectrum disorder (ASD) was rarely discussed. A cluster of recent articles, including an article by Culpin et al. in this issue (see following study below), has highlighted not only that suicidal thoughts and suicide attempts can occur in adolescents and young adults with ASD, but also that suicidality is likely more common in ASD than in the general population. Retrospectively, the lack of focus on suicidality in ASD seems surprising when self-injurious behavior has long been a focus of attention in ASD. The emerging studies indicate that the increased risk of self-injurious behavior in younger and less cognitively able children with ASD is matched by an increased risk of suicidality in those at a more advanced developmental level.”

Autistic Traits and Suicidal Thoughts, Plans, and Self-Harm in Late Adolescence: Population-Based Cohort Study.To examine the hypothesis that autism spectrum disorders (ASD) diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any observed associations are explained by depression at 12 years. Children with impaired social communication had a higher risk of self-harm with suicidal intent, suicidal thoughts, and suicidal plans by age 16 years as compared to those without. Approximately 32% of the total estimated association between social communication impairment and self-harm was explained by depressive symptoms at 12 years. Social communication impairments are an important autistic trait in relation to suicidality.”

April 2018

Frequent Penile Erection in a Boy with Autism-Spectrum Disorder: Case Report.We report a boy with autism-spectrum disorder, who developed frequent penile erections after an increase in risperidone dosage for a month. The patient fully recovered two days after risperidone discontinuation. This report concerns the youngest case of psychotropic medication-induced sexual disorders, which illustrates the differences in presentation between children and adults.”

Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Full text. “For 2014, the overall prevalence of ASD among the 11 ADDM sites was 16.8 per 1,000 (one in 59) children aged 8 years. The latest findings from the ADDM Network provide evidence that the prevalence of ASD is higher than previously reported estimates and continues to vary among certain racial/ethnic groups and communities. With prevalence of ASD ranging from 13.1 to 29.3 per 1,000 children aged 8 years in different communities throughout the United States, the need for behavioral, educational, residential, and occupational services remains high, as does the need for increased research on both genetic and nongenetic risk factors for ASD.”

Cerebral hypoperfusion in autism spectrum disorder.Cerebral hypoperfusion, or insufficient blood flow in the brain, occurs in many areas of the brain in patients diagnosed with autism spectrum disorder (ASD). Hypoperfusion was demonstrated in the brains of individuals with ASD when compared to normal healthy control brains either using positron emission tomography (PET) or single‑photon emission computed tomography (SPECT). Moreover, correlations between symptom scores and hypoperfusion in the brains of individuals diagnosed with an ASD were found indicating that the greater the autism symptom pathology, the more significant the cerebral hypoperfusion or vascular pathology in the brain. Evidence suggests that brain inflammation and vascular inflammation may explain a part of the hypoperfusion. There is also evidence of a lack of normal compensatory increase in blood flow when the subjects are challenged with a task. Some studies propose treatments that can address the hypoperfusion found among individuals diagnosed with an ASD, bringing symptom relief to some extent.”


The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis.Results of the meta-analysis-a method for synthesizing research-showed physical activity interventions to have a moderate or large effect on a variety of outcomes, including for the development of manipulative skills, locomotor skills, skill-related fitness, social functioning, and muscular strength and endurance. The authors conclude that physical activity’s standing as an evidence-based strategy for youth with ASD is reinforced.”

An update on pharmacotherapy of autism spectrum disorder in children and adolescents. Full article. “To date, no medication is proven to be effective in treating core symptoms of autism spectrum disorder (ASD). Psychotropic medications are widely used to target emotional and behavioural symptoms in ASD. Currently, only risperidone and aripiprazole have been approved by the US Food and Drug Administration (FDA) for treatment of irritability associated with ASD in children and adolescents. However, associated metabolic side-effects are concerning. Evidence supports use of methylphenidate and atomoxetine for attention deficit hyperactivity disorder (ADHD) symptoms and clonidine and guanfacine ER appear to be helpful. SSRIs are poorly tolerated and lack evidence in reducing restricted repetitive behaviours (RRB), anxiety, and depression.”

Prenatal Exposure to Acetaminophen and Risk for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Cohort Studies. Full article. “Acetaminophen is the most commonly used analgesic and antipyretic during pregnancy. Evidence of neuro-disruptive properties is accumulating. The available data is of observational nature only. Studies differed gravely in exposure and outcome assessment. Acetaminophen use during pregnancy is associated with an increased risk for ADHD, ASD and hyperactivity symptoms.”

Why is vitamin B6 effective in alleviating the symptoms of autism?Vitamin B6 is widely used to treat the symptoms observed in autism. Vitamin B6 is beneficial for about half of autistic individuals in decreasing behavioral problems. Although the exact pathogenesis is not defined, it is evident that certain neurotransmitter systems are impaired in the brains of autistic patients, causing the symptoms observed in the disease. In fact, impairment of many neurotransmitter systems has been reported, including GABA, serotonin, dopamine, and noradrenalin. Furthermore, vitamin B6 is important for the synthesis of many neurotransmitters, including GABA, serotonin, dopamine, noradrenalin, histamine, glycine, and d-serine, indicating that vitamin B6 supplementation may enhance many neurotransmitter systems. Thus, vitamin B6 supplementation can treat the impaired neurotransmitter systems in a given patient, even if the actual impaired neurotransmitter systems are not defined in that patient.”

Coenzyme Q10 supplementation reduces oxidative stress and decreases antioxidant enzyme activity in children with autism spectrum disorders.Antioxidants and oxidative stress can participate in pathobiochemical mechanisms of autism spectrum disorders (ASDs). The aim was to identify the effects of early CoQ10 supplementation on oxidative stress in children with ASDs. CoQ10 supportive therapy was determined after three months with daily dose 2 ͯ 30 mg improved oxidative stress in the children with ASDs. Based on the results, high doses of CoQ10 can improve gastrointestinal problems and sleep disorders in children with ASDs with an increase in the CoQ10 of the serum.”

A comparison of blood metal levels in autism spectrum disorder and unaffected children in Shenzhen of China and factors involved in bioaccumulation of metals.The present study compared blood plasma metals in children with autism spectrum disorder (ASD) with those in unaffected children in Shenzhen (China). The results showed that children with ASD had higher Pb, Hg, and Cd than unaffected children, while essential elements Zn, Se, and Mn showed an opposite pattern. Moreover, the children exposed to passive smoking had higher Cd than those without the exposure. Positive associations were found between levels of Hg or Pb and seafood consumption as well as body mass index (BMI).”

Older Adults with Autism Spectrum Disorders in Sweden: A Register Study of Diagnoses, Psychiatric Care Utilization and Psychotropic Medication of 601 Individuals.In a Swedish sample of persons eligible for disability services and aged 55 years or older in 2012, persons (n = 601) with autism spectrum disorder diagnoses registered in specialist care were identified. More than 60% had been in contact with psychiatric care. The majority had no intellectual disability (ID) diagnosis recorded during the study period. Apart from ID, affective disorders, anxiety and psychotic disorders were most commonly registered; alcohol/substance abuse disorders were uncommon. Psychotropic drug prescriptions were very common, especially in the ID group.”

Stimulant Withdrawal in a Child with Autism Spectrum Disorder and ADHD – A Case Report.We describe the case history and review scientific English language literature pertaining to acute withdrawal effects associated with methylphenidate and amphetamine derivatives in children. An 11-year-old female with ASD and ADHD referred to our clinic experienced vomiting, headaches, and light sensitivity following abrupt discontinuation of methylphenidate; she subsequently presented with migraines and marked malaise immediately after a dose reduction in lisdexamfetamine. Evidence supports the notion that ADHD symptoms in children with ASD can be effectively treated with methylphenidate; however, beneficial effects are less robust relative to children with a primary ADHD diagnosis. Children affected by ASD are also more susceptible to adverse effects. Adults experiencing stimulant withdrawal often experience depression, fatigue, changes in appetite, and insomnia or hypersomnia.

Resveratrol attenuates pro-inflammatory cytokines and activation of JAK1-STAT3 in BTBR T+ Itpr3tf/J autistic mice.Resveratrol plays a role in several disorders such as neuroimmune, autoimmune, and allergic disorders. Results indicate the efficacy of resveratrol in reducing cytokines and JAK-1/STAT3 signaling in BTBR mice, which is a novel and important finding and might be important for future therapies in neuroimmune dysfunction.”

Higher Autistic Traits Among Criminals, But No Link to Psychopathy: Findings from a High-Security Prison in Portugal.The relationship between autism, criminality and psychopathy has gained increased attention in recent years. We measured autistic traits (with the Autism Spectrum Quotient) in a sample of 101 inmates from a high-security prison and compared them to a control group. Our study points to the presence of autistic traits as being independent risk factors for imprisonment, although not associated with psychopathy.

Study of the Effect of Bisphenol A on Oxidative Stress in Children with Autism Spectrum Disorders.The role of bisphenol A (BPA) in autism was investigated in 49 children with autism spectrum disorders (ASDs) and 40 comparable age and sex matched children used as controls. In addition, 8-Hydroxydeoxyguanosine (8-oxodG) was also studied as a biomarker of oxidative stress in the same set of two selected groups. The results showed that both BPA and 8-oxodG were significantly higher in children with autism than those of control children. There were positive correlations between both BPA and 8-oxodG with ASDs severity. The observed results revealed that BPA may increase oxidative stress resulting in mitochondrial dysfunction that affecting the behavior and functioning of ASDs children.”

Therapeutic use of carbohydrate-restricted diets in an autistic child; a case report of clinical and 18FDG PET findings. Full article. “The ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that has been used successfully in the treatment of refractory epilepsies for almost 100 years. There has been accumulating evidence to show that the KD may provide a therapeutic benefit in autism spectrum disorders, albeit by a yet-unknown mechanism. We report a case of a 6-year-old patient with high-functioning autism and subclinical epileptic discharges who responded poorly to several behavioural and psychopharmacological treatments. The patient was subsequently placed on the KD due to significant glucose hypometabolism in the brain as revealed by an 18FDG PET. As soon as one month after starting the KD, the patient’s behavior and intellect improved (in regard to hyperactivity, attention span, abnormal reactions to visual and auditory stimuli, usage of objects, adaptability to changes, communication skills, fear, anxiety, and emotional reactions); these improvements continued until the end of the observation period at 16 months on the KD. The 18FDG PET, measured at 12 months on the KD, revealed that 18F-FDG uptake decreased markedly and diffusely in the whole cerebral cortex with a relatively low reduction in basal ganglia in comparison to the pre-KD assessment. It warrants further investigation if the 18FDG PET imaging could serve as a biomarker in identifying individuals with autism who might benefit from the KD due to underlying abnormalities related to glucose hypometabolism.”

Epigenetics and Autism Spectrum Disorder: Is There a Correlation? Full article. “Epigenetics refers to the heritable changes in gene expression without changing the underlying DNA sequence. In this opinion article, we will briefly discuss the recent advancements in understanding the contribution of epigenetic factors that can play a role in determining the predisposition to autism.”

Fluctuations in clinical symptoms with changes in serum 25(OH) vitamin D levels in autistic children: Three cases report.Clinical trials, including case reports, case-control studies, and a double-blinded randomized clinical study, have suggested that high-dose vitamin D3 regimens may ameliorate the core symptoms of ASD. Vitamin D3 supplementation was effective in about three-quarters of children with ASD. To further investigate the relationship between vitamin D and ASD symptoms in vitamin D-responsive autistic children, changes in symptoms were assessed in three children with ASD who were given vitamin D3 supplementation followed by a long interruption. The core symptoms of ASD were remarkably improved during the vitamin D3 supplementation period when serum 25-hydroxyvitamin D [25(OH)]D levels reached over 40.0 ng/mL. However, symptoms reappeared after the supplementation was stopped, when serum 25(OH)D levels fell below 30.0 ng/mL but were again improved with re-administration of vitamin D3 after the interruption, when serum 25(OH)D levels exceeded 40.0 ng/mL. Overall, these results showed that the core symptoms of ASD fluctuated in severity with changes in serum 25(OH)D levels in children, indicating that maintaining a responsive 25(OH)D level is important for treating ASD.”

Skeletal Growth Dysregulation in Australian Male Infants and Toddlers With Autism Spectrum Disorder.Recent findings suggest that infants with Autism Spectrum Disorder (ASD) are smaller in size at birth compared to typically developing infants but grow larger than their peers during the first year. Little is known about their rate of growth, especially for height and weight. Our findings confirmed that infants with ASD are smaller in size at birth for head circumference (HC), height, and weight, but grow at a faster rate in HC and height than their peers from birth to 3 years.”

Sympathetic, Metabolic Adaptations, and Oxidative Stress in Autism Spectrum Disorders: How Far From Physiology? Full article. “The present paper may suggest the need to broaden horizons and the study target on ASD, including oxidative stress, neurotransmitters evaluation, and sympathetic activity measurements. There is increasing evidence that ASD patients show excessive ROS [reactive oxygen species] production as reported by many studies.”

Clostridium Bacteria and Autism Spectrum Conditions: A Systematic Review and Hypothetical Contribution of Environmental Glyphosate Levels. Full article. “Researchers have shown evidence regarding the impact of gut bacteria on neurological outcomes, altering behavior and potentially affecting the onset and/or severity of psychiatric disorders. Pesticides and agrotoxics are also included among this long list of ASD-related environmental stressors. Of note, ingestion of glyphosate (GLY), a broad-spectrum systemic herbicide, can reduce beneficial bacteria in the gastrointestinal tract microbiota without exerting any effects on the Clostridium population, which is highly resistant to this herbicide. In the present study, (i) we performed a systematic review to evaluate the relationship between Clostridium bacteria and the probability of developing and/or aggravating autism among children. Two independent researches selected the studies and analyzed the data. The results of the present systematic review demonstrate an interrelation between Clostridium bacteria colonization of the intestinal tract and autism. Finally, (ii) we also hypothesize about how environmental GLY levels may deleteriously influence the gut-brain axis by boosting the growth of Clostridium bacteria in autistic toddlers.”

Sleep disturbances are associated with specific sensory sensitivities in children with autism. Full article. “Sleep disturbances are associated with specific sensory sensitivities in children with autism. While it is often assumed that sensitivities in all sensory domains are similarly associated with sleep problems, our results suggest that hypersensitivity towards touch exhibits the strongest relationship with sleep disturbances when examining children autism. We speculate that hypersensitivity towards touch interferes with sleep onset and maintenance in a considerable number of children with autism who exhibit severe sleep disturbances. This may indicate the existence of a specific sleep disturbance mechanism that is associated with sensitivity to touch.”

Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD. Full article. “Children with autism spectrum disorder (ASD) have a variety of medical and psychiatric conditions and an increased use of health care services. There is limited information about the prevalence of psychiatric and medical conditions in adolescents and young adults with ASD. Our objective was to describe the frequency of medical and psychiatric conditions in a large population of diverse, insured transition-aged individuals with ASD. Over one-third (34%) of individuals with ASD had a co-occurring psychiatric condition; the most commonly reported medical conditions included infections (42%), obesity (25%), neurologic conditions (18%), allergy and/or immunologic conditions (16%), musculoskeletal conditions (15%), and gastrointestinal (11%) conditions. Although more research is needed to identify factors contributing to this excess burden of disease, there is a pressing need for all clinicians to approach ASD as a chronic health condition requiring regular follow-up and routine screening and treatment of medical and psychiatric issues.”

Transition of Individuals With Autism to Adulthood: A Review of Qualitative Studies. Full article. “Many young adults with autism spectrum disorder experience poor transition outcomes in key areas, including postsecondary employment, higher education, health care, social connectedness, and independent living, yet we lack a clear understanding of the specific factors that impact these outcomes. Findings revealed that poor transition outcomes are influenced by several factors, including poor person-environment fit, uncertainty about the roles of parents, and the lack of comprehensive or integrated services. These findings also revealed the aspects of familial, organizational, and policy contexts that may be targeted for interventions. Finally, stakeholders emphasized that supports should be individualized and focused on the changing aspects of the young adult’s social and physical environment rather than behavior change. We discuss implications for policy and practice and provide recommendations for further research.”

Barriers to Receipt of Services for Young Adults With Autism. Full article. “In this study, we examine experiences of families of young adults (YAs) on the autism spectrum to better understand dynamics leading to poor YA outcomes. Few adults with ASD were receiving autism-specific assistance no matter their level of cognitive functioning. Existing systems, such as service agencies and college disability support offices, had seldom been designed to meet their needs. Some families gave up on services, some used self-directed services they had to manage themselves, and others paid out of pocket for services they could access no other way. Inadequate services often led to YA failure and worsening of symptoms. The majority of families bore the financial and emotional brunt of finding or creating services and community experiences to meet their adult child’s needs.”

March 2018

Chinese children with autism: A multiple chemical elements profile in erythrocytes.The present work aimed to investigate the multiple chemical elements profile in the erythrocytes of autistic versus typically developing children (TDC) of China. Analyses were carried out to explore the possible association between levels of elements and the risk as well as the severity of ASD. Erythrocyte levels of 11 elements (32%) among 34 detected elements in autistic group were significantly different from those in the TDC group. To our knowledge, this is the first study which compared the levels of rare earth elements in erythrocytes between children with or without ASD. Five elements including Pb, Na, Ca, Sb, and La are associated with the Childhood Autism Rating Scale (CARS) total score. Also, a series of tendencies were found in this research which was believed to affect auditory response, taste, smell, and touch, as well as fear or nervousness. It can be concluded that Chinese autistic children suffer from multi-chemical element imbalances which involves a complex combination of genetic and environmental factors. The results showed a significant correlation between abnormal levels of several chemical elements and the severity of the autistic syndrome.”

Anxiety and Mood Disorder in Children With Autism Spectrum Disorder and ADHD.Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur. A generalized linear model revealed that children with ASD and ADHD had an increased risk of anxiety disorder and mood disorder compared with children with ASD alone. Increasing age was the most significant contributor to the presence of anxiety disorder and mood disorder. Co-occurrence of ADHD is common in children with ASD. Children with both ASD and ADHD have an increased risk of anxiety and mood disorders. Physicians who care for children with ASD should be aware of the coexistence of these treatable conditions.”

Excipient of medication the probable cause of urticaria in a boy with autism. Full article. “An allergic response of urticaria concomitantly with use of risperidone in a child has not been reported before. Allergy and urticaria associated with risperidone have previously been reported in adults only.”

Tantrums, Emotion Reactions and Their EEG Correlates in Childhood Benign Rolandic Epilepsy vs. Complex Partial Seizures: Exploratory Observations. Full article. “We explored associations between EEG pathophysiology and emotional/behavioral (E/B) problems of children with two types of epilepsy using standard parent questionnaires and two new indicators: tantrums recorded by parents at home and brief, emotion-eliciting situations in the laboratory. Children with Benign Rolandic epilepsy (BRE) reportedly had shorter, more angry tantrums from which they recovered quickly. Children with Complex Partial Seizures (CPS) had longer, sadder tantrums often followed by bad moods. More generally, BRE correlated with anger and aggression; CPS with sadness and withdrawal. Across all children, high voltage theta and/or interictal epileptiform discharges (IEDs) correlated with negative emotional reactions. Such EEG abnormalities in left hemisphere correlated with greater social fear, right hemisphere EEG abnormalities with greater anger. Right hemisphere localization in CPS was also associated with parent-reported problems at home. If epilepsy alters neural circuitry thereby increasing negative emotions, additional assessment of anti-epileptic drug treatment of epilepsy-related E/B problems would be warranted.”

Education and employment status of adults with autism spectrum disorders in Germany – a cross-sectional-survey. Full article. “Adults with autism spectrum disorders (ASD) experience challenges in participating in the labour market and struggle to achieve and maintain appropriate professional positions, possibly due to impairments of communication and social interaction. Studies have shown high rates of unemployment as well as evidence of inadequate employment. Despite largely high formal qualifications, the clinically mostly late-diagnosed adults with ASD represented in our sample are disadvantaged regarding their participation in the German labour market, especially with respect to rates of unemployment, early retirement and overeducation.”

High prevalence of serum folate receptor autoantibodies in children with autism spectrum disorders.Supplementation of folic acid by pregnant mothers is thought to lower the risk of autism spectrum disorders (ASDs) in the offspring. Folic acid is taken up by cells via receptors with high affinity for folate and reduced folic acid derivatives. However, this is blocked by the presence of folate receptor autoantibodies (FRAA). Cerebral FRAA have been detected with high frequency in children with ASDs, suggesting the existence of a link between folic acid uptake and disease etiology. Serum FRAA are more prevalent in children with ASDs than in TD children. Our data suggest that children with ASDs may have defects in folic acid absorption that play a role in the onset of ASDs.”

Differential immune responses and microbiota profiles in children with autism spectrum disorders and co-morbid gastrointestinal symptoms.Many studies have reported the increased presence of gastrointestinal (GI) symptoms in children with autism spectrum disorders (ASD). The aim of this study was to determine whether there are biological signatures in terms of immune dysfunction and microbiota composition in children with ASD with GI symptoms. Overall our findings suggest that children with ASD who experience GI symptoms have an imbalance in their immune response, possibly influenced by or influencing metagenomic changes, and may have a propensity to impaired gut barrier function which may contribute to their symptoms and clinical outcome.”

The Effects of Structured Physical Activity Program on Social Interaction and Communication for Children with Autism. Full article. “The purpose of this study was to investigate the effects of structured physical activity program on social interaction and communication of children with autism spectrum disorder (ASD). The study concluded that the special structured physical activity program positively influenced social interaction and communication skills of children with ASD, especially in social skills, communication, prompt response, and frequency of expression.”

Erythrocyte fatty acid profiles in children are not predictive of autism spectrum disorder status: a case control study. Full article. “While no reliable biomarker has yet been found for autism spectrum disorder (ASD), fatty acids have been investigated as potential biomarkers because of their association with brain development and neural functions. However, the ability of fatty acids to classify individuals with ASD from age/gender-matched neurotypical (NEU) peers has largely been ignored in favor of investigating population-level differences. Contrary to existing work, this classification task between ASD and NEU cohorts is the main focus of this work. The data presented herein suggest that fatty acids do not allow for classification at the individual level.”

Gut Microbial Dysbiosis in Indian Children with Autism Spectrum Disorders.Our study showed prominent dysbiosis in the gut microbiome of ASD children, with higher relative abundances of families Lactobacillaceae, Bifidobacteraceae, and Veillonellaceae, whereas the gut microbiome of healthy children was dominated by the family Prevotellaceae. Comparative meta-analysis with a publicly available dataset from the US population consisting of 20 ASD and 20 healthy control samples from children of similar age, revealed a significantly high abundance of genus Lactobacillus in ASD children from both the populations. The results reveal the microbial dysbiosis and an association of selected Lactobacillus species with the gut microbiome of ASD children.”

Interplay Between Peripheral and Central Inflammation in Autism Spectrum Disorders: Possible Nutritional and Therapeutic Strategies. Full article. “Pre- and post-natal factors can affect brain development and function, impacting health outcomes with particular relevance to neurodevelopmental diseases, such as autism spectrum disorders (ASDs). During development, fatty acids and sugars, as well as satiety hormones, like insulin and leptin, and inflammatory factors related to obesity-induced low grade inflammation, could play a role in the impairment of neuroendocrine system and brain neuronal circuits regulating behavior in offspring. On the other side, post-natal factors, such as mode of delivery, stress, diet, or antibiotic treatment are associated to a modification of gut microbiota composition, perturbing microbiota-gut-brain axis. Indeed, the interplay between the gastrointestinal tract and the central nervous system not only occurs through neural, hormonal, and immune pathways, but also through microbe-derived metabolic products. The modification of unhealthy perinatal and postnatal environment, manipulation of gut microbiota, nutritional, and dietary interventions could represent possible strategies in preventing or limiting ASDs, through targeting inflammatory process and gut microbiota.”

Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial. Full article. “This study involved a randomized, controlled, single-blind 12-month treatment study of a comprehensive nutritional and dietary intervention. Treatment began with a special vitamin/mineral supplement, and additional treatments were added sequentially, including essential fatty acids, Epsom salt baths, carnitine, digestive enzymes, and a healthy gluten-free, casein-free, soy-free (HGCSF) diet. There was a significant improvement in nonverbal intellectual ability in the treatment group compared to the non-treatment group. The treatment group had significantly greater increases in EPA, DHA, carnitine, and vitamins A, B2, B5, B6, B12, folic acid, and Coenzyme Q10. The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD. Parents reported that the vitamin/mineral supplements, essential fatty acids, and HGCSF diet were the most beneficial.”

Promoting Social Learning at Recess for Children with ASD and Related Social Challenges. Full article. “The school playground provides an ideal opportunity for social inclusion; however, children with autism spectrum disorder (ASD) often struggle to engage in appropriate social interactions in this unstructured environment. Thus, they may spend recess time alone. The FRIEND Playground Program is a structured, play-based intervention aimed at improving social interactions of children with ASD and other social challenges during recess. The current research study employed a multiple baseline across participant design to systematically evaluate whether this intervention yields increased social engagement and initiations with peers during recess. Seven participants with ASD or other social challenges received 20 min of direct intervention from trained playground facilitators during school recess each day. Results suggest that the FRIEND Playground Program produced meaningful increases in social engagement and social initiations from baseline among participants with ASD and other social challenges.”

Autistic traits in a sample of adult patients with schizophrenia: prevalence and correlates.Schizophrenia and autism spectrum disorder (ASD) are currently conceptualized as distinct disorders. However, the relationship between these two disorders has been revisited in recent years due to evidence that they share phenotypic and genotypic expressions. This study aimed to identify ASD traits in patients with schizophrenia, and to define their demographic, psychopathological, cognitive and functional correlates. Results of this study indicate the existence, in a sample of patients with a diagnosis of schizophrenia, of a distinct group of subjects with ASD features, characterized by specific symptomatological and cognitive profile.”

Early electronic screen exposure and autistic-like symptoms. Full article. “Currently, children have “more access to electronic media on the daily basis than those of previous generation. Some studies suggest that increases screen time is associated with melanopsin-expressing neurons and decreasing gamma-aminobutyric acid (GABA) neurotransmitter, and thus results aberrant behavior, decreased cognitive, and language development. In all cases, the first exposure was started before 2 years old and the intention of exposure was very high in the majority of cases (≥ 3 hours/day). Children who started watching television before 12 months and watched more than 2 hours a day were six times more likely to have language delays.”

The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Full article. “Acupuncture complementary to behavioral and educational intervention significantly decreased the overall scores on the Childhood Autism Rating Scale (CARS) and the Autism Behavior Checklist; however, it was unclear which of the ASD symptoms improved. Acupuncture as a monotherapy also reduced the overall CARS score. The reported adverse events were acceptable. This review suggests that acupuncture may be effective and safe for pediatric ASD.”

Prevalence and Risk Factors of Anxiety in a Clinical Dutch Sample of Children with an Autism Spectrum Disorder. Full article. “Anxiety is highly prevalent in children with an autism spectrum disorder (ASD). The findings showed that more than 60% of the participating children with ASD had at least subclinical anxiety symptoms according to children. More than 80% of the children with ASD had at least subclinical anxiety symptoms according to parents. It was found that younger children and girls with ASD had more anxiety symptoms than older children and boys with ASD. Moreover, it was found that children with a higher performance (non-verbal) IQ and lower verbal IQ had more specific phobia symptoms. The findings suggest that in a clinical context, children with ASD have a high risk to have co-occurring anxiety symptoms, especially girls and younger children with ASD.”

An Exploratory Trial of Transdermal Nicotine for Aggression and Irritability in Adults with Autism Spectrum Disorder.We explored the feasibility, tolerability, and preliminary efficacy of targeting nicotinic acetylcholine receptors (nAChRs) using transdermal nicotine to reduce aggressive symptoms in adults with ASD. All participants tolerated nicotine treatment well. Aberrant Behavior Checklist-Irritability (ABC-I) subscale change from baseline, was improved by nicotine compared to placebo. Sleep ratings were also improved by nicotine and correlated with ABC-I improvement. These findings support further investigation of nAChR agonists for aggression and sleep in ASD.”

Exploring sleep quality of young children with autism spectrum disorder and disruptive behaviors.Sleep disturbances in autism spectrum disorder (ASD) are common and may impair daytime functioning as well as add to parental burden. The study findings add strong support for the need to screen for sleep disturbances in all children with ASD, regardless of age and cognitive level. Poor sleepers exhibited significantly greater daytime behavioral problems and parents of children in this group reported significantly higher levels of stress. Above and beyond the co-occurring disruptive behavior, poor sleep quality appears to pose substantial additive burden on child and parents.”

Prevalence of Co-occurring Medical and Behavioral Conditions/Symptoms Among 4- and 8-Year-Old Children with Autism Spectrum Disorder in Selected Areas of the United States in 2010.We compared the prevalence of various medical and behavioral co-occurring conditions/symptoms between 4- and 8-year-olds with autism spectrum disorder (ASD) from five sites in the Autism and Developmental Disabilities Monitoring Network during the 2010 survey year, accounting for sociodemographic differences. Over 95% of children had at least one co-occurring condition/symptom. Overall, the prevalence was higher in 8- than 4-year-olds for 67% of co-occurring conditions/symptoms examined. Further, our data suggested that co-occurring conditions/symptoms increased or decreased the age at which children were first evaluated for ASD. Similarly, among the 8-year-olds, the prevalence of most co-occurring conditions/symptoms was higher in children with a previous ASD diagnosis documented in their records. These findings are informative for understanding and screening co-occurring conditions/symptoms in ASD.”

Alterations in plasma cytokine levels in chinese children with autism spectrum disorder.Alteration of immune system function is an important risk factor for autism spectrum disorder (ASD). Here we found that the levels of cytokines, including Eotaxin, TGF-β1 and TNF-α, are elevated in Chinese children with ASD, as compared to typically developing children. The change in TGF-β1 level was most prominent in boys, while that of Eotaxin was more significant in girls. These results provide evidence for changes in cytokine profile in Chinese children with ASD.”

Maternal cytomegalovirus sero-positivity and autism symptoms in children.We tested whether maternal CMV and/or HSV2 sero-positivity was associated with ASD symptoms in children. The children of mothers sero-positive for CMV, but not for HSV2, had SRS-2 scores 3.6-4.2 points higher, depending on the adjustment model, than sero-negative women, a significant finding, robust to several statistical adjustments. Our results suggest that maternal CMV infections may influence ASD symptoms.

Dying before their time: Addressing premature mortality among autistic people. Full article. “People with autism think about killing themselves and die from suicide at a horrifying rate. Small studies find that 20%–40% of adults with autism have considered killing themselves and 15% report making at least one attempt. A large Swedish cohort study found that adults with autism are nine times more likely to die from suicide than other adults. Studies of children with autism find that 11% have suicidal ideation and 4%–7% have made suicide attempts, and the risk of making a suicide attempt is six times that of other children. The risk of early mortality from all causes among people with autism is nearly twice that of the general population. Those with autism and no accompanying learning disability die an average of 16 years earlier. Those with autism and intellectual or learning disabilities die an average of 30 years earlier.”

Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis.We found that the rates of depressive disorders are high among individuals with ASD. Compared to typically developing individuals, individuals with ASD are 4-times more likely to experience depression in their lifetime. These results suggest that individuals with ASD should be regularly screened and offered treatment for depression.

February 2018

ω-3 and ω-6 Fatty Acid Supplementation May Reduce Autism Symptoms Based on Parent Report in Preterm Toddlers. Full text. “This pilot trial confirmed adequate numbers of children enrolled and participated fully in the trial. No safety concerns were noted. It also found clinically-significant improvements in ASD symptoms for children randomly assigned to receive Omega-3-6-9 Junior, but effects were confined to one subscale.”

Characteristics of Children Prescribed Antipsychotics: Analysis of Routinely Collected Data. Full article. “Antipsychotics are licensed for psychosis and are also prescribed for behavior control. This study aims to examine characteristics and outcomes of children prescribed antipsychotics. Antipsychotics are predominantly used for those with intellectual difficulty/autism rather than those with a psychotic diagnosis. There is evidence that rates of respiratory disease, epilepsy, and diabetes are also higher postantipsychotic use for all. In those with intellectual difficulty/autism, hospital-admitted depression and injury are higher postantipsychotic use. The use of antipsychotics for behavioral management is likely to have increased cost implications to the healthcare system.”

Propranolol for treating emotional, behavioural, autonomic dysregulation in children and adolescents with autism spectrum disorders.This review sought to appraise the use of propranolol as a pharmacological alternative when managing emotional, behavioural and autonomic dysregulation (EBAD) and other symptoms. From the eight single-dose clinical trials, propranolol led to significant improvements in cognitive performance – verbal problem solving, social skills, mouth fixation, and conversation reciprocity; and changes in neural correlates – improvement in semantic networks and functional connectivity. The remaining eight case series and single case reports showed improvements in EBAD, anxiety, aggressive, self-injurious and hypersexual behaviours. Additionally, propranolol significantly improved similar behavioural domains (aggression and self-injury) for those with acquired brain injury.”

Untangling the most probable role for vitamin D3 in autism. Full article. “Recent studies indicate an important role for vitamin D3 in autism spectrum disorder (ASD), although its mechanism is not completely understood. Combined with the exponential increasing rates of ASD around the world, these observations suggest a contagious disease is probably transferred to the fetus via the placenta becoming infected by a cervical virus. Vitamin D3 boosts immune responses clearing viral infections and increases serotonin and estrogen brain levels. Here we review the different roles and untangle the most probable one vitamin D3 plays in ASD.”

Protective role of alpha-lipoic acid in impairments of social and stereotyped behaviors induced by early postnatal administration of thimerosal in male rat.The results of this preclinical study, consistent with previous studies on mice and rats, reveals that neonatal dose-dependent exposure to Thimerosal mimicking the childhood vaccine schedule can induce abnormal social interactions and stereotyped behaviors similar to those observed in neurodevelopmental disorders such as autism, and, for the first time, revealed that these abnormalities may be ameliorated by ALA. This indicates that ALA may protect against mercurial-induced abnormal behaviors.”

Evidence the U.S. autism epidemic initiated by acetaminophen (Tylenol) is aggravated by oral antibiotic amoxicillin/clavulanate (Augmentin) and now exponentially by herbicide glyphosate (Roundup). Full article. “Two toxins most implicated in the U.S. autism epidemic are analgesic/antipyretic acetaminophen (Tylenol) and oral antibiotic amoxicillin/clavulanate (Augmentin). Recently herbicide glyphosate (Roundup) was exponentially implicated. What do these toxins have in common? Acetaminophen depletes sulfate and glutathione required to detoxify it. Oral antibiotics kill and glyphosate inhibits intestinal bacteria that synthesize methionine (precursor of sulfate and glutathione, and required to methylate DNA), bacteria that synthesize tryptophan (sole precursor of neuroinhibitor serotonin), and bacteria that restrain ammonia-generating anaerobes. Sulfate plus glutathione normally sulfate fetal adrenal androgen dehydroepiandrosterone to DHEAS – major precursor of placental/postnatal estrogens. Glyphosate (and heavy metals) also inhibit aromatase that turns androgens to estrogens. Placental/postnatal estrogens dehydrate/mature brain myelin sheaths, mature corpus callosum and left hemisphere preferentially, dilate brain blood vessels, and elevate brain serotonin and oxytocin. Stress-induced weak androgens and estrogen depletion coherently explain white matter asymmetry and dysconnection in autism, extreme male brain, low brain blood flow, hyperexcitability, social anxiety, and insufficient maternal oxytocin at birth to limit fetal brain chloride/water and mature GABA.”

Toxoplasmosis, but not borreliosis, is associated with psychiatric disorders and symptoms. Full text. “Infection by the parasite Toxoplasma, which affects about 33% of world population, is associated with increased risk of several mental health disorders, the most strongly with schizophrenia. The typical symptom associated with toxoplasmosis was anxiety, and the typical toxoplasmosis-associated disorders were autism, schizophrenia, attention deficit hyperactivity disorder, Asperger syndrome, antisocial personality disorder, OCD, and anxiety disorder.”

Mitochondrial dysfunction and autism: comprehensive genetic analyses of children with autism and mtDNA deletion. Full article. “Mitochondrial DNA (MtDNA) alterations are more common in patients with ASD than in control individuals. MtDNA deletions are not isolated genetic alterations found in ASD; they coexist either with other ASD-associated genetic risk factors or with alterations in genes responsible for intergenomic communication. These findings indicate that mitochondrial dysfunction is not rare in ASD. The occurring mtDNA deletions in ASD may be mostly a consequence of the alterations of the causative culprit genes for autism or genes responsible for mtDNA maintenance, or because of the harmful effect of environmental factors.”

Effects of L- Carnosine Supplementation on Sleep Disorders and Disease Severity in Autistic Children: A Randomized, Controlled Clinical Trial.Carnosine acts as an antioxidant, antitoxic and neuroprotective agent. The aim of this trial study was to examine the effects of carnosine supplementation on the sleep disorders and severity of autism core symptoms in autistic patients. Carnosine supplementation did not change anthropometric indices and showed no effect on autism severity, whereas it significantly reduced sleep duration, parasomnias and total sleep disorders score by 7.59% when compared with the control group. The results suggest that carnosine supplementation could be effective in improving sleep disturbances, in particular sleep duration and parasomnias subscales.”

A pilot study of high-dose intravenous immunoglobulin 5% for autism: Impact on autism spectrum and markers of neuroinflammation.Since research has demonstrated a link between autism spectrum disorder (ASD) and immune dysfunction, this study investigated the efficacy and tolerability of intravenous immunoglobulin (IVIG) infusion in children with ASD. Fourteen patients received IVIG treatment and were assessed using standardized cognitive and behavioral tests. Following treatment with IVIG, significant improvement was observed across several subscales of the clinical tests and significant reductions were seen in the markers of neuroinflammation. These data suggest that inflammatory etiologies may play a role in select cases of autism, and IVIG treatment may exert a positive impact on behaviors and markers of inflammation in ASD.”

Scurvy as a mimicker of osteomyelitis in a child with autism spectrum disorder. Full article. “We describe a case of scurvy in a 10-year-old boy with autism spectrum disorder. His clinical presentation was initially thought to be due to osteomyelitis, for which empirical antimicrobial therapy was initiated. Further invasive and ultimately unnecessary investigations were avoided when scurvy was considered in the context of a restricted diet and classic signs of vitamin C deficiency. Infectious Diseases specialists should be aware of scurvy as an important mimicker of osteoarticular infections when involved in the care of patients at risk for nutritional deficiencies.

A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder.Children administered a modified ketogenic gluten-free diet with supplemental MCT significantly improved core autism features assessed from the ADOS-2 after 3 months on diet.”

Aluminium in brain tissue in autism. Full article. “Human exposure to the environmental toxin aluminium has been linked, if tentatively, to autism spectrum disorder. We have also used an aluminium-selective fluor to identify aluminium in brain tissue using fluorescence microscopy. The aluminium content of brain tissue in autism was consistently high. The mean (standard deviation) aluminium content across all 5 individuals for each lobe were 3.82(5.42), 2.30(2.00), 2.79(4.05) and 3.82(5.17) μg/g dry wt. for the occipital, frontal, temporal and parietal lobes respectively. These are some of the highest values for aluminium in human brain tissue yet recorded and one has to question why, for example, the aluminium content of the occipital lobe of a 15year old boy would be 8.74 (11.59) μg/g dry wt.? While aluminium was imaged associated with neurones it appeared to be present intracellularly in microglia-like cells and other inflammatory non-neuronal cells in the meninges, vasculature, grey and white matter. The pre-eminence of intracellular aluminium associated with non-neuronal cells was a standout observation in autism brain tissue and may offer clues as to both the origin of the brain aluminium as well as a putative role in autism spectrum disorder.”

Nutrition and Bone Density in Boys with Autism Spectrum Disorder.Boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. Our aim was to examine macro- and micronutrient intakes and self-reported physical activity in boys with ASD compared to TDC and the relationship of these variables with BMD. Compared to typically developing controls, boys with ASD had lower protein, calcium, and phosphorus intakes, activity levels, and BMD z scores at the lumbar spine, femoral neck, total hip, and whole body less head. Protein, calcium, and phosphorus intakes were associated positively with BMD.”

Safety and Observations from a Placebo-Controlled, Crossover Study to Assess Use of Autologous Umbilical Cord Blood Stem Cells to Improve Symptoms in Children with Autism.The aim of this exploratory study was to assess the safety and clinical effects of autologous umbilical cord blood (AUCB) infusion in children with idiopathic autism spectrum disorder (ASD). There were no serious adverse events. There were trends toward improvement, particularly in socialization, but there were no statistically significant differences for any endpoints. The results of this study suggest that autologous umbilical cord infusions are safe for children with ASD.”

Folate receptor autoantibodies are prevalent in children diagnosed with autism spectrum disorder, their normal siblings and parents.Folate is an essential nutrient during fetal and infant development. Autoantibodies against the folate receptor alpha can block folate transport from the mother to the fetus and to the brain in infants. Children diagnosed with autism and their immediate family members were evaluated for the prevalence of folate receptor autoantibodies. The autoantibody was highly prevalent in affected families with similar distribution in parents, normal siblings and affected children. The presence of these antibodies appears to have a familial origin and may contribute to developmental deficits when combined with other factors.”

Use of N-Acetylcysteine in Psychiatric Conditions among Children and Adolescents: A Scoping Review. Full article. “Because of its antioxidant and glutamate modulating properties, the NAC has become a focus of interest in recent studies designed to investigate the treatment options for the core symptoms of ASD and comorbid irritability. Although the evidence available to date for its therapeutic activity is marred by low statistical power, the NAC may be a potential treatment option as an adjunct to antipsychotics in efforts to improve symptoms of irritability.”

Butyrate enhances mitochondrial function during oxidative stress in cell lines from boys with autism. Full article. “Butyrate (BT) is a ubiquitous short-chain fatty acid (SCFA) principally derived from the enteric microbiome. BT positively modulates mitochondrial function, including enhancing oxidative phosphorylation and beta-oxidation and has been proposed as a neuroprotectant. BT and other SCFAs have also been associated with autism spectrum disorders (ASD), a condition associated with mitochondrial dysfunction.

Gastrointestinal symptoms and autism spectrum disorder: links and risks – a possible new overlap syndrome. Full article. “According to current recommendations, children with ASD are at risk of having alimentary tract disorders. GI symptoms may overlap with ASD core symptoms through different mechanisms. Shared pathogenetic factors and pathophysiological mechanisms may possibly link ASD and GI disturbances as shown by most recent studies. Unexplained worsening of nonverbal behaviors such as agitation, anxiety, aggression, self-injury, or sleep deprivation should alert caregivers, physicians, and other professionals about this possibility. This may speed up the diagnosis and treatment commencement, and alleviate both GI and ASD symptoms through reducing pain, stress, or discomfort by treating the comorbid disorder.”

January 2018

Alterations of oral microbiota distinguish children with autism spectrum disorders from healthy controls.The role of the oral microbiota in ASD remains unexplored. We demonstrated that the salivary and dental microbiota of ASD patients were highly distinct from those of healthy individuals. Lower bacterial diversity was observed in ASD children compared to controls, especially in dental samples.”

Do You C What I C: Emergency Department Evaluation and Diagnosis of Pediatric Scurvy in an Autistic Child With a Restricted Diet.Here, we report a case of pediatric scurvy in an 11-year-old autistic child with a restricted diet who presented with refusal to walk, fatigue, a purpuric rash, and gingival bleeding. The diagnosis was made based on diet history, physical examination findings, and symptom resolution with vitamin C supplementation. Our case report reaffirms that vitamin C deficiency still occurs and should be considered in children with restrictive diets. Early recognition of this disease by physicians provides early diagnosis, avoids costly diagnostic workup and hospitalization, and expedites effective treatment.”

Mild prenatal hypoxia-ischemia leads to social deficits and central and peripheral inflammation in exposed offspring.Hypoxic-ischemic encephalopathy (HIE) resulting from intrauterine or perinatal hypoxic-ischemia (HI) is a leading cause of long-term neonatal neurodisability. While most studies of long-term outcome have focused on moderate and severe HIE in term infants, recent work has shown that those with mild HIE may have subtle neurological impairments. Here we show that mild HI insult alters behaviour, inflammation and the corticosterone stress response in a rat model of pre-term HIE. Mild HI exposure led to social deficits in exposed offspring at postnatal day 30. This was also accompanied by elevations in circulating adrenocorticotropic hormone and corticosterone indicating an exaggerated stress response. In summary we find that a mild HI exposure leads to social deficits, central and peripheral inflammation, and an abnormal corticosterone response which are three core features of autism spectrum disorder.”

Fecal calprotectin levels correlate with main domains of the autism diagnostic interview-revised (ADI-R) in a sample of individuals with autism spectrum disorders from Slovakia. Full text. “There is convincing evidence that the intestinal inflammation is involved in etiology of ASD. Increased levels of inflammatory markers were shown to be associated with more aberrant behaviors and communication of subjects with ASD. Calprotectin in the feces is produced by activated neutrophils and epithelial cells of the gut mucosa, and its levels reflect local inflammation of the gastrointestinal tract. In the group with ASD significant correlations of fecal calprotectin with all domains of the ADI-R diagnostic tool were found: qualitative abnormalities in reciprocal social interaction and communication, restrictive and repetitive patterns of behavior. Results suggest that low grade intestinal inflammation may be one of factors implicated in the pathophysiology of ASD.”

The Relationship between Autism Spectrum Disorder and Melatonin during Fetal Development. Full text. “The properties of melatonin have been reported by a number of researchers. This hormone plays multiple roles, including neuroprotection and circadian entraining. Normal melatonin concentrations during pregnancy aid in neuroprotection and normal neurodevelopment of the fetus through the inhibition of excessive oxidative stress in the vulnerable central nervous system. Additionally, as the normal sleep pattern and circadian rhythm are maintained by sufficient melatonin levels, normal melatonin secretion may also influence neurodevelopment. Eventually, the well-known functions of melatonin in neuroprotection and circadian entraining may reduce the risk of ASD. Moreover, the prevalence of circadian disturbances in individuals with ASD suggests that circadian rhythm may a predictive indicator of ASD.”

Prenatal paracetamol exposure and child neurodevelopment: A review.The non-prescription medication paracetamol (acetaminophen, APAP) is currently recommended as a safe pain and fever treatment during pregnancy. However, recent studies suggest a possible association between APAP use in pregnancy and offspring neurodevelopment. A review of publications reporting associations between prenatal APAP use and offspring neurodevelopmental outcomes. These nine studies suggest an increased risk of adverse neurodevelopmental outcomes following prenatal APAP exposure. Given the current findings, pregnant women should be cautioned against indiscriminate use of APAP.”

Genetic and clinical evidence of mitochondrial dysfunction in autism spectrum disorder and intellectual disability.Clinical conditions commonly associated with mitochondrial disorders (CAMDs) are often present in autism spectrum disorders (ASD) and intellectual disability (ID). Subjects with ASD and ID showed higher frequencies of constipation, edema, seizures, vision alterations, strabismus and sphincter incontinence than HCs subjects.”

Vitamin A and vitamin D deficiencies exacerbate symptoms in children with autism spectrum disorders.Higher proportions of children with picky eating, resistance to new foods, and eating problems were observed in the ASD group when compared with the control group. Serum retinol and 25-OH vitamin D levels in autistic children were significantly lower than those in the control children. Additionally, VA [vitamin A] and VD [vitamin D] co-deficiency impacts more on the symptoms and development in autistic children.”

Relationships between autism spectrum disorder and intolerance of uncertainty.Youth with ASD without co-occurring intellectual disability experience high levels of intolerance of uncertainty (IU), which is related to anxiety. This study found that IU may also have a relationship with certain aspects of ASD, particularly emotion dysregulation.”

Immune Abnormalities in Autism Spectrum Disorder-Could They Hold Promise for Causative Treatment? Full article. “Several studies hypothesize a role for neuroinflammation in ASD and are supported by brain tissue and cerebrospinal fluid analysis, as well as evidence of microglial activation. It has been shown that immune abnormalities occur in a substantial number of individuals with ASD. Identifying subgroups with immune system dysregulation and linking specific cellular immunophenotypes to different symptoms would be key to defining a group of patients with immune abnormalities as a major etiology underlying behavioral symptoms. This review summarizes recent insights into immune system dysfunction in individuals with ASD and discusses the potential implications for future therapies.”

Association of Maternal Use of Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of Autism Spectrum Disorder in Offspring. Full article. “Maternal exposure to folic acid and multivitamin supplements before and during pregnancy is associated with a reduced risk of ASD in the offspring compared with the offspring of mothers without such exposure.”


December 2017

Scurvy: When it is a Forgotten Illness the Surgery Makes the Diagnosis. Full text. “Unlike most of animal species, human beings lack the enzymatic process for the conversion of glucose to ascorbic acid (vitaminC), and therefore getting the vitamin from food sources is essential. The association of the various signs caused by a deficiency of vitamin C is called scurvy or Barlow’s disease, an easily treatable disease but can be fatal. It is rare in the developed countries and even economically underdeveloped societies in which the basic diet is already rich in ascorbate. Recent studies of sporadic cases report a high incidence of scurvy in children with autism or psychomotor retardation and the fact that musculoskeletal manifestations are more common. The mosaics of the symptoms of scurvy are varied and include dermatological, dental, bone and systemic manifestations, making it a forgotten and misdiagnosed illness. A heightened awareness is needed to avoid an unnecessary surgery, unnecessary tests and procedures and to be able to start treatment for a potentially fatal but easily curable disease.”

Mitochondrial Etiology of Neuropsychiatric Disorders.Considerable biochemical evidence has accumulated revealing mitochondrial defects associated with neuropsychiatric diseases. Inherited and acquired mtDNA mutations have recently been associated with autism spectrum disorder, which parallels previous evidence of mtDNA variation in other neurological diseases. Therefore, mitochondrial dysfunction may be central to the etiology of a wide spectrum of neurological diseases. The mitochondria and the nucleus communicate to coordinate energy production and utilization, providing the potential for therapeutics by manipulating nuclear regulation of mitochondrial gene expression.”

Identification of the Antigenic Epitopes of Maternal Autoantibodies in Autism Spectrum Disorders.Several groups have described the presence of fetal brain-reactive maternal autoantibodies in the plasma of some mothers whose children have autism spectrum disorder (ASD). To further understand the binding repertoire of the maternal autoantibodies, as well as the presence of any meaningful differences with respect to the recognition and binding of these ASD- specific autoantibodies to each of these neuronal autoantigens, we utilized overlapping peptide microarrays incubated with maternal plasma samples obtained from the Childhood Autism Risk from Genetics and Environment (CHARGE) Study. Results suggest that there are differences in the binding repertoire between the antigen positive ASD and TD maternal samples. Further, the autoantibodies in plasma from mothers of children with ASD bound to a more diverse set of peptides, and there were specific peptide binding combinations observed only in this group. Future studies are underway to determine the critical amino acids necessary for autoantibody binding, which will be essential in developing a potential therapeutic strategy for maternal autoantibody related (MAR) ASD.”

DHA mitigates autistic behaviors accompanied by dopaminergic change in a gene/prenatal stress mouse model.Using the mouse model, we examined autistic-like behaviors in greater detail, and additionally explored whether diet supplementation with docosahexaenoic acid (DHA) may mitigate the behavioral changes. he results indicate that autism-associated behaviors and changes in the dopaminergic system in this setting can be mitigated with DHA supplementation.”

Comprehensive Management of Autism: Current Evidence. Full text. “Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and nonverbal communication, and restricted repetitive behavior. The goals of treatment are to target core behaviors, improve social interactions and communication, and reduce disruptive behavior. The present paper discusses the role of applied behavioral analysis and pharmacotherapy.”

Herbal Medicine as an Alternative Treatment in Autism Spectrum Disorder: A Systematic Review. Full text. “This review focuses on the efficacy and safety of herbal medicines in the management of autism spectrum disorder (ASD) in humans and animals. All human and animal studies on the effects of herbs with the key outcome of change in autism symptoms were included. Preclinical studies using critically validated models were conducted, with some promising preliminary results. Data availability on controlled clinical studies is currently very limited. The use of different methodologies and the very small number of patients raise doubts about the effects of these preparations. Available data do not yet allow us to suggest the effectiveness of herbal medicines as an add-on in the treatment of ASD symptoms.

Is food refusal in autistic children related to TAS2R38 genotype?A variation of the gene TAS2R38, associated with bitter taste sensitivity, can cause a different perception of some foods. In particular, some children are hypersensitive to bitterness and show a more restricted repertoire of accepted foods. We evaluate bitter sensitivity in ASD children with or without food selectivity, through a simple bitter taste test with edible strips. The results show that food refusal in ASD children can be mediated by bitter taste sensitivity thus suggesting that the bitter sensitivity test may be used as a device to orientate tailored food proposals for the practical management of food selectivity in ASD.”

High prevalence of diabetes mellitus, hypertension and obesity among persons with a recorded diagnosis of intellectual disability or autism spectrum disorder.Compared with the general population, men and women with ID/ASD had 1.6-3.4-fold higher age-adjusted odds of having a registered diagnosis of obesity or diabetes mellitus. A registered diagnosis of hypertension was only more common among men with ID/ASD than in the general population. Diabetes and blood pressure health screening, along with efforts to prevent development of obesity already in childhood, are necessary for individuals with IDs and ASD.

Association of Folic Acid Supplementation During Pregnancy With the Risk of Autistic Traits in Children Exposed to Antiepileptic Drugs In Utero.To explore whether folic acid supplementation and folate status in pregnancy are associated with reduced risk of autistic traits owing to in utero AED [antiepileptic drug] exposure. Risk of autistic traits in children exposed to AEDs in utero may be mitigated by periconceptional folic acid supplementation and folate status. Fertile women using AEDs should take folic acid supplements continuously.”

Dental amalgam fillings and the use of technological devices as an environmental factor: Updating the cumulative mercury exposure-based hypothesis of autism. Full text. “There has been a lot of controversy in the past regarding the association of thimerosal, mercury (Hg)-containing preservative in vaccines, and the increased probability of developing autism among children. With the lack of information concerning amalgam hazards, it has been suggested that the traces of Hg found in dental fillings could be considered safe; however, this may not be true since the link between Hg exposure and autism also needs to include the individual’s susceptibility. In 2011, as a more consensual theory, we alternatively proposed the “cumulative Hg exposure-based hypothesis” which considers not only one but the total contribution of different environmental sources of this element, such as (i) maternal amalgam fillings, (ii) pollution, (iii) food, and also (iv) thimerosal-preserved vaccines together with a genetic/biochemical susceptibility to remove Hg from the body. Common technological devices (e.g., mobile phones, mobile base stations, and magnetic resonance imaging machines and other wireless devices) produce electromagnetic fields (EMFs). Neurobehavioral and neurodevelopmental symptoms such as retarded memory, learning, cognition, and attention have been attributed to EMF exposure. A recent in vivo study observed autism-relevant social abnormalities in mice exposed to extremely low-frequency EMFs during perinatal development. These recent evidence (2014), far from being conflictive, is consistent with our previous cumulative Hg exposure-based hypothesis of ASD (2011) and could be included as the fifth (v) additional environmental factor, synergistically contributing to the release of Hg in mothers with dental amalgam fillings, and increasing the probability of developing and/or aggravating autism among children.”

Targeting gut microbiome: A novel and potential therapy for autism.Children with neurodevelopmental disorder, including ASD, are regularly affected by gastrointestinal problems and dysbiosis of gut microbiota. A large body of preclinical literature indicates that gut microbiome plays an important role in the bidirectional gut-brain axis that communicates between the gut and central nervous system. Moreover, accumulating evidences suggest that the gut microbiome is involved in the pathogenesis of ASD. The present review introduces the increasing evidence suggesting the reciprocal interaction network among microbiome, gut and brain. It also discusses the possible mechanisms by which gut microbiome influences the etiology of ASD via altering gut-brain axis. Most importantly, it highlights the new findings of targeting gut microbiome, including probiotic treatment and fecal microbiota transplant, as novel and potential therapeutics for ASD diseases.”

Differences in fecal microbial metabolites and microbiota of children with autism spectrum disorders.Evidence supporting that gut problems are linked to ASD symptoms has been accumulating both in humans and animal models of ASD. Gut microbes and their metabolites may be linked not only to GI problems but also to ASD behavior symptoms. Despite this high interest, most previous studies have looked mainly at microbial structure, and studies on fecal metabolites are rare in the context of ASD. Of the 59 metabolites detected, isopropanol concentrations were significantly higher in feces of children with ASD after multiple testing corrections. We also observed similar trends of fecal metabolites to previous studies; children with ASD have higher fecal p-cresol and possibly lower GABA concentrations. In addition, the data suggests that a group of metabolites-caprate, nicotinate, glutamine, thymine, and aspartate-may potentially function as a modest biomarker to separate ASD participants from the neurotypical group (78% sensitivity and 81% specificity). Despite a relatively short list of fecal metabolites, the data in this study support that children with ASD have altered metabolite profiles in feces when compared with neurotypical children and warrant further investigation of metabolites in larger cohorts.

Occurrence of glyphosate and AMPA residues in soy-based infant formula sold in Brazil.Glyphosate is an herbicide widely used in the world, being applied in several crops, among them soybeans. Recently, glyphosate and its metabolite aminomethylphosphonic acid (AMPA) have been identified as possible contributors to the emergence of various diseases such as autism, Parkinson’s and Alzheimer’s diseases, as well as cancer. The child population consuming cereal-based foods is the most exposed to the effects of pesticides because of their developmental phase and they have a higher food intake per kilogram of body weight than adults. Glyphosate and AMPA were determined by liquid chromatography with fluorescence detection. The method was validated and showed accuracy and precision with a limit of quantification (LOQ) of 0.02 mg kg-1. Among those samples that contained levels above the LOQ, the variation of glyphosate residues was from 0.03 mg kg-1 to 1.08 mg kg-1 and for AMPA residues was from 0.02 mg kg-1 to 0.17 mg kg-1.”

Characteristics Associated with Drug Prescription and Compliance Among Young Children with Autism Spectrum Disorder.Psychotropic drugs are prescribed to people with autism spectrum disorder (ASD) usually as a means to alleviate comorbidities associated with the disorder. However, despite the uncertainty regarding the efficacy of these treatments for ASD, their prevalence is continuously increasing. A total of 122 prescriptions were made for 75 children in our sample. Drug prescription was significantly associated with the severity of ASD and the types of comorbidity (p < 0.05). Atypical antipsychotic drugs were the most prevalent drugs (49 children; 23.2%), followed by stimulants (28 children; 13.2%) and first-generation antipsychotic drugs (16 children; 7.6%). The average CR [Compliance rate] in our sample was 75% ± 3% with about half of the children demonstrating full compliance, and less than fifth of them not complying at all with their drug prescription. CR had a positively linear association with ASD severity at a marginal statistical significance.”

Correlation between serum 25-hydroxyvitamin D level and core symptoms of autism spectrum disorder in children. Article in Chinese. “Serum 25-hydroxyvitamin D level in children with ASD is obviously lower than that in the healthy control group, and there are negative correlations between vitamin D levels and core symptoms of ASD.”

Association between behavioral problems and gastrointestinal disorders among children with autism spectrum disorder. Article in Chinese. “Children with ASD have higher risk of GID than the normal developing children. While the stereotyped behaviors, problem behaviors and emotional problems are severer in the ASD children with GID. Hence, it is important to provide comprehensive treatment and management for these groups of children.”

Association between maternal hypothyroidism and autism spectrum disorders in the children.Children of hypothyroid women had higher ASD rates than children of women without the diagnosis. This occurred in women diagnosed prior to as well as during pregnancy. Maternal hypothyroidism was associated with ASD for both boys and girls. Of women with a diagnosis of hypothyroidism during pregnancy, normal TSH and fT4 levels were not associated with increased risk of ASD in the children.”

Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014-2016. Full text. “Key findings Data from the National Health Interview Survey ● During 2014-2016, the prevalence of children aged 3-17 years who had ever been diagnosed with a developmental disability increased from 5.76% to 6.99%. ● During this same time, the prevalence of diagnosed autism spectrum disorder and intellectual disability did not change significantly. ● The prevalence of autism spectrum disorder, intellectual disability, other developmental delay, and any developmental disability was higher among boys compared with girls.”

Systematic Review and Meta-Analysis of Reported Adverse Events of Long-term Intranasal Oxytocin Treatment for Autism Spectrum Disorder.Recent studies suggested oxytocin as a possible drug to treat social deficits caused by Autism Spectrum Disorder (ASD), but the safety of intranasal oxytocin in autistic patients is not established. The aim of this review was to characterise the side effect profile of long-term intranasal oxytocin in treatment of ASD compared to placebo. Of the 223 participants in the five included studies, 123 were given oxytocin and 100 given placebos. Nasal discomfort (14.3%), tiredness (7.2%), irritability (9.0%), diarrhoea (4.5%), and skin irritation (4.5%) were the most common adverse events. Five severe adverse events were reported, namely aggression (one in placebo, two in oxytocin) and seizures (one in placebo, one in oxytocin). Results from this systematic review supports intranasal oxytocin to be well tolerated and safe for use in ASD population.”

Quality of life and its related factors for adults with autism spectrum disorder. Participants with autism spectrum disorder scored significantly lower in all domains of quality of life than did the controls. Adults with autism spectrum disorder reported higher anxiety level, more loneliness, and higher scores on four sensory quadrants than neuro-typical adults. The predictors of the physical health domain were anxiety and sensation-sensitivity behaviors. Loneliness and sensation-sensitivity behaviors were predictive of the psychological health domain. Comorbid psychiatric disorders and loneliness were predictive of the social relationship domain.”

Childhood Ingestions of Environmental Toxins: What Are the Risks?Infants and children are at higher risk than adolescents and adults for exposure to environmental toxins via ingestion for a number of reasons: their smaller size (and proportionately larger dose of ingested toxins), their closer proximity to the ground, dirt, and indoor dust, their boundless curiosity and oral exploratory behaviors, pica habits that may persist into school-age for children with autism or other developmental delays, their proportionately larger daily water and milk intake, and food preferences that differ markedly from adolescents and adults. Children depend on adults to protect them and keep their home environment safe. Pediatric care providers can integrate environmental health topics into their well-child care practices, offering guidance and resources to parents concerned with reducing the risks to their children posed by hazards in their homes, daycare centers, preschools, schools, and the other environments in which they spend time.”

Exercise Effects for Children With Autism Spectrum Disorder: Metabolic Health, Autistic Traits, and Quality of Life.The experimental group showed beneficial effects on metabolic indicators (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol), autism traits, and parent-perceived quality of life. Our results provide support for exercise and physical activity, including basic coordination and strength exercises, as important therapeutic interventions for children with ASD.”

Maternal Immune Activation in Neurodevelopmental Disorders. Full text. “Converging lines of evidence from basic science and clinical studies suggest a relationship between maternal immune activation (MIA) and neurodevelopmental disorders such as autism spectrum disorder (ASD) and schizophrenia. The mechanisms through which MIA increases the risk of neurodevelopmental disorders have become a subject of intensive research. This review aims to describe how dysregulation of microglial function and immune mechanisms may link MIA and neurodevelopmental pathologies.”

Limp in a Child With Autism Spectrum Disorder. Full text. “This case serves as a reminder that even in an age where high-resolution imaging is readily available at our fingertips, one must not underestimate the importance of taking a detailed dietary history. In doing so, our patient was spared from invasive investigations including an MRI and the associated risks of a general anesthetic. Clinicians should maintain a high index of suspicion for nutritional deficiencies in patients with ASD. The high prevalence of nutritional deficiencies suggests that perhaps there is a role for screening for vitamin C deficiency and other nutritional deficiencies in at-risk populations and in children with unexplained anemia. Earlier identification of this child’s restrictive diet could have allowed for health care providers to intervene prior to the development of severe clinical manifestations of the disease.”

How do Parents Manage Irritability, Challenging Behaviour, Non-Compliance and Anxiety in Children with Autism Spectrum Disorders? A Meta-Synthesis. Full text. “Although there is increasing research interest in the parenting of children with ASD, at present, little is known about everyday strategies used to manage problem behaviour. We conducted a meta-synthesis to explore what strategies parents use to manage irritability, non-compliance, challenging behaviour and anxiety in their children with ASD. Approaches included: (1) accommodating the child; (2) modifying the environment; (3) providing structure, routine and occupation; (4) supervision and monitoring; (5) managing non-compliance with everyday tasks; (6) responding to problem behaviour; (7) managing distress; (8) maintaining safety and (9) analysing and planning. Results suggest complex parenting demands in children with ASD and problem behaviour.”

Sleep problems in children with autism spectrum disorder and intellectual disability without autism spectrum disorder.The objective of this study was to evaluate the sleep problems and their correlations in children with autism spectrum disorder (ASD), intellectual disability without ASD (ID), and typically developing children (TDC). Sleep disturbances are more frequent in children with ASD and ID than TDC. Co-sleeping with parents and family history of sleep problems increase the risk of sleep disturbances. Thus, behavioral techniques especially focusing on co-sleeping problems and focusing on parents’ sleep habits may improve the sleep disturbances in children with ID and ASD.”

Is exposure to aluminium adjuvants associated with social impairments in mice? A pilot study.Our group has shown that significant correlations exist between rates of Autism Spectrum Disorder (ASD) and total aluminum adjuvants given to children through vaccines in several Western countries. Aluminum injected mice showed diminished social interest compared to controls at week 8 and 17. They also demonstrated abnormal social novelty from controls at week 8 and week 29. This is the first experimental study, to our knowledge, to demonstrate that aluminum adjuvants can impair social behaviour if applied in the early period of postnatal development. The study, however, is insufficient to make any assertive claims about the link between aluminium adjuvants and ASD in humans.”

Documenting and Understanding Parent’s Intervention Choices for Their Child with Autism Spectrum Disorder.Understanding why parents choose some interventions but not others for their child with autism is important for a number of reasons. Estimating the proportion of evidence-based interventions engaged, identifying the agencies influencing parental decisions, and elucidating the barriers or reasons leading to intervention rejection or discontinuation can result in better service provision. New Zealand parents (n = 570) of a child with autism reported what interventions were being engaged, and why some interventions were engaged but not others. Funding was a major determinant of intervention engagement, while medical professionals exerted the most influence. Sources of support were not related to intervention engagement, but parental perceptions of their child’s symptom severity were. Finally, non-engagement does not necessarily reflect parental opposition to an intervention, but rather the existence of barriers.”

Treating Food Approval-Seeking Behavior: One Bite at a Time.The prevalence of feeding problems in children with autism is high. The current investigation was a treatment of a unique presentation of food-related prompt dependence with a 6-year-old boy with autism who was reliant upon approval from adults for consumption of every bite of food. Instructions were used to establish independent eating, in which the number of bites specified in the instruction was systematically increased. Independent bites increased from a baseline level of 0.67% to a final phase level of almost 100%, and the instruction was faded to “eat your lunch.”

Cytokine levels and associations with symptom severity in male and female children with autism spectrum disorder. Full text. Australian study. “Results showed a significant negative association between platelet-derived growth factor (PDGF)-BB, and the severity of ASD symptoms. Furthermore, a significant interaction with sex suggested a different immune profile for females compared to males. ASD symptom severity was negatively associated with levels of 4 cytokines, IL-1β, IL-8, MIP-1β, and VEGF, in females, but not in males. Results of the present study suggest that an altered cytokine response or profile is associated with the severity of ASD-related symptoms, with sex a potential modifier of this relationship.”

The Role of Omega-3 Fatty Acids in Developmental Psychopathology: A Systematic Review on Early Psychosis, Autism, and ADHD. Full text. “The trials included in this review varied in their durations, sample size and amounts of omega-3 PUFAs supplementation, therefore there is still uncertainty about the effects of these fatty acids on symptoms of ASD in children. In particular the three RCTs included have different duration (six weeks, six months and 16 weeks), while omega-3 PUFAs erythrocyte membranes may reach a steady state after six months and at least four months is needed to demonstrate an effect on cognitive performance. Even longer study periods of one year might be needed to demonstrate behavioral changes in response to omega-3 PUFAs supplementation. Given the importance of DHA in brain function and development, and its possible implications in the modulation of ASD symptoms, it is important to continue to investigate the positive effects of the supplementation. In this population, the dietary intake of omega-3 PUFAs rich foods is low due to a monotonous dietary pattern: the incorporation of DHA into cellular membranes may be therefore insufficient.”

The Metal Neurotoxins: An Important Role in Current Human Neural Epidemics? Full text. “Many published studies have illustrated that several of the present day neurological epidemics (autism, attention deficit disorder, Alzheimer’s) cannot be correlated to any single neurotoxicant. However, the present scientific examination of the numerous global blood monitoring databases for adults that include the concentrations of the neurotoxic elements, aluminum (Al), arsenic (As), lead (Pb), manganese (Mn), mercury (Hg), and selenium (Se) clearly indicate that, when considered in combination, for some, the human body may become easily over-burdened.”

Sleep patterns predictive of daytime challenging behavior in individuals with low-functioning autism.We analyzed over 20,000 nights of sleep from 67 individuals with autism to investigate whether daytime behaviors can be predicted from prior sleep patterns. Better-than-chance accuracy was obtained for 81% of individuals, with measures of night-to-night variation in sleep timing and duration most relevant for accurate prediction. Our results highlight the importance of regular sleep patterns for better daytime functioning and represent a step toward the development of ‘smart sleep technologies’ to pre-empt behavior in individuals with autism.”

November 2017

Prescribing Patterns in a Psychiatrically Referred Sample of Youth With Autism Spectrum Disorder.The aim of this study was to examine the pattern of psychopharmacologic interventions in a psychiatrically referred sample of youth with autism spectrum disorder (ASD). Psychiatrically referred youth with ASD suffered from multiple psychopathologies and had a marked level of morbidity. The most prevalent psychopathology was ADHD (83%), anxiety disorders (67%), bipolar spectrum disorder (43%), and mood disorder not otherwise specified (44%). The majority (80%) of the subjects received combination therapy (mean ± SD number of psychotropic medications = 3 ± 1.5). Half of the subjects reported an adverse event, most commonly weight gain (28%) and sedation (12%), both from antipsychotic medication use.”

Long-term perspectives of family quality of life following music therapy with young children on the autism spectrum: a phenomenological study.Mothers perceived long-term benefits to social relationships within the family, leading to perceived enrichment in child and family quality of life following music therapy sessions.”

Relationship Between Neonatal Vitamin D at Birth and Risk of Autism Spectrum Disorders: the NBSIB Study.Previous studies suggested that lower vitamin D might be a risk factor for autism spectrum disorders (ASDs). A total of 310 children were diagnosed as having ASDs; thus, the prevalence was 1.11%. The concentration of 25(OH)D3 in 310 ASD and 1240 controls were assessed. The median 25(OH)D3 level was significantly lower in children with ASD as compared to controls. Compared with the fourth quartiles, the relative risk (RR) of ASDs was significantly increased for neonates in each of the three lower quartiles of the distribution of 25(OH)D3, and increased risk of ASDs by 260%, 150%, and 90%, respectively. This model predicted the lowest relative risk of ID in the 72rd percentile (corresponding to 48.1 nmol/L of 25(OH)D3). Neonatal vitamin D status was significantly associated with the risk of ASDs and intellectual disability.”

The Association Between Child and Family Characteristics and the Mental Health and Wellbeing of Caregivers of Children with Autism in Mid-Childhood.We examined predictors of mental health difficulties and wellbeing in caregivers of children with autism in the Pre-school Autism Communication Trial cohort in middle childhood (N = 104). Child’s intellectual disability, daily living skills impairment, elevated emotional and behavioural difficulties, high educational level of caregiver and household income below the median significantly predicted caregivers’ mental health difficulties, but autism severity, child communication skills and family circumstances did not. Lower caregiver mental wellbeing was predicted by elevated child emotional and behavioural difficulties.”

Association of Autism Spectrum Disorders and Inflammatory Bowel Disease.Children with ASD were more likely to meet criteria for Crohn’s disease (CD) and Ulcerative colitis (UC) compared to controls. This higher prevalence of CD and UC in children with ASD compared to controls confirms the association of ASD with IBD.”

Parental Immunisation Needs and Attitudes Survey in paediatric hospital clinics and community maternal and child health centres in Melbourne, Australia.Despite high support for vaccination, 43% of parents reported vaccine concerns including the number of vaccines given in the first 2 years (25%), vaccine ingredients (22%), allergies (18%), weakening of the immune system (17%) and autism (11%). Despite high support for vaccines, nearly half of Australian parents have some concerns and a quarter lack vaccine decision-making confidence regarding childhood vaccines.”

Autism spectrum disorder and birth spacing: Findings from the study to explore early development (SEED).We investigated whether the amount of time between pregnancies was associated autism spectrum disorder (ASD) or other developmental disabilities (DD) in children. ASD was increased in second and later-born children who were conceived less than 18 months or 60 or more months after the mother’s previous birth.”

School Discipline, Hospitalization, and Police Contact Overlap Among Individuals with Autism Spectrum Disorder.The objective was to examine the frequency, correlates, and overlap of school disciplinary actions, psychiatric hospitalizations, and police contact among children and adolescents with autism. Survey results from 2525 caregivers of individuals with autism in elementary through high school were examined. Logistic regression was used to examine predictors of each outcome. Youth with autism most frequently experienced school disciplinary action (15.0%), followed by police contact (7.9%) and hospitalization (7.8%). Experiencing any one of the three events increased risk of experiencing either of the other events.”

Teaching reading comprehension to learners with autism spectrum disorder: Discrepancies between teacher and research-recommended practices.This study utilized survey methodology to gather perceptions and experiences of teachers and to compare teacher preparedness to use effective instructional practices emerging from the extant research to teacher-reported effective practices in the classroom. Study findings, based on 112 participants, reveal a discrepancy between teacher-reported effective practices, and the practices identified as effective through research, indicating a research to practice gap.”

Sexual Orientation in Autism Spectrum Disorder.Research suggests that individuals with Autism Spectrum Disorder (ASD) report increased homosexuality, bisexuality, and asexuality, but decreased heterosexuality. It is important to increase awareness about increased non-heterosexuality in ASD among autistic populations, medical professionals and care-takers, so as to provide specialized care, if needed and increase support and inclusion for non-heterosexual autistic individuals.”

Salivary α-amylase as a marker of stress reduction in individuals with intellectual disability and autism in response to occupational and music therapy.Here, in two independent studies, we examine how sessions consisting of occupational or music therapy, both widely recognised for their effectiveness, modulate levels of salivary α-amylase (sAA), a now time- and cost-efficient marker of stress, in individuals with intellectual disability and autism spectrum disorder. In comparison to control sessions, occupational therapy significantly dampened rises in sAA levels while music therapy significantly decreased baseline sAA levels, highlighting the ability of both types of therapy to reduce stress and by proxy contribute to enhancing overall well-being.”

Methylphenidate for children and adolescents with autism spectrum disorder. Full text. “We found that short-term use of methylphenidate might improve symptoms of hyperactivity and possibly inattention in children with ASD who are tolerant of the medication, although the low quality of evidence means that we cannot be certain of the true magnitude of any effect. There was no evidence that methylphenidate has a negative impact on the core symptoms of ASD, or that it improves social interaction, stereotypical behaviours, or overall ASD. The evidence for adverse events is of very low quality because trials were short and excluded children intolerant of methylphenidate in the test-dose phase. Future RCTs should consider extending the duration of treatment and follow-up.”

Initial evidence that non-clinical autistic traits are associated with lower income. Full text. “Among non-clinical samples, autistic traits correlate with a range of educational and social outcomes. However, previous work has not investigated the relationship between autistic traits and income, a key determinant of socio-economic status and well-being. We found a negative association between AQ [Autism Spectrum Quotient] and household income, which remained robust after controlling for age, gender, education, employment status, ethnicity, and socially desirable responding. These results provide initial evidence that income is negatively related to autistic traits among the general population.”

A psycho-legal perspective on sexual offending in individuals with autism Spectrum disorder.It is important to consider whether there are innate vulnerabilities that increase the risk of an individual with an autistic spectrum disorder (ASD), predominantly those defendants with a diagnosis of Asperger’s Syndrome, being charged and convicted of a sexual offence. The significance of such can be readily seen in recent English case law, with judgments on appeal finding convictions unsafe where there have been a number of failings in the Judge’s summing up. In this article, we will consider the gravity of Judges omitting to highlight a defendant’s diagnosis of autism spectrum disorder and the necessity of detailed explanations to jury members regarding the condition and its effect upon thoughts and behaviour. Recognition of the social impairments inherent in ASDs are vital to this work and we shall consider whether the difficulty with the capacity to develop appropriate, consenting sexual relationships as a result of impaired social cognition may be one of the factors which increases the risk of sexual offending in individuals with ASD.”

Postsecondary Expectations of High-School Students With Autism Spectrum Disorders. Full text. “This study examined the perceptions of adulthood among 31 high school students with autism spectrum disorder (ASD). We had two research aims: (1) to report students’ postsecondary expectations in terms of school, work, friendships and living arrangement and (2) to describe how our sample defined adulthood. The majority of students expected to attain traditional markers of adulthood after high school; however, for some the pathways to achieving these outcomes were narrowly defined and perceived as a rigid, linear process. Independence, maturity and personal responsibility were the most highly endorsed characteristics of adulthood, followed by chronological age and traditional markers. Implications for transition planning and adult services are discussed.”

The prevalence of gluten free diet use among preschool children with autism spectrum disorder.Gluten free diets (GFDs) are commonly used as an alternative therapy for autism spectrum disorder (ASD); however, the effectiveness is still uncertain which makes it important to know who tries this type of diet. We found that one in five preschool aged children with ASD had ever used a GFD. Children with gastrointestinal conditions and developmental regression were more likely to have tried a GFD.”

Parent disclosure of complementary health approaches used for children with autism spectrum disorder: Barriers and facilitators.Complementary health approaches (CHA) are widely used among children with autism spectrum disorder (ASD). As part of shared treatment decision-making, healthcare providers are encouraged to discuss CHA with parents of children with ASD. Yet prior research suggests that parents often do not disclose CHA used for children, and their reasons for nondisclosure are poorly understood. We, therefore, aimed to identify barriers and facilitators to parent disclosure of CHA used for children with ASD. We used content analysis to identify six main themes indicating that the following factors play a role in disclosure: parents’ drive to optimize their child’s health, parent self-efficacy discussing CHA with healthcare providers, parent beliefs about the effectiveness of CHA, parent-provider relationship quality, provider attitudes and knowledge regarding CHA and ASD, and visit characteristics.”

Neonatal and regressive forms of autism: Diseases with similar symptoms but a different etiology.Signs and symptoms of ASD often appear in the first year of life while the disease strikes other infants who had previously been developing normally at around 2years of age. Ozonoff and her colleagues recently suggested that there are three different pathways or trajectories for the development of ASD in infants 6-24months of age. I hypothesize that pathway 1 is caused by in utero insult/injury, pathway 2 by obstetric complications at birth, and pathway 3 by environmental triggers of ASD affecting infants 0-3years of age. Faster progress can be made in elucidating the underlying causes of neonatal and regressive forms of ASD if the diseases are investigated separately, instead of being part of the same disorder.”

Sulforaphane from Broccoli Reduces Symptoms of Autism: A Follow-up Case Series from a Randomized Double-blind Study. Full text. “After we completed the intervention phase of the original trial (2011-2013), many caregivers used over-the-counter dietary SF supplements in order to attempt to maintain improvements similar to those noted during the intervention. We periodically followed the progress of study participants through the summer of 2016. Many parents and caregivers articulated the positive effects of SF, both during the intervention phase and in the ensuing 3 years reported herein.”

Prevalence and Predictors of Non-Suicidal Self-Injury among Children with Autism Spectrum Disorder.To find the prevalence as well as to identify the predictors as protective and risk factors of Non-Suicidal Self-Injury (NSSI) among children with autism spectrum disorder (ASD). Statistical analysis indicated overall point prevalence of NSSI was 33%. Moreover banging/self-beating (47%), scratching (38), pinching (35%), picking scabs (33%), self-biting (32%), pulling hair (30%) and rubbing skin (19%) emerged as common forms of challenging behavior. Non-suicidal self-injury is a serious challenge among children with ASD.”

What do parents of children with autism expect from participation in research? A community survey about early autism studies.The large majority of parents showed positive attitudes overall, and these were associated with greater access to services, higher service quality ratings and higher rates of intellectual disability among their children. Parents valued the scientific goals of research, but half of parents also reported that an intervention component would be an essential prerequisite for them to participate in research. If enrolled in a study, parents were positive about most commonly used measures though less favourably disposed towards brain scans for children. They valued direct contact with the research team and openness in data sharing.”

Is High Folic Acid Intake a Risk Factor for Autism?-A Review. Full text. “In this review, we outline the reasons excess FA supplementation is a concern and review the history and effects of supplementation. We then examine the effects of FA on neuronal development from tissue culture experiments, review recent advances in understanding of metabolic functional blocks in causing ASD and treatment for these with alternative forms such as folinic acid, and finally summarize the conflicting epidemiological findings regarding ASD. Based on the evidence evaluated, we conclude that caution regarding over supplementing is warranted.”

Microbial Therapeutics Designed for Infant Health. Full text. “Acknowledgment of the gut microbiome as a vital asset to health has led to multiple studies attempting to elucidate its mechanisms of action. During the first year of life, many factors can cause fluctuation in the developing gut microbiome. Host genetics, maternal health status, mode of delivery, gestational age, feeding regime, and perinatal antibiotic usage, are known factors which can influence the development of the infant gut microbiome. Subsequently, microbial therapies have been introduced, in addition to suitable prebiotic ingredients, which when administered, may aid in the prevention of a microbial disturbance in the gastrointestinal tract. The aim of this mini-review is to highlight the beneficial effects of different probiotic and prebiotic treatments in early life, with particular emphasis on the different conditions which negatively impact microbial colonisation at birth.”

Autoimmunity as a Driving Force of Cognitive Evolution. Full text. “In the last decades, increasingly robust experimental approaches have formally demonstrated that autoimmunity is a physiological process involved in a large range of functions including cognition. On this basis, the recently enunciated “brain superautoantigens” theory proposes that autoimmunity has been a driving force of cognitive evolution. It is notably suggested that the immune and nervous systems have somehow co-evolved and exerted a mutual selection pressure benefiting to both systems. Brain superautoantigens may also constitute an Achilles heel responsible for the particular susceptibility of Homo sapiens to “neuroimmune co-pathologies” i.e., disorders affecting both neural and T-cell repertoires. These may notably include paraneoplastic syndromes, multiple sclerosis as well as autism, schizophrenia and neurodegenerative diseases.”

Binding of mycotoxins to proteins involved in neuronal plasticity: a combined in silico/wet investigation. Full text. “We have applied a combined computational procedure based on inverse and direct docking in order to identify putative protein targets of a panel of mycotoxins and xenobiotic compounds that can contaminate food and that are known to have several detrimental effects on human health. This procedure allowed us to identify a panel of human proteins as possible targets for aflatoxins, gliotoxin, ochratoxin A and deoxynivalenol. Steady-state fluorescence and microscale thermophoresis experiments allowed us to confirm the binding of some of these mycotoxins to acetylcholinesterase and X-linked neuroligin 4, two proteins involved in synapse activity and, particularly for the second protein, neuronal plasticity and development. Considering the possible involvement of X-linked neuroligin 4 in the etiopathogenesis of autism spectrum syndrome, this finding opens up a new avenue to explore the hypothetical role of these xenobiotic compounds in the onset of this pathology.”

Vitamin A Improves the Symptoms of Autism Spectrum Disorders and Decreases 5-Hydroxytryptamine (5-HT): a Pilot Study. Full text. “This study suggested that VA [vitamin A] supplementation may improve symptoms and reduce 5-HT levels in children with ASD, indicating that VA supplementation is a reasonable therapy at least for a subset of children with autism.”

Joint effects of prenatal air pollutant exposure and maternal folic acid supplementation on risk of autism spectrum disorder.We examined interactions between periconceptional folic acid (FA) and air pollution exposure on risk of ASD. Mothers exposed to higher levels of air pollution during the first trimester of pregnancy and who reported low supplemental FA intake during the first pregnancy month were at a higher ASD risk compared to mothers exposed to lower levels of air pollution and who reported high first month FA intake. Our results suggest that periconceptional FA intake may reduce ASD risk in those with high prenatal air pollution exposure.”

Prevalence and risk factors for autism spectrum disorder in epilepsy: a systematic review and meta-analysis.Current research supports a high prevalence of ASD in epilepsy. This study helps to define the clinical profile of patients with epilepsy who are at risk for ASD, which may help clinicians in early screening and diagnosis of ASD in this population. A meta-analysis of 19 studies showed a pooled ASD prevalence of 6.3% in individuals with epilepsy.”

Systematic Assessment of Research on Autism Spectrum Disorder (ASD) and Mercury Reveals Conflicts of Interest and the Need for Transparency in Autism Research. Full text. “This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to August 2015, finding that of the studies with public health and/or industry affiliation, 86% reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 21% find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest.”

Sensory Sensitivity and Food Selectivity in Children with Autism Spectrum Disorder.We compared oral sensory processing between children with and without ASD, ages 3-11 years. We also examined the relationships between atypical oral sensory processing, food selectivity, and fruit/vegetable consumption in children with ASD. We found that more children with ASD presented with atypical sensory processing than children without ASD. Among children with ASD, those with atypical oral sensory sensitivity refused more foods and ate fewer vegetables than those with typical oral sensory sensitivity. The findings suggest that efforts to address food selectivity in children with ASD may be enhanced by including strategies that address oral sensory processing.”

Sensory abnormalities in children with autism spectrum disorder. Full text “The clinical picture of children with autism spectrum disorder is characterized by deficits of social interaction and communication, as well as by repetitive interests and activities. Sensory abnormalities are a very frequent feature that often go unnoticed due to the communication difficulties of these patients. This narrative review summarizes the main features of sensory abnormalities and the respective implications for the interpretation of several signs and symptoms of autism spectrum disorder, and therefore for its management. Atypical sensory reactivity of subjects with autism spectrum disorder may be the key to understand many of their abnormal behaviors, and thus it is a relevant aspect to be taken into account in their daily management in all the contexts in which they live. A formal evaluation of sensory function should be always performed in these children.”

Curriculum in Psychiatry and Neurology for Pharmacy Programs. Full text. “Pharmacy curriculum recommendations exist for several therapeutic areas including oncology, pharmacogenomics, pediatrics, geriatrics, and substance abuse, but not psychiatry and neurology. In order to develop recommendations for optimal curriculum in psychiatry and neurology for pharmacy programs, The College of Psychiatric and Neurologic Pharmacists (CPNP) created a task force comprised of pharmacists with expertise in psychiatry and neurology, from diverse geographic regions and from both public and private academic programs. In most cases, programs reported devoting more instruction time to more common disorders (eg, depression, epilepsy, pain) where pharmacist interaction time is considerable. Exceptions were autism spectrum disorder, traumatic brain injury, and eating disorders, which were not taught at all in some pharmacy programs despite being present in at least 1% of the population.”

October 2017

Psychotropic medication use in autism spectrum disorders may affect functional brain connectivity.Prescription of psychotropic medications is common in autism spectrum disorders (ASDs), either off-label or to treat comorbid conditions such as ADHD or depression. Psychotropic medications are intended to alter brain function. Yet, studies investigating the functional brain organization in ASDs rarely take medication usage into account. This could explain some of the inconsistent findings of atypical brain network connectivity reported in the autism literature. Different functional connectivity patterns were identified in the ASD group taking psychotropic medications (ASD-on), as compared to the TD group and the ASD subgroup not using psychotropic medications (ASD-none). The ASD-on group showed distinct underconnectivity between the cerebellum and basal ganglia but cortico-cortical overconnectivity compared to the TD group. These results suggest that psychotropic medications may affect functional connectivity, and that medication status should be taken into consideration when studying brain function in autism.”

Increased stool immunoglobulin A level in children with autism spectrum disorders. Immunoglobulin A (IgA) is the main antibody secreted by intestinal immune cells, we investigated stool IgA content as a means of understanding the gut immune status of ASD patients. We found that IgA levels were significantly higher in stool samples from ASD patients than from healthy children. This finding may suggest the presence of gut immune abnormalities in ASD patients.”

Body composition of patients with autism spectrum disorder through bioelectrical impedance.According to the these parameters, a large percentual of ASD children and adolescents in this sample had total overweight and obesity and truncal adiposity, which causes concern, as well as the percentage of underweight participants.”

Rapid Assessment of Microbiota Changes in Individuals with Autism Spectrum Disorder Using Bacteria-derived Membrane Vesicles in Urine. Full text. “Individuals with autism spectrum disorder (ASD) have altered gut microbiota, which appears to regulate ASD symptoms via gut microbiota-brain interactions. Microbiomes secrete extracellular membrane vesicles (EVs) to communicate with host cells and secreted EVs are widely distributed throughout the body including the blood and urine. Microbiota identified from urine EVs included gut microbiota reported in previous studies and their up- and down-regulation in ASD individuals were partially consistent with microbiota profiles previously assessed from ASD fecal samples. However, overall microbiota profiles identified in the present study represented a distinctive microbiota landscape for ASD. Particularly, the occupancy of g_Pseudomonas, g_Sphingomonas, g_Agrobacterium, g_Achromobacter, and g_Roseateles decreased in ASD, whereas g_Streptococcus, g_Akkermansia, g_Rhodococcus, and g_Halomonas increased. These results demonstrate distinctively altered gut microbiota profiles in ASD, and validate the utilization of urine EVs for the rapid assessment of microbiota in ASD.”

Are gastrointestinal and sleep problems associated with behavioral symptoms of autism spectrum disorder?Many children with autism spectrum disorder (ASD) suffer from concurrent medical symptoms, including gastrointestinal (GI) and sleeping problems. ASD children with GI symptoms reported more severe ASD core symptoms than others. Autistic children’s GI symptoms were associated with maternal sleep problems during pregnancy, child’s 0-6 month food sources and picky eating. ASD children with sleep disturbances had lower performance in daily living skills, social cognition, social communication and intellectual development than ASD children without sleep disturbances. Autistic children with GI or/and sleep problems may represent clinically relevant subtypes of ASD, for which targeted treatments may be needed.”

Brief Report: Sexual Orientation in Individuals with Autistic Traits: Population Based Study of 47,000 Adults in Stockholm County.Participants with autistic traits were more likely to identify as bisexual and to feel that their sexual orientation could neither be described as hetero-, homo- nor bisexual, compared to individuals without autistic traits. Autistic traits are associated with minority sexual orientation, and perhaps with uncertain self-identification and/or a defiance of traditional ways of categorizing sexual identity.”

Anxiety Disorders and Obsessive-Compulsive Disorder in Individuals with Autism Spectrum Disorder.Research suggests that anxiety disorders and OCD are highly prevalent in individuals with ASD. Though several treatments for anxiety have been adapted for youth with ASD (e.g., cognitive behavior therapy), pharmacological treatments and treatments for adults are still marked undeveloped.”

Parent-Reported Problematic Sleep Behaviors in Children with Comorbid Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.Sleep problems are frequent and well documented in children with Autism Spectrum Disorders (ASD), children with Attention Deficit/Hyperactivity Disorder (ADHD) and children with internalizing problems, however limited work has examined sleep problems in children presenting with comorbid ASD/ADHD. Internalizing difficulties, rather than ASD or ADHD symptom severity, was the most consistent predictor of problematic sleep behaviors (i.e., nightmares overtiredness, sleeping less than other children, trouble sleeping, and Total Problematic Sleep Behaviors) in this sample. Further, parent report of problematic sleep behaviors was significantly associated with functional domains after controlling for ASD, ADHD, and internalizing symptoms.”

Neuroprotection through flavonoid: Enhancement of the glyoxalase pathway. Full text. “The glyoxalase pathway functions to detoxify reactive dicarbonyl compounds, most importantly methylglyoxal. The glyoxalase pathway is an antioxidant defense mechanism that is essential for neuroprotection. Excessive concentrations of methylglyoxal have deleterious effects on cells, leading to increased levels of inflammation and oxidative stress. Neurodegenerative diseases – including Alzheimer’s, Parkinson’s, Aging and Autism Spectrum Disorder – are often induced or exacerbated by accumulation of methylglyoxal. Antioxidant compounds possess several distinct mechanisms that enhance the glyoxalase pathway and function as neuroprotectants. Flavonoids are well-researched secondary plant metabolites that appear to be effective in reducing levels of oxidative stress and inflammation in neural cells. Novel flavonoids could be designed, synthesized and tested to protect against neurodegenerative diseases through regulating the glyoxalase pathway.”

Don’t ask me what’s the matter, ask me what matters: acute mental health facility experiences of people living with Autism Spectrum Conditions.This qualitative study explored how mental health inpatients with autistic spectrum conditions experience and cope with anxiety when admitted to an acute mental health inpatient facility in the UK. Broad response patterns were identified that could be associated with their anxiety i.e. isolating themselves from others, including patients and staff, ceasing to eat and sleep adequately and all too often self-harming or exhibiting aggressive and violent responses. The anxiety caused by the physical environment appears to be overlooked by mental health practitioners so attention to anxiety inducing encounters is needed when planning acute care mental health service improvement and research is required to clearly understand the experiences of this vulnerable group.”

What will my child’s future hold? phenotypes of intellectual development in 2-8-year-olds with autism spectrum disorder.We examined how the IQs of children with autism spectrum disorder change between ages 2 and 8, and identified four patterns. Two groups exhibited persistently lower IQs. One group showed IQ increases of greater than 30 points with improved communicate abilities and declining disruptive behaviors. The final group had IQs in the average or better range at both time points, and 14% of them lost their diagnoses. Over half of the children experienced improved intellectual functioning between ages 2 and 8, whereas about 25% showed declines. Findings were not associated with intervention history.”

Examining bidirectional effects between the autism spectrum disorder (ASD) core symptom domains and anxiety in children with ASD.Although a bidirectional relationship between autism spectrum disorder (ASD) and anxiety symptoms is assumed, few studies have investigated this. Moreover, little is known about potential differential relationships of the two core symptom domains of ASD – social communication impairment and restricted, repetitive behavior – with anxiety over time. Our results do not support a bidirectional relationship between the ASD core symptom domains and anxiety, but suggest that higher levels of anxiety symptoms increase the risk of more social communication impairment over time in children with ASD. This underlines the importance of treating anxiety symptoms to improve both social and emotional functioning.”

Autistic Siblings with Novel Mutations in Two Different Genes: Insight for Genetic Workups of Autistic Siblings and Connection to Mitochondrial Dysfunction. Full text. “The prevalence of autism spectrum disorder (ASD) is high, yet the etiology of this disorder is still uncertain. Advancements in genetic analysis have provided the ability to identify potential genetic changes that may contribute to ASD. Interestingly, several genetic syndromes have been linked to metabolic dysfunction, suggesting an avenue for treatment. In this case study, we report siblings with ASD who had similar initial phenotypic presentations. Whole exome sequencing (WES) revealed a novel c.795delT mutation in the WDR45 gene affecting the girl, which was consistent with her eventual progression to a Rett-like syndrome phenotype including seizures along with a stereotypical cyclic breathing pattern. These cases demonstrate the importance of advanced genetic testing combined with metabolic evaluations in the workup of children with ASD.”

Autism and primary care dentistry: parents’ experiences of taking children with autism or working diagnosis of autism for dental examinations.Accessing and receiving preventative dental treatment can be difficult for children with autism due to sensory processing disorders and/or challenging behaviours coupled with a reported reluctance by dentists to treat these children. Key themes identified were flexibility of the dental team and environment, confidence of the parents to advocate for their children’s needs, continuity of services and clear referral pathways to specialist services. Cross-cutting all themes was the value of clear communication. The experiences provide greater understanding of issues such as hyper-empathy, the dental chair, challenges of the waiting room, perceived medical authority, and the importance of continuation of care. In line with previous research about the importance of family-centred care, a strong relationship between parents and the whole dental team is essential for children with autism to access dental examinations and have satisfactory experience of care.”

The Occurrence of Antibodies Against Gluten in Children with Autism Spectrum Disorders Does Not Correlate with Serological Markers of Impaired Intestinal Permeability. Full text. “There is evidence that children with autism spectrum disorders (ASDs) display an increased immune reactivity against gluten, which is supposed to be the effect of intestinal barrier abnormalities. The aim of study was to evaluate the relation of antibody induced by gluten to zonulin and intestinal fatty acid binding proteins (I-FABP), that is, serological markers of an impaired gut barrier. Serum concentrations of zonulin and I-FABP showed no statistically significant association with antibody positivity. An increased production of antibodies related to gliadin and neural TG6 in ASD children is not related to serological markers of an impaired intestinal barrier.”

Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input. Full text. “This paper provides information about the prevalence and topography of self-injurious behavior in children and adults with autism spectrum disorder and intellectual disability. Dominant models regarding the etiology of self-injury in this population are reviewed, with a focus on the role of reactivity to pain and sensory input. Neuroimaging studies are presented and suggestions are offered for future research.”

Oxidative stress markers and genetic polymorphisms of glutathione S-transferase T1, M1, and P1 in a subset of children with autism spectrum disorder in Lagos, Nigeria. Full text. “The role of oxidative stress has been identified in the development of autism spectrum disorder (ASD), and polymorphisms of glutathione S-transferase have been associated with some diseases linked to oxidative stress. Individuals with ASD showed a significant diminished level of reduced glutathione, however, the distribution of GSTT1, GSTM1, and GSTP1 polymorphisms was not found to be associated with autism in this study population.”

Interventions Targeting Sensory Challenges in Children With Autism Spectrum Disorder—An Update [Internet]. Online book. “To evaluate the effectiveness and safety of interventions targeting sensory challenges in children with autism spectrum disorder (ASD).”

Medical Therapies for Children With Autism Spectrum Disorder—An Update [Internet]. Online book. “To evaluate the comparative effectiveness and safety of medical interventions (defined broadly as interventions involving the administration of external substances to the body or use of external nonbehavioral procedures to treat symptoms of autism spectrum disorder [ASD]) for children with ASD.”

Cryptorchidism and increased risk of neurodevelopmental disorders.Male congenital malformations as cryptorchidism may contribute to the development of neurodevelopmental disorders directly or via shared familial genetic and/or environmental factors, but the evidence is sparse. Boys with cryptorchidism were more likely to be diagnosed with intellectual disability, autism spectrum disorders (ASD), attention-deficit hyperactivity disorder (ADHD), anxiety, and other behavioral/emotional disorders compared to boys without cryptorchidism. Cryptorchidism may be associated with increased risks of intellectual disability, ASD, ADHD, and other behavioral/emotional disorders. Cryptorchidism and neurodevelopmental disorders may have shared genetic or in-utero/early postnatal risk factors, which need to be further investigated.”

Iron and vitamin D levels among autism spectrum disorders children. Full text. “The aim of this study was to investigate iron deficiency anemia and Vitamin D deficiency among autism children and to assess the importance of risk factors. Multivariate logistic regression analysis revealed that serum iron deficiency, serum calcium levels, serum Vitamin D levels; ferritin, reduced physical activity; child order, body mass index percentiles, and parental consanguinity can all be considered strong predictors and major factors associated with autism spectrum disorders. This study suggests that deficiency of iron and Vitamin D as well as anemia were more common in autistic compared to control children.”

Atopic Dermatitis: Disease Background and Risk Factors.Atopic dermatitis usually presents early in life and is thought to represent the initial-step in the “atopic march” which is characterized by the development of other atopic diseases later in life such as asthma, allergic rhinitis and/or rhinoconjunctivitis, food allergies and hay fever. Other comorbid diseases that have been associated with AD include increase risk of viral and bacterial skin infections, neuropsychiatric diseases such as attention-deficit hyperactivity disorders (ADHD) and autistic spectrum disorder (ASD).”

Sex-Specific Neurotoxic Effects of Organophosphate Pesticides Across the Life Course. This review discusses the sex-specific effects of exposure to various organophosphate (OP) pesticides throughout the life course and potential reasons for the differential vulnerabilities observed across sexes. Reported sex-specific effects suggest that males are more susceptible to OPs, which reflects the sex-dependent prevalence of various neurodevelopmental and neurodegenerative disorders such as autism and amyotrophic lateral sclerosis (ALS), in which males are at greater risk. Thus, this review proposes that the biological sex-specific effects elicited by OP exposure may in part underlie the dimorphic susceptibilities observed in neurological disorders.”

Brain derived neurotrophic factor and serotonin transporter binding as markers of clinical response to fluoxetine therapy in children with autism.Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), has shown favorable effects in some children with autism. Fluoxetine treatment led to positive effects in several aspects of communication, socialization and cognitive awareness, with 6 out 13 subjects being particularly good responders. These six also had a significant decrease in BDNF [brain derived neurotropic factor] and minimal change in SERT [serotonin transporter] binding after therapy. The other 7 subjects showed a trend towards an increase in BDNF and SERT binding. Our results indicate that fluoxetine may improve core autistic symptoms, and that this clinical response is linked to a decrease in serum BDNF.”

Multifactorial Origin of Neurodevelopmental Disorders: Approaches to Understanding Complex Etiologies. Full text. “A significant body of evidence supports the multifactorial etiology of neurodevelopmental disorders (NDDs) affecting children. The present review focuses on early exposure to environmental chemicals as a risk factor for neurodevelopment, and presents the major lines of evidence derived from epidemiological studies. We introduce the exposome concept that, encompassing the totality of human environmental exposures to multiple risk factors, aims at explaining individual vulnerability and resilience to early chemical exposure. In this framework, we synthetically review the role of variable gene backgrounds, the involvement of epigenetic mechanisms as well as the function played by potential effect modifiers such as socioeconomic status. We describe laboratory rodent studies where the neurodevelopmental effects of environmental chemicals are assessed in the presence of either a “vulnerable” gene background or adverse pregnancy conditions (i.e., maternal stress).”

Risperidone in combination with other drugs: Experimental research in individuals with autism spectrum disorder.Many individuals with autism spectrum disorder simultaneously receive 2 or more drugs intended to improve their behavior, but few studies have evaluated the effects of such polypharmacy. This article summarizes those studies that have systematically examined the effects of risperidone, an antipsychotic drug that is approved by the U.S. Food and Drug Administration to treat “irritability” in children and adolescents with autism spectrum disorder, in combination with another drug with respect to experimental design, assessment techniques, drug co-administered, reported effects, and participant characteristics. The drug combinations that have been evaluated do not parallel those commonly co-administered to individuals with autism spectrum disorder in the United States, and there is no compelling empirical evidence to support the practice of prescribing risperidone in combination with another drug in an attempt to benefit individuals with autism spectrum disorder.

Microbiota-related Changes in Bile Acid & Tryptophan Metabolism are Associated with Gastrointestinal Dysfunction in a Mouse Model of Autism. Full text. “There is growing awareness that the gut microbiome may contribute to gastrointestinal and behavioral symptomatology of autism spectrum disorder (ASD). However, the exact mechanisms by which intestinal bacteria can affect gut-brain axis signaling in autism are as yet poorly understood. Here we explore interactions between intestinal microbiota, gut physiology and behavior in a mouse model of ASD. We show that a reduction in the abundance of particular intestinal bacteria in “autistic” mice is associated with gastrointestinal distress and social behavior deficits. This work supports the concept of targeting the gut microbiota for reversing gastrointestinal symptoms in ASD, and identifies specific plausible targets for microbiota-based interventions.”

Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis.Children with ASD, either in the form of clinical diagnosis or self-report, were significantly less likely to have been breastfed than children without ASD. Subgroup analyses revealed that results remained significant for children who were breastfed with additional supplementation. This meta-analysis provides evidence that breastfeeding (exclusively or including additional supplements) may protect against ASD.”

Supplementation of omega 3 fatty acids may improve hyperactivity, lethargy, and stereotypy in children with autism spectrum disorders: a meta-analysis of randomized controlled trials. Full text. “Deficiency of omega 3 fatty acids may be linked to autism spectrum disorder (ASD). Meta-analysis showed that supplementation of omega 3 fatty acids improved hyperactivity, lethargy, and stereotypy. Our preliminary meta-analysis suggests that supplementation of omega 3 fatty acids may improve hyperactivity, lethargy, and stereotypy in ASD patients. However, the number of studies was limited and the overall effects were small, precluding definitive conclusions.”

Verbal Ability and Psychiatric Symptoms in Clinically Referred Inpatient and Outpatient Youth with ASD.Youth with autism spectrum disorder (ASD) experience high rates of psychiatric symptoms, but the relation between verbal ability and psychiatric symptoms is unknown. Results indicated that verbal youth were more likely to present with and meet clinical cutoffs for depression and oppositional defiant disorder symptoms, with greater impairment associated with depression. Youth in inpatient settings had greater symptom severity and impairment across almost all psychiatric comorbidities.”

Study of the C677T and 1298AC polymorphic genotypes of MTHFR Gene in autism spectrum disorder. Full text. “There is an increased risk of ASDs associated with common mutations affecting the folate/methylation cycle. There is a significant association between severity and occurrence of autism with MTHFR gene polymorphisms C677T and A1298C.”

Comparing the effects of age, pubertal development, and symptom profile on cortisol rhythm in children and adolescents with autism spectrum disorder.Elevations in stress hormone, cortisol, during the evening may indicate increased stress from changes throughout the day in youth with autism spectrum disorder (ASD). The current study shows that age and pubertal development are also related to increases in evening cortisol, and this maladaptive elevation in cortisol in ASD is not going away with age. These cortisol elevations may also be associated with other psychological symptoms and warrant further investigation in adolescents with ASD.”

Suicide Attempts Among Adolescents with Self-Reported Disabilities.Analyses using Wisconsin’s 2012 Dane County Youth Assessment Survey data found that youth in each disability category were 3-9 times more likely to report suicide attempt(s) relative to peers, and the endorsement of multiple disabilities tripled the risk SA relative to youth reporting a single disability. Some disability sub-groups, including youth reporting autism spectrum disorder, hearing, and vision impairments reported surprisingly high rates of SA [suicide attempts].”

Mitochondrial dysfunction in the gastrointestinal mucosa of children with autism: A blinded case-control study. Full text. “Gastrointestinal (GI) symptoms are prevalent in autism spectrum disorder (ASD) but the pathophysiology is poorly understood. Imbalances in the enteric microbiome have been associated with ASD and can cause GI dysfunction potentially through disruption of mitochondrial function as microbiome metabolites modulate mitochondrial function and mitochondrial dysfunction is highly associated with GI symptoms. Mitochondrial function in the gut mucosa from children with ASD was found to be significantly different than other groups who manifested similar GI symptomatology suggesting a unique pathophysiology for GI symptoms in children with ASD. Abnormalities localized to the cecum suggest a role for imbalances in the microbiome, potentially in the production of butyrate, in children with ASD.”

l-Carnosine As an Adjunctive Therapy to Risperidone in Children with Autistic Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial.Significantly greater score reduction in the hyperactivity/noncompliance subscale occurred in the l-carnosine group compared with the placebo group at the end of the trial. Although no significant difference was detected on the irritability subscale scores, l-carnosine add-on can improve hyperactivity/noncompliance subscales of the ABC-C rating scale in patients with ASD.”

The association between maternal use of folic acid supplements during pregnancy and risk of autism spectrum disorders in children: a meta-analysis. Full text. “It was found that supplementation with folic acid during pregnancy could reduce the risk of ASD as compared to those women without folic acid supplementation. The associations were significant among Asian, European, and American populations. In summary, this comprehensive meta-analysis suggested that maternal use of folic acid supplements during pregnancy could significantly reduce the risk of ASD in children regardless of ethnicity, as compared to those women who did not supplement with folic acid.”

The Gut Microbiome Feelings of the Brain: A Perspective for Non-Microbiologists. Full text. “Tremendous progress has been made in exploring the interactions between nutrients, the microbiome, and the intestinal, epithelium-enteric nervous, endocrine and immune systems and the brain. The basis of the gut-brain axis comprises of an array of multichannel sensing and trafficking pathways that are suggested to convey the enteric signals to the brain. These are mediated by neuroanatomy (represented by the vagal and spinal afferent neurons), the neuroendocrine-hypothalamic-pituitary-adrenal (HPA) axis (represented by the gut hormones), immune routes (represented by multiple cytokines), microbially-derived neurotransmitters, and finally the gate keepers of the intestinal and brain barriers. Their mutual and harmonious but intricate interaction is essential for human life and brain performance. However, a failure in the interaction leads to a number of inflammatory-, autoimmune-, neurodegenerative-, metabolic-, mood-, behavioral-, cognitive-, autism-spectrum-, stress- and pain-related disorders.”

Challenges of Females with Autism: A Parental Perspective.Some of the issues parents discussed were similar to those experienced by males with ASD, such as challenges in social interactions. However, other issues discussed were of particular relevance to girls with ASD, including difficulties socializing with other girls, sex-specific puberty issues, barriers in accessing intervention and sexual vulnerability.”

Recommendations for Identifying Sleep Problems and Treatment Resources for Children with Autism Spectrum Disorder. Full text. “Many young children experience sleep problems that may influence their daytime functioning. These sleep problems are especially prevalent in young children with autism spectrum disorder (ASD). Therefore, general recommendations for identifying and treating sleep problems in children with ASD are needed for behavior analysts to identify potential sleep problems and make empirically informed decisions regarding treatment options. The current paper seeks to provide behavior analysts, who work with children with ASD, with informative research on pediatric sleep problems, sleep measures, and options for behavioral sleep treatment.”

Antidepressant Exposure During Pregnancy and Risk of Autism in the Offspring, 1: Meta-Review of Meta-Analyses.The findings across meta-analyses have been reasonably consistent. Antidepressant exposure during pregnancy is associated with an increased risk of ASD in the offspring. The risk is decreased after adjusting for confounding variables and is mostly no longer statistically significant after adjusting for maternal mental illness. Additionally, antidepressant exposure is associated with an increased risk of ASD in the offspring even when exposure is limited to the preconception period, when the drugs cannot have a physiological effect on the fetus. These findings suggest that maternal mental illness is an important determinant of the risk of ASD associated with antidepressant exposure during pregnancy.”

Social impairments in autism spectrum disorder are related to maternal immune history profile. Full text. “Maternal immune activation has been highlighted as a factor that might increase the risk and severity of autism spectrum disorder (ASD) in children. Results showed that children whose mothers reported a history of immune activation (allergies and asthma) had significantly higher scores on the Social Responsiveness Scale, suggesting more severe social impairment symptoms in these children. This increasing severity of social impairment symptoms was further shown on the SRS cognition and mannerisms subscales. While immune history was associated with an increase in the severity of social impairment symptoms, history of autoimmune conditions in the mother did not have any effect in this cohort. To the best of our knowledge, this study is the first to show an association between immune activation history in the mother and increased ASD symptom severity in children with ASD. These findings support the idea of an immune system-mediated subtype in ASD, where the immune history of the mother may be an important factor.”

Potential Sex Differences Relative to Autism Spectrum Disorder and Metals.This study aims to summarize the current body of literature on the relationship between various toxic metals exposures (i.e., aluminum, antimony, arsenic, beryllium, cadmium, chromium, lead, manganese, and nickel) and autism spectrum disorder (ASD), with a focus on potential sex differences in these associations. Results for each metal were conflicting, but studies on cadmium and lead yielded the highest proportion of studies with positive results (72% and 36%, respectively). Based on our examination of existing literature, the current evidence warrants a considerable need for evaluations of sex differences in future studies assessing the association between metals exposures and ASD. Additionally, failure to account for potential sex differences could result in bias and misinterpretation of exposure-disease relationships.”

Is acetaminophen safe in pregnancy? Acetaminophen use in childhood was associated with autism spectrum disorder, asthma symptoms, wheezing, and allergic disease. Acetaminophen is the safest medicine as analgesics for nociceptive pain and antipyretics in childhood and pregnancy. There is no alternative medication of acetaminophen. Acetaminophen should not be withheld from children or pregnant women for fears it might develop adverse effects. Acetaminophen should be used at the lowest effective dosage and for the shortest time. When we know the possible, rare but serious complications, we should use acetaminophen in pregnancy only when needed and no safer option for pain or fever relief is available. Health care providers should help inform the general lay public about this difficult dilemma.”

Maternal Multivitamin Intake, Plasma Folate and Vitamin B12 Levels and Autism Spectrum Disorder Risk in Offspring.There was a ‘U shaped’ relationship between maternal multivitamin supplementation frequency and ASD risk. Extremely high maternal plasma folate and B12 levels at birth were associated with ASD risk. This hypothesis-generating study does not question the importance of consuming adequate folic acid and vitamin B12 during pregnancy; rather, raises new questions about the impact of extremely elevated levels of plasma folate and B12 exposure in-utero on early brain development.

Prevalence of Schizophrenia Spectrum Disorders in Average-IQ Adults with Autism Spectrum Disorders: A Meta-analysis.Since their separation as independent diagnostics, autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) have been conceptualized as mutually exclusive disorders. Similarities between both disorders can lead to misdiagnosis, especially when it comes to average-IQ adults who were not identified during childhood. The pooled prevalence of SSD in the total ASD sample was close to 6%, pointing to a high co-occurrence of the two conditions. Further research is needed to determine the factors that predispose members of this population to the emergence of psychotic disorders.”

Biochemical assessments of thyroid profile, serum 25-hydroxycholecalciferol and cluster of differentiation 5 expression levels among children with autism. Full text. “The exact pathogenesis of autism is still unknown. Both thyroid hormones and 25(OH)D are important for brain development, in addition to CD5; all have immunomodulatory actions by which their dysregulation may have a potential role in autism pathogenesis. Elevated CD5 expression and decreased 25(OH)D stores could play a potential role in the pathogenesis of autism via their immune-modulator actions. High TSH serum levels among autistic children, although within the physiological range, reflect the presence of thyroid dysfunction among such children, which needs further assessment.”

Antenatal nutritional supplementation and autism spectrum disorders in the Stockholm youth cohort: population based cohort study. Full text. “Prevalence of ASD with intellectual disability was 0.26% in the maternal multivitamin use group and 0.48% in the no nutritional supplementation use group. Maternal multivitamin use with or without additional iron or folic acid, or both was associated with lower odds of ASD with intellectual disability in the child compared with mothers who did not use multivitamins, iron, and folic acid.”

Narratives of mothers of children with autism spectrum disorders: focus on eating behavior. Full text. “To investigate the eating behavior of individuals with autism through their mothers’ narratives. Results show that autism-related factors may affect the child’s food choices. Environmental factors, particularly the parents’ behavior, may also play a decisive role, both in reinforcing the child’s food choices and in encouraging a healthier and more diversified diet. Professionals should instruct parents regarding their decisive role in reinforcing or discouraging inappropriate mealtime behavior in children with autism.”

September 2017

The association between mercury levels and autism spectrum disorders: A systematic review and meta-analysis.The relationship between mercury and autism spectrum disorders (ASD) has always been a topic of controversy among researchers. This study aimed to assess the relationship between ASD and mercury levels in hair, urine, blood, red blood cells (RBC), and brain through a meta-analysis. The mercury level in whole blood, RBC, and brain was significantly higher in ASD patients than healthy subjects, whereas mercury level in hair was significantly lower in ASD patients than healthy subjects. The mercury level in urine was not significantly different between ASD patients and healthy subjects. Results of the current meta-analysis revealed that mercury is an important causal factor in the etiology of ASD. It seems that the detoxification and excretory mechanisms are impaired in ASD patients which lead to accumulation of mercury in the body. Future additional studies on mercury levels in different tissues of ASD patients should be undertaken.”

Psychiatric comorbidities and use of psychotropic medications in people with autism spectrum disorder in the United States.This study investigated psychotropic medication usage in two large, cohorts of people with autism spectrum disorder (ASD) throughout the calendar year 2014. This study identified a large number of children and adults in the US with autism spectrum disorder (autism) from employer-sponsored and government funded (Medicaid) health insurance data. Psychotropic medications were used by over two thirds of people, and four in ten people received two medications at the same time. The chances of receiving medication increased for individuals with other psychiatric conditions (e.g., ADHD), and also increased with age.”

Beta-carotene as a Novel Therapy for the Treatment of “Autistic Like Behavior” in Animal Models of Autism.Autism-affected individuals are characterized by lower plasma oxytocin and its ectoenzyme regulator CD38. Oxytocin, a hypothalamic hormone secreted upon the release of CD38, plays a role in social behavior and bonding. All-trans retinoic acid is a potent inducer of CD38 and can be used as a novel therapeutic strategy in autism. We investigated the role of beta-carotene in rescuing autistic-like behavior in BALB/c and BTBR mice. Beta-carotene oral supplementation to BALB/c and BTBR mice at birth significantly reduced restricted and stereotyped behaviors and interests, increased social interactions and communication, CD38, and oxytocin, probably by enhancing brain neuroplasticity without toxicity. Thus, beta-carotene administered after birth to newborns of families predisposed to “autism” has the potential to prevent/ameliorate” autistic like behavior”. These results support further clinical studies.”

Gastrointestinal dysfunctions as a risk factor for sleep disorders in children with idiopathic autism spectrum disorder: A retrospective cohort study.Sleep disorders often co-occur with autism spectrum disorder. They further exacerbate autism spectrum disorder symptoms and interfere with children’s and parental quality of life. This study examines whether gastrointestinal dysfunctions increase the odds of having sleep disorders in 610 children with idiopathic autism spectrum disorder, aged 2-18 years, from the Autism Genetic Resource Exchange research program. Early detection and treatment of gastrointestinal dysfunctions in autism spectrum disorder may be means to reduce prevalence and severity of sleep problems and improve quality of life and developmental outcomes in this population.”

When Asperger’s Disorder Came Out. Full text. “Removing the Asperger’s label, valued by patients for its distinctiveness from autism brings with it the potential to inflict iatrogenic harm. This paper demonstrates how the DSM-5 reclassification has the potential to threaten the identity of those affected, and discusses the problem of autism as a stigmatizing diagnostic label.”

Vitamin D, neurosteroids and autism. Full text. “Vitamin D had been for a long time investigated for its effects on bone metabolism. Recently has been observed that the incidence of some neurodevelopmental disorders (including autism) increases hand in hand with vitamin D deficiency. Indeed, vitamin D was reported to modulate the biosynthesis of neurotransmitters and neurotrophic factors; moreover, its receptor was found in the central nervous system. Vitamin D deficiency was therefore assessed as a risk factor for autism, however the biological mechanism has not yet been revealed. In our review we focused on potential connections among vitamin D, steroids and autism. Potential mechanisms of vitamin D action are also discussed.”

Food and the gut: relevance to some of the autisms.The notion of a gut-brain-behaviour axis has garnered support from various findings: an overrepresentation of functional and pathological bowel states, bowel and behavioural findings showing bidirectional associations, a possible relationship between diet, GI function and autism and recently, greater focus on aspects of the GI tract such as the collected gut microbiota in relation to autism. Gaps remain in our knowledge of the functions of the GI tract linked to autism, specifically regarding mechanisms of action onward to behavioural presentation. Set however within the context of diversity in the presentation of autism, science appears to be moving towards defining important GI-related autism phenotypes with the possibility of promising dietary and other related intervention options onward to improving quality of life.”

Research Letter: Folic acid supplementation and intake of folate in pregnancy in relation to offspring risk of autism spectrum disorder. Full text. “In conclusion, we were not able to substantiate a hypothesized beneficial effect on child risk of ASD by maternal folic acid supplementation in the periconceptional period.”

A Randomized, Placebo-Controlled Trial of Metformin for the Treatment of Overweight Induced by Antipsychotic Medication in Young People With Autism Spectrum Disorder: Open-Label Extension.A previous study reported on a 16-week placebo-controlled, randomized clinical trial (RCT) of metformin for weight stabilization in 61 children and adolescents 6 to 17 years old with autism spectrum disorder who were prescribed atypical antipsychotics. The present study describes the results of a 16-week open-label extension. Fifty-two participants from the acute trial (85%) entered the extension; 22 had been on metformin during the initial RCT and 30 had been on placebo. Participants who initially had been taking metformin during the 16-week RCT maintained prior decreases in BMI z-scores but did not have additional weight loss. Three participants discontinued treatment because of an adverse event. No significant changes were noted on metabolic measures, although the decrease in hemoglobin A1c was large (∼1 mmol) and consistent across the acute and open-label phases. Metformin can be effective for decreasing weight gain associated with atypical antipsychotic use and maintaining prior improvement in children and adolescents with autism spectrum disorder.”

Omega-3 and -6 fatty acid supplementation and sensory processing in toddlers with ASD symptomology born preterm: A randomized controlled trial.The findings provide support for larger randomized trials of omega fatty acid supplementation for children at risk of sensory processing difficulties, especially those born preterm.”

Effect of vitamin A supplementation on gut microbiota in children with autism spectrum disorders – a pilot study. Full text. “There were significant increases in the proportion of Bacteroidetes/Bacteroidales and decreases in Bifidobacterium after the VAI, accompanying significant increases in autism biomarkers, while no significant changes were observed in autism symptoms. These findings indicated that VA could regulate gut microbiota and benefit children with ASD partly.”

Gut Dysbiosis in Animals Due to Environmental Chemical Exposures. Full text. “In this review, we will first consider the current knowledge of how endocrine disrupting chemicals (EDCs), heavy metals, air pollution, and nanoparticles can influence the gut microbiome. The second part of the review will consider how potential environmental chemical-induced gut microbiome changes might subsequently induce pathophysiological responses in the host.”

Combined Prenatal Pesticide Exposure and Folic Acid Intake in Relation to Autism Spectrum Disorder. Full text. “In this study population, associations between pesticide exposures and ASD were attenuated among those with high versus low FA [folic acid] intake during the first month of pregnancy.”

Randomized trial of omega-3 for autism spectrum disorders: Effect on cell membrane composition and behavior.Primary outcome measures were erythrocyte membrane FA composition and TAS. Secondary outcome measures were Social Responsiveness Scale and Clinical Global Impression-Severity. Treatment with ω3 improved the erythrocyte membrane ω6/ω3 ratio without changing TAS. There was a within subjects significant improvement in Social Motivation and Social Communication subscales scores, with a moderate to large effect size, but no treatment effect (treatment-placebo order).

Iron deficiency parameters in autism spectrum disorder: clinical correlates and associated factors. Full text. “Hemoglobin levels of children with ASD were lower than healthy children, but this was not sufficient to result in anemia. Hemoglobin levels of children with severe ASD were lower than children with mild-moderate ASD and IDA [irin deficiency anaemia] was higher in severe ASD patients. We also indicated that there was a significant correlation between hematocrit levels of children with ASD and CARS, AuBC, and AbBC total scores.”

Subcutaneous injections of aluminum at vaccine adjuvant levels activate innate immune genes in mouse brain that are homologous with biomarkers of autism. Full text. “Aluminum (Al) is an environmental toxin with demonstrated negative impact on human health, especially the nervous system, to which humans are regularly exposed. Compared to dietary Al of which only ~0.25% is absorbed into systemic circulation, Al from vaccines may be absorbed at over 50% efficiency in the short term and at nearly 100% efficiency long-term. Al adjuvant promotes brain inflammation and males appear to be more susceptible to Al’s toxic effects.”

Levetiracetam is associated with decrease in subclinical epileptiform discharges and improved cognitive functions in pediatric patients with autism spectrum disorder. Full text. “Subclinical epileptiform discharges (SEDs) are common in pediatric patients with autism spectrum disorder (ASD), but the effect of antiepileptic drugs on SEDs in ASD remains inconclusive. This physician-blinded, prospective, randomized controlled trial investigated an association between the anticonvulsant drug levetiracetam and SEDs in children with ASD. Levetiracetam appears to be effective for controlling SEDs in pediatric patients with ASD and was also associated with improved behavioral and cognitive functions.”

Maternal SSRI exposure increases the risk of autistic offspring: A meta-analysis and systematic review.Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants used to preclude maternal pregnancy depression. There is a growing body of literature assessing the association of prenatal exposure to SSRIs with autism spectrum disorder (ASD). The present systematic review and meta-analysis reviewed the medical literature and pooled the results of the association of prenatal exposure to SSRIs with ASD. The evidence from the present study suggests that prenatal exposure to SSRIs is associated with a higher risk of ASD.”

Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services.Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood).”

Problems managed and medications prescribed during encounters with people with autism spectrum disorder in Australian general practice.This study describes the problems managed and medications prescribed by general practitioners in Australia during encounters where an autism spectrum disorder was recorded. At ‘autism spectrum disorder‘ encounters, there was a significantly higher management rate of psychological problems, and significantly lower management rates of skin, respiratory and general/unspecified problems, than at ‘non-autism spectrum disorder‘ encounters. The rate of psychological medication prescription was significantly higher at ‘autism spectrum disorder‘ encounters than at ‘non-autism spectrum disorder‘ encounters. The most common medications prescribed at ‘autism spectrum disorder‘ encounters were antipsychotics and antidepressants.”

Health Concerns and Health Service Utilization in a Population Cohort of Young Adults with Autism Spectrum Disorder.Individuals with autism spectrum disorder (ASD) have many health needs that place demands on the health service sector. Young adults with ASD were more likely to have almost all the examined clinical health issues and health service use indicators compared to peers without developmental disability. They were more likely to have at least one psychiatric diagnosis, and visit the family physician, pediatrician, psychiatrist, and emergency department for psychiatric reasons, compared to peers with other developmental disability.”

The overlap between autistic spectrum conditions and borderline personality disorder. Full text. “Similar to ASC [Autism Spectrum Conditions], BPD [Borderline Personality Disorder] patients have elevated autistic traits and a strong drive to systemize, suggesting an overlap between BPD and ASC.”

Autism-spectrum disorders in adolescence and adulthood: focus on sexuality.Just like their typically developing counterparts, individuals with ASD show the whole range of normal-to-problematic sexual behaviors. Improving sexual knowledge could lead to less inappropriate sexual behaviors and could improve sexual health as part of a healthy and satisfying life.”

Prescription Trends of Psychotropics in Children and Adolescents with Autism Based on Nationwide Health Insurance Data. Full text. “Psychotropic drugs were used for less than one-third of patients newly diagnosed with autism, and prescription differed by sex and age. Increased diagnostic incidence is associated with an increased prescription of psychotropic drugs. Atypical antipsychotics were the most commonly used, followed by antidepressants.”

Bone Mineral Density in Boys Diagnosed with Autism Spectrum Disorder: A Case-Control Study.This study compared bone mineral density (BMD) of the spine obtained by dual-energy X-ray absorptiometry (DEXA), nutritional status, biochemical markers, and gastrointestinal (GI) symptoms in 4-8 year old boys with Autism Spectrum Disorder (ASD) with a group of age-matched, healthy boys without ASD. Boys with ASD had significantly lower spine BMD compared to controls but this was not correlated with any biochemical markers, dietary intake of calcium and vitamin D, elimination diet status, or GI symptomology. Reduced BMD in 4-8 year old boys with ASD appears to involve factors other than nutrient intake and GI status, and requires further study.”

August 2017

Dietary Supplement for Core Symptoms of Autism Spectrum Disorder: Where Are We Now and Where Should We Go? Full text. “Most studies were small and short term, and there is little evidence to support effectiveness of dietary supplements for children with ASD.” I encourage parents to read the full article, there are subgroups of children that do benefit from a gluten free diet and supplements. If anyone bothers to go to the references and read the studies, the abstracts DO NOT reflect the results of the study.

Increase in Psychoactive Drug Prescriptions in the Years Following Autism Spectrum Diagnosis: A Population-Based Cohort Study. Full text. “In our cohort of 2,989 individuals, diagnosis of another psychiatric disorder before autism spectrum strongly predicted psychoactive drug use. We observed that the proportion of users of psychoactive drugs increased from 35.6% the year before, to 53.2% 5 years after the autism spectrum diagnosis. Psychoactive polypharmacy (≥2 psychoactive drug classes) also increased from 9% to 22% in that time. Age and time since diagnosis strongly associated with the types and combinations of psychoactive drugs prescribed.”

Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Follow-Up Study.Patients with ASD had a higher incidence of suicide attempts than did those without ASD. Both adolescents and young adults with ASD were more likely to attempt suicide in later life after adjusting for demographic data and psychiatric comorbidities.”

Autism Spectrum Disorder Related Functional Connectivity Changes in the Language Network in Children, Adolescents and Adults. Full text. “Autism spectrum disorder (ASD) is a neurodevelopmental disability with global implication. Altered brain connectivity in the language network has frequently been reported in ASD patients using task-based functional magnetic resonance imaging (fMRI) compared to typically developing (TD) participants. Most of these studies have focused on a specific age group or mixed age groups with ASD. In the current study, we investigated age-related changes in functional connectivity related measure, degree centrality (DC), in the language network across three age groups with ASD (113 children, 113 adolescents and 103 adults) using resting-state fMRI data collected from the autism brain imaging data exchange repository.”

Oxytocin and social functioning. Full text. “Social anxiety is a form of anxiety characterized by continuous fear of one or more social or performance situations. Although multiple treatment modalities (cognitive behavioral therapy, selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors, benzodiazepines) exist for social anxiety, they are effective for only 60% to 70% of patients. Thus, researchers have looked for other candidates for social anxiety treatment. Our review focuses on the peptide oxytocin as a potential therapeutic option for individuals with social anxiety. Animal research both in nonprimates and primates supports oxytocin’s role in facilitation of prosocial behaviors and its anxiolytic effects. Human studies indicate significant associations between social anxiety and oxytocin receptor gene alleles, as well as social anxiety and oxytocin plasma levels. In addition, intranasal administration of oxytocin in humans has favorable effects on social anxiety symptomology. Other disorders, including autism, schizophrenia, and anorexia, have components of social anxiety in their pathophysiology. The therapeutic role of oxytocin for social dysfunction in these disorders is discussed.”

Children with autism spectrum disorder who improve with fever: Insights from the Simons Simplex Collection.This study explored characteristics of children with ASD who are reported to improve during fever. Parents of 17% of children with ASD report improvements across a range of domains during fever including cognition, communication, repetitive behaviors, social interaction, and behavior. Children who are reported to improve during fever have significantly lower non-verbal cognitive skills and language levels and more repetitive behaviors. Understanding the profiles of children who improve during episodes of fever may provide insights into new treatments for ASD.”

Behavioral Phenotype of ASD Preschoolers with Gastrointestinal Symptoms or Food Selectivity.This study investigated the prevalence and type of gastrointestinal (GI) and food selectivity (FS) symptoms in 163 preschoolers with ASD, and their possible links with core ASD features and emotional/behavioural problems. The GI plus FS group presented with Sleep Problems, Self-injurious Behaviors and Anxiety Problems. Results indicated the need for early identification of GI disturbances and FS in order to design tailored intervention for these symptoms frequently associated to challenging behaviours in ASD.”

Parents Suggest Which Indicators of Progress and Outcomes Should be Measured in Young Children with Autism Spectrum Disorder.Measurement in research with young children tends to focus on core impairments in ASD. We conducted a systematic review of qualitative studies of what matters to parents. Parent advisory groups completed structured activities to explore their perceptions of the relative importance of a wide range of outcome constructs. Their highest ranked outcomes impacted directly on everyday life and functioning (anxiety, distress, hypersensitivity, sleep problems, happiness, relationships with brothers and sisters, and parent stress).”

Bone Mineral Density in Boys Diagnosed with Autism Spectrum Disorder: A Case-Control Study.Boys with ASD had significantly lower spine BMD compared to controls but this was not correlated with any biochemical markers, dietary intake of calcium and vitamin D, elimination diet status, or GI symptomology. Reduced BMD in 4-8 year old boys with ASD appears to involve factors other than nutrient intake and GI status, and requires further study.”

Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence.We reviewed studies having to do with autism spectrum disorder and the gastrointestinal system, dating back to 1980. We found that the median prevalence of constipation was 22.2%, diarrhea 13.0%, and any symptom 46.8%. All symptoms had a wide range of estimates across studies. GI symptoms were associated with characteristics of the study, including who measured the GI symptoms. We call for the development of a reliable and valid GI questionnaire for studies of ASD.”

Influence of gut microbiota on neuropsychiatric disorders. Full text “Alterations in the gut microbiota composition in humans have also been linked to a variety of neuropsychiatric conditions, including depression, autism and Parkinson’s disease. Here, we review the evidence supporting a role of the gut microbiota in neuropsychiatric disorders and the state of the art regarding the mechanisms underlying its contribution to mental illness and health.”

Is Taurine a Biomarker in Autistic Spectrum Disorder?The causes of autistic spectrum disorder (ASD) are not clear but a high heritability implicates an important role for genetic factors. Reports also implicate oxidative stress and inflammation in the etiology of ASD. Thus, taurine, a well-known antioxidant and regulator of inflammation, was investigated here using the sera from both girls and boys with ASD as well as their siblings and parents. 21 out of 66 children with ASD had low taurine concentrations. Since taurine has anti-oxidant activity, children with ASD with low taurine concentrations will be examined for abnormal mitochondrial function. Our data imply that taurine may be a valid biomarker in a subgroup of ASD.”

Investigating the driving performance of drivers with and without autism spectrum disorders under complex driving conditions.The performances of licensed drivers with autism spectrum disorders appeared to be safer in respect to car-following distance but were poorer in their response to challenging traffic situations. Driver education for individuals with autism spectrum disorders should focus on quick identification of hazards, prompt execution of responses, and effective allocation of attention to reduce lapses in driving. Drivers with autism spectrum disorders were observed to be poorer in traffic scenarios requiring critical response. Driver education for individuals with autism spectrum disorders should focus on managing anxiety and effective attention allocation while driving. Driving simulators can be used as a safe means for training critical response to challenging traffic scenarios.”

Neuropsychological Characteristics of Children with Mixed Autism and ADHD. Full text. “Our study showed significant differences in the neuropsychological characteristics of children with ASD + ADHD compared to those with ASD only. Children with ASD + ADHD showed higher symptoms of anxiety, worse working memory, and less empathy, as measured by the “Reading the Mind in the Eyes.” This suggests that having ADHD brings further challenges to individuals with ASD and may negatively impact their management and outcome. Our findings may have implications for clinical assessment as well as for intervention.”

Co-Occurrence of ASD and ADHD Traits in an Adult Population.A significant correlation was found between ADHD and autistic traits. In particular, higher inattention and overall ADHD scores were associated with self-reported deficits in communication and social skills. Our findings are similar to results from studies on clinical populations, suggesting that ADHD and ASD might share common etiology.”

Hydrogen breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in autism.The aim of this study is to assess the prevalence of small intestinal bacterial overgrowth (SIBO) by hydrogen breath test in patients with autism spectrum disorders (ASD) with respect to a consistent control group. SIBO was significantly associated with worse symptoms of autism, demonstrating that children with SIBO may significantly contribute to symptoms of autism.”

Role of mycotoxins in the pathobiology of autism: A first evidence.Among xenobiotics, mycotoxins are worldwide contaminants of food that provoke toxicological effects, crucially resembling several symptoms associated with autism such as oxidative stress, intestinal permeability, and inflammation. Here, we focused on a group of mycotoxins to test their role in the manifestation of autism. Ochratoxin A (OTA), gliotoxin, zearalenone, and sphingosine/sphinganine ratio were determined by LC analysis in sera and urines. Our results are the first describing a possible role of OTA in the pathobiology of autism. Recalling the male prevalence of ASD (male/female = 4-5/1), it is noted that, in animal models, OTA exerts its neurotoxicity especially in males. A personalized diet coupled with probiotic administration, especially OTA adsorbing Lactobacillus, could ameliorate autistic symptoms in OTA-positive patients.”

Neuroprotective Actions of Dietary Choline. Full text. “Maternal dietary choline supplementation in BTBR mice during pregnancy and lactation alleviated anxiety-like behaviors and improved deficits in social behavior in adolescent and adult progeny.”

Structural and Pragmatic Language in Children with ASD: Longitudinal Impact on Anxiety and Externalizing Behaviors.Here, we examined how structural language and pragmatic language predicted anxiety and externalizing behaviors. Pragmatic language, was inversely related to child anxiety and co-occurring externalizing behaviors. Structural language skills positively predicted child anxiety. These findings suggest that children with ASD may be at heightened risk for anxiety and externalizing disorders due to their pragmatic language deficits.”

Folate metabolism abnormalities in autism: potential biomarkers.Autism spectrum disorder (ASD) has been linked to abnormalities in folate metabolism. Polymorphisms in folate genes may act in complex polygenic ways to increase the risk of developing ASD. Autoantibodies that block folate transport into the brain have been associated with ASD and children with ASD and these autoantibodies respond to high doses of a reduced form of folate known as folinic acid (leucovorin calcium). Some of the same abnormalities are also found in mothers of children with ASD and supplementing folate during preconception and gestational periods reduces the risk to the offspring from developing ASD. These data suggest that folate pathway abnormalities may be a major metabolic disturbance underlying ASD that can be leveraged as biomarkers to improve symptoms and prevent ASD.”

Personality Characteristics and Neurocognitive Functions in Parents of Children with Autism Spectrum Disorder.Compared to the parents of well-developed children, the parents of children with ASD were more likely to be unconcerned, rigid, stubborn, introverted, and reticent. They displayed less novelty and thrill-seeking behaviors, and had limited social skills and maturity. Although the general cognitive functions including IQ were relatively intact in the parents of children with ASD, there were impairments in their planning, flexibility and visual processing functions.”

Recent developments in understanding the role of the gut microbiota in brain health and disease. Full text. “There is a growing appreciation of the role of the gut microbiota in all aspects of health and disease, including brain health. Indeed, roles for the bacterial commensals in various psychiatric and neurological conditions, such as depression, autism, stroke, Parkinson’s disease, and Alzheimer’s disease, are emerging. Microbiota dysregulation has been documented in all of these conditions or in animal models thereof. Moreover, depletion or modulation of the gut microbiota can affect the severity of the central pathology or behavioral deficits observed in a variety of brain disorders. Additionally, recent preclinical and clinical evidence suggest that targeting the microbiota through prebiotic, probiotic, or dietary interventions may be an effective “psychobiotic” strategy for treating symptoms in mood, neurodevelopmental disorders, and neurodegenerative diseases.”

Immunological cytokine profiling identifies TNF-α as a key molecule dysregulated in autistic children. Full text. “Our results provide further support for altered innate immunity being an important autism pathogenic factor, with autistic children showing increased blood TNF-α concentrations associated with symptom severity, and decreased expression of the THRIL gene involved in regulating TNF-α.”

DEVELOPMENTAL NEUROTOXICITY AND AUTISM: A POTENTIAL LINK BETWEEN INDOOR NEUROACTIVE POLLUTANTS AND THE CURIOUS BIRTH ORDER RISK FACTOR.Epidemiological and demographic studies find an increased risk of autism among first-borns. Toxicological studies show that some semi-volatile substances found in infant products produce adverse effects in neural and endocrine systems of animals, including behavioral and developmental effects. Several factors elevate the exposure of human infants to these chemicals. The highest exposures found in infants are comparable to the exposures that induce neural toxicity in animals. A review of these literatures suggests a linking hypothesis that could bridge the epidemiological and toxicological lines of evidence: an infant’s exposure to neuroactive compounds emitted by infant products is increased by product newness and abundance; exposure is likely maximized for first-born children in families that can afford new products. Exposure is reduced for subsequently-born children who reuse these now neuroactive-depleted products. The presence of neuroactive chemical emissions from infant products has implications for birth-order effects and for other curious risk factors in autism, including gender, socioeconomic status, and season-of-birth risk factors.”

Role of Endocannabinoids on Neuroinflammation in Autism Spectrum Disorder Prevention. Full text. “Neuroinflammtion had been shown in postmortem brain specimens from Autism Spectrum Disorder [ASD] patients. The Endocannabinoids System (ES) consists of a family of locally produced, short-lived, endogenous, phospholipid-derived agonists (endocannabinoids) that control energy balance and body composition. The growing number of medical benefits of ES, such as their ability to regulate processes like neuroinflammation, neurogenesis and memory, raise the question of their potential role as a preventive treatment of ASD. To test this hypothesis, basic and clinical studies allow us a thorough investigation of the role of ES in the pathogenesis of ASD. This hypothesis will help to understand the mechanism of ES and its role in ASD.”

Current nutritional approaches in managing autism spectrum disorder: A review.The link between nutrition and autism spectrum disorder (ASD), which is a complex developmental disorder manifesting itself in significant delays or deviation in interaction and communication, has provided a fresh point of view and signals that nutrition may have a role in the aetiology of ASD, as well as play an active role in treatment by alleviating symptoms. The research put forward that in individuals with ASD, while gluten-free/casein-free and ketogenic diets, camel milk, curcumin, probiotics, and fermentable foods can play a role in alleviating ASD symptoms, consumption of sugar, additives, pesticides, genetically modified organisms, inorganic processed foods, and hard-to-digest starches may aggravate symptoms. This review emphasizes the value of identifying current nutritional approaches specific to individuals with ASD and integrating their effects on symptoms to the conversation and presents suggestions for future research designed to identify medical nutrition therapies targeting this population to better understand the link between ASD and nutrition.” So it seems that the benefit of using a nutritional approach in the treatment of ASD just continues to grow in strength.

July 2017

Brief Report: What Happens When I Can No Longer Support My Autistic Relative? Worries About the Future for Family Members of Autistic Adults.Very little is known about autism and adulthood. Family members are often the primary support for autistic adults and frequently express concerns about what the future will hold and what support will be available for their relative. 120 family members of autistic adults completed an online survey exploring concerns about the future for their relative. The most endorsed concerns were “their needs won’t be met” (77% worried weekly), “whether they will be happy” (72% worried weekly) and “who will care for them” (58% worried weekly).”

The putative role of environmental aluminium in the development of chronic neuropathology in adults and children. How strong is the evidence and what could be the mechanisms involved? Full text. “The conceptualisation of autistic spectrum disorder and Alzheimer’s disease has undergone something of a paradigm shift in recent years and rather than being viewed as single illnesses with a unitary pathogenesis and pathophysiology they are increasingly considered to be heterogeneous syndromes with a complex multifactorial aetiopathogenesis, involving a highly complex and diverse combination of genetic, epigenetic and environmental factors. One such environmental factor implicated as a potential cause in both syndromes is aluminium, as an element or as part of a salt, received, for example, in oral form or as an adjuvant. Such administration has the potential to induce pathology via several routes such as provoking dysfunction and/or activation of glial cells which play an indispensable role in the regulation of central nervous system homeostasis and neurodevelopment. Other routes include the generation of oxidative stress, depletion of reduced glutathione, direct and indirect reductions in mitochondrial performance and integrity, and increasing the production of proinflammatory cytokines in both the brain and peripherally. The mechanisms whereby environmental aluminium could contribute to the development of the highly specific pattern of neuropathology seen in Alzheimer’s disease are described. Also detailed are several mechanisms whereby significant quantities of aluminium introduced via immunisation could produce chronic neuropathology in genetically susceptible children. Accordingly, it is recommended that the use of aluminium salts in immunisations should be discontinued and that adults should take steps to minimise their exposure to environmental aluminium.”

Alterations of Growth Factors in Autism and Attention-Deficit/Hyperactivity Disorder. Full text. “Growth factors (GFs) are cytokines that regulate the neural development. Recent evidence indicates that alterations in the expression level of GFs during embryogenesis are linked to the pathophysiology and clinical manifestations of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). In this concise review, we summarize the current evidence that supports the role of brain-derived neurotrophic factor, insulin-like growth factor 2, hepatocyte growth factor (HGF), glial-derived neurotrophic factor, nerve growth factor, neurotrophins 3 and 4, and epidermal growth factor in the pathogenesis of ADHD and ASD. We also highlight the potential use of these GFs as clinical markers for diagnosis and prognosis of these neurodevelopmental disorders.”

A Dopamine Hypothesis of Autism Spectrum Disorder. Full text. “In this paper, we present such a hypothesis by proposing that autistic behavior arises from dysfunctions in the midbrain dopaminergic system. We present clinical studies of dopamine antagonists which seem to have improving effects on autistic behavior. Furthermore, we explore the means of testing our hypothesis by using neuroreceptor imaging, which could provide comprehensive evidence for dopamine signaling dysfunctions in autistic subjects. Lastly, we discuss the limitations of our hypothesis. Along these lines, we aim to provide a dopaminergic model of ASD which might lead to a better understanding of the ASD pathogenesis.”

Effect of Omega-3 and -6 Supplementation on Language in Preterm Toddlers Exhibiting Autism Spectrum Disorder Symptoms.Early intervention is critical for children with ASD, and the present study presents pilot data on a clinical trial of omega-3 and -6 fatty acid supplementation and language development, a secondary trial outcome, in children at risk for ASD. We randomized 31 children to receive an omega-3 and -6 supplement or a placebo for 3 months, and measured their language abilities at baseline and after supplementation. Gesture use, but not word production, increased for children in the treatment group more than children in the placebo group. These results suggest possible effectiveness of omega-3 and -6 supplementation for language development in children at risk for ASD.”

Prevalence of Sleep Abnormalities in Indian Children With Autism Spectrum Disorder: A Cross-Sectional Study.Nearly three fourths of children with ASD have sleep abnormalities with a possible effect on the behavioral phenotype. The polysomnographic findings provide further insight with opportunity for pharmacological interventions. Screening for sleep problems is imperative for the appropriate management and overall improvement in quality of life in children with ASD.”

Genetic predictors of celiac disease, lactose intolerance, and vitamin D function and presence of peptide morphins in urine of children with neurodevelopmental disorders. Gastrointestinal disturbances, nutritional deficiencies, and food intolerances are frequently observed in children with neurodevelopmental disorders (NDD). Intestinal peptide permeability was estimated in NDD patients and healthy children by measuring the level of peptides in urine using high-performance liquid chromatography. Levels of opioid peptides, casomorphin 8, and gluten exorphin C were significantly elevated in urine samples of NDD patients. We have also found that lower serum levels of vitamin D (25-OH) showed association with childhood autism (CHA), a subgroup of NDD. We hypothesize that vitamin D might be important for the development of CHA.”

Cataloguing Treatments Discussed and Used in Online Autism Communities. Full text. “A large number of patients discuss treatments in online health communities (OHCs). One research question of interest to health researchers is whether treatments being discussed in OHCs are eventually used by community members in their real lives. We notice that some of the treatments, such as chelation, are discussed prevalently in the communities. However, they are not necessarily options that are mostly taken in practice. Within the top treatment list that represents actual usage, non-chemical psycho-social interventions such as speech therapy and special education are popular, although they are not necessarily the most popular ones under discussion. The most important building block of future work following this study is to compare the list of treatments discovered in OHCs automatically by the computational tool with established clinical guidelines. For example, while effectiveness of chelation is still under investigation by researchers, it already becomes a rather popular choice among autism community members. It is therefore critical to further quantify how broad the gap is between established guideline and patients’ actual practice.”

The Putative Role of Environmental Mercury in the Pathogenesis and Pathophysiology of Autism Spectrum Disorders and Subtypes.Environmental mercury is neurotoxic at doses well below the current reference levels considered to be safe, with evidence of neurotoxicity in children exposed to environmental sources including fish consumption and ethylmercury-containing vaccines. Possible neurotoxic mechanisms of mercury include direct effects on sulfhydryl groups, pericytes and cerebral endothelial cells, accumulation within astrocytes, microglial activation, induction of chronic oxidative stress, activation of immune-inflammatory pathways and impairment of mitochondrial functioning. (Epi-)genetic factors which may increase susceptibility to the toxic effects of mercury in ASD include the following: a greater propensity of males to the long-term neurotoxic effects of postnatal exposure and genetic polymorphisms in glutathione transferases and other glutathione-related genes and in selenoproteins. Furthermore, immune and inflammatory responses to immunisations with mercury-containing adjuvants are strongly influenced by polymorphisms in the human leukocyte antigen (HLA) region and by genes encoding effector proteins such as cytokines and pattern recognition receptors. Some epidemiological studies investigating a possible relationship between high environmental exposure to methylmercury and impaired neurodevelopment have reported a positive dose-dependent effect. Retrospective studies, on the other hand, reported no relationship between a range of ethylmercury-containing vaccines and chronic neuropathology or ASD. On the basis of these results, we would argue that more clinically relevant research is required to examine whether environmental mercury is associated with ASD or subtypes. Specific recommendations for future research are discussed.”

Comparative safety of antiepileptic drugs for neurological development in children exposed during pregnancy and breast feeding: a systematic review and network meta-analysis. Full text. “Antiepileptic drugs (AEDs) are used by pregnant women for various conditions, such as epilepsy, pain syndromes, psychiatric disorders and chronic migraine. AED use during pregnancy is associated with risks to the fetus as these drugs can cross the placenta or may be transferred to the infant through breast feeding and may be associated with adverse neurodevelopment outcomes. Valproate alone or combined with another AED is associated with the greatest odds of adverse neurodevelopmental outcomes compared with control. Oxcarbazepine and lamotrigine were associated with increased occurrence of autism. Counselling is advised for women considering pregnancy to tailor the safest regimen.”

Background lead and mercury exposures: Psychological and behavioral problems in children.The potential harm from exposure to nonessential metals, particularly mercury (Hg) and lead (Pb), has been the focus of research for years. Initial interest focused on relatively high exposures; however, recent evidence suggests that even background exposures might have adverse consequences for child development. With increasing Pb levels, children exhibit higher levels of hostile distrust and oppositional defiant behaviors, were more dissatisfied and uncertain about their emotions, and had difficulties with communication. These significant associations were found within a range of blood Pb levels from 0.19 to 3.25μg/dL, well below the “reference value” for children of >5μg/dL. This study is the first to demonstrate an association between very low-level Pb exposure and fundamental psychological mechanisms that might explain prior associations with more complex outcomes such as delinquency. Analyses of vagal reactivity yielded entirely novel associations suggesting that Hg may increase autism spectrum behaviors in children with sustained vagal tone during acute stress.”

Visual systemizing preference in children with autism: A randomized controlled trial of intranasal oxytocin.Several studies have suggested that the neuropeptide oxytocin may enhance aspects of social communication in autism. Little is known, however, about its effects on nonsocial manifestations, such as restricted interests and repetitive behaviors. Unlike control subjects who showed no gaze preference, individuals with ASD preferred to fixate on more highly systemized pictures. Intranasal oxytocin eliminated this preference in ASD participants, who now showed a similar response to control subjects on placebo. In contrast, control participants increased their visual preference for more systemized images after receiving oxytocin versus placebo. These results suggest that, in addition to its effects on social communication, oxytocin may play a role in some of the nonsocial manifestations of autism.”

The Gap Between Adaptive Behavior and Intelligence in Autism Persists into Young Adulthood and is Linked to Psychiatric Co-morbidities.For individuals with autism spectrum disorder (ASD), long-term outcomes have been troubling, and intact IQ has not been shown to be protective. These findings emphasize key intervention targets of both adaptive skill and psychopathology for transition-age youth and young adults with ASD, as well as the need for ongoing monitoring of anxiety and depression symptoms during this developmental window.”

Twenty-Five Year Survival of Children with Intellectual Disability in Western Australia. Although children with intellectual disability experience higher mortality at all ages compared with those without intellectual disability, the greatest burden is for those with severe intellectual disability. However, even children with mild to moderate intellectual disability have increased risk of death compared with unaffected children.”

Brain carnitine deficiency causes nonsyndromic autism with an extreme male bias: A hypothesis. Full text. “Could 10-20% of autism be prevented? We hypothesize that nonsyndromic or “essential” autism involves extreme male bias in infants who are genetically normal, but they develop deficiency of carnitine and perhaps other nutrients in the brain causing autism that may be amenable to early reversal and prevention. That brain carnitine deficiency might cause autism is suggested by reports of severe carnitine deficiency in autism and by evidence that TMLHE deficiency – a defect in carnitine biosynthesis – is a risk factor for autism.”

Caring for children with autism spectrum condition in paediatric emergency departments. The needs of children with autism spectrum condition (ASC) in paediatric emergency departments (EDs) can often be overlooked. EDs are high-stress environments for children with ASC, which can result in meltdowns, making the diagnostic process challenging. There should be provision for children with ASC, who can have sensory, behavioural and communication needs, in the same way that analgesia is provided for children in pain.”

An update on anesthetics and impact on the brain.While anesthetics are indispensable clinical tools and generally considered safe and effective, a growing concern over the potential neurotoxicity of anesthesia or specific anesthetic agents has called into question the safety of general anesthetics, especially when administered at extremes of age. Exposure to general anesthetics is potentially harmful to the human brain, and the consequent long-term cognitive deficits should be classified as an iatrogenic pathology, and considered a public health problem.”

Intranasal oxytocin treatment for social deficits and biomarkers of response in children with autism. Full text. “Emerging evidence suggests that the neuropeptide oxytocin, which regulates mammalian social functioning, may be a promising treatment for ASD. However, prior oxytocin treatment trials in ASD patients have produced equivocal results, perhaps because of variability in patients’ underlying neuropeptide biology. Here we provide evidence that oxytocin treatment improves social abilities in children with ASD and that individuals with the lowest pretreatment blood oxytocin concentrations benefit the most from oxytocin administration. These findings reveal a personalized component to oxytocin treatment which may have important implications for accurately testing oxytocin’s therapeutic potential, both for ASD and for a broad range of developmental and psychiatric disorders in which patients exhibit social impairments.”

Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial. Full text. “The safety and activity of low-dose suramin showed promise as a novel approach to treatment of ASD in this small study.”

Vagus nerve stimulation as a potential adjuvant to behavioral therapy for autism and other neurodevelopmental disorders. Full text. “Vagus nerve stimulation (VNS) is an FDA approved therapy that is safe and effective in reducing seizure frequency and duration in individuals with epilepsy. Individuals with neurodevelopmental disorders often exhibit decreased vagal tone, and studies indicate that VNS can be used to overcome an insufficient vagal response. Multiple studies have also documented significant improvements in quality of life after VNS therapy in individuals with neurodevelopmental disorders.”

A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice.Atypical antipsychotic (AA) drugs, including risperidone (RIS), are used to treat schizophrenia, bipolar disorder, and autism, and are prescribed off-label for other mental health issues. AA drugs are associated with severe metabolic side effects of obesity and type 2 diabetes. Cross-sectional and longitudinal data also show that risperidone causes bone loss and increases fracture risk in both men and women.”

The role of probiotics in children with autism spectrum disorder: A prospective, open-label study.After probiotic supplementation, the stool PCR of autistic children showed increases in the colony counts of Bifidobacteria and Lactobacilli levels, with a significant reduction in their body weight as well as significant improvements in the severity of autism (assessed by the ATEC), and gastrointestinal symptoms (assessed by the 6-GSI) compared to the baseline evaluated at the start of the study. We concluded that probiotics have beneficial effects on both behavioral and GI manifestations of ASD. Probiotics (a non-pharmacological and relatively risk-free option) could be recommended for children with ASD as an adjuvant therapy.”

Autism-Like Behaviours and Memory Deficits Result from a Western Diet in Mice. Full text. “This is the first report to show that a WD [Western Diet] can profoundly suppress social interactions and induce dominant-like behaviours in naïve adult mice. The spectrum of behaviours that were found to be induced are reminiscent of symptoms associated with autism, and, if paralleled in humans, suggest that a WD might exacerbate autism spectrum disorder.”

General practice encounters for young patients with autism spectrum disorder in Australia.This study compared the patient demographics and reasons for encounter in general practice for patients <25 years with and without an autism spectrum disorder identified as a reason for encounter and/or problem managed. At autism spectrum disorder (vs non-autism spectrum disorder) encounters, there were more psychological, general and unspecified, and social reasons for encounter and fewer preventive and acute health reasons for encounter. People with an autism spectrum disorder have complex health care needs that require a skilled general practice workforce.”

Prenatal maternal stress events and phenotypic outcomes in Autism Spectrum Disorder. Findings indicate that ASD, in the context of prenatal maternal stress exposure, may be associated with a more severe phenotype, particularly when there are multiple prenatal exposures.”

Using Animal Models to Study the Role of the Gut-Brain Axis in Autism. Full text. “Individuals with autism spectrum disorders (ASD) commonly also suffer from gastrointestinal (GI) dysfunction; however, few animal model studies have systematically examined both ASD and GI dysfunction. In this review, we highlight studies investigating GI dysfunction and alterations in gut microbiota in animal models of ASD with the aim of determining if routinely used microbiology and enteric neurophysiology assays could expand our understanding of the link between the two.”

Increased Hyperacusis with Risperidone in an Autistic Child. Full text. “In the literature, there is only one case on hyperacusis that worsened with risperidone in a 5-year-old girl with autism. Here we represent the case of an 11-year-old boy with autism, in whom hyperacusis worsened with risperidone, decreased after the discontinuation of the medication, and re-occurred after the prescription of the drug again. Although auditory hypersensitivity tends to affect the child’s daily life negatively and is found to be correlated with behavioral problems in autistic patients, we still know very little about its etiology, treatment, and conditions related to it.”

Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis. Full text. “The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.”

Neurobehavioral comorbidities of epilepsy: Role of inflammation.Interference with inflammatory pathways or actions can reduce the severity of seizures, depression, and ASD-like behavior. Inflammation in the brain can be induced by seizure activity as well as by behavioral, environmental, and physiologic stressors. Furthermore, induction of inflammation at an early time point during gestation and in early neonatal life can precipitate both an ASD-like phenotype as well as a more excitable brain. It appears likely that priming of the brain due to early inflammation could provide a means by which subsequent inflammatory processes associated with epilepsy, ASD, and depression may lead to comorbidity.”

Medical comorbidities in children and adolescents with autism spectrum disorders and attention deficit hyperactivity disorders: a systematic review.This thorough literature search provides an overview of relevant articles on medical comorbidity in ADHD and/or ASD, and shows that medical disorders in these children and adolescents appear to be widespread. Those who work with children with ASD and/or ADHD should be well aware of this and actively promote routine medical assessment.”

Behavioral regression in 2 patients with autism spectrum disorder and attention-deficit/hyperactivity disorder after oral surgery performed with a general anesthetic.The authors describe postoperative behavioral changes in 2 patients with autism spectrum disorder and attention deficit hyperactivity disorder that the patients’ caretakers described as regression. In both cases, behaviors representative of autism spectrum disorder and attention deficit hyperactivity disorder worsened after uncomplicated oral surgery after receipt of a general anesthetic in the operating room. In both cases, behavioral changes caused great difficulties for the patients and caretakers and were difficult to address.”

June 2017

Status of essential elements in autism spectrum disorder: systematic review and meta-analysis.Meta-analyses showed that the hair concentrations of chromium, cobalt, iodine, iron, and magnesium in ASD patients were significantly lower than those of control subjects, while there were higher magnesium levels in the hair of ASD patients compared to that of controls. Patients with ASD had higher blood levels of copper and lower levels of zinc compared to controls. Further urinary iodine levels in patients with ASD were decreased in comparison with controls.”

Dietary DHA, Bioaccessibility, and Neurobehavioural Development in Children.As main conclusions, it can be mentioned that high DHA intake may prevent autism disorder. However, more studies are required to strengthen the connection between autism and dietary DHA.”

Pathological game use in adults with and without Autism Spectrum Disorder.This study tested whether adults with autism spectrum disorder (ASD) are at higher risk for pathological game use than typically developing (TD) adults. The results indicated that adults with ASD endorsed more symptoms of video game pathology than did TD adults. Additionally, escapism motives for playing video games was associated with game pathology scores in both ASD and TD adults.”

Study on the Association among Mycotoxins and other Variables in Children with Autism. Full text. “Mycotoxins are agricultural contaminants of fungal origin that represent real risk factors for human health and especially for children. Thus, the main hypothesis of this work is that the deterioration of the clinical manifestation of autism in children may result from the exposure to mycotoxins through the consumption of contaminated food. These results suggest the need for a deeper examination of the role that mycotoxins may have on the etiology of ASD.”

Evidence of Mitochondrial Dysfunction in Autism: Biochemical Links, Genetic-Based Associations, and Non-Energy-Related Mechanisms. Full pdf. “The literature reviewed here suggests a link between abnormalities in mitochondrial homeostasis and ASD and provides biochemical and genetic evidence to support a role for mitochondrial dysfunction in the pathogenesis of the autism phenotype. Positive patient behavioral responses to conventional mitochondrial disease therapies are promising, however, further investigation is necessary. Future work should focus on determining how mitochondrial dysfunction causes the autistic phenotype as well as how defects in mitochondrial homeostasis predispose individuals to ASD via interaction with environmental toxins, dietary factors, and epigenetic modifications during critical periods of development.”

Lack of effect of vitamin D3 supplementation in autism: a 20-week, placebo-controlled RCT.Data suggest a potential role for vitamin D in autism spectrum disorder (ASD). 38 children completed the trial. Baseline 25(OH)D was 54.2±19.7 nmol/L. Following vitamin D3 supplementation, there was a significant increase in 25(OH)D to 83.8 nmol/L but no effect on the primary endpoint. However, there was an improvement in self-care on DD-CGAS. In contrast, there was also a trend toward decreased inappropriate speech in the placebo group. Vitamin D supplementation had no effect on the primary outcome with limited and inconsistent effects in children with ASD.”

Aripiprazole-Related Diurnal Enuresis in Children: 2 Cases (Aripiprazole-Related Enuresis).Aripiprazole is an atypical antipsychotic with dopaminergic and serotonergic effects. Enuresis as an adverse effect has been reported with aripiprazole use in children with autism spectrum disorders. Here, we report 2 cases without autism spectrum disorders who developed diurnal enuresis after starting aripiprazole and ceased after discontinuation of the medication.”

The Co-Occurrence of Autism Spectrum Disorder in Children With ADHD. Approximately one in eight children currently diagnosed with ADHD was also diagnosed with ASD. Children diagnosed with both disorders had greater treatment needs, more co-occurring conditions, and were more likely to have a combined hyperactive/impulsive and inattentive ADHD subtype.”

Correlates of Police Involvement Among Adolescents and Adults with Autism Spectrum Disorder.Approximately 16% of individuals were reported to have some form of police involvement during the study period. Aggressive behaviors were the primary concern necessitating police involvement. Individuals with police involvement were more likely to be older, have a history of aggression, live outside the family home, and have parents with higher rates of caregiver strain and financial difficulty at baseline.”

Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review.Six RCTs (214 participants) were included. One trial found that compared with the control group, in the GFCF diet group there were significant improvements in the scores for the ‘communication’ subdomain of the Autism Diagnostic Observation Schedule and for the ‘social interaction’ subdomain of the Gilliam Autism Rating Scale. Another trial found significant differences between groups in the post-intervention scores for the ‘autistic traits’, ‘communication’, and ‘social contact’ subdomains of a standardized Danish scheme. The remaining differences, if present, referred to parent-based assessment tools or other developmental/ASD-related features. No adverse events associated with a GFCF diet were reported. Overall, there is little evidence that a GFCF diet is beneficial for the symptoms of ASD in children.” Again those children for which a GFCF diet is beneficial get lost in the statistics. Unfortunately the review is not open-access, therefore we do not know which studies were selected.

Tryptophan status in autism spectrum disorder and the influence of supplementation on its level. Full text. “Some dietary-derived essential compounds, such as the amino acid tryptophan, appear to be impaired in patients with ASD. Tryptophan (Trp) plays a significant role in the human organism and serves as a precursor for a wide range of bioactive compounds, including major neurotransmitters. Research indicates that tryptophan might be deficient in subjects with ASD. Statistical evaluations in the concentration of tryptophan in ASD patients with different severity of symptoms were reported. A significant difference in tryptophan levels in all groups was observed. Supplementation with B vitamins and magnesium has an influence on the Trp concentration. These results assess that the Trp level in ASD subjects is critical and that intake of B vitamins and magnesium with diet might influence its metabolic homeostasis.”

Prenatal fever and autism risk. Full text. “Some studies suggest that prenatal infection increases risk of autism spectrum disorders (ASDs). This study was undertaken in a prospective cohort in Norway to examine whether we could find evidence to support an association of the prenatal occurrence of fever, a common manifestation of infection, with ASD risk. Maternal exposure to second-trimester fever was associated with increased ASD risk. Risk increased markedly with exposure to three or more fever episodes after 12 weeks’ gestation. ASD risk appears to increase with maternal fever, particularly in the second trimester. Risk magnified dose dependently with exposure to multiple fevers after 12 weeks’ gestation. Our findings support a role for gestational maternal infection and innate immune responses to infection in the pathogenesis of at least some cases of ASD.”

Children with autism need better hospital care, says RCN.Nurses have called for improvements to the care of children with autism in hospitals and the community. About 1% of children in the UK have autism spectrum disorder (ASD), which affects social interaction, behaviour and communication. However, as healthcare services are pushed to breaking point, support for such children is dwindling, the RCN warns.

Risk of Second Seizure in Pediatric Patients With Idiopathic Autism.Epilepsy is a comorbidity of idiopathic autism spectrum disorder. Patients with idiopathic autism spectrum disorder, ≥1 seizure, and age 2 to 23 years were included. 153 patients were included; 141 (92%) had a second seizure. The average age at first seizure was 7.14 years (median: 5.08 years) and 8.12 years (median: 7.3 years) at second seizure. Average time between first and second seizure was 7.68 months. A high risk of seizure recurrence was found in this population. There was a short time to second seizure, with most having a recurrence within 1 year.”

Factors associated with stress in families of children with autism spectrum disorder. Forty-four percent of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child’s ASD.”

Homocysteine as a Diagnostic and Etiopathogenic Factor in Children with Autism Spectrum Disorder.The aim of our study was assessment of hair magnesium and serum homocysteine concentrations in children with autism. Our research showed normal magnesium blood levels and significantly high homocysteine levels and very low hair magnesium levels, low concentration of hair magnesium progresses with age. Our hypothesis is that magnesium deficiency, as a relevant epigenetic factor, might be decreasing methylation of homocysteine, therefore decreasing genome transcription and lowering the synaptic plasticity. We suggest that analysis of hair magnesium and serum homocysteine levels might be useful in identification of children with autism spectrum disorder, as well as control of its treatment. Obtained results and performed analysis might therefore justify supplementation of magnesium among children with autism.

Neurodevelopmental Delay Diagnosis Rates Are Increased in a Region with Aerial Pesticide Application. Full text. “A number of studies have implicated pesticides in childhood developmental delay (DD) and autism spectrum disorder (ASD). To study this factor, we examined ASD/DD diagnoses rates in an area near our regional medical center that employs yearly aerial pyrethroid pesticide applications to combat mosquito-borne encephalitis. The aim of this study was to determine if areas with aerial pesticide exposure had higher rates of ASD/DD diagnoses. This regional study identified higher rates of ASD/DD diagnoses in an area with aerial pesticides application. codes with aerial pyrethroid exposure were 37% more likely to have higher rates of ASD/DD.”

Increased risk for an atypical autism diagnosis following Thimerosal-containing vaccine exposure in the United States: A prospective longitudinal case-control study in the Vaccine Safety Datalink.Thimerosal is an organic-mercury (Hg)-containing compound (49.55% Hg by weight) historically added to many multi-dose vials of vaccine as a preservative and still added to some vaccines today. Concerns about the toxic effects from Thimerosal-containing childhood vaccines and the risk of an atypical autism diagnosis were evaluated in this study. Cases diagnosed with atypical autism were statistically significantly more likely to have received greater overall and dose-dependent exposures to Hg from TM-HepB vaccines administered within the first month of life, first two months of life, and first six months of life than the controls. Similar phenomena were observed when cases and controls were separated by gender. The present study provides important epidemiological evidence significantly associating increasing Hg exposure from Thimerosal-containing childhood vaccines and the subsequent risk of atypical autism diagnosis, and suggests that Thimerosal should be eliminated from vaccines.”

Behavioral Symptoms of Reported Abuse in Children and Adolescents with Autism Spectrum Disorder in Inpatient Settings.The objective of this study was to examine how behavioral manifestations of trauma due to abuse are expressed in youth with autism spectrum disorder (ASD). Findings indicate that patients with ASD and reported abuse (i.e. physical, sexual, and/or emotional) have more intrusive thoughts, distressing memories, loss of interest, irritability, and lethargy than those without reported maltreatment. Those with clinical diagnoses of posttraumatic stress disorder (PTSD) had more severe and externalized symptoms than those with reported abuse not diagnosed with PTSD. Results emphasize the need for trauma screening measures to guide evidence-based treatments for children with ASD.”

Herbal Medicine Treatment for Children with Autism Spectrum Disorder: A Systematic Review. Full text. “The results of this systematic review indicated that herbal medicines combined with conventional treatment seem to have a positive effect on the treatment of ASD in children. Herbal medicines plus integrative therapy as an adjuvant to conventional therapy also have an encouraging effect in the treatment of autistic children. However, owing to the low methodological quality of the included studies, small sample size, and diversity of herbal medicines, firm conclusions could not be drawn.”

Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial. Full text. “Suramin was first synthesized in 1916, making it one of the oldest manmade drugs still in medical use. It is used to treat African sleeping sickness. Here, we report the findings of the Suramin Autism Treatment-1 (SAT-1) trial, the first direct test of suramin, the cell danger hypothesis, and the relevance of abnormal purinergic signaling in children with ASD. A single intravenous dose of suramin was associated with improved scores for language, social interaction, and decreased restricted or repetitive behaviors. None of these improvements occurred in the five children who received placebo. The generalizability of these findings is unknown. These studies showed that low-dose suramin was effective in treating ASD-like symptoms and did not produce toxicity even when used for at least 4 months. These data help form the foundation for future studies that will test the safety and efficacy of suramin, provide fresh directions for the development of new antipurinergic drugs, and add support to the hypothesis that a potentially treatable metabolic syndrome may contribute to the pathogenesis of autism.

Human Embryonic Stem Cells in the Treatment of Autism: A Case Series. Full text. “Human embryonic stem cell therapy has been shown to improve blood perfusion in the brain; thus, this therapy may be effective in improving motor skills, social skills, and cognition in patients with autism spectrum disorder. The patients showed improvements in eye coordination, writing, balancing, cognition, and speech and showed reduced hypersensitivity to noises and smells.”

The amino acid profile in blood plasma of young boys with autism. Full text. The mean plasma concentration values of citrulline, .-aminobutyric acid, isoleucine, leucine, phenylalanine, tryptophan and ornithine were significantly lower in boys with autism as compared to the control group. None of the amino acids measured differentiate autistic children from healthy children. The sum of exogenous amino acids was lower in the study group than in the control group but this difference was not statistically significant. Lower levels of exogenous amino acids confirm the possible role of these amino acids in autism. Determination of exogenous amino acids in plasma, however, cannot be used as a diagnostic test but it can still support autistic patients care.”

Serum thyroid-stimulating hormone and interleukin-8 levels in boys with autism spectrum disorder. Full pdf. “Eleven proteins were found that together could confirm ASD with modest accuracy using multiple training and test sets. Two of the 11 proteins identified here were further tested using a different detection platform and with a larger sample of ASD and TD boys. The two proteins, thyroid-stimulating hormone (TSH) and interleukin-8 (IL-8), have been previously identified as putative biomarkers for ASD. TSH levels were significantly lower in ASD boys, whereas IL-8 levels were significantly elevated. The diagnostic accuracy for ASD based upon TSH or IL-8 levels alone varied from 74 to 76%, but using both proteins together, the diagnostic accuracy increased to 82%. In addition, TSH levels were negatively correlated with the Autism Diagnostic Observation Schedule subdomain scores.”

Fetal and postnatal metal dysregulation in autism.Significant divergences are apparent in metal uptake between ASD cases and their control siblings, but only during discrete developmental periods. Cases have reduced uptake of essential elements manganese and zinc, and higher uptake of the neurotoxin lead. Manganese and lead are also correlated with ASD severity and autistic traits. Our study suggests that metal toxicant uptake and essential element deficiency during specific developmental windows increases ASD risk and severity, supporting the hypothesis of systemic elemental dysregulation in ASD.”

May 2017

Questions Remain Regarding the Effectiveness of Many Commonly Used Autism Treatments.Parents of newly diagnosed children with autism spectrum disorder (ASD) are faced with a dizzying array of treatments that promise to improve their child’s autism symptoms, cognitive and language abilities, and health. Desperate to leave no stone unturned as they strive to help their child have the best possible future, many parents spend countless hours and large amounts of money on unproven therapies. Unfortunately, as the 2 systematic reviews published in this issue of Pediatrics describe, the scientific field has not done enough to provide definitive answers about the effectiveness of many commonly used treatments.

The first article, by Sathe et al1 (“Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review”), provides a detailed review of studies on the effects of various supplements, including omega-3 fatty acids, digestive enzymes, methyl-B12, levocarnitine, and gluten- or casein-free diets. The results of the existing studies were mixed, with some studies finding positive results and others finding no benefit. The available studies are small and short-term, precluding any definitive answer about whether nutritional supplements or dietary therapies are helpful for children with ASD. This is unfortunate in light of the fact that special diets and dietary supplements are the most commonly used complementary and alternative treatment by children and adolescents …

Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review.Nineteen randomized controlled trials (RCTs), 4 with a low risk of bias, evaluated supplements or variations of the gluten/casein-free diet and other dietary approaches. Populations, interventions, and outcomes varied. Ω-3 supplementation did not affect challenging behaviors and was associated with minimal harms (low SOE). Two RCTs of different digestive enzymes reported mixed effects on symptom severity (insufficient SOE). Studies of other supplements (methyl B12, levocarnitine) reported some improvements in symptom severity (insufficient SOE). Studies evaluating gluten/casein-free diets reported some parent-rated improvements in communication and challenging behaviors; however, data were inadequate to make conclusions about the body of evidence (insufficient SOE). Studies of gluten- or casein-containing challenge foods reported no effects on behavior or gastrointestinal symptoms with challenge foods (insufficient SOE).” Although this may not seem a positive review, it is much more positive than such reviews a number of years ago. Also the Editorial introducing the study in the journal of Pediatrics [above] surprisingly points out how little research has been done in this area.

What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis.Of children meeting criteria for ASD, the true male-to-female ratio is not 4:1, as is often assumed; rather, it is closer to 3:1. There appears to be a diagnostic gender bias, meaning that girls who meet criteria for ASD are at disproportionate risk of not receiving a clinical diagnosis.”

Employers’ perception of the costs and the benefits of hiring individuals with autism spectrum disorder in open employment in Australia. Full text. “This study examines the benefits and costs of employing adults with ASD, from the perspective of employers. Fifty-nine employers employing adults with ASD in open employment were asked to complete an online survey comparing employees with and without ASD on the basis of job similarity. The findings suggest that employing an adult with ASD provides benefits to employers and their organisations without incurring additional costs.” Highly recommend parents of teenage children to read this article to see what type of companies may employ their child. As well as ways to approach prospective employers.

Abnormal Brain Connectivity Spectrum Disorders Following Thimerosal Administration: A Prospective Longitudinal Case-Control Assessment of Medical Records in the Vaccine Safety Datalink. Full text. “Autism spectrum disorder (ASD), tic disorder (TD), and hyperkinetic syndrome of childhood (attention deficit disorder [ADD]/attention deficit hyperactivity disorder [ADHD]) are disorders recently defined as abnormal connectivity spectrum disorders (ACSDs) because they show a similar pattern of abnormal brain connectivity. This study examines whether these disorders are associated with exposure to thimerosal, a mercury (Hg)-based preservative. A hypothesis testing case-control study evaluated the Vaccine Safety Datalink for the potential dose-dependent odds ratios (ORs) for diagnoses of ASD, TD, and ADD/ADHD compared to controls, following exposure to Hg from thimerosal-containing Haemophilus influenzae type b vaccines administrated within the first 15 months of life. On a per 25 μg Hg basis, cases diagnosed with ASD, TD, or ADD/ADHD were significantly more likely than controls to have received increased Hg exposure. The results suggest that Hg exposure from thimerosal is significantly associated with the ACSDs of ASD, TD, and ADD/ADHD.”

What do Cochrane systematic reviews say about interventions for autism spectrum disorders? Full text. “This review included 17 Cochrane systematic reviews. None of them provided high-quality evidence for any autism-related outcome. Acupuncture, early intensive behavioral intervention, gluten and casein-free diets, music therapy, parent-mediated early intervention, social skill groups and the Theory of Mind cognitive model seem to have benefits for patients with autism spectrum disorders (very low to low-quality evidence). Aripiprazole, risperidone, clomipramine, tianeptine and selective serotonin reuptake inhibitors are pharmacological options that seem to have some benefits (this last one only for adults), but all of them are associated with high risks of important adverse events.”

Autism risk following antidepressant medication during pregnancy. “Medication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.”

“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions.Camouflaging of autistic characteristics in social situations is hypothesised as a common social coping strategy for adults with autism spectrum conditions (ASC). Camouflaging may impact diagnosis, quality of life, and long-term outcomes, but little is known about it. This qualitative study examined camouflaging experiences in 92 adults with ASC, with questions focusing on the nature, motivations, and consequences of camouflaging. Thematic analysis was used to identify key elements of camouflaging, which informed development of a three-stage model of the camouflaging process. First, motivations for camouflaging included fitting in and increasing connections with others. Second, camouflaging itself comprised a combination of masking and compensation techniques. Third, short- and long-term consequences of camouflaging included exhaustion, challenging stereotypes, and threats to self-perception.”

Risperidone Therapy and CYP2D6 Genotype. Free book. “Risperidone is the most commonly prescribed antipsychotic medication in the US. It is an atypical (second generation) antipsychotic used in the treatment of schizophrenia, bipolar disorder, severe dementia, and irritability associated with autism. Risperidone is metabolized to the active metabolite 9-hydroxyrisperidone by the enzyme CYP2D6 and to a lesser extent by CYP3A4. Individuals who carry two inactive copies of the CYP2D6 gene are termed “poor metabolizers” and may have a decreased capacity to metabolize risperidone. These individuals may be at a higher risk of adverse effects because of increased exposure to plasma risperidone, compared to normal metabolizers, who carry two active copies of CYP2D6. Individuals who are CYP2D6 ultrarapid metabolizers (who carry more than two functional copies of CYP2D6) may have a decreased response to therapy, resulting from lower steady-state risperidone concentrations.”

Aripiprazole Therapy and CYP2D6 Genotype. Free book. “Aripiprazole is an atypical antipsychotic used in the management of schizophrenia, bipolar disorder, major depressive disorder, irritability associated with autistic disorder, and treatment of Tourette’s disorder. The metabolism and elimination of aripiprazole is mainly mediated through two enzymes, CYP2D6 and CYP3A4. Approximately 8% of Caucasians, 3–8% of Black/African Americans and up to 2% of Asians cannot metabolize CYP2D6 substrates and are classified as “poor metabolizers” (1). The FDA-approved drug label for aripiprazole states that in CYP2D6 poor metabolizers, half of the usual dose should be administered. In CYP2D6 poor metabolizers who are taking concomitant strong CYP3A4 inhibitors (e.g., itraconazole, clarithromycin), a quarter of the usual dose should be used.”

Characterization of Medication Use in a Multicenter Sample of Pediatric Inpatients with Autism Spectrum Disorder.Nearly 11% of youth with Autism Spectrum Disorder (ASD) undergo psychiatric hospitalization, and 65% are treated with psychotropic medication. Here we characterize psychotropic medication usage in subjects enrolled in the Autism Inpatient Collection. Participant psychotropic medication usage rates topped 90% at admission and discharge, though there was a decline at 2-month follow-up. Antipsychotics, ADHD medications, and sleep aids were the most commonly reported classes of medications.”

Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder.Behavioral problems were significantly improved following AT [adnotonsillectomy] in ASD children with OSA [obstructive sleep apnoea]. Early detection and treatment of children with OSA is essential to prevent behavioral problems and to support mental development.”

Efficacy of Structured Yoga Intervention for Sleep, Gastrointestinal and Behaviour Problems of ASD Children: An Exploratory Study. Full text. “According to parent’s feedback after one month of intervention most of the children improved in sleep and digestion related problems. During night children slept without any interruption for longer period compared to pre-intervention, going to bed in the night and getting up from bed in the morning not sleeping during day time were some of the improvements observed and this helped parents and other family members to have good sleep themselves during night. Some children who were snoring and breathing from mouth during sleep also stopped. Many children started taking balanced food instead of over eating every time.”

Sleep in Children with Autism Spectrum Disorder.Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin.”

Association between autism spectrum disorder and epilepsy in children.There is a significant association between ASD and epilepsy in children. The possibility of the comorbidity between ASD and epilepsy may be assessed according to the status of growth and development before the age of one year, sensory responses and behavioral competencies, and the presence or absence of epileptic seizures.”

The Gut Microbiota and Autism Spectrum Disorders. Full text. “Gastrointestinal (GI) symptoms are a common comorbidity in patients with autism spectrum disorder (ASD), but the underlying mechanisms are unknown. Many studies have shown alterations in the composition of the fecal flora and metabolic products of the gut microbiome in patients with ASD. The gut microbiota influences brain development and behaviors through the neuroendocrine, neuroimmune and autonomic nervous systems. In addition, an abnormal gut microbiota is associated with several diseases, such as inflammatory bowel disease (IBD), ASD and mood disorders. Here, we review the bidirectional interactions between the central nervous system and the gastrointestinal tract (brain-gut axis) and the role of the gut microbiota in the central nervous system (CNS) and ASD. Microbiome-mediated therapies might be a safe and effective treatment for ASD.”

Increased Serum Zonulin Levels as an Intestinal Permeability Marker in Autistic Subjects.Serum levels of zonulin, which regulates tight junctions between enterocytes and is a physiological modulator controlling intestinal permeability, in patients with autism spectrum disorders (ASDs). Serum zonulin levels were significantly higher in the patients with ASD compared with the healthy controls. There was a positive correlation between zonulin levels and Childhood Autism Rating Scale score when all subjects were assessed. This study suggests that zonulin, which regulates intestinal permeability, plays a role in the development of symptoms of ASD.”

Predictive value of selected biomarkers related to metabolism and oxidative stress in children with autism spectrum disorder.Several and reproducible studies have suggested that oxidative stress may represent one of the primary etiological mechanism of ASD that can be targeted for therapeutic intervention. Using either spectrophotometric or ELISA-colorimetric assay, levels of lipid peroxides, vitamin E, vitamin C, glutathione (GSH)/glutathione disulfide (GSSG) together with the enzymatic activity of catalase, plasma glutathione peroxidase (GPx), and blood superoxide dismutase (SOD), were measured in peripheral blood samples, as biomarkers related to oxidative stress. A remarkable increase in the area under the curve for most of the combined markers, representing both energy impaired metabolism or oxidative stress, was observed. Agents with activity against the impaired metabolic pathway associated with ASD including the metabolic defects and involved enzymes hold a promise as a novel therapy for ASD.”

Mast cells in neuroinflammation and brain disorders.It is well recognized that neuroinflammation is involved in the pathogenesis of various neurodegenerative diseases. Microglia and astrocytes are major pathogenic components within this process and known to respond to proinflammatory mediators released from immune cells such as mast cells. Mast cells reside in the brain and are an important source of inflammatory molecules. Mast cell interactions with glial cells and neurons result in the release of mediators such as cytokines, proteases and reactive oxygen species. During neuroinflammation, excessive levels of these mediators can influence neurogenesis, neurodegeneration and blood-brain barrier (BBB) permeability. Mast cells are considered first responders and are able to initiate and magnify immune responses in the brain. Their possible role in neurodegenerative disorders such as multiple sclerosis, Alzheimer’s disease and autism has gained increasing interest.

Postnatal treatment using curcumin supplements to amend the damage in VPA-induced rodent models of autism. Full text. “To summarize, this study shows evidence of the postnatal therapeutic role of curcumin in improving most of the impaired parameters in VPA (valproic acid) -induced rodent models with persistent autistic features. The mechanism of action underlying the therapeutic effects of curcumin should be investigated in the near future. Studies of the protective effects of curcumin are also recommended.”

Blood Mercury, Arsenic, Cadmium, and Lead in Children with Autism Spectrum Disorder. Environmental factors have been implicated in the etiology of autism spectrum disorder (ASD); however, the role of heavy metals has not been fully defined. This study investigated whether blood levels of mercury, arsenic, cadmium, and lead of children with ASD significantly differ from those of age- and sex-matched controls. Data showed that the children with ASD had significantly higher levels of mercury and arsenic and a lower level of cadmium. The levels of lead did not differ significantly between the groups. The results of this study are consistent with numerous previous studies, supporting an important role for heavy metal exposure, particularly mercury, in the etiology of ASD.”

Suicidality in Autistic Spectrum Disorders.Prevalence of suicide attempts varied between 7% and 47%, while suicidal ideation was reported in up to 72% of cases. Being male and having a history of self-harm and depression were cited as significant risk factors. Suicidal attempts and ideation are increased in ASD; however, the extent of the increase and the risk factors identified within this group remain under-investigated.”

Maternal experience raising girls with autism spectrum disorder: a qualitative study. Mothers reported a sense of exclusion from the neurotypical population and male-dominant ASD population and transformation in relationship. Themes identified were skepticism and delayed diagnosis, disbelief from others, lack of information about girls with ASD, higher social demands in adolescence, puberty challenges around hygiene, disappointment about physical appearance, vulnerability in relationships and worries about future functioning. The mother-daughter relationship started with an early expectation of a close and intimate relationship that then underwent a transformation, which challenged maternal competence, reshaped expectations and created a different bond between mother and daughter.”

April 2017

Autism, epilepsy, and synaptopathies: a not rare association.ASD are often associated with neurological conditions: the co-occurrence of epilepsy is well documented and there is also evidence of a higher prevalence of EEG abnormalities with 4-86% of individuals with ASD presenting epileptiform or not epileptiform EEG abnormalities. The presence of epilepsy in people with ASD may be determined by several structural alterations, genetic conditions, or metabolic dysfunctions, known to play a role in the emergence of both epilepsy and autism.”

Grand-maternal smoking in pregnancy and grandchild’s autistic traits and diagnosed autism. Full text. “Here we use the Avon Longitudinal Study of Parents and Children (ALSPAC) to test the hypothesis that if the mother or father (F1) had been exposed to their own mother’s (F0) smoking during pregnancy, the offspring (F2) would be at increased risk of autism. We find an association between maternal grandmother smoking in pregnancy and grand daughters having adverse scores in Social Communication and Repetitive Behaviour measures that are independently predictive of diagnosed autism. In line with this, we show an association with actual diagnosis of autism in her grandchildren. Paternal grandmothers smoking in pregnancy showed no associations.”

Brief Report: Metformin for Antipsychotic-Induced Weight Gain in Youth with Autism Spectrum Disorder.Antipsychotic treatment in youth with autism spectrum disorder (ASD) is becoming increasingly common, placing individuals at risk for antipsychotic-induced weight gain and associated complications. Metformin hydrochloride, a biguanide medication FDA-approved for treatment of type-2 diabetes in youth, may hold promise for treatment of antipsychotic-induced weight gain in youth with ASD. In this report we assess the long-term impact of metformin on antipsychotic-associated weight gain in a naturalistic sample of 53 youth with ASD. Results indicate that treatment with metformin stabilized BMI z-score over a nearly 2 year mean treatment period. Further work is indicated to determine the safety and efficacy of metformin treatment in youth with ASD, as well as predictors of response as a treatment for antipsychotic-induced weight gain.”

EEG abnormalities and long term seizure outcome in high functioning autism. Electroencephalographic abnormalities may occur in autistic spectrum disorders (ASD) even in the absence of clinical seizures. These abnormalities may vary from nonspecific changes to epileptiform abnormalities and are more common compared to the overall population. In this study we investigated the presence of EEG abnormalities in sixteen children diagnosed with high-functioning ASD. EEG recording was performed for at least 2 h and included at least 90 min of sleep activity. While none of the patients had clinical seizures, 5 patients (31.3%) were detected to have EEG abnormalities. Four of these were epileptiform (25%), and one patient developed seizure during follow-up. Our results support the fact that EEG abnormalities are observed at a higher rate also in ASD with a better functionality. The potential impact of EEG abnormalities on cognition and behavior, and the risk of epilepsy should be considered during long-term follow-up of these patients.”

Gestational vitamin D deficiency and autism spectrum disorder. Full text. “Based on a sample of 4334 children and their mothers, of whom 68 children were diagnosed with ASD, we show that gestational 25OHD deficiency is associated with a higher risk of being diagnosed with ASD. The finding from this study lends weight to the growing body of epidemiological and animal model-based research linking gestational vitamin D deficiency and altered brain development.”

Prevalence of Congenital Cytomegalovirus Infection Assessed Through Viral Genome Detection in Dried Blood Spots in Children with Autism Spectrum Disorders. Full text. “In conclusion, the prevalence of congenital CMV infection in our cohort of children with ASD was much higher than that in the general population (5% versus 0.6%), which supports an etiological association between ASD and CMV infection. Consequently, detection of CMV-DNA via DBS can be considered in the work-up of children with ASD. Given the potential prevention and treatment of CMV infection, this study could have intriguing consequences, at least for a group of patients with ASD.”

The effect of dietary supplements on clinical aspects of autism spectrum disorder: A systematic review of the literature.Types of dietary supplements evaluated in these studies included amino acids, fatty acids and vitamins/minerals. N-acetylcysteine was shown to exert a beneficial effect on symptoms of irritability. On the other hand, literature data about the efficacy of d-cycloserine and pyridoxine-magnesium supplements was controversial. No significant effect was identified for fatty acids, N,N-dimethylglycine and inositol. Literature data about ascorbic acid and methyl B12 was few, although some encouraging results were found. No serious adverse events were reported in the vast majority of the studies, while the prevalence of adverse reactions was similar between treatment and placebo groups. The use of dietary supplements in children with autism seems to be a safe practice with encouraging data about their clinical efficacy.”

Improvement in Excoriation (Skin-Picking) with use of Risperidone in a Patient with Developmental Disability. Full text. “In this case, an 11-year-old male with intellectual disability and autistic spectrum disorder, with self-injurious skin-picking, was treated with risperidone with complete resolution of skin-picking symptoms. risperidone has been approved for irritability and aggression in Autistic spectrum disorder, and may be a valuable treatment option for skin-picking in pediatric patients with developmental disabilities.”

Melatonin and circadian rhythms in autism: Case report.Among the most co-occurring conditions in autism spectrum disorders (ASD), there are sleep disorders which may exacerbate associated behavioral disorders and lead to intensification of existing autistic symptoms. Several studies investigating the use of melatonin in the treatment of sleep disorders in ASD have shown comparative efficiency in sleep with little or no side effects.”

Next Generation Sequencing Mitochondrial DNA Analysis in Autism Spectrum Disorder. Autism is a complex genetic disorder where both de-novo and inherited genetics factors play a role. Next generation sequencing approaches have been extensively used to identify rare variants associated with autism. To date, all such studies were focused on nuclear genome; thereby leaving the role of mitochondrial DNA (mtDNA) variation in autism unexplored. Our findings provide further support for the role of mitochondria in ASD and confirm that whole-exome sequencing allows for analysis of mtDNA, which sets a stage for further comprehensive genetic investigations of the role of mitochondria in autism.”

Developmental Neurotoxicity of Traffic-Related Air Pollution: Focus on Autism.Several studies suggest that young individuals may be particularly susceptible to air pollution-induced neurotoxicity and that perinatal exposure may cause or contribute to developmental disabilities and behavioral abnormalities. In particular, a number of recent studies have found associations between exposures to traffic-related air pollution and autism spectrum disorders (ASD).”

The role of oxidative stress, inflammation and acetaminophen exposure from birth to early childhood in the induction of autism. Full text. “The wide range of factors associated with the induction of autism is invariably linked with either inflammation or oxidative stress, and sometimes both. The use of acetaminophen in babies and young children may be much more strongly associated with autism than its use during pregnancy, perhaps because of well-known deficiencies in the metabolic breakdown of pharmaceuticals during early development. Thus, one explanation for the increased prevalence of autism is that increased exposure to acetaminophen, exacerbated by inflammation and oxidative stress, is neurotoxic in babies and small children. This view mandates extreme urgency in probing the long-term effects of acetaminophen use in babies and the possibility that many cases of infantile autism may actually be induced by acetaminophen exposure shortly after birth.”

Environmental factors influencing the risk of autism. Full pdf. “Autism is a developmental disability with age of onset in childhood (under 3 years old), which is characterized by definite impairments in social interactions, abnormalities in speech, and stereotyped pattern of behaviors. Due to the progress of autism in recent decades, a wide range of studies have been done to identify the etiological factors of autism. It has been found that genetic and environmental factors are both involved in autism pathogenesis. Hence, in this review article, a set of environmental factors involved in the occurrence of autism has been collected, and finally, some practical recommendations for reduction of the risk of this devastating disease in children are represented.”

Vitamin D-related genes are subjected to significant de novo mutation burdens in autism spectrum disorder.Vitamin D deficiency is a putative environmental risk factor for autism spectrum disorder (ASD). Besides, de novo mutations (DNMs) play essential roles in ASD. However, it remains unclear whether vitamin D-related genes (VDRGs) carry a strong DNM burden. We provide straightforward genetic evidences for the first time that VDRGs with a strong degree of DNM burden in ASD and DNMs of VDRGs could be involved in the mechanism underlying in ASD pathogenesis.”

The role of cholesterol metabolism and various steroid abnormalities in autism spectrum disorders: A hypothesis paper.Based on evidence from the relevant research literature, we present a hypothesis that there may be a link between cholesterol, vitamin D, and steroid hormones which subsequently impacts on the development of at least some of the “autisms” [Coleman & Gillberg]. Our hypothesis, driven by the peer reviewed literature, posits that there may be links between cholesterol metabolism, which we will refer to as “steroid metabolism” and findings of steroid abnormalities of various kinds (cortisol, testosterone, estrogens, progesterone, vitamin D) in autism spectrum disorder (ASD). Further research investigating these potential links is warranted to further our understanding of the biological mechanisms underlying ASD.”

Whose Expertise Is It? Evidence for Autistic Adults as Critical Autism Experts. Full pdf. “Autistic and non-autistic adults’ agreement with scientific knowledge about autism, how they define autism, and their endorsement of stigmatizing conceptions of autism has not previously been examined. Autistic participants exhibited more scientifically based knowledge than others. They were more likely to describe autism experientially or as a neutral difference, and more often opposed the medical model. As one autistic participant stated, “everybody is an expert bar the person with a diagnosis. That needs to change”.”

Gingival bleeding in a patient with autism spectrum disorder: A key finding leading to a diagnosis of scurvy.This case reports a patient with ASD in which gingival bleeding was the key finding that led to a diagnosis of scurvy. The literature review discusses behavioral food aversions in patients with ASD that lead to significant nutritional deficiencies, such as scurvy. Through this case report, the objective is to raise clinical awareness to consider relatively rare diseases in patients with ASD who have atypical feeding patterns.”

Vitamin-D Deficiency As a Potential Environmental Risk Factor in Multiple Sclerosis, Schizophrenia, and Autism. Full pdf. “Several studies found lower vitamin-D levels in children with autism compared to their siblings, parents, and non-family controls. Low vitamin-D levels were already present at birth in children later diagnosed with ASD but not in their healthy siblings. Subsequent research demonstrated that the vitamin-D status of mothers corresponded with their offspring’s vitamin-D status at birth. Low levels of vitamin-D during pregnancy impacted negatively on the cognitive status, early development, and ASD diagnosis.”

“We will never be normal”: The Experience of Discovering a Partner Has Autism Spectrum Disorder.Online forums and lay literature suggest that partners of individuals with Autism Spectrum Disorder (ASD) experience depression, distress, and trauma in their everyday lives, exacerbated during the time surrounding diagnosis. In this content analysis, 29 participants were provided with an online open-ended statement asking them to describe in writing their experiences of discovering that their partners had ASD during their relationships. Six themes emerged, including: facing unique challenges within relationships; insisting partners seek diagnosis; initial shock and relief; losing hope for normalcy; making accommodations within relationships; and wishing for professional support. Marriage and family therapists should help couples minimize blaming and promote self-awareness, appropriate relationship expectations, and mutual understanding.” Here is a link to a presentation given by the author of the study.

Clinical clues for autoimmunity and neuroinflammation in patients with autistic regression.The charts of 206 children with ASD and 33 diagnosed with autistic regression variant were reviewed. The incidence of febrile illness in the 6 months prior to initial parental concern was significantly higher in the children with autistic regression compared with those with ASD. The overall prevalence of familial autoimmunity was also higher in children with autistic regression compared with those with ASD. Type 1 diabetes and autoimmune thyroiditis were both more common in families with children with autistic regression.”

Transition to work: Perspectives from the autism spectrum. The aim was to gain better understanding of the experience of transition to work, barriers and also the factors that promote workplace success. Organisation support, advice from co-workers, supportive leadership, allowance of environmental modifications and presence of a consultant were identified as enablers that most facilitated success at work. Challenges included task-related difficulties, individual factors, social difficulties and distractibility, not managing work-related stress, and being perceived to be too frank.”

Autism and schizophrenia: one, two or many disorders?Autism and psychotic disorders such as schizophrenia co-occur more frequently than would be expected by chance alone. Exactly why this should be remains unclear, but a better understanding would have important implications for diagnosis, treatment and for biological explanations of both conditions.”

March 2017

Consensus Statement of the Indian Academy of Pediatrics on Evaluation and Management of Autism Spectrum Disorder. Full text. This reference is included to show that recommendations are slowly changing to include underlying co-morbid issues in ASD individuals. “Associated conditions with ASD could include intellectual or language impairment, known genetic conditions, catatonia, motor deficits (e.g., abnormal gait, clumsiness, toe-walking or hypotonia), macrocephaly, medical disorders (e.g., seizures, lead poisoning in children with pica); neurodevelopmental, behavioral and/ or mental health co-morbidities (e.g., hyperactivity, anxiety, depression, behavioral dysregulation), sleep problems (e.g., late onset, frequent waking, restlessness) that may affect daytime function, gastrointestinal, feeding, and nutrition problems (e.g., constipation, restricted diet), and delays in acquisition of self-help skills (e.g., toileting, dressing, hygiene).

Gastrointestinal problems: The frequency and types of gastrointestinal (GI) disorders in children with ASD are similar to those in children without ASD. These include chronic functional constipation and fecal incontinence; gastroesophageal reflux disease; chronic abdominal pain and chronic diarrhea. GI disorders in children with ASD generally should be managed in the same way as in children without an ASD.”

Complementary and alternative therapies: There is no evidence for effectiveness of these therapies and pediatricians should be able to counsel caregivers not to opt for these therapies.” Unfortunately, only one “cherry picked” reference quoted.

Still more comprehensive than Australian paediatric guidelines.

Simplifying study of fever’s dramatic relief of autistic behavior.Dramatic relief of autistic behavior by infectious fever continues to tantalize parents and practitioners, yet researchers still hesitate to study its physiology/biochemistry, fearing stress and heat of brain imaging, contagion, and fever’s complexity. Yet what could be more revealing than a common event that virtually ‘normalizes’ autistic behavior for a time? This paper proposes study of three simplified scenarios: (1) improvements appearing hours before fever, (2) return of autistic behavior soon after fever, (3) improvements persisting long after fever. Each scenario limits some risk – and some explanation – inviting triangulation of decisive factor(s) in relief and recurrence. Return of autistic behavior after fever may be most revealing. The complex mechanisms that generated fever have all abated; simpler cooling mechanisms prevail – how many plausible explanations can there be? The decisive factor in fever’s benefit is concluded to be water drawn/carried from brain myelin and astrocytes by osmolytes glutamine and taurine released from muscles and brain; the decisive factor in return of autistic behavior after fever is return of water.”

Vitamin D Deficiency in Obsessive-Compulsive Disorder Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: A Case Control Study. Full text. “Previous studies have indicated that vitamin D deficiency is common in psychiatric patients, particularly in those with neuropsychiatric disorders such as autism and schizophrenia. There has been an increasing interest in immune-related neuropsychiatric symptoms that are triggered by group A beta-hemolytic streptococcal infections. In this study, we aimed to compare the serum levels of vitamin D between obsessive-compulsive disorder (OCD) patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and control subjects. This study supports the hypothesis that an association between vitamin D metabolism and PANDAS-related OCD exists.”

Autoimmunity, Autoantibodies, and Autism Spectrum Disorder.It is becoming increasingly accepted that ASD is no longer defined simply as a behavioral disorder, but rather as a highly complex and heterogeneous biological disorder. Although research has focused on the identification of genetic abnormalities, emerging studies increasingly suggest that immune dysfunction is a viable risk factor contributing to the neurodevelopmental deficits observed in ASD.”

Identification of likely associations between cerebral folate deficiency and complex genetic- and metabolic pathogenesis of autism spectrum disorders by utilization of a pilot interaction modeling approach.Recently, cerebral folate deficiency (CFD) was suggested to be involved in the pathogenesis of autism spectrum disorders (ASD). However, the exact role of folate metabolism in the pathogenesis of ASD, identification of underlying pathogenic mechanisms and impaired metabolic pathways remain unexplained. Two independent interaction modules (comprising three pathways) covering enzymes encoded by ASD-related genes and folate cofactors utilizing enzymes were generated. Module 1 suggested possible interference of CFD with serine and lysine metabolism, while module 2 identified correlations with purine metabolism and inosine monophosphate production. Since our approach was primarily conceived as a proof of principle, further amendments of the presented initial model are necessary to obtain additional actionable outcomes.”

Dopamine antagonists for treatment resistance in autism spectrum disorders: review and focus on BDNF stimulators loxapine and amitriptyline.Drug development is urgently needed for individuals with autism spectrum disorders (ASD) and psychiatric comorbidity, which often presents as aggression and self-injury. At the same time, most psychiatric medications are drugs that have been repurposed following clinical observations of efficacy for a new treatment purpose. While behavioral treatments can improve core symptoms in ASD, pharmacotherapy and specifically dopamine antagonists are often prescribed for serious challenging behaviors including aggression. The classical antipsychotics received some study and are still often used in antipsychotic polypharmacy however individuals with ASD are more susceptible to the neuromotor side effects which may further impair already compromised mobility as well as cause tardive dyskinesia and neuroleptic malignant syndrome. The novel antipsychotics risperidone and aripiprazole have received most study in ASD and are FDA-approved for irritability in children over age 5 years. However individuals with ASD are more prone to weight gain, Type II diabetes and associated side effects, for which most novel antipsychotics carry a black box warning. The common practice of prescribing SSRIs that inhibit metabolism of many psychoactive drugs together with antipsychotics compounds the side effects.”

Environmental risk factors for autism: an evidence-based review of systematic reviews and meta-analyses. Full pdf. “According to recent evidence, up to 40-50% of variance in autism spectrum disorder (ASD) liability might be determined by environmental factors. The reviews on nutritional elements have been inconclusive about the detrimental effects of deficiency in folic acid and omega 3, but vitamin D seems to be deficient in patients with ASD. The studies on toxic elements have been largely limited by their design, but there is enough evidence for the association between some heavy metals (most important inorganic mercury and lead) and ASD that warrants further investigation. Mechanisms of the association between environmental factors and ASD are debated but might include non-causative association (including confounding), gene-related effect, oxidative stress, inflammation, hypoxia/ischemia, endocrine disruption, neurotransmitter alterations, and interference with signaling pathways.

Classical conditioning for preserving the effects of short melatonin treatment in children with delayed sleep: a pilot study. Full text. “Melatonin treatment is effective in treating sleep onset problems in children with delayed melatonin onset, but effects usually disappear when treatment is discontinued. In this pilot study, we investigated whether classical conditioning might help in preserving treatment effects of melatonin in children with sleep onset problems, with and without comorbid attention deficit hyperactivity disorder (ADHD) or autism. Melatonin treatment was effective in advancing dim light melatonin onset and reducing sleep onset problems, and positive effects were found on health and behavior problems. After stopping melatonin, sleep returned to baseline levels. We found that for children without comorbidity in the experimental group, sleep latency and sleep start delayed less in the stop week, which suggests an effect of classical conditioning. However, classical conditioning seems counterproductive in children with ADHD or autism.

Relationship between selenium, lead, and mercury in red blood cells of Saudi autistic children.Environmental contribution to ASD is due in large part to the sensitivity of the developing brain to external exposures such as lead (Pb), and mercury (Hg) as toxic heavy metals or due to a poor detoxification ability as the phenotype of this disorder. Selenium (Se) as an antioxidant element that counteracts the neurotoxicity of Hg, and Pb, presumably through the formation of nontoxic complexes. In the present study, Pb, Hg, and Se were measured in red blood cells (RBCs) of 35 children with ASD and 30 age- and gender-matched healthy control children. The obtained data demonstrates a significant elevation of Hg and Pb together with a significant decrease in the Se levels in RBCs of patients with ASD when compared to the healthy controls. The ratios of Se to both Pb and Hg were remarkably altered, being indicative of heavy metal neurotoxicity in patients with ASD. In conclusion, the present study indicates the importance of Se for prevention and/or therapy of heavy metal neurotoxicity.

Personal experiences of the Criminal Justice System by individuals with autism spectrum disorders.The processes of arrest, investigation, trial and imprisonment are often extremely difficult for individuals with autism spectrum disorders. The majority of those given a custodial sentence coped well in prison, probably due to the high levels of structure and firm frameworks in that environment. Explanation factors associated with the offences indicated that autism spectrum disorder characteristics such as misunderstandings, obsessions and idiosyncratic beliefs and/or behaviours were frequently involved, but stress was the most common explanation provided by the participants. The findings suggest limited understanding of autism spectrum disorders within the Criminal Justice System which needs to be significantly improved in order to secure their legal protection.”

Behavioral improvements in a valproic acid rat model of autism following vitamin D supplementation.The aim was to identify the effects of early vitamin D supplementation on autism-like behaviors (ASD) induced by valproic acid (VPA, an anti-convulsant and a mood stabilizer) in rats. 10 male Wistar rat pups with prenatal exposure to saline were in control group, and 20 Pups with prenatal exposure to VPA were divided into ASD-N (0.9% saline treated) and ASD-D group (vitamin D 80,000 IU/kg treated) on postnatal day 12. The repetitive behavior of the ASD-N group exhibited a negative linear relationship with serum 25(OH)D3 on PND 42. In conclusion, early vitamin D supplementation in infant rat with ASD induced by VPA significantly improved development and behavior of rats related with ASD.”

Risk of autism spectrum disorders in children born to mothers with rheumatoid arthritis: A systematic literature review.Three studies were included in the final analysis. A case-control study was unable to detect a difference in the prevalence of RA in ASD mothers versus control mothers. Another case-control study showed a statistically significant 8-fold increase in autoimmune disorders, including RA, in mothers of ASD offspring compared to controls. Forty-six percent of ASD offspring had a first-degree relative with RA compared to 26% of controls. Moreover, in a population-based cohort study, investigators observed an increased risk of ASD in children with a maternal history of RA compared to children born to unaffected mothers.”

Association of Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorders with Mean Platelet Volume and Vitamin D. Full text. “The hematological parameters of the patients, including MPV [Mean Platelet Volume], vitamin B12, and vitamin D, were assessed. There was no statistically significant difference in hematological parameters between the groups, but there were significant differences in terms of vitamin D and vitamin B12. The patient groups showed lower levels of vitamin B12 and vitamin D. In the ADHD group, there was a negative correlation between both vitamins and MPV. Both ADHD and ASDs may accompany increased risk for cardiovascular disease due to the presence of vitamin B12 and D deficiency.”

Aging and Autism Spectrum Disorder: A Naturalistic, Longitudinal Study of the Comorbidities and Behavioral and Neuropsychiatric Symptoms in Adults with ASD. Little is known about Autism Spectrum Disorder (ASD) in persons over age 50. In a retrospective, naturalistic review of 74 individuals aged 30 and older meeting DSM-5 criteria for ASD, the point prevalence of behavioral and neuropsychiatric symptoms (BNPS) declined significantly for 12 of 13 BNPS over a mean of 25 years while many other features of ASD remained stable. GI disorders (68.9%) and seizure disorders (23%) were common, and 25.7% of the sample had a BMI >30. Females were more likely to engage in screaming (p < 0.05) and oppositional behavior (p < 0.05). Current age did not have a significant effect on BNPS prevalence.”

Shorter sleep duration is associated with social impairment and comorbidities in ASD. Sleep disturbance, particularly insomnia, is common in children with autism spectrum disorders (ASD). Furthermore, disturbed sleep affects core symptoms and other related comorbidities. Severity scores for social/communication impairment and restricted and repetitive behaviors (RRB) were increased, and IQ scores were decreased, for children reported to sleep ≤420 minutes per night (lower 5th percentile) compared to children sleeping ≥660 minutes (upper 95th percentile). Our results indicate that reduced amounts of sleep are related to more severe symptoms in children with ASD.”

Acute Dystonia due to Aripiprazole Use in Two Children with Autism Spectrum Disorder in the First Five Years of Life. Full text. “It has been is speculated that aripiprazole has a protective effect for extrapyramidal side effects, movement disorders, and metabolic problems. But the increased use in children and adolescents is associated with an increase in the number of case reports related with such problems. Nevertheless, our review of the literature uncovered limited data regarding the association between acute dystonia and aripiprazole use in ASD children under five years of age is. In this paper, we present two cases of autistic spectrum disorder children with ages under 5 years that developed acute dystonia taking aripiprazole.”

Distinct Microbiome-Neuroimmune Signatures Correlate With Functional Abdominal Pain in Children With Autism Spectrum Disorder. Full text. “Our findings identify distinctive mucosal microbial signatures in ASD children with FGID [functional gastrointestinal disorders] that correlate with cytokine and tryptophan homeostasis. Future studies are needed to establish whether these disease-associated Clostridiales species confer early pathogenic signals in children with ASD and FGID.”

Tightening the Case for Gut Microbiota in Autism-Spectrum Disorder. Editorial. Full text. “The study by Luna et al in this issue of Cellular and Molecular Gastroenterology and Hepatology tightens the case for a microbial hub and serotonin and cytokine spokes in the gastrointestinal dysfunction of ASD. Compared with ASD-unaffected children, children with ASD and gastrointestinal dysfunction had increased mucosal tissue levels of select microbial taxa, mainly members of the genus Clostridium.”

The Impact of Dynamic Seating on Classroom Behavior of Students with Autism Spectrum. Full text. “The aim of this study was to compare the effectiveness of dynamic seating devices on improving a students’ in-seat and on-task behaviors and decreasing autism related behaviors within the classroom setting. This study proposes that ball seating in the classroom causes an increase of 86.7% in in-seat behaviors of ASD students. Therapy balls provide sitting and moving concurrently, which may satisfy sensory needs. As a result of normalizing arousal levels and regulating sensory inputs with rocking and bouncing on a ball, students with autism could be satisfied physiologically and would not need to engage in selfstimulatory behaviors. Furthermore, the teachers’ reports supported the use of balls and air cushions for the students in class. Accordingly, the students were calmer when compared to the use of common chairs.”

L-Methylfolate supplementation in a child with autism and methyltetrahydrofolate reductase, enzyme gene C677TT allele.Errors in folate metabolism may play a role in the pathology of autism spectrum disorders because of increased vulnerability to oxidative stress. We report a case where L-methylfolate supplementation improved symptoms of aggression and disruptive behavior in a child with autism who tested positive for the C677TT allele of the methyltetrahydrofolate reductase enzyme gene. To our knowledge, this is the first report of L-methylfolate administration in this situation. Further controlled studies of L-methylfolate in this population are warranted.”

Metabolic Dysfunction Underlying Autism Spectrum Disorder and Potential Treatment Approaches. Full text. “Recent studies have increasingly implicated mitochondrial dysfunction in ASD. The fact that mitochondria are an integral part of diverse cellular functions and are susceptible to many insults could explain how a wide range of factors can contribute to a consistent behavioral phenotype in ASD. Meanwhile, the high-fat, low-carbohydrate ketogenic diet (KD), used for nearly a century to treat medically intractable epilepsy, has been shown to enhance mitochondrial function through a multiplicity of mechanisms and affect additional molecular targets that may address symptoms and comorbidities of ASD. Here, we review the evidence for the use of metabolism-based therapies such as the KD in the treatment of ASD as well as emerging co-morbid models of epilepsy and autism.”

A late-diagnosed phenylketonuria case presenting with autism spectrum disorder in early childhood. Full text. “This case illustrates that because the majority of autism cases are idiopathic, an occasional patient with a metabolic disorder might be overlooked especially in the era of newborn screening. We also discuss the possible pathogenetic processes leading to autistic symptoms in phenylketonuria, and wish to draw attention to the possibility of cases missed in the screening program because of less than 100% coverage or insufficient food intake before blood sampling. Clinicians should keep in mind the possibility of treatable disorders in children with autism even when such disorders appear unlikely.”

Aggressive behaviors and treatable risk factors of preschool children with autism spectrum disorder.Aggressive behaviors of children with ASD were significantly associated with two treatable factors: sleep problems and ADHD symptoms. These findings have substantial clinical implications: treatment of these two risk factors may be helpful in managing aggressive behavior in children with ASD.”

The association between parents’ ratings of ASD symptoms and anxiety in a sample of high-functioning boys and adolescents with Autism Spectrum Disorder. For pre-adolescents, high levels of tension in social situations were associated with 3.5-times greater likelihood of having GAD; for adolescents, experiencing difficulty in changes in routine was associated with a 10-fold increase in risk of GAD.”

An Italian Prospective Experience on the Association Between Congenital Cytomegalovirus Infection and Autistic Spectrum Disorder.Seventy proven congenitally-infected infants, born between 2007 and 2012, were referred to our centre for CMV diagnosis and follow-up, which consisted of a consolidated protocol allowing an early evaluation of autism. We considered four children 2-year old, two of whom, at the age of 3, were diagnosed with ASD demonstrating a 2-3 fold higher prevalence (2.86%), than that in general Italian population (0.66-1.36%). Our protocol enabled us to make the earliest diagnosis and highlight the role of the virus among other causes of autism, which may be a long term sequela of congenital CMV.”

February 2017

Noise and autism spectrum disorder in children: An exploratory survey.Most teachers found noise control to be an important issue for students with autism and many observed children using ear defenders. In terms of managing issues related to noise, most teachers agreed that thick or soundproof walls and carpet in the classroom were the most important issues for children with ASD.”

Maternal Immunoreactivity to Herpes Simplex Virus 2 and Risk of Autism Spectrum Disorder in Male Offspring. Full text. “High levels of HSV-2 IgG antibodies in maternal midpregnancy plasma were associated with increased risk of ASD in male offspring. No association was found between ASD and the presence of IgG antibodies to Toxoplasma gondii, rubella virus, CMV, or HSV-1. In our cohort, high levels of antibodies to herpes simplex virus 2 at midpregnancy were associated with an elevated risk of autism spectrum disorder in male offspring.”

Effects of ω-3 fatty acids on stereotypical behavior and social interactions in Wistar rats prenatally exposed to lipopolysaccarides.Prenatal exposure to LPS [lipopolysaccharides] significantly increased the episodes of stereotyped movements and decreased social interaction in the offspring, after ω-3 PUFA supplementation these parameters reversed. Supplementation with ω-3 PUFA reversed animal behaviors that often are observed in autism and other mental disorders in rats prenatally exposed to LPS, and also exerted neuroprotective effects in marker levels of neuronal damage and expression of TGF-β.”

The Immune System, Cytokines, and Biomarkers in Autism Spectrum Disorder. Full text. “A diagnosis of ASD continues to be behaviorally defined. However, the body of research and accumulating evidence with respect to immune system perturbations in ASD suggest that a broader approach should be taken in order to understand biological systems as they pertain to ASD and associated behaviors. The clinical trials of immune-modulating agents, taken together with previous examples of immune system perturbations in children with ASD, suggest that cytokines are worthy of consideration as potential biomarkers of a subgroup of individuals with an ASD diagnosis and more severe behavioral outcomes.”

Salivary biomarker levels and oral health status of children with autistic spectrum disorders: a comparative study.It was observed that salivary pH and buffering capacity were lower in children with ASD than their healthy siblings, the dental caries incidence was higher in ASD children when compared to their healthy siblings and oral hygiene was fair with gingival bleeding in children with ASD.”

Independent Maternal and Fetal Genetic Effects on Mid-gestational Circulating Levels of Environmental Pollutants. Full text. “Our results support genetic control of mid-gestational biomarkers for environmental exposures by non-overlapping maternal and fetal genetic determinants, suggesting that future studies of environmental risk factors should take genetic variation into consideration. The independent influence of fetal genetics supports previous hypotheses that fetal genotypes expressed in placenta can influence maternal physiology and the transplacental transfer of organohalogens.”

Pediatric Hypovitaminosis D: Molecular Perspectives and Clinical Implications. Full text. An excellent review of the importance of adequate vitamin D in paediatrics.Vitamin D plays an important role in repairing DNA damage; thus, its deficiency would result in impaired DNA repair and higher de novo genetic mutation rates linked to an increased risk of autism. There is evidence that vitamin D influences fetal brain growth and neuronal differentiation, and there is an inverse correlation between the serum level of calcidiol concentration and autism rating scale, and a higher level of calcidiol may reduce the risk of autism. There are now speculations that problematic social behaviors in autistic children may also be linked to vitamin D deficiency and abnormal level of serotonin. Higher levels of serotonin have been linked to a gene activated by vitamin D, which in turn produces an enzyme, tryptophan hydroxylase 2 (TPH-2), that converts tryptophan to 5-hydroxytryptamine (serotonin) that leads to a higher level of serotonin production, and another gene that makes the enzyme tryptophan hydroxylase 1 (TPH-1) to be inhibited by vitamin D to halt serotonin production.”

Vitamin D and autism, what’s new?An increasing amount of evidence points to the possibility that gestational and early childhood vitamin D deficiency [25(OH)D < 40 ng/ml] cause some cases of autism. Vitamin D is metabolized into a seco-steroid hormone that regulates about 3% of the 26,000 genes in the coding human genome. It is also a neurosteroid that is active in brain development, having effects on cellular proliferation, differentiation, calcium signaling, neurotrophic and neuroprotective actions; it also appears to have an effect on neurotransmission and synaptic plasticity. Children who are, or who are destined to become, autistic have lower 25(OH)D levels at 3 months of gestation, at birth and at age 8 compared to their unaffected siblings. Two open label trials found high dose vitamin D improves the core symptoms of autism in about 75% of autistic children. A few of the improvements were remarkable. In terms of prevention, a recent small study showed vitamin D supplementation during pregnancy (5000 IU/day) and during infancy and early childhood (1000 IU/day) significantly reduced the expected incidence of autism in mothers who already had one autistic child from 20% to 5%. Vitamin D is safe; for example, over the last 15 years, Poison Control reports there have been approximately 15,000 cases of vitamin D overdose. However only three of these 15,000 people developed clinical toxicity and no one died. Given those facts, practitioners might consider treating autism with 300 IU/kg/day, and seek to prevent autism by supplementing pregnant and lactating women (5000 IU/day) and infants and young children (150 IU/kg/day) checking 25(OH)D levels every 3 months.”

Relationship between Long Chain n-3 Polyunsaturated Fatty Acids and Autism Spectrum Disorder: Systematic Review and Meta-Analysis of Case-Control and Randomised Controlled Trials. Full text. “Omega-3 long chain polyunsaturated fatty acid supplementation (n-3 LCPUFA) for treatment of Autism Spectrum Disorder (ASD) is popular. Two meta-analyses were conducted; meta-analysis 1 compared blood levels of LCPUFA and their ratios arachidonic acid (ARA) to docosahexaenoic acid (DHA), ARA to eicosapentaenoic acid (EPA), or total n-6 to total n-3 LCPUFA in ASD to those of typically developing individuals (with no neurodevelopmental disorders). Compared with placebo, n-3 LCPUFA improved social interaction and repetitive and restricted interests and behaviours. Populations with ASD have lower n-3 LCPUFA status and n-3 LCPUFA supplementation can potentially improve some ASD symptoms. Further research with large sample size and adequate study duration is warranted to confirm the efficacy of n-3 LCPUFA.”

New evidences on the altered gut microbiota in autism spectrum disorders. Full text. “The finding that, besides the bacterial gut microbiota, also the gut mycobiota contributes to the alteration of the intestinal microbial community structure in ASDs opens the possibility for new potential intervention strategies aimed at the relief of gastrointestinal symptoms in ASDs.”

Elevated Urinary Glyphosate and Clostridia Metabolites With Altered Dopamine Metabolism in Triplets With Autistic Spectrum Disorder or Suspected Seizure Disorder: A Case Study. Full text. “The pattern of metabolites in the urine samples of the males with autism are consistent with a recent theory of autism that connects widespread glyphosate use with alteration of animal and human gastrointestinal flora. That theory is that the normally beneficial bacteria species that are sensitive to glyphosate are diminished and harmful bacteria species, such as Clostridia, that are insensitive to glyphosate, are increased following exposure to glyphosate. Excessive dopamine, caused by inhibition of dopamine-beta-hydroxylase by Clostridia metabolites, in turn, produces oxidative species that damage neuronal Krebs cycle enzymes, neuronal mitochondria, and neuronal structural elements such as the neurofibrils.”

Detection of Clostridium perfringens toxin genes in the gut microbiota of autistic children.We studied stool specimens from 33 autistic children aged 2-9 years with gastrointestinal (GI) abnormalities and 13 control children without autism and without GI symptoms. Our results indicate that autistic subjects with gastrointestinal disease harbor statistically significantly higher counts of C. perfringens in their gut compared to control children. Autistic subjects also harbor statistically significantly higher counts of beta2-toxin gene-producing C. perfringens in their gut compared to control children, and the incidence of beta2-toxin gene-producing C. perfringens is significantly higher in autistic subjects compared to control children.”

The Effect of Mitochondrial Supplements on Mitochondrial Activity in Children with Autism Spectrum Disorder. Full text. “Recent studies suggest that ASD is linked to mitochondrial dysfunction, although the exact nature of mitochondrial abnormalities in ASD appears to be complicated. For example, classic mitochondrial disease is found in 5% of children with ASD, yet up to 50% of children with ASD may have biomarkers of mitochondrial dysfunction. This study provides empirical support for common mitochondrial treatments and demonstrates that the relationship between activities of mitochondrial components might be a marker to follow in addition to absolute activities. Measurements of mitochondrial activity that can be practically repeated over time may be very useful to monitor the biochemical effects of treatments.

Thyroid dysfunction in children with autism spectrum disorder is associated with folate receptor alpha autoimmune disorder.Folate receptor α (FRα) autoantibodies (FRAAs) are prevalent in Autism Spectrum Disorder (ASD). FRAAs disrupt folate transport across the blood-brain barrier by binding to the FRα. Thyroid dysfunction is frequently found in children with ASD. The thyroid showed significant FRα expression during the early prenatal period but expression decreased significantly in later gestation and postnatal thyroid tissue. This study suggests that thyroid dysfunction in ASD may be related to the blocking FRAA. The high expression of FRα in the early fetal thyroid suggests that fetal and neonatal exposure to maternal FRAAs could affect the development of the thyroid and may contribute to the pathology in ASD.”

The Need for Objective Measures of Stress in Autism. Full text. “We believe that stress evaluation should not be subjective. Individuals with autism spectrum disorder should benefit from objective continuous measures of stress, especially knowing that almost half of individuals with autism do not have access to effective communication to express this inner stress.”

Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Full text. ” This review discusses an elimination diet as a treatment for attention deficit hyperactivity disorder and autism spectrum disorder, with a focus on the efficacy of the food additives exclusion diet, glutenfree/casein-free diet and oligoantigenic diet. The GFCF diet might be beneficial for children with ASD and food intolerance/allergy or underlying gastrointestinal disease. However, the evidence for the effectiveness of GFCF diets in children with ASD is weak and thus these diets cannot be generally recommended as a treatment for children with ASD. With regard to oligoantigenic diets, if applied under close supervision, these interventions could be valuable instruments to assess whether ADHD is triggered by food. Furthermore, we have observed large individual differences in terms of time that is needed for any positive effects of the diet to surface during the elimination phase. Some children appear to be ‘fastresponders’, who show a positive reaction after a few days, whereas other children are ‘slow-responders’, who show a positive reaction after a couple of weeks.” Clinically we see huge differences in behaviour in ASD and ADHD children when reactive foods are eliminated from their diet. Designing a rigorus dietary elimination study, is extremley difficult to do. Unfortunately, when such elimination diet studies are done, those children that respond get lost when the data gets “massaged” statistically.

January 2017

The Experiences of Fathers Who Have Offspring with Autism Spectrum Disorder.Fathers described their experiences as a path towards acceptance, with independence and integration for their offspring being key goals. Fathers saw themselves as advocates fighting obstructive services to access appropriate care. The value placed on formal and informal support varied, although the need for personalised support was emphasised.”

Efficacy of group social skills interventions for youth with autism spectrum disorder: A systematic review and meta-analysis.Results show that overall positive aggregate effects were medium. Effects were large for self-report, medium for task-based measures, small for parent- and observer-report, and nonsignificant for teacher-report. Moderation analyses of self-report revealed the effect was wholly attributable to youth reporting that they learned about skilled social behaviors, but not that they enacted them. Social skills interventions presently appear modestly effective for youth with ASD, but may not generalize to school settings or self-reported social behavior.”

Protein-restricted diet during pregnancy after insemination alters behavioral phenotypes of the progeny.Epidemiological studies suggest that hyponutrition during the fetal period increases the risk of mental disorders such as attention deficit hyperactivity disorder and autism-spectrum disorder, which has been experimentally supported using animal models. Significant epigenetic alterations in the brains of the progenies induced by the maternal-protein restriction were observed in the present study. To our knowledge, this is first study to evaluate the effect of maternal hyponutrition on behavioral phenotypes using reproductive technology.”

Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study. Full text. “Several previous studies have reported abnormal gut bacteria in children with ASD. The gut microbiome-ASD connection has been tested in a mouse model of ASD, where the microbiome was mechanistically linked to abnormal metabolites and behavior. Similarly, a study of children with ASD found that oral non-absorbable antibiotic treatment improved GI and ASD symptoms, albeit temporarily. Here, a small open-label clinical trial evaluated the impact of Microbiota Transfer Therapy (MTT) on gut microbiota composition and GI and ASD symptoms of 18 ASD-diagnosed children. The Gastrointestinal Symptom Rating Scale revealed an approximately 80% reduction of GI symptoms at the end of treatment, including significant improvements in symptoms of constipation, diarrhea, indigestion, and abdominal pain. Improvements persisted 8 weeks after treatment. Similarly, clinical assessments showed that behavioral ASD symptoms improved significantly and remained improved 8 weeks after treatment ended.”

Hyperuricemia in Children and Adolescents with Autism Spectrum Disorder Treated with Risperidone: The Risk Factors for Metabolic Adverse Effects. Full text. “Hyperuricemia may play a role in metabolic adverse effect in children and adolescents with ASDs receiving the high dose and/or the long-term treatment with risperidone.”

Analysis of methionine synthase (rs1805087) gene polymorphism in autism patients in Northern Iran.It was recently shown that the genes involved in the folate/homocysteine pathway may be risk factors for autistic children. One of the genes that may be the risk factor for autism is Methionine synthase (MTR). MTR is responsible for the regeneration of methionine from homocysteine. The present study suggests that the G allele of MTR A2756G polymorphism is associated with an increased risk of autism.”

Immune dysfunction and neuroinflammation in autism spectrum disorder.It was found that that often individuals diagnosed with ASD have alterations in immune cells such as T cells, B cells, monocytes, natural killer cells, and dendritic cells. Also, many individuals diagnosed with ASD have alterations in immunoglobulins and increased autoantibodies. Finally, an important portion of individuals diagnosed with ASD has elevated peripheral cytokines and chemokines and associated neuroinflammation. In conclusion, immune dysregulation and inflammation are important components of ASD diagnosis and are key components of the diagnosis and treatment of ASD.”

Bone microarchitecture in adolescent boys with autism spectrum disorder.Bone microarchitectural parameters are impaired in ASD, with reductions in bone strength estimates (stiffness and failure load) at the ultradistal radius and distal tibia. This may result from lower physical activity and calcium intake, and decreased IGF-1 responsiveness.”

Feeding Problems and Nutrient Intake in Children with and without Autism: A Comparative Study.The majority (79%) of the parents of ASD children reported some concern regarding their feeding behavior as compared to 64% of the parents of typically developing children. ASD children consumed fewer number of food items, particularly fruits, vegetables, and proteins; had significantly lower daily intake of potassium, copper, and folate. The findings underscore the need for comprehensive assessment and empirically-supported interventions for eating problems and dietary deficiencies found in ASD children.”

ω-3 Fatty Acid Supplementation Does Not Affect Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis.Among studies that used the Aberrant Behavior Checklist, parents’ ratings indicated significant improvement in lethargy symptoms in the ω-3 FA group compared with the placebo group (2 RCTs). Among studies that used the Behavioral Assessment System for Children, parents’ ratings indicated significant worsening of both externalizing behavior and social skills in the ω-3 FA group compared with the placebo group. One RCT reported a significant improvement in the ω-3 FA group for the daily-living component of the Vineland Adaptive Behavior Scale. Adverse effects were similar in both groups.” This review highlights the the differences in results obtained when investigating the benefit of omega-3 oils. However, none of the studies are looking at the quality of the omega-3 oils being used. See Supplements – Buyer beware for a discussion about the poor quality of omega- supplements on the market.

Dietary adequacy of Egyptian children with autism spectrum disorder compared to healthy developing children.The present study aimed at comparing dietary regimens and habits of normally developing apparently healthy children, without diagnosed ASD, with a pediatric population of individuals affected by autistic disorder. A total of 23.8% of children with autistic disorder vs. 11.3% in the healthy control group had a nutrient intake with features below the Recommended Dietary Allowance (RDA) of protein. Children with autistic disorder showed low dietary intake of some micronutrients; calcium (Ca), magnesium (Mg), iron (Fe), selenium (Se) and sodium (Na), also they had significantly high intake of potassium (K) and vitamin C compared to healthy controls. Serum Mg, Fe, Ca, folate and vitamin B12 in children with autistic disorder were significantly low compared with healthy children. The evidence reported in the present study should recommend screening of the nutritional status of ASD children for nutrient adequacy to reduce these deficiencies by dietary means or by administering appropriate vitamin and mineral supplements.

Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms. Full text. “Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition.”

Brief Report: Mealtime Behaviors of Chinese American Children with Autism Spectrum Disorder.The top problematic mealtime behaviors reported by parents were prefers “crunchy” food (54.2%); not willing to try new foods (48%); and does not remain seated at the table until the meal is finished (46%). This study found that the majority of the Chinese-American children with ASD seldom or never were aggressive (96%) or disruptive during mealtimes (92.3%). Compared to their white counterparts, Chinese-American children with ASD showed slightly lower scores on problematic mealtime behaviors.”

Being on Your Own or Feeling Lonely? Loneliness and Other Social Variables in Youths with Autism Spectrum Disorders.Results indicated that only at an adolescent age, the ASD group reported higher levels of loneliness than the control groups. Further, the ASD group generally expressed relatively low levels of desire for social interaction, although these youths displayed a similar increase in the wish to belong during adolescence as participants in the control groups. Finally, the ASD group exhibited lower levels of social competence and social skills and higher levels of social problems and social anxiety than the control groups, and in all groups these social variables correlated in a theoretically meaningful with loneliness.”

Significant Association of Urinary Toxic Metals and Autism-Related Symptoms-A Nonlinear Statistical Analysis with Cross Validation. Full text. “Average excretion levels of several toxic metals (lead, tin, thallium, antimony) were significantly higher in the ASD group. Similarly, nonlinear methods determined a significantly stronger association between the behavioral measures and toxic metal excretion. The association was strongest for the Aberrant Behavior Checklist (including subscales on Irritability, Stereotypy, Hyperactivity, and Inappropriate Speech).”

Atypical Color Preference in Children with Autism Spectrum Disorder. Full text. “When mean rank of preference was computed in each of the ASD and TD groups with regard to each color, it was found that boys with ASD were significantly less likely than TD boys to prefer yellow and more likely than TD boys to prefer green and brown colors. These results appear to be caused by hyper-sensation characteristic of ASD, due to which boys with this disorder perceive yellow as being sensory-overloading.”

The Effects of Exercise Dose on Stereotypical Behavior in Children with Autism.While it appears high-intensity aerobic exercise may exacerbate stereotypic behaviors in children with ASD, low-to-moderate intensity exercise produces significant and large reductions in these behaviors. This provides an easily administered and cost-effective way to positively impact these individuals.”


December 2016

ASD and schizophrenia show distinct developmental profiles in common genetic overlap with population-based social communication difficulties.Difficulties in social communication are part of the phenotypic overlap between autism spectrum disorders (ASD) and schizophrenia. both clinical ASD and schizophrenia share some genetic influences with impairments in social communication, but reveal distinct developmental profiles in their genetic links, consistent with the onset of clinical symptoms.”

Propionic acid metabolism, ASD, and vitamin B12: is there a role for environmental nitrous oxide?A pathogenic makeover of gut microbiome to facilitate the growth of microbes capable of producing propionic acid (PPA), like Clostridia species, has been proposed as an infectious contributing etiology to the PPA model of ASD, however the reason for this pathogenic microbial overgrowth is not clear. This discussion highlights a previously identified novel environmental factor (i.e., nitrous oxide, N2O) in the etiopathogenesis of ASD and related neuropathology and posits that altered PPA metabolism in ASD may represent a key manifestation of this particular exposure.

Mathematical Modeling of the Methionine Cycle and Transsulfuration Pathway in Individuals with Autism Spectrum Disorder.Previous research has shown a connection between metabolic abnormalities in the methionine cycle and transsulfuration pathway and autism spectrum disorder. Sensitivity analysis identified the parameter describing the rate of glutamylcysteine synthesis, the rate-limiting step in glutathione production, to be particularly important in determining steady-state metabolite concentrations.”

Folic acid supplementation: what is new? Fetal, obstetric, long-term benefits and risks. Full text. “Recently, reducing the risk of autism by folic acid intake and the time of its consumption have been closely investigated. The optimal protective effect of folic acid in preventing autism is achieved when folic acid is taken preconceptionally and in early pregnancy because this is the critical period for brain development and development of neurologic pathologies.”

Fetal origins of autism spectrum disorders: the non-associated maternal factors. Full text. “There is increasing evidence that maternal exposures are involved in the pathophysiology of ASD in the developing fetus. Many genes have been postulated to be involved with the development of ASD, which can be potentiated by environmental insults. There appears to be at least one crucial time period between the first and second trimester where the associated risk of ASD development appears to be lower after this checkpoint has been reached.”

Measurement in saliva from neurotypical adults of biomarkers pertinent to autism spectrum disorders. Full text. “In summary, the data prove the concept that saliva is an appropriate body fluid in which to measure biomarkers important to autism. We found measurable levels in 74–100% of saliva samples from 12 healthy neurotypical adults on two occasions for 10 biomarkers important to autism: glutamine, glutamic acid, CD26, C4B, IFN-γ, cortisol, melatonin, testosterone, MT-2 and GSSG, but in <50% of samples for carnitine, GABA, IL-12, serotonin, cystine and rGSH.”

Can probiotics benefit children with autism spectrum disorders? Full text. “Children with autism are commonly affected by gastrointestinal problems such as abdominal pain, constipation and diarrhea. In recent years, there has been a growing interest in the use of probiotics in this population, as it hypothetically may help to improve bowel habits and the behavioral and social functioning of these individuals. The gut microbiome plays an important role in the pathophysiology of organic as well as functional gastrointestinal disorders. The present review presents a number of reported clinical, immunological and microbiome-related changes seen in children with autism compared to normally developed children. It also discusses gut inflammation, permeability concerns, and absorption abnormalities that may contribute to these problems. Most importantly, it discusses evidence, from human and animal studies, of a potential role of probiotics in the treatment of gastrointestinal symptoms in children with autism.”

Developmental Vitamin D deficiency and Autism: Putative pathogenic mechanisms. Vitamin D deficiency is emerging as a consistently reported risk factor in children. One reason for the prominence now being given to this risk factor is that it would appear to interact with several other epidemiological risk factors for autism. Vitamin D is an active neurosteroid and plays crucial neuroprotective roles in the developing brain. It has important roles in cell proliferation and differentiation, immunomodulation, regulation of neurotransmission and steroidogenesis. Animal studies have suggested that transient prenatal vitamin D deficiency is associated with altered brain development.”

Imbalance between the anti- and pro-inflammatory milieu in blood leukocytes of autistic children.Accumulating evidence suggests an association between immune dysfunction and autism disorders in a significant subset of children. In addition, an imbalance between pro- and anti-inflammatory pathways has been proposed to play an important role in the pathogenesis of several neurodevelopmental disorders including autism; however, the role of anti-inflammatory molecules IL-27 and CTLA-4 and pro-inflammatory cytokines IL-21 and IL-22 has not previously been explored in autistic children. Our study shows dysregulation of the immune balance in cells from autistic children as depicted by enhanced pro-inflammatory cytokines, ‘IL-21/IL-22’ and decreased anti-inflammatory molecules, ‘IL-27/CTLA-4’.”

Occupational Therapy Interventions for Adolescents With Autism Spectrum Disorder. Full text. “In this Evidence Connection article, we describe a case report of an adolescent with autism spectrum disorder. The occupational therapy assessment and treatment processes for school, home, community, and transition settings are described.”

Resveratrol suppresses neuroinflammation in the experimental paradigm of autism spectrum disorders.The major finding of the study is that resveratrol restored the core and associated symptoms of autistic phenotype by suppressing oxidative-nitrosative stress, mitochondrial dysfunction, TNF-α and MMP-9 expression in PPA induced ASD in rats. Therefore, resveratrol might serve as an adjunct potential therapeutic agent for amelioration of neurobehavioural and biochemical deficits associated with autism spectrum disorders.”

Co-occurrence of autistic and schizotypal traits and its association with emotional and psychosocial function in Chinese college students.Empirical findings suggest an overlap between autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD). The results showed that the co-occurrence rate of autistic and schizotypal trait was 3.4% at baseline and 2.4% at one-year follow-up. The interaction between autistic traits and schizotypal traits was associated with better executive functioning and social functioning but poorer emotional expression.”

Increased Serum Levels of Tumor Necrosis Factor-Alpha, Resistin, and Visfatin in the Children with Autism Spectrum Disorders: A Case-Control Study. Full text. “Several proinflammatory and immunoinflammatory disturbances have been observed in the etiology of ASD. Serum visfatin, resistin, and TNF-α levels in children with ASD were significantly higher than that in the healthy patients …… suggesting that elevated levels of serum proinflammatory agents may be implicated in the pathophysiology of ASD.”

Caesarean section and risk of autism across gestational age: a multi-national cohort study of 5 million births.Across the five countries, emergency or planned CS is consistently associated with a modest increased risk of ASD from gestational weeks 36 to 42 when compared with vaginal delivery.”

Adults with autism spectrum disorders: a review of outcomes, social attainment, and interventions.The core social communication impairments continue into adulthood among persons with ASD, but the restrictive, repetitive patterns of behavior and activities have received less attention. Adults with ASD experience more behavioral and emotional regulation issues than their peers. In terms of social attainments, adults with ASD have a greater tendency to be overeducated for their jobs and have a lower employment rate. They are also more likely to live with their parents. Interventions make a positive impact upon social communication skills and employment.”

The potential relevance of docosahexaenoic acid and eicosapentaenoic acid to the etiopathogenesis of childhood neuropsychiatric disorders.The majority of studies on attention-deficit/hyperactivity disorder (ADHD) and autism found a significant decrease in DHA levels in patients versus healthy controls.”

Systematic review of the association between particulate matter exposure and autism spectrum disorders. “Particulate matter (PM) as an environmental pollutant is suspected to be associated with autism spectrum disorders. To conclude, the evidence from the studies allows us to conclude that there is an association between PM exposure and ASD whose strength varies according to the particle size studied with the association with PM2.5 and diesel PM being stronger.”

Autism genes are selectively targeted by environmental pollutants including pesticides, heavy metals, bisphenol A, phthalates and many others in food, cosmetics or household products. Full text. “Many suspect compounds identified in epidemiology, including tetrachlorodibenzodioxin, pesticides, particulate matter, benzo(a)pyrene, heavy metals, valproate, acetaminophen, SSRI’s, cocaine, bisphenol A, phthalates, polyhalogenated biphenyls, flame retardants, diesel constituents, terbutaline and oxytocin, inter alia showed a significant degree of bias towards ASG’s, as did relevant endogenous agents (retinoids, sex steroids, thyroxine, melatonin, folate, dopamine, serotonin). Numerous other suspected endocrine disruptors (over 100) selectively targeted ASG’s including paraquat, atrazine and other pesticides not yet studied in autism and many compounds used in food, cosmetics or household products, including tretinoin, soy phytoestrogens, aspartame, titanium dioxide and sodium fluoride. Further epidemiological studies and neurodevelopmental and behavioural research is warranted to determine the relevance of large number of suspect candidates whose addition to the environment, household, food and cosmetics might be fuelling the autism epidemic in a gene-dependent manner.”

Peripheral Inflammatory Markers Contributing to Comorbidities in Autism. Full text. “This study evaluates the contribution of peripheral biomarkers to comorbidities and clinical findings in autism. In conclusion, peripheral inflammatory markers might be useful as potential biomarkers to predict comorbidities in autism as well as reinforce and aid informed decision-making related to EEG findings in children with Autism spectrum disorders (ASD).”

Psychosis in autism: comparison of the features of both conditions in a dually affected cohort.Our data show there may be a specific subtype of ASD linked to comorbid psychosis. The results support findings that psychosis in people with ASD is often atypical, particularly regarding affective disturbance.”

Gastrointestinal dysfunction and autism: caution with misdiagnoses as many mysteries remain to be unraveled! Full text. “Parents should not be blamed for their child having FTT [failure to thrive] that eventually is shown to be part of ASD. They should not be involved with child protective services if their infant has FTT and the medical team involved in the infant’s care is not able to identify a cause and misses early signs of ASD or fails to tentatively consider such a diagnosis. They should not have to be extirpately exonerated later after irrevocable parental anger has developed and when the ASD diagnosis is explicily evident to all, as the fallacious faux pas of child neglect should not have been made at all.”

[Diagnostics and treatment of autism spectrum disorders in older adults: a study by experts]. Full text article in Dutch. “Empirical research into the diagnostics and treatment of older adults with autism spectrum disorders (ASD) is very limited; so far, only 17 studies have been published. Increasingly, ASD is being identified and treated within the domain of geriatric psychiatry. According to the experts, older patients with ASD, form a specific group in psychiatry. With regard to diagnosis, there was a consensus that increased attention needs to be given to age-related aspects by linking symptoms more specifically to the patient’s phase of life and to the ageing process.”

Speculations on vitamin K, VKORC1 genotype and autism.Humans vary in the gene that encodes for Vitamin K. Recent research has documented the protective effect of Vitamin K on neural cells and its role in maintaining normal neural development. Of interest, specific neural effects of Vitamin K overlap with key brain development aberrations, including those associated with autism.”

Blood-brain barrier and intestinal epithelial barrier alterations in autism spectrum disorders. Full text. “In the ASD brain, there is an altered expression of genes associated with BBB integrity coupled with increased neuroinflammation and possibly impaired gut barrier integrity.”

Assessment of suicidality in children and adolescents with diagnosis of high functioning autism spectrum disorder in a Turkish clinical sample.Consistent with the previous findings, rate of suicidality is higher in individuals with ASD. The rate of suicidal behaviors was 29% and suicide attempt was 12.7%.”

Associations of Acute and Chronic Stress Hormones with Cognitive Functions in Autism Spectrum Disorder.ASD children exhibited higher hair and salivary cortisol, which reflects chronic and acute stress hormone levels of subjects, respectively, than TD children. These results suggest that chronic stress hormone elevation may have relationships with some aspects of cognitive dysfunction in ASD subjects.”

Beneficial Effects of a Protein Rich Diet on Coping Neurotrans-mitter Levels During Ampicillin-Induced Neurotoxicity Compared to Propionic-Acid Induced Autistic Biochemical Features. Full text. “The results of the present experiments demonstrated that Amp [Ampicillin] treatment for three weeks has affected the neurotransmitter levels in brain of rats which was almost the same as that found in PA [proprionic acid] model of autism. Amp administration has previously been shown to disturb microbiome and promote the overgrowth of propionobacteria; hence can be connected with development of autism in our animal model. Amp treatment along with protein rich diet induced satisfactory improvement of neurotransmitter levels in brain tissue. The synthesis of neurotransmitters in mammalian brain responds rapidly to changes in precursor availability.”

Primary Carnitine Deficiency and Newborn Screening for Disorders of the Carnitine Cycle. Deletion of the trimethyllysine hydroxylase gene, a key gene in carnitine biosynthesis, has been associated with non-dysmorphic autism.” See also Trial of carnitine therapy in TMLHE deficiency and non-dysmorphic autism and Preventable Forms of Autism?

Are there lessons to be learned from the prevailing patterns of psychotropic drug use in patients with autism spectrum disorder? Full text editorial. “In light of limited scientific evidence on the response of the psychotropic treatments in ASD populations, the findings of the review on the prevalence and patterns of psychotropic use in ASD are very telling and underscore the gulf between limited evidence-based pharmacotherapeutic options and the substantial use of psychopharmacotherapy for managing the burden of psychopathology in ASD populations.”

Mitochondrial Dysfunction in Autism Spectrum Disorders. Full text. “Autism is classified as a psychiatric disorder which is characterised entirely by behaviours. Recent studies however, have presented evidence for systemic physiological abnormalities in ASD. The studies reviewed herein provide support to the idea of a link between mitochondrial dysfunction and the behavioural phenotype of autism.”

Dyspraxia and autistic traits in adults with and without autism spectrum conditions. Full text. “Dyspraxia is significantly more prevalent in adults with ASC compared to controls, confirming reports that motor coordination difficulties are significantly more common in this group. Interestingly, in the general population, dyspraxia was associated with significantly higher autistic traits and lower empathy. These results suggest that motor coordination skills are important for effective social skills and empathy.”

The effectiveness of an outdoor adventure programme for young children with autism spectrum disorder: a controlled study.The study included 51 participants (40 males, 11 females; age 3y 4mo-7y 4mo) enrolled in ASD special education kindergartens. Outcomes after the intervention revealed significant improvement in social-communication and different directions in the two groups in the social cognition, social motivation, and autistic mannerisms. While the group that received an outdoor adventure programme showed a tendency toward a reduction in severity, the control group showed the opposite. The outdoor adventure programme required problem-solving skills and forced the child to communicate in exciting situations. This study suggests that an outdoor adventure programme may be an effective intervention in addition to traditional treatments in young children with ASD.

November 2016

Gestational vitamin D deficiency and autism-related traits: the Generation R Study. Gestational vitamin D deficiency was associated with autism-related traits in a large population-based sample. Because gestational vitamin D deficiency is readily preventable with safe, cheap and accessible supplements, this candidate risk factor warrants closer scrutiny.”

Maternal Polycystic Ovary Syndrome and Risk for Attention-Deficit/Hyperactivity Disorder in the Offspring. Full text. “Maternal PCOS increased the odds of offspring ADHD by 42% after adjustment for confounders. The risk was somewhat elevated for ADHD with comorbid autism spectrum disorder.

Bone Accrual in Males with Autism Spectrum Disorder.Boys with ASD had lower spine, hip, and whole body BMD z-scores compared with controls. Although pubertal bone accrual was similar to that in controls, BMD in children with ASD remained low over a 4-year follow-up period, suggesting that low BMD is a consequence of prepubertal factors, such as low physical activity.”

Epilepsy surgery in patients with autism. Aggression and other aberrant behaviors observed in the clinical setting improved in 24 patients. According to caregivers, most patients also experienced some degree of improvement in daily social and cognitive function. Three patients had no functional or behavioral changes associated with seizure reduction, and 2 patients experienced worsening of seizures and behavioral symptoms. The reduction in aberrant behaviors observed in this series suggests that some behaviors previously attributed to autism may be associated with intractable epilepsy, and further highlights the need for systematic evaluation of the relationship between the symptoms of autism and refractory seizures.”

Rate of epilepsy in people with autism and the rate of autism in people with epilepsy are high.Examination of family members of individuals with epilepsy can also provide a likelihood of a genetic link between autism and epilepsy.”

Gut Microbiota and Autism: Key Concepts and Findings.There is an emerging body of evidence linking the intestinal microbiota with autism spectrum disorders (ASD). Studies have demonstrated differences in the composition of gut bacteria between children with ASD and controls. Certain intestinal bacteria have been observed in abundance and may be involved in the pathogenesis of ASD; including members of the Clostridium and Sutterella genus. Evidence from animal models suggest that certain microbial shifts in the gut may produce changes consistent with the clinical picture of autism, with proposed mechanisms including toxin production, aberrations in fermentation processes/products, and immunological and metabolic abnormalities.”

Can urinary indolylacroylglycine (IAG) levels be used to determine whether children with autism will benefit from dietary intervention? Read more on urinary indolyl-3-acryloylglycine here. “We found no evidence to support the hypothesis that children with ASD who suffer with bowel problems have increased levels of urinary indolyl-3-acryloylglycine in comparison to children with ASD who do not have gastrointestinal problems.”

Comparative efficacy of alpha-linolenic acid and gamma-linolenic acid to attenuate valproic acid-induced autism-like features. Valproic acid is used for treating seizures. Gamma-linolenic acid [GLA] is found in borage, blackcurrent and evening primrose oils. “It can be concluded that ALA and GLA can impart favorable protection against the VPA-induced autism-like features with GLA having pronounced effect.”

Prescription Drug Use and Polypharmacy Among Medicaid-Enrolled Adults with Autism: A Retrospective Cross-Sectional Analysis.Around 85% of adults with ASD used at least one psychotropic drug class compared with 42% of adults without ASD. Highly common psychotropics were antipsychotics (66%ASD vs 20%noASD), anticonvulsants (59%ASD vs 20%noASD), and anxiolytics/hypnotics/sedatives (21%ASD vs 11%noASD). Other than psychotropics, many adults with ASD used medical prescription drugs such as antimicrobials (47%), dermatologic agents (48%), respiratory agents (38%), gastrointestinal agents (31%), alternative medications (25%), antiparkinsonian agents (22.6%), antihyperlipidemics/statins (7.3%), and immunologics (2.0%). Rates of general (48%ASD vs 32%noASD) and psychotropic polypharmacy (19%ASD vs 6%noASD) were significantly higher in the ASD group.”

Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder.This study is a double-blinded, randomized clinical trial (RCT) that was conducted on 109 children with ASD (85 boys and 24 girls; aged 3-10 years). The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children. Supplementation of vitamin D was well tolerated by the ASD children. The daily doses used in the therapy group was 300 IU vitamin D3/kg/day, not to exceed 5,000 IU/day. The autism symptoms of the children improved significantly, following 4-month vitamin D3 supplementation, but not in the placebo group. This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD. This study is the first double-blinded RCT proving the efficacy of vitamin D3 in ASD patients. Depending on the parameters measured in the study, oral vitamin D supplementation may safely improve signs and symptoms of ASD and could be recommended for children with ASD.” There is a New Zealand study currently underway, investigating the effect of vitamin D and omega-3 supplementation in ASD.

Changes in Food Selectivity in Children with Autism Spectrum Disorder.Food selectivity is a common problem in children with autism spectrum disorder (ASD) and has an adverse impact on nutrient adequacy and family mealtimes. In this study, we assessed food selectivity in 18 children with ASD at two time points (mean age = 6.8 and 13.2 years), and examined changes in food selectivity. While food refusal improved overall, we did not observe an increase in food repertoire (number of unique foods eaten). These findings support the need for interventions early in childhood to increase variety and promote healthy eating among children with ASD.” This is why it is essential to address restricted eating habits early, they do not improve significantly as children grow older.

What Happens to Children Who Move off the Autism Spectrum? A Clinical Follow-Up Study.None of the participants met criteria for an autism diagnosis. Ninety-two percent had a lifetime diagnosis and 81% had a present psychiatric disorder based on the K-SADS. ADHD, specific phobia and Obsessive Compulsive Disorder (OCD) were the most common disorders.” Parents need to be aware that even though their children may be doing well (and may possibly lose their ASD diagnosis), they are not in the clear as they enter adulthood. Many psychiatric disorders are evident at an early age. They need to be addressed at this early age so that they are able to function well as they become mature adults.

Defining the hidden evidence in autism research. Forty per cent of rigorously designed clinical trials remain unpublished – a cross-sectional analysis.Publication bias presents a major problem in current clinical research. This study was designed to quantify publication bias in rigorously designed ASD research. The search delivered N = 30 (60%) trials were published, N = 20 (40%) remained unpublished. The majority of trials investigated drugs. The results emphasize the serious issue of publication bias. The large proportion of unpublished results precludes valuable information and has the potential to distort evidence for treatment approaches in ASD.

Omega-3 supplementation in autism spectrum disorders: A still open question? Full text. “Various attempts to suspend the omega-3 supplementation during the 22 months of follow-up failed because of significant symptom worsening (restlessness, agitation, decrease of responsiveness to teaching), which then disappeared after the resumption of the treatment. Considering anecdotal experiences, including that of our patient, and nonrandomized trials,[10],[11] the presence of a subgroup of ASD patients who are really responders to omega-3 cannot be excluded. These responders might not appear when evaluating the omega-3 effects in a sample taken as a whole.[12] Further, considering the high heterogeneity of ASD phenotypes and etiologies, it seems to be very unlikely that a given treatment produces the same results in all affected individuals.[13]

Serological screening for Celiac Disease in 382 pre-schoolers with Autism Spectrum Disorder. Full text. “Among the GI symptoms reported by parents of children with ASD and CD in our sample there were diarrhea and inappetence. The former is one of the most frequently reported GI symptoms in ASD children in several studies [5, 40] while the latter has been recently detected as one of the most common GI symptoms in a large sample of pre-schoolers with ASD [41]. Besides, half of the ASD children with CD were asymptomatic at the time of the serological screening: this prevalence could be ascribed not only to the presence of true asymptomatic forms of CD but also to the severe communication difficulties of non-verbal preschool children with ASD, making them unable to express GI and systemic symptoms suggestive of CD (e.g. recurrent abdominal pain, abdominal distension, chronic fatigue) [4, 42]. Otherwise, pre-schoolers with ASD could show their GI-related distress in alternative ways through a greater severity of problem behaviors such as irritability [43], anxiety and affective problems [44, 45], or externalizing behaviors (oppositional defiant behaviors and tantrums) [46]. These clinical data contributed to highlight the importance of a serological screening for CD in young children with ASD, even in absence of clear GI or systemic symptoms or other risk factors related to CD.”

Extremely low gestational age and very low birth weight for gestational age are risk factors for ASD in a large cohort study of 10-year-old children born at 23-27 weeks gestation. Our study confirms that low gestational age is associated with increased risk for ASD irrespective of intellectual ability, whereas severe fetal growth restriction is strongly associated with ASD without ID. Maternal report of cervical-vaginal infection is associated with increased risk of ASD with ID, and peripartum maternal fever is associated with increased risk for ID without ASD.”

Intranasal Oxytocin Enhances Connectivity in the Neural Circuitry Supporting Social Motivation and Social Perception in Children with Autism.Using functional magnetic resonance imaging, we show that OT administration in ASD increases activity in brain regions important for perceiving social-emotional information. Further, OT enhances connectivity between nodes of the brain’s reward and socioemotional processing systems, and does so preferentially for social (versus nonsocial) stimuli.”

The Prevalence and Correlates of Involvement in the Criminal Justice System Among Youth on the Autism Spectrum. By age 21, approximately 20% of youth with autism had been stopped and questioned by police and nearly 5% had been arrested. Female youth were less likely to be involved in the criminal justice system, whereas youth displaying externalizing behaviors were more likely to be involved in the criminal justice system.”

A Profile on Emergency Department Utilization in Adolescents and Young Adults with Autism Spectrum Disorders.The current study examined the rates of ED utilization between 2005 and 2013 in ASD youth 12- to 21-years-old. Adolescents with ASD accessed ED services four times as often as adolescents without ASD.”

The Relationship between Zinc Levels and Autism: A Systematic Review and Meta-analysis.There was significant statistical difference between plasma Zn concentration and autistic patients besides healthy controls. Based on sensitivity analysis, zinc supplements can be used for the nutritional therapy for autistic patients.”

[Impact of anxiety disorders on quality of life of adolescents with autism spectrum disorder without intellectual disability]. This study shows that anxiety disorders could be a risk factor for impairment of the “physical well-being” dimension of QoL [Quality of Life] in adolescents with ASD without intellectual disability.”

Integrative analysis of genetic data sets reveals a shared innate immune component in autism spectrum disorder and its co-morbidities.Our analysis reveals a novel shared innate immune component between ASD and all but three of its co-morbidities that were examined. The disease genes that overlap these two innate immunity pathways can be used to classify the cases of ASD and its co-morbidities vs. controls with at least 70 % accuracy. This finding suggests that a neuropsychiatric condition and the majority of its non-brain-related co-morbidities share a dysregulated signal that serves as not only a common genetic basis for the diseases but also as a link to environmental triggers. It also raises the possibility that treatment and/or prophylaxis used for disorders of innate immunity may be successfully used for ASD patients with immune-related phenotypes.”

Effects of acute beta-adrenergic antagonism on verbal problem solving in autism spectrum disorder and exploration of treatment response markers.Reducing noradrenergic activity may improve aspects of network processing and thus improve cognitive abilities, such as verbal problem solving, in individuals with ASD. The present pilot study explores the effects of acute administration of the beta-adrenergic antagonist propranolol on verbal problem solving in adults and adolescents with ASD. Participants solved the anagrams more quickly in the propranolol condition, as compared to the placebo condition, suggesting a potential cognitive benefit of this agent.”

Ketogenic diet and childhood neurological disorders other than epilepsy: an overview.In the last years, ketogenic diet (KD) has been experimentally utilized in various childhood neurologic disorders such as mitochondriopathies, alternating hemiplegia of childhood (AHC), brain tumors, migraine, and autism spectrum disorder (ASD). KD could improve cognitive and social skills in a subset of children with ASD.”

Neuroinflammation in Autism: Plausible Role of Maternal Inflammation, Dietary Omega 3, and Microbiota.Several genetic causes of autism spectrum disorder (ASD) have been identified. However, more recent work has highlighted that certain environmental exposures early in life may also account for some cases of autism. Imbalanced levels of essential fatty acids, and especially polyunsaturated fatty acids (PUFAs), are observed in patients with ASD and other neurodevelopmental disorders (e.g., attention deficit hyperactivity disorder (ADHD) and schizophrenia). Interestingly, PUFAs, and specifically n-3 PUFAs, are powerful immunomodulators that exert anti-inflammatory properties. These prenatal dietary and immunologic factors not only impact the fetal brain, but also affect the microbiota. Recent work suggests that the microbiota could be the missing link between environmental insults in prenatal life and future neurodevelopmental disorders. As both nutrition and inflammation can massively affect the microbiota, we discuss here how understanding the crosstalk between these three actors could provide a promising framework to better elucidate ASD etiology.”

Analysis of the Duodenal Microbiome in Autistic Individuals: Association with Carbohydrate Digestion. There was a positive correlation between the abundance of Clostridium species, and disaccharidase activity, in autistic individuals.”

Psychotropic Medication Use among Insured Children with Autism Spectrum Disorder. Nearly half (48.5 %) of children with ASD received psychotropics in the year observed; the most common classes were stimulants, alpha-agonists, or atomoxetine (30.2 %), antipsychotics (20.5 %), and antidepressants (17.8 %). The widespread use of psychotropics we observed, particularly given weak evidence supporting the effectiveness of these medications for most children with ASD, highlights challenges in ASD treatment.”

Effect of gluten free diet [GFD] on gastrointestinal and behavioral indices for children with autism spectrum disorders: a randomized clinical trial. “Of the 80 children, 53.9% had gastrointestinal abnormalities. In the GFD group, the prevalence of gastrointestinal symptoms decreased significantly after intake of GFD (40.57% vs. 17.10%) but increased insignificantly in the RD group (42.45% vs. 44.05%). GFD intervention resulted in a significant decrease in behavioral disorders (80.03±14.07 vs. 75.82±15.37) but an insignificant increase in the RD group (79.92±15.49 vs. 80.92±16.24).

The relationship between screen time, nighttime sleep duration, and behavioural problems in preschool children in China. This study was done in 3-6 year old children. “After adjusting for potential confounders, children with ST [Screen Time] ≥2 h/day had a significantly increased risk of having total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial problems, as well as behavioural symptoms of autism spectrum disorder.”

Autism Spectrum Disorder and Avoidant/Restrictive Food Intake Disorder. A very interesting case study. I will leave the reader to make up their own mind if parents are going about this in the right way. More importantly, common sense is telling us that nutritionally this child is starving. Compare this case to this documentary The Girl Who Never Ate.

Ketogenic diets improve behaviors associated with autism spectrum disorder in a sex-specific manner in the EL mouse.Ketogenic diet feeding improved multiple measures of sociability and reduced repetitive behavior in female mice; effects in males were more limited. Additional experiments in female mice showed that a less strict, more clinically-relevant diet formula was equally effective in improving sociability and reducing repetitive behavior. Taken together these results add to the growing number of studies suggesting that ketogenic and related diets may provide significant relief from the core symptoms of autism spectrum disorder, and suggest that in some cases there may be increased efficacy in females.”

Change in Autism Diagnoses Prior to and Following the Introduction of DSM-5. Australian study. “A significant trend-relative reduction in the number of children registered to receive autism-specific funding was evident post 2013, suggesting the more stringent DSM-5 criteria may have curbed the trend of increasing diagnoses over time.”

Autism in 2016: the need for answers.While the association between air pollutants, pesticides and other endocrine-disrupting chemicals, and risk for autism spectrum disorder is receiving increasing confirmation, the hypothesis of a real causal relation between them needs further data. The possible pathogenic mechanisms by which environmental factors can lead to autism spectrum disorder in genetically predisposed individuals were summarized, giving particular emphasis to the increasingly important role of epigenetics.”

October 2016

Month of Conception and Learning Disabilities: A Record-Linkage Study of 801,592 Children.Seasonal variations were specific to autistic spectrum disorder, intellectual disabilities, and learning difficulties (e.g., dyslexia) and were absent for sensory or motor/physical impairments and mental, physical, or communication problems. Seasonality accounted for 11.4% (95% confidence interval: 9.0, 13.7) of all cases. Some biologically plausible causes of this variation, such as infection and maternal vitamin D levels, are potentially amendable to intervention.”

Beneficial Effects of Co-Ultramicronized Palmitoylethanolamide/Luteolin in a Mouse Model of Autism and in a Case Report of Autism.Co-ultraPEA-LUT® treatment ameliorated social and nonsocial behaviors in valproic acid-induced autistic mice and improved clinical picture with reduction in stereotypes in a 10-year-old male child. These data suggest that ASD symptomatology may be improved by agents documented to control activation of mast cells and microglia.”

Maternal vitamin D deficiency and the risk of autism spectrum disorders: population-based study. Full text. “These findings imply gestational vitamin D substitution as a means of ASD prevention.”

Asperger syndrome in childhood – personality dimensions in adult life: temperament, character and outcome trajectories. Full text. “Three distinct temperament and character profiles emerged from the data. Those no longer meeting criteria for ASD had high reward dependence while those with a stable ASD diagnosis and psychiatric comorbidity showed elevated harm avoidance and low self-directedness and cooperativeness. Finally, those with a stable ASD and no comorbidity showed low novelty seeking and somewhat elevated harm avoidance.”

A systematic review of the association between allergic asthma and autism.Autism Spectrum Disorder and asthma could be associated conditions, as evidenced by the higher prevalence of asthma in autistic children with respect to typically developed controls.”

Infantile autism: impact of diagnosis and repercussions in family relationships. Full text. “The health professionals who report autism should better prepare the family to cope with the difficulties of this syndrome and autonomously care for the autistic child.”

No Apparent Cardiac Conduction Effects of Acute Treatment with Risperidone in Children with Autism Spectrum Disorder.Using conventional doses during acute treatment in children with ASD and serious behavioral problems, there was no difference in the mean change in QTc between risperidone and placebo.”

Cytokine Profile in Autism Spectrum Disorders in Children.The interleukin-8 (IL-8) level was significantly higher, while that of IL-10 was significantly lower in patients with childhood autism than in controls. Furthermore, the IL-8 level was significantly higher in childhood autism than in Asperger syndrome.”

Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study.The risk of substance use-related problems was the highest among individuals with ASD and ADHD. We conclude that ASD is a risk factor for substance use-related problems.”

Treatment of Autism Spectrum Disorder in Children and Adolescents. Full text. “Risperidone and aripiprazole are currently the only medications FDA approved for symptoms associated with autism spectrum disorders, targeting the irritability often seen with this diagnosis. Children and adolescents with autism spectrum disorder appear to be more susceptible to adverse effects with medications.”

Perinatal issues for women with high functioning autism spectrum disorder.Findings suggest that women with ASD may face particular challenges during pregnancy, birthing and early mothering. These challenges evolve from perceptions of the woman about her midwives and other caregivers. If a woman perceives that her midwife is judgemental about her, then she may withdraw from the care and support she and her baby need.”

Folinic acid improves verbal communication in children with autism and language impairment: a randomized double-blind placebo-controlled trial. Full text. “In this small trial of children with non-syndromic ASD and language impairment, treatment with high-dose folinic acid for 12 weeks resulted in improvement in verbal communication as compared with placebo, particularly in those participants who were positive for FRAAs [folate receptor-α autoantibodies].”

Clinical utility of folate pathway genetic polymorphisms in the diagnosis of autism spectrum disorders.Genetic polymorphisms of the folate pathway were moderate predictors of autism risk. MTHFR C677T and hyperhomocysteinemia have been identified as risk factors for autism worldwide. Synergistic interactions between MTHFR C677T and MTRR A66G increase homocysteine.”

The role of phthalate esters in autism development: A systematic review.This review reveals evidence showing a connection between exposure to phthalates and ASD. These case control studies showed a compromised phthalate metabolite glucuronidation pathway, as a probable explanation of mechanism of the relation between phthalate exposure and ASD.”

Microbiota and neurologic diseases: potential effects of probiotics. Full text. “Overall, trials involving animal models and adults have reported encouraging results, suggesting that the administration of probiotic strains may exert some prophylactic and therapeutic effects in a wide range of neurologic conditions. Studies involving children have mainly focused on autism spectrum disorder and have shown that probiotics seem to improve neuro behavioural symptoms.”

Severe hypercalcaemia in a child secondary to use of alternative therapies. This report is an example of the importance of consulting a practitioner that is well experienced in treating ASD children.

Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders.Patients with autism spectrum disorder (ASD) are at increased risk for fracture, and peri-pubertal boys with ASD have lower bone mineral density (BMD) than controls.”

Brief Report: Prevalence of Self-injurious Behaviors among Children with Autism Spectrum Disorder-A Population-Based Study.SIB prevalence averaged 27.7 % across all sites and surveillance years. Clinicians should inquire about SIB during assessments of children with ASD.”

Vitamin D Deficiency in Adult Patients with Schizophreniform and Autism Spectrum Syndromes: A One-Year Cohort Study at a German Tertiary Care Hospital. Full text. “We found very high rates of 25(OH)vitamin D deficiencies in both patient groups and have discussed whether our findings might be related to alterations in the immunological mechanisms. Irrespective of the possible pathophysiological links between vitamin D deficiency and schizophrenia or autism spectrum disorders, a more frequent measurement of vitamin D levels seems to be justified in these patient groups.”

N-acetylcysteine in the treatment of psychiatric disorders: Current status and future prospects.This study reviews the available data regarding the use of NAC in different psychiatric disorders including substance use disorders, autism, obsessive-compulsive spectrum disorders, schizophrenia, depression, bipolar disorder. Promising results were found in trials testing the use of NAC, mainly as an add-on treatment, in cannabis use disorder in young people, depression in bipolar disorder, negative symptoms in schizophrenia, and excoriation (skin-picking) disorder. Despite initial optimism, recent findings regarding NAC efficacy in autism have been disappointing.”

A Putative Blood-Based Biomarker for Autism Spectrum Disorder-Associated Ileocolitis. Gastrointestinal symptoms are common in children with autism spectrum disorder (ASD). A significant proportion of children with ASD and gastrointestinal symptoms have histologic evidence of ileocolitis (inflammation of the terminal ileum and/or colon).”

Decreasing GABA function within the medial prefrontal cortex or basolateral amygdala decreases sociability.Decreasing GABA transmission in either the medial PFC or BLA decreased sociability. Thus, changes in GABA signaling observed in conditions such as autism or schizophrenia may mediate the social withdrawal characteristic of these conditions. Moreover, they suggest that social withdrawal may be treated by drugs that potentiate GABA transmission.”

Emerging Roles for the Gut Microbiome in Autism Spectrum Disorder.The microbiome is an integral part of human physiology; recent studies show that changes in the gut microbiota can modulate gastrointestinal physiology, immune function, and even behavior. Links between particular bacteria from the indigenous gut microbiota and phenotypes relevant to ASD raise the important question of whether microbial dysbiosis plays a role in the development or presentation of ASD symptoms. Here we review reports of microbial dysbiosis in ASD.”

The Significance of the Enteric Microbiome on the Development of Childhood Disease: A Review of Prebiotic and Probiotic Therapies in Disorders of Childhood.Certain childhood diseases have been associated with microbiome alterations, namely necrotizing enterocolitis, infantile colic, asthma, atopic disease, gastrointestinal disease, diabetes, malnutrition, mood/anxiety disorders, and autism spectrum disorders. Treatment studies suggest that probiotics are potentially protective against the development of some of these diseases.”

Genetic Evidence for Elevated Pathogenicity of Mitochondrial DNA Heteroplasmy in Autism Spectrum Disorder. Full text. “Increasing clinical and biochemical evidence implicate mitochondrial dysfunction in the pathophysiology of Autism Spectrum Disorder (ASD). Taken together, our genetic findings substantiate pathogenic mtDNA [mitochondrial DNA] mutations as a potential cause for ASD and synergize with recent work calling attention to their unique metabolic phenotypes for diagnosis and treatment of children with ASD”

Gut-to-Brain Axis in Autism Spectrum Disorders: Central Role for the Microbiome. Intestinal microbial dysbiosis, in prenatal and postnatal phases, is an important example of these environmental factors, and gastrointestinal problems including adverse reactions to foods are often reported in these children. In this review, we address the clinical and preclinical findings on the role of the intestinal microbiome in ASD and suggest possible underlying mechanisms.”

Oral health status of children and young adults with autism spectrum disorders: systematic review and meta-analysis.Prevalence of dental caries and periodontal disease in children and young adults with ASD can be considered as high, pointing to the need for oral health policies focused on these individuals.”

Screen time of infants in Sydney, Australia: a birth cohort study. Full text. “There is emerging evidence that excess screen time in children causes adverse cognitive, developmental and health outcomes. This study has shown that a large proportion of very young children residing in SWS have screen exposures for >2 hours per day. Factors contributing to excess screen time have also been identified in this study; however, a greater understanding of risk factors needs to be ascertained in order to facilitate greater public health efforts to reduce screen exposure.”

Oxytocin receptor gene variations predict neural and behavioral response to oxytocin in autism.These findings suggest biological functions of the OXTR SNP variants on autistic oxytocin responses, and implied that clinical oxytocin efficacy may be genetically predicted before its actual administration, which would contribute to establishment of future precision medicines for ASD.”

September 2016

The Genetic Intersection of Neurodevelopmental Disorders and Shared Medical Comorbidities – Relations that Translate from Bench to Bedside. Full text. “Syndromic Disorder genes were the largest subgroup of overlapping ASD risk genes. Since disruptions in SYN NDDs by definition affect multiple organ systems, it was not surprising that there were numerous co-occurring conditions associated with ASD genes, including GI, CANCER, IMMUNO, GU, and CARDIAC disorders. GI was composed of eight genes: CDKL5, CHD7, CNTNAP2, DHCR7, MET, NIPBL, PTEN, and TCF4. This coincides with the high prevalence of GI disturbances, over 40%, in children with ASD, and is consistent with the perspective that functional genetic variations that increase risk for ASD may also underlie ASD-associated GI dysfunctions.

Diagnostic evaluation for autism spectrum disorder: a survey of health professionals in Australia. Full text. “Despite the internationally recognised best practice guidelines for ASD diagnosis, and position statements from professional bodies, Australia does not have a national standard for ASD diagnosis.

Teaching Feminine Hygiene Skills to Young females with Autism Spectrum Disorder and Intellectual Disability. Full text. “Little applied research focuses on teaching feminine hygiene skills to females with disabilities, yet this is a common clinical concern. The current study demonstrates the use of chaining to teach two young females with autism spectrum disorder feminine hygiene skills.

Hypothesis on supine sleep, sudden infant death syndrome reduction and association with increasing autism incidence. Full text. “In conclusion, it is proposed that there may be an association between supine sleep and autism incidence increase. No other potential stressor than supine sleep is known to have been introduced globally in widely separated regions, nor one that matches the temporal patterns described here. The biological rationale proposed is that supine sleep may be a stressor, increasing gene methylation in, and disrupting needed sleep cyclicity for developing socio-emotional neural circuits.

Reduced GABA and altered somatosensory function in children with autism spectrum disorder.Our results suggest that reduced brain GABA levels could underlie altered tactile function in ASD, and that altered GABA function in ASD disrupts the link between GABA and behavior.

Sex-specific effects of docosahexaenoic acid (DHA) on the microbiome and behavior of socially-isolated mice.These results indicate that DHA alters commensal community composition and produces beneficial effects on anxiety and depressive-like behaviors in a sex-specific manner. The present study provides insight into the mechanistic role that gut microbes may play in the regulation of anxiety and depressive-like behaviors and how dietary intervention can modulate these effects.”

Unexpected improvement in core autism spectrum disorder symptoms after long-term treatment with probiotics. Full Text. “The probiotic treatment reduced the severity of abdominal symptoms as expected but an improvement in Autistic core symptoms was unexpectedly clinically evident already after few weeks from probiotic treatment start. The appropriate use of probiotics deserves further research, which hopefully will open new avenues in the fight against ASD.”

Autism spectrum disorders and bisphenol A: Is serotonin the lacking link in the chain? “Bisphenol A (BPA) is an ubiquitous xenoestrogen widely employed in a variety of consumer products including plastic and metal food and beverage containers, dental sealants and fillings, medical equipment and thermal receipts. Therefore, most people are exposed almost continuously to BPA in industrialized countries. The link between BPA and autism could be a defect of the normal in utero or perinatal serotonergic system development.”

A scoping review of what is known of the physical health of adults with autism spectrum disorder.From the findings, it can be stated with confidence that people with ASD have a high rate of comorbidity and increased risk for chronic disease.”

Use of psychotropic drugs in patients with autism spectrum disorders: a systematic review. The prevalence of psychopharmacotherapy ranged from 2.7% to 80% (median (overall): 45.7%; median (children): 41.9%; median (adults): 61.5%), with psychotropic polypharmacy occurring in 5.4-54% (median: 23.0%). Regarding drug classes, antipsychotics were most frequently used, followed by attention-deficit/hyperactivity disorder (ADHD) medication and antidepressants. Both older age and psychiatric comorbidity were associated with higher prevalences of psychopharmacotherapy and psychotropic polypharmacy.”

Effects of exposure to bisphenol A and ethinyl estradiol on the gut microbiota of parents and their offspring in a rodent model.Intestinal flora alterations were also linked to changes in various metabolic and other pathways. Thus, BPA and EE exposure may disrupt the normal gut flora, which may in turn result in systemic effects. Probiotic supplementation might be an effective means to mitigate disease-promoting effects of these chemicals.”

Experiences of Sex Education and Sexual Awareness in Young Adults with Autism Spectrum Disorder.This report suggest that mainstream sex and relationship education is not sufficient for people with ASD, specific methods and curricular are necessary to match their needs.”

Power and Autistic Traits. Full text. “Autistic traits can help people gain and sustain power, and has probably done so throughout history, says the present paper.”

Dietary interventions that reduce mTOR activity rescue autistic-like behavioral deficits in mice.The current results suggest that activated mTOR signaling pathway in the brain may be a convergent pathway in the pathogenesis of ASD bridging genetic background and environmental triggers (food allergy) and that mTOR over-activation could serve as a potential therapeutic target for the treatment of ASD.”

Gut Instincts: microbiota as a key regulator of brain development, ageing and neurodegeneration. Recently, the gut microbiota has been implicated in a variety of conditions including depression, autism, schizophrenia and Parkinson’s disease. It is plausible that such neuropsychiatric disorders might be treated in the future by targeting the microbiota either by microbiota transplantation, antibiotics or psychobiotics.”

Prevention of behavioral deficits in rats exposed to folate receptor antibodies: implication in autism.Folate receptor alpha (FRα) autoantibodies have been associated with fetal abnormalities and cerebral folate deficiency-related developmental disorders. Over 70% of the children with autism spectrum disorders (ASD) are positive for these autoantibodies and high-dose folinic acid is beneficial in treating these children.”

Mood disorders and non celiac gluten sensitivity.The association between gluten related disorders and psychiatric diseases has been firmly demonstrated. Non celiac gluten sensitivity (NCGS) is a syndrome diagnosed in patients responsive to gluten free diet after ruling out celiac disease and wheat allergy.”

Effect of the Family-based Art Therapy Program on the Social Interactions, Verbal Skills and Stereotypic Behaviors of Children with Autism Spectrum Disorders (ASD). Full text. “Applying the family- based art therapy can be effective in changing stereotypical behaviors of autistic children, because these practices are so attractive, flexible and diverse.”

Beyond the hype and hope: Critical considerations for intranasal oxytocin research in autism spectrum disorder.there remains significant potential for oxytocin to ameliorate aspects of the persistent and debilitating social impairments in individuals with ASD. Given the considerable media hype around new treatments for ASD, as well as the needs of eager families, there is an urgent need for researchers to prioritise considering such factors when conducting well-designed and controlled studies to further advance this field.”

A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder. Full text. “The strongest evidence was between prenatal exposure to particulate matter and ASD. Our research supports the need for health protective public policy to reduce exposures to harmful airborne contaminants among pregnant women and children.”

Association of Peripheral Blood Levels of Brain-Derived Neurotrophic Factor With Autism Spectrum Disorder in Children: A Systematic Review and Meta-analysis.Children with ASD have increased peripheral blood levels of BDNF, strengthening the clinical evidence of an abnormal neurotrophic factor profile in this population.”

Intestinal Dysbiosis and Yeast Isolation in Stool of Subjects with Autism Spectrum Disorders.High frequency of gastrointestinal yeast presence in ASD subjects was shown through a simple cultural approach (Candida spp. in 57.5 % of ASDs and no controls). Also GI symptoms, such as constipation and alternating bowel, did correlate (multivariate analyses) with the increased permeability to lactulose. The present data provide rationale basis to a possible specific therapeutic intervention in restoring gut homeostasis in ASDs.”

Lower maternal serum 25(OH) D in first trimester associated with higher autism risk in Chinese offspring.Lower first trimester maternal serum levels of 25(OH) D were associated with increased risk of developing autism in offspring.”

Aging with autism spectrum disorder: an emerging public health problem.the first generation of diagnosed patients with ASD is now in old age. Many such ASD patients have needed family and institutional support for their lives subsequent to childhood diagnosis. Due to aging and death of their parents and other supportive figures leading to a loss of social structures, there is no better time than now for the medical community to act.”

Does prenatal stress alter the developing connectome?Stress-related symptoms are common in women during pregnancy and are risk factors for neurobehavioral disorders ranging from autism spectrum disorder, attention deficit hyperactivity disorder, and addiction, to major depression and schizophrenia.”

Aggression in Autism Spectrum Disorder: Supporting the Entire Family. A case report. This is not a unique case that is presented. There are many similar reports, where the whole family is affected and needs understanding and support.

Longitudinal association between early atopic dermatitis and subsequent attention-deficit or autistic disorder: A population-based case-control study.toddlers who suffer from AD at the age younger than 3 years are at a higher risk of developing ADHD and ASD during later childhood. Pediatricians taking care of toddlers with AD should have knowledge of this increased risk of developing ADHD and ASD later in life, especially when children have certain comorbidities such as allergic rhinitis, allergic conjunctivitis, and asthma.”

Altered neurotransmitter metabolism in adolescents with high-functioning autism. “Multiple linear regression revealed significantly higher Glu [Glutamine]/Cr [Creatine] and lower GABA+/Glu concentrations in the HFA [high functioning autism] group compared to the controls. These results imply that imbalanced neurotransmitter levels of excitation and inhibition are associated with HFA in adolescents.”

Maternal antineuronal antibodies and risk of childhood autism spectrum disorders: A case-control study.Mothers of autistic children had significantly higher seropositivity for anti-Yo antibodies (34.7%) than control women. Some maternal antineuronal antibodies may contribute significantly to the risk of childhood autism.”

Resveratrol treatment attenuates chemokine receptor expression in the BTBR T+tf/J mouse model of autism.Emerging evidence increasingly suggests that chemokine receptors have a pivotal role in the central nervous system and are involved in the pathogenesis of numerous neuroinflammatory diseases. Resveratrol is widely used to treat neurodegenerative diseases, but its effect on autism has not been investigated. Resveratrol downregulated the chemokine receptor levels, which might provide unique targets for future therapies for autism.”

Acetaminophen Use for Fever in Children Associated with Autism Spectrum Disorder. Full text. “In summary, we have presented evidence for the association of acetaminophen use with ASD.”

Can psychiatric childhood disorders be due to inborn errors of metabolism? Full text. “Psychiatrist should be aware of inborn errors of metabolism. In the literature, most relevant articles were found concerning ASD and psychosis in combination with a metabolic disorder. This overview gives the child and adolescent psychiatrist some direction for further investigations and referral to a metabolic unit.”

Perception of Life as Stressful, Not Biological Response to Stress, is Associated with Greater Social Disability in Adults with Autism Spectrum Disorder.Results indicated that adults with ASD experienced significantly more stressful life events and perceived stress, and greater systolic blood pressure reactivity than typical community volunteers. Results also indicated that perceived stress and stressful life events were significantly associated with social disability. Interventions targeting stress management might improve social function in adults with ASD.”

Assessment of serum trace elements and electrolytes in children with childhood and atypical autism.The obtained data demonstrate that children with ASD unspecified are characterized by significantly lower Ni, Cr, and Se levels as compared to the age- and sex-matched controls. At the same time, significantly decreased serum Ni and Se concentrations were detected in patients with childhood autism. In turn, children with atypical autism were characterized by more variable serum trace element spectrum.”

Specific Medical Conditions Are Associated with Unique Behavioral Profiles in Autism Spectrum Disorders. Full text. “Autism spectrum disorder (ASD) is a heterogeneous group of disorders which occurs with numerous medical conditions. In previous research, subtyping in ASD has been based mostly on cognitive ability and ASD symptom severity. The aim of the current study was to investigate whether specific medical conditions in ASD are associated with unique behavioral profiles.”

Efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in patients with common comorbidities in children, adolescents and adults: a review. Full text. “Results from this review suggest that ATX [atomoxetine] is effective in the treatment of some youth and adults with ADHD and comorbid disorders, and may be a treatment option in these patients.”

Environmental Enrichment Therapy for Autism: Outcomes with Increased Access. Full text. “Environmental enrichment, delivered via an online system, therefore appears to be an effective, low-cost means of treating the symptoms of ASD.”

August 2016

Effectiveness of Antidepressant Medications for Symptoms of Irritability and Disruptive Behaviors in Children and Adolescents.Antidepressant medication exposure appears to have a small effect on irritability and related symptoms in youth.

Fecal Microbiota Transplantation and Its Usage in Neuropsychiatric Disorders. Full text.

Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders.Patients with autism spectrum disorder (ASD) are at increased risk for fracture, and peri-pubertal boys with ASD have lower bone mineral density (BMD) than controls.”

Heart rate variability during sleep in children with autism spectrum disorder.Our findings suggest possible deficits in vagal influence to the heart during sleep, especially during REM sleep. Children with ASD may have higher sympathetic dominance during sleep but rather due to decreased vagal influence.

Perinatal Exposure to Traffic-Related Air Pollution and Autism Spectrum Disorders.Early life exposure to low levels of NOx [nitrogen oxides] and PM10 [particulate matter with diameters <10µm] from road traffic does not appear to increase the risk of ASD.

Gluten Intolerance and Neurodevelopmental Disorders: Is Nitric Oxide the Common Biomarker Linking These Conditions? Full text. “Heightened NO [nitric oxide] metabolism may help to explain the preliminary evidence suggesting a tepid connection between ADHD, ASD and CD.

Peripheral brain-derived neurotrophic factor in autism spectrum disorder: a systematic review and meta-analysis.Brain-derived neurotrophic factor (BDNF) regulates neuronal survival and growth and promotes synaptic plasticity. Subgroup analyses revealed higher BDNF levels in ASD compared with controls for both serum and plasma. This meta-analysis suggests that peripheral BDNF levels are a potential biomarker of ASD.”

Relationship Between Subtypes of Restricted and Repetitive Behaviors and Sleep Disturbance in Autism Spectrum Disorder. We examined the association of two types of restricted and repetitive behaviors, repetitive sensory motor (RSM) and insistence on sameness (IS), with sleep problems in children with autism spectrum disorder (ASD). RSM behaviors were positively associated with parent-reported sleep problems, and this relationship remained significant after controlling for anxiety symptoms. IS was not significantly associated with sleep problems.” This is always a priority in my treatment protocol for children. If they are sleeping better, their behaviour is consistently better the following day.

Increased Risk of Autism Development in Children Whose Mothers Experienced Birth Complications or Received Labor and Delivery Drugs.This study surveyed mothers of ASD and non-ASD children to determine possible effects of labor and delivery (L&D) drugs on the development of ASD. We also observed a synergistic effect between administrations of L&D drugs and experiencing a birth complication, in which both obstetrics factors occurring together increased the likelihood of the fetus developing ASD later in life. The present study shows the possible effects of L&D drugs, such as Pitocin labor-inducing and analgesic drugs, on children and ASD.”

Altered plasma levels of chemokines in autism and their association with social behaviors. Chemokines are immune molcules involved in the inflammatory response. “Chemokines have been implicated in the etiology and pathogenesis of ASD. The current study investigated the plasma levels of seven chemokines (RANTES, Eotaxin, MIP-1 α, MIP-1 β, MCP-1, IP-10, and MIG) in 42 young autistic patients and 35 age-matched typically developing (TD) children. Among these seven chemokines, MIP-1α, MIP-1β and IP-10 levels were found to be associated with social behaviors in all the participants. Moreover, MIP-1α and IP-10 were found to be independent predictors of social behaviors. The results of our study support the hypothesis that altered chemokine levels are involved in the pathophysiology of ASD and they indicate that chemokines plasma levels could be potential biomarkers for ASD.

Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort.Following adjustment for comorbid psychiatric disorders, women with PCOS were still at a significantly increased risk for bulimia, schizophrenia, bipolar disorder, depressive and anxiety disorders, personality disorders, with the highest AORs [adjusted odds ratios] for ASD and tics.

Neurological, Metabolic, and Psychiatric Adverse Events in Children and Adolescents Treated With Aripiprazole. The main reported adverse effects in the non-PS [psychotic disorder] group were chronic insomnia, Parkinsonism, behavioral changes psychoses, and weight gain, whereas the adverse effects in the PS group was predominantly anxiety, convulsions, and neuroleptic malignant syndrome. Although aripiprazole is considered safe and well tolerated in children and adolescents, severe adverse events as neuroleptic malignant syndrome, extreme insomnia, and suicidal behavior has been reported to health authorities.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder. Full text. “The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

Prenatal Inflammation, Infections and Mental Disorders.Evidence for the effect of prenatal exposure to maternal infection on risk for mental disorders [schizophrenia spectrum disorders, autism spectrum disorders, attention-deficit hyperactivity disorder, anorexia nervosa, and mood disorders] exists for several different infections, suggesting that common factors occurring in infections (e.g. elevated cytokine levels and fever), rather than the infectious agent itself, might be the underlying factor in increasing the risk for mental disorders.

Environmental risk factors for autism spectrum disorders.Air pollution, organic toxicants, seasonal factors, psychological stress, migration, birth order, and nutrition may have a close relationship with the incidence of ASD.

The Role of the Immune System in Autism Spectrum Disorder.During gestation, prenatal insults including maternal infection and subsequent immunological activation may increase the risk of autism in the child. Similarly, the presence of maternally derived anti-brain autoantibodies found in approximately 20% of mothers whose children are at risk for developing autism has defined an additional subphenotype of ASD.

Stress, anxiety, and depression among parents of children with autism spectrum disorder in Oman: a case-control study. Full text. “This study corroborates with other studies carried out in other populations that caring for children impacts the mental health status of caregivers.

Hormone disorder and vitamin deficiency in attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs).Our study results highlight the importance of supplementation of vitamins B12 and D in the ASD and ADHD patients.

Polychlorinated Biphenyl and Organochlorine Pesticide Concentrations in Maternal Mid-Pregnancy Serum Samples: Association with Autism Spectrum Disorder and Intellectual Disability.Our results suggest higher levels of some organochlorine compounds during pregnancy are associated with ASD and ID.”

Oxytocin efficacy is modulated by dosage and oxytocin receptor genotype in young adults with high-functioning autism: a 24-week randomized clinical trial.These results suggest that efficacy of long-term oxytocin administration in young men with high-functioning ASD depends on the oxytocin dosage and genetic background of the oxytocin receptor, which contributes to the effectiveness of oxytocin treatment of ASD.”

Parent Perceptions of Sexual Education Needs for Their Children With Autism.All parents in this study found that some level of sexual education was necessary and important and that all children had been introduced to sexual information but in varying degrees. Topic preferences included those that would increase the recognition of healthy relationships, provide a measure of self-protection, and ameliorate undesirable consequences of sexual activity.

Metformin for Treatment of Overweight Induced by Atypical Antipsychotic Medication in Young People With Autism Spectrum Disorder: A Randomized Clinical Trial.Metformin reduced BMI scores from baseline to week 16 significantly more than placebo. Statistically significant improvements were also noted in secondary body composition measures and but not in metabolic variables. Overall, metformin was well tolerated. Five participants in the metformin group discontinued treatment owing to adverse events (agitation, 4; sedation, 1). Participants receiving metformin vs placebo experienced gastrointestinal adverse events during a significantly higher percentage of treatment days.

The maternal effect in infantile autism: elevated DNA damage degree in patients and their mothers.Oxidative stress is assumed to play a key role in the pathogenesis of infantile autism. It is known that oxidative stress has a prominent genotoxic effect, which is realized through inducing single and double strand breaks of the nuclear DNA. We evaluated the degree of DNA damage in patients with infantile autism and their mothers using DNA comet assay. [DNA comet assay results] were considerably higher in the sample of autistic children, than in age-matching healthy controls. Interestingly, these parameters were also elevated in healthy mothers of autistic children, with no difference from the values in the group of autistic children. The control group of healthy women of reproductive age, who had no children with autism, differed by the DNA comet tail moment from the group of mothers of autistic children, but did not differ significantly from the control group of healthy children. The results suggest that there are genotoxic factors in mentally healthy mothers of autistic children, which can determine the pathological process in the foeti via environmental “maternal effect” during gestation.

Brief Report: Prevalence of Self-injurious Behaviors among Children with Autism Spectrum Disorder-A Population-Based Study.Self-injurious behaviors (SIB) have been reported in more than 30 % of children with an autism spectrum disorder (ASD) in clinic-based studies.

Sexuality in High-Functioning Autism: A Systematic Review and Meta-analysis. Exhibiting higher levels of sexual understanding, females with HFA were subject to more adverse sexual experiences than males with HFA and neurotypical counterparts. Males reported greater desire for, and engagement in both solitary and dyadic sexual contact.

The role of phthalate esters in autism development: A systematic review. This review reveals evidence showing a connection between exposure to phthalates and ASD.”

Oxytocin and Autism Spectrum Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. “7 out of the 11 studies that examined social cognition reported improvements. Additionally, one out of the 4 studies on restricted, repetitive behaviors, reported improvements following oxytocin administration.”

A preliminary investigation on the relationship between gut microbiota and gene expressions in peripheral mononuclear cells of infants with autism spectrum disorders. Our results strongly suggested that altered gut microbiota in infants resulted from ASD development and was associated with systemic immunity dysregulation, especially chronic inflammation.

Shank3 Is Part of a Zinc-Sensitive Signaling System That Regulates Excitatory Synaptic Strength.Shank3 is a postsynaptic protein associated with neurodevelopmental disorders such as autism and schizophrenia. In this study, we show that Shank3 is a key component of a zinc-sensitive signaling system that regulates excitatory synaptic transmission. Intriguingly, an autism-associated mutation in Shank3 partially impairs this signaling system. Therefore, perturbation of zinc homeostasis may impair, not only synaptic functionality and plasticity, but also may lead to cognitive and behavioral abnormalities seen in patients with psychiatric disorders.

Autism Spectrum Disorders and Metabolic Complications of Obesity.In children with ASD, mood stabilizers, antipsychotics, antiepileptic drugs, and selective serotonin reuptake inhibitors were associated with obesity.

Respite Care and Stress Among Caregivers of Children With Autism Spectrum Disorder: An Integrative Review.While most studies found that respite care was associated with lower stress [in carers], several found that respite care was associated with higher stress.

July 2016

Parenting stress as an indirect pathway to mental health concerns among mothers of children with autism spectrum disorder.Autism spectrum disorder symptom severity was positively related to both parenting stress and maternal psychopathology symptoms.

Histamine regulation of microglia: gene-environment interaction in the regulation of central nervous system inflammation.Microglia mediate neuroinflammation and regulate brain development and homeostasis. Microglial abnormalities are implicated in a range of neuropsychiatric pathology, including Tourette syndrome (TS) and autism.

Aggression in autism spectrum disorder: presentation and treatment options.Aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress levels, and reduced availability of educational and social support.” Yet again there is no mention in this article of the possibility of underlying pain or discomfort as a cause of aggression.

Mothers of Children with Autism have Different Rates of Cancer According to the Presence of Intellectual Disability in Their Child.Mothers of children with autism without ID had increased risk of cancer, which may relate to common genetic pathways.

Aripiprazole for the treatment of irritability and aggression in children and adolescents affected by autism spectrum disorders.consideration should be given to the potential causes of irritability and aggression, such as coexisting medical conditions and environmental factors including inappropriate intervention of parents and teachers.

Weight Gain Effects of Second-Generation Antipsychotic Treatment in Autism Spectrum Disorder.Treatment with risperidone, aripiprazole, and olanzapine resulted in statistically significant increase in BMI

Altered urinary porphyrins and mercury exposure as biomarkers for autism severity in Egyptian children with autism spectrum disorder.Results showed that children with ASD had significantly higher levels of Hg [mercury], Pb [lead], ……. compared to healthy controls and healthy siblings of the ASD children. Mothers of ASD children showed a higher percentage of dental amalgam restorations compared to the mothers of healthy controls suggesting that high Hg levels in children with ASD may relate to the increased exposure to Hg from maternal dental amalgam during pregnancy and lactation.

A Meta-Analytic Review of the Efficacy of Physical Exercise Interventions on Cognition in Individuals with Autism Spectrum Disorder and ADHD. The results revealed an overall small to medium effect of exercise on cognition, supporting the efficacy of exercise interventions in enhancing certain aspects of cognitive performance in individuals with ASD and/or ADHD.

Treatment of Severe Self-Injurious Behavior in Autism Spectrum Disorder by Neuromodulation. “An increasing number of case reports and series document the safe and effective use of electroconvulsive therapy (ECT) in children, adolescents, and young adults with autism spectrum disorder who engage in severe, intractable, repetitive self-injurious behavior (SIB) without environmental or operant function.”

Response to Electroconvulsive Therapy in Patients With Autism Spectrum Disorder and Intractable Challenging Behaviors Associated With Symptoms of Catatonia. “Electroconvulsive therapy could be a potentially beneficial intervention in patients with ASD and severe challenging behaviors associated with catatonic symptoms including agitated or excited forms of catatonia.”

Feeding behavior and dietary intake of male children and adolescents with Autism Spectrum Disorder: a case-control study. “ASD patients consumed in average more calories than controls, had a limited food repertoire, high prevalence of children with inadequate calcium, sodium, iron vitamin B5, folate, and vitamin C intake.”

The Therapeutic Effects of Camel Milk: A Systematic Review of Animal and Human Trials. “Identified studies highlighted treatment with camel milk of diseases, including diabetes, autism, cancer, various infections, heavy metal toxicity, colitis, and alcohol-induced toxicity. Although most studies using both the human and animal model do show a clinical benefit with an intervention and camel milk, limitations of these studies must be taken into consideration before widespread use.”

Vitamin A deficiency and xerophthalmia in children of a developed country. “Fifty-two of the 146 children had VAD [vitamin A deficiency]; their average age was 8.4 years (range 11 days to 18 years old). In this Australian cohort, the most common pre-existing medical conditions in those children whose vitamin A status was investigated were cystic fibrosis, gastro-oesophageal reflux disease, micronutrient deficiency and short gut syndrome. The most common medical conditions affecting children with measured VAD in this cohort include autism, coeliac disease and cystic fibrosis. A significant association was found between VAD and anaemia and serum iron levels. Of the 146 children, 28 had ophthalmology review, of whom 13 had VAD.”

The relationship between mercury and autism: A comprehensive review and discussion. This review found 91 studies that examine the potential relationship between mercury and ASD from 1999 to February 2016. Of these studies, the vast majority (74%) suggest that mercury is a risk factor for ASD, revealing both direct and indirect effects. The preponderance of the evidence indicates that mercury exposure is causal and/or contributory in ASD.

June 2016

The positive association between elevated blood lead levels and brain-specific autoantibodies in autistic children from low lead-polluted areas. In children with autism spectrum disorder (ASD), it has been documented increased levels of brain-specific autoantibodies. Furthermore, lead (Pb) has been identified as one of the main neurotoxicants acting as environmental triggers for ASD as it induces neuroinflammation and autoimmunity.

Relationship between adipic acid concentration and the core symptoms of autism spectrum disorders.Overall, no increase in the concentration of adipic acid in children with ASDs compared to TD children, however when considering vitamin B supplementation in ASD there were significantly increased level of urinary adipic acid in children with an ASD not taking vitamin B supplementation compared to supplemented children or to TD children. Interestingly, the increase in adipic acid concentration was significantly and indirectly correlated with the severity of the deficit in socialization and communication skills in children with an ASD.Dr Bernard Rimland pioneered the use of vitamin B6 and magnesium in autism. There have been various reports of vitamin B6 and magnesium improving verbal skills, non-verbal skills, and social interaction skills in ASD individuals. This study suggests that urinary adipic acid may be a marker to identify a subgroup of ASD individuals that may benefit from vitamin B6 supplementation. The level of adipic acid can be measured in a urinary Organic Acid Test.

Sibling Experiences: Living with Young Persons with Autism Spectrum Disorders.Like other young people, those with autism spectrum disorder (ASD) have an impact on siblings in both positive and negative ways.

Gut to brain interaction in Autism Spectrum Disorders: a randomized controlled trial on the role of probiotics on clinical, biochemical and neurophysiological parameters. Full text. Here are details of a clinical trial recruiting ASD patients. The aim of the study is to look at GI disturbances in ASD individuals, the link to gut dysbiosis, and how probiotic treatment may affect a number of biomarkers and core symptoms of ASD. “One of the possible outcome of this study is the identification of a subgroup of children with ASD and GI symptoms that could represent a particular endophenotype of ASD characterized by an abnormal gut microflora. We expect that these children, after a probiotic treatment, could show changes in GI symptomatology and in related blood, urinary and fecal biomarkers through their effects in restoring the balance of intestinal microflora, and in attenuating immunological abnormalities. Moreover, we expect that the treatment with probiotics in individuals with ASD and GI symptoms may produce also more significant improvement in autistic symptoms, in behavioral profiles, in adaptive functioning and in cognitive and linguistic development in comparison with individuals with ASD and GI symptoms treated with placebo.

Risperidone-induced priapism in an autistic child: a case report. Full text. Priapism is a prolonged erection of the penis. “Clinicians who prescribe risperidone should be aware of the possibility of this rare complication in their patients. Information about this possible side effect and instructions regarding appropriate response should be made available to caregivers of those in the at-risk group of young patients.”

Dietary Patterns of Children with Autism Spectrum Disorder: A Study Based in Egypt. Full text. “Tailoring a specially designed balanced diet with appropriate micronutrient supplementation may ameliorate the severity of autism symptoms and related abnormal behaviours.”

Feeding Disorders in Children with Autism Spectrum Disorders Are Associated with Eosinophilic Esophagitis.Feeding disorders in children with ASD should not be assumed to be solely behavioral and an esophagogastroduodenoscopy should be performed to evaluate for EoE [Eosinophilic Esophagitis].

Out of School and Into Distress: Families of Young Adults with Intellectual and Developmental Disabilities in Transition.Parents reported significantly higher levels of distress after their child transitioned out of school. Employed parents and parents of a child with an autism spectrum disorder are at increased risk for distress.

An Introduction to the Psychopharmacology of Children and Adolescents With Autism Spectrum Disorder.There are currently no FDA-approved medications to treat the core symptoms of ASD. Consequently, all medications, besides risperidone and aripiprazole for severe irritability, are considered off-label. Additionally, due to reduced levels of effectiveness and higher rates of side effects, more typical medications such as antidepressants and stimulants should be used with caution.

Parenting stress among parents of children with Neurodevelopmental Disorders.Another interesting finding was that IQ level or emotional and behavioral problems are associated with the higher levels of parenting stress.

Effect of gluten free diet on gastrointestinal and behavioral indices for children with autism spectrum disorders: a randomized clinical trial.Of the 80 children, 53.9% had gastrointestinal abnormalities. In the GFD [gluten free diet] group, the prevalence of gastrointestinal symptoms decreased significantly after intake of GFD but increased insignificantly in the RD [regular diet] group. GFD intervention resulted in a significant decrease in behavioral disorders but an insignificant increase in the RD group.

Maternal Infection during Pregnancy and Risk of Autism Spectrum Disorders: A Systematic Review and Meta-analysis.These findings indicate that maternal infection during pregnancy increases the risk of ASD in offspring. Possible mechanisms may include direct effects of pathogens and, more indirectly, the effects of inflammatory responses on the developing brain.

Prenatal exposure to the organophosphate insecticide chlorpyrifos enhances brain oxidative stress and prostaglandin E2 synthesis in a mouse model of idiopathic autism. Full text. “Organophosphate insecticides, among which chlorpyrifos (CPF), are widely diffused environmental toxicants associated with neurobehavioral deficits and increased risk of ASD occurrence in children. The results further support the hypothesis that oxidative stress might be the link between environmental neurotoxicants such as CPF and ASD.

Autism spectrum disorder prevalence and associations with air concentrations of lead, mercury, and arsenic.ambient metal concentrations were negatively associated with ASD prevalence. After adjusting for confounding factors, tracts with air concentrations of lead in the highest quartile had significantly higher ASD prevalence than tracts with lead concentrations in the lowest quartile.

Opioid peptides and gastrointestinal symptoms in autism spectrum disorders. Full text. “oxidative stress in individuals with ASD may be a consequence of metabolic sulfur deficiency, abnormal gut bacteria growth, and increased intestinal permeability, thus suggesting a possible correlation between gastrointestinal abnormalities and symptoms of ASD. Although the evidence to support opioid-free diets (gluten-free, casein-free) is limited and weak, dietary restrictions should only be introduced after gastrointestinal symptoms have appeared or intolerance or allergy to these foods has been diagnosed.

Autism and epilepsy: A population-based nationwide cohort study. Individuals with epilepsy are at increased risk of ASD, especially if epilepsy appears in childhood. Further, ASD is more common in the siblings and offspring of individuals with epilepsy, suggesting shared etiology.

Autism-specific maternal anti-fetal brain autoantibodies are associated with metabolic conditions.In this exploratory study, mothers whose children had severe ASD and who experienced diabetes were more likely to have anti-fetal brain autoantibodies 2-5 years later.

Experiences of emergency department care from the perspective of families in which a child has autism spectrum disorder.Care for children with autism spectrum disorder (ASD) in the emergency department (ED) is increasingly recognized as difficult.

A randomised, double blind, placebo-controlled trial of a fixed dose of N-acetyl cysteine in children with autistic disorder. There are now two published pilot studies suggesting efficacy, particularly in symptoms of irritability. “This was a placebo-controlled, randomised clinical trial of 500 mg/day oral N-acetyl cysteine over 6 months. This study failed to demonstrate any benefit of adjunctive N-acetyl cysteine in treating autistic disorder.

Psychophysiological Associations with Gastrointestinal Symptomatology in Autism Spectrum Disorder.Heart rate variability, a measure of parasympathetic modulation of cardiac activity, was found to be positively associated with lower gastrointestinal tract symptomatology at baseline. This relationship was particularly strong for participants with co-occurring diagnoses of anxiety disorder and for those with a history of regressive ASD or loss of previously acquired skills. Clinicians should be aware that gastrointestinal problems, anxiety, and autonomic dysfunction may cluster in children with ASD and should be addressed in a multidisciplinary treatment plan.” I continuously say that ASD children should have a comprehensive evaluation for underlying co-morbidities rather than practicing “lazy medicine” and writing out a script for a psychoactive drug.

Identification and Treatment of Pathophysiological Comorbidities of Autism Spectrum Disorder to Achieve Optimal Outcomes. Full text. Excellent review. “In this paper we review some of the pathophysiological abnormalities associated with ASD and their potential associated treatments. Overall, there is evidence for some children with ASD being affected by seizure and epilepsy, neurotransmitter dysfunction, sleep disorders, metabolic abnormalities, including abnormalities in folate, cobalamin, tetrahydrobiopterin, carnitine, redox and mitochondrial metabolism, and immune and gastrointestinal disorders.

Improvement in Symptoms of Autism Spectrum Disorder in Children With the Use of Gastrin-Releasing Peptide: An Open Trial. Full text. “Evidence has suggested a link between gastrin-releasing peptide (GRP) and neuropsychiatric disturbances. Recent preclinical studies have raisedthe hypothesis that some ASD symptoms, such as socialinteraction deficits and reduced interest in bonding, maybe caused by a lack of GRP action at some early point indevelopment. Gastrin-releasing peptide was safe and well tolerated by most subjects and may be effective for core symptoms of autism.

Vitamin D and omega-3 fatty acid supplements in children with autism spectrum disorder: a study protocol for a factorial randomised, double-blind, placebo-controlled trial. Full text of study protocol. “There is strong mechanistic evidence to suggest that vitamin D and omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFAs), specifically docosahexaenoic acid (DHA), have the potential to significantly improve the symptoms of autism spectrum disorder (ASD).

Efficacy of Folic Acid Supplementation in Autistic Children Participating in Structured Teaching: An Open-Label Trial. Full text. “The results illustrated folic acid intervention improved autism symptoms towards sociability, cognitive verbal/preverbal, receptive language, and affective expression and communication. These results unravel that children with ASD—or, at the very least, a subset of children with ASD—could benefit from this simple and safe nutritional supplementation.

The effect of epilepsy on autistic symptom severity assessed by the social responsiveness scale in children with autism spectrum disorder. Full text. “ASD participants with epilepsy were significantly more impaired than ASD participants on some measures of social functioning such as social awareness and social communication.

Atopic diseases and inflammation of the brain in the pathogenesis of autism spectrum disorders. Full text. “Recent epidemiological studies have shown a strong statistical correlation between risk for ASD and either maternal or infantile atopic diseases, such as asthma, eczema, food allergies and food intolerance, all of which involve activation of mast cells (MCs). Serum IL-6 and TNF may define an ASD subgroup that benefits most from treatment with the natural flavonoid luteolin.

Acetaminophen use in pregnancy and neurodevelopment: attention function and autism spectrum symptoms. Full text. “Prenatal acetaminophen exposure was associated with a greater number of autism spectrum symptoms in males and showed adverse effects on attention-related outcomes for both genders. These associations seem to be dependent on the frequency of exposure.

Bedtime Electronic Media Use and Sleep in Children with Autism Spectrum Disorder.Overall, these findings indicate that incorporating television and video games into the bedtime routine is associated with sleep onset difficulties among children with ASD. Exposure to violent media before bed is also associated with poor sleep.

Truths, Myths and Needs of Special Diets: Attention-Deficit/Hyperactivity Disorder, Autism, Non-Celiac Gluten Sensitivity, and Vegetarianism. Full Text.

Psychoactive pharmaceuticals at environmental concentrations induce in vitro gene expression associated with neurological disorders. Full text. “We found that psychoactive pharmaceuticals altered the gene expression of neuronal systems in vitro at environmental concentrations. These altered gene expressions are associated with potential neurological disorders by playing a key role in the formation, growth and regulation of neurons.

May 2016

Safety of Selective Serotonin Reuptake Inhibitors in Pregnancy: A Review of Current Evidence.Exposure to SSRIs in pregnancy has been associated with miscarriage, premature delivery, neonatal complications, birth defects-specifically cardiac defects-and, more recently, neurodevelopmental disorders in childhood, specifically autism spectrum disorders. It is important that every pregnant woman being treated with an SSRI (or considering such treatment) carefully weighs the risks of treatment against the risk of untreated depression for both herself and her child.

Brain GABA levels across psychiatric disorders: A systematic literature review and meta-analysis of 1 H-MRS studies.In conclusion, this meta-analysis provided evidence for lower brain GABA levels in ASD……. compared with healthy controls.”

Risk of Psychiatric and Neurodevelopmental Disorders Among Siblings of Probands With Autism Spectrum Disorders.Autism spectrum disorders were also associated with schizophrenia spectrum disorders, affective disorders, anxiety disorders, and other neurotic and personality disorders among siblings.

Chemicals, Nutrition, and Autism Spectrum Disorder: A Mini-Review. Full text. “Several chemical exposures such as air pollution (e.g., particular matter 2.5), pesticides, bisphenol A, phthalates, mercury, and nutrition deficiency such as folic acid, vitamin D, or fatty acid may possibly be associated with an increased risk of ASD, whereas other traditional risk factors such as smoking/tobacco, alcohol, or polychlorinated biphenyls are less likely to be associated with ASD.

Genome-wide association study of serum coenzyme Q10 levels identifies susceptibility loci linked to neuronal diseases.In summary, this study demonstrates that serum CoQ10 levels are associated with common genetic loci that are linked to neuronal diseases [like Alzheimer disease, autism, and schizophrenia].

The landscape of DNA methylation amid a perfect storm of autism aetiologies.The dynamic developmental landscape of DNA methylation is vulnerable to numerous genetic and environmental insults: therefore, understanding pathways that are central to this ‘perfect storm’ will be crucial to improving the diagnosis and treatment of ASD.

Persistence of self-injurious behaviour in autism spectrum disorder over 3 years: a prospective cohort study of risk markers.Behavioural correlates of being non-verbal, having lower ability and higher levels of overactivity, impulsivity and repetitive behaviour, were associated with self-injury..” Sad that 3 years of research was done on 67 ASD individuals with self-injury but no evaluation for PAIN as the driver for the self-injury.

DNA methylation: a mechanism linking environmental chemical exposures to risk of autism spectrum disorders?..we describe epidemiological and experimental evidence implicating altered DNA methylation as a potential mechanism by which environmental chemicals confer risk for ASD..

Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study...the association between ASD symptoms and most family functioning measures was accounted forby child internalising and externalising disorders, ADHD severity, and socioeconomic status; however, ASD symptoms appear to be independently associated with poorer FQoL [family quality of life] in children with ADHD.”

A Comparison Between Caregiver-Reported Anxiety and Other Emotional and Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorders Attending Specialist or Mainstream Schools.Increasing numbers of students with Autism Spectrum Disorder (ASD) are attending mainstream schools. Nonetheless, concerns about their emotional well-being and mental health in these settings have also been raised. Students with ASD attending mainstream schools experienced higher levels of social anxiety symptoms compared to their specialist school counterparts.

Mean serum-level of common organic pollutants is predictive of behavioral severity in children with autism spectrum disorders.The ASD cohort displayed greater quantitative variance of analyte concentrations than controls, suggesting a wide range of detoxification functioning in the ASD cohort. This study supports the hypothesis that environmental exposure to organic pollutants may play a significant role in the behavioral presentation of autism.

CSF concentrations of 5-methyltetrahydrofolate in a cohort of young children with autism. this study examined CSF 5-methyltetrahydrofolate (5-MTHF) concentrations in a group of young children with autism.” “CSF 5-MTHF levels vary significantly over time in an unpredictable fashion and do not show a significant relationship to typical clinical features of autism. Reduced CSF 5-MTHF levels are a nonspecific finding in autism.”

SnapShot: Microglia in Disease.dysregulation of microglia contributes to the pathology of neurodevelopmental disorders such as autism spectrum disorders; neurodegenerative disorders such as Alzheimer’s disease; and schizophrenia

Associations between cytokines, endocrine stress response, and gastrointestinal symptoms in autism spectrum disorder.The relationship between cortisol response to stress and GI functioning was greater for children who had a history of regressive autism.

Epigenetic Effect of Environmental Factors on Autism Spectrum Disorders. Full text. “findings support the idea that the phenotypes of ASDs caused by epigenetic dysregulation are reversible and thus treatable.

Correlation between Nutrition and Symptoms: Nutritional Survey of Children with Autism Spectrum Disorder in Chongqing, China.These results suggest that reduced macronutrient intakes, severe feeding behavior issues, constipation, and vitamin A deficiency are quite common among children with ASD. Further, a low serum vitamin A level may be a risk factor for symptoms of ASD.

Mass spectrometric evaluation of neurotransmitter levels in IMR 32 cell line in response to Ayurvedic medicines.Herbal medicines given as part of ayurvedic medicine increased the neurotransmitter levels ……… these ayurvedic medicines when prescribed to children with ASD might alleviate the abnormal behavioral symptoms by maintaining neurotransmitter homeostasis.” Herbal medicine can be very useful in the treatment of ASD children.

A comparative consecutive case series of 20 children with a diagnosis of ADHD receiving homeopathic treatment, compared with 10 children receiving usual care.In this small consecutive sample the intervention was associated with improvements in criminality, anger and children with a concomitant diagnosis of Autism Spectrum Disorder ASD.”

Risperidone-Induced Acute Respiratory Distress in an Adolescent with Autism. No abstract available. However it is a reminder that pharmaceutical medications can have serious side effects.

A sexually dichotomous, autistic-like phenotype is induced by Group B Streptococcus maternofetal immune activation...these data show for the first time that gestational exposure to GBS plays an important role in the generation of neurodevelopmental abnormalities reminiscent of human autism spectrum disorders (ASD). These results provide new evidence in favor of the role of a common and modifiable infectious/inflammatory environmental factor in human ASD pathophysiology.

Gut microbiome and psyche: paradigm shift in the concept of brain-gut axis. [German]”a faulty composition of the gut microbiota in childhood influences the maturation of the central nervous system and thus may favor the development of mental disorders such as autism, depression, or other.

Cataract secondary to self-inflicted blunt trauma in children with autism spectrum disorder.We report 3 cases of bilateral cataract secondary to self-inflicted blunt eye trauma in children with autism spectrum disorder (ASD). All 3 children hit their foreheads, orbits, or globes repeatedly for long periods of time and developed cataracts.” This case report is so sad in that NO ONE investigated WHY these three children were self-injuring themselves. The most common reason is underlying PAIN.

Population-Based Prevalence of Intellectual Disability and Autism Spectrum Disorders in Western Australia: A Comparison With Previous Estimates.prevalence of intellectual disability (ID) and/or autism spectrum disorders (ASDs) in Western Australia (WA).A cohort of children born from 1983 to 2010 in WA with an ID and/or ASD…The prevalence of ID has risen in WA over the last 10 years with most of this increase due to mild or moderate ID. Whilst the prevalence of ASD has also increased over this time this does not fully explain the observed increase. Aboriginal children are at a 2.5-fold risk of ID but are less likely to be accessing disability services.

The missing voices of Indigenous Australians with autism in research.The purpose of this Letter to the Editor is to raise awareness among those who read Autism about the limited amount of peer-reviewed literature on Aboriginal and Torres Strait Islander Australians living on the autism spectrum. This letter summarises the results of our search on Pubmed and Google Scholar for peer-reviewed literature on this subject. It then concludes by explaining why more research should be conducted on Aboriginal and Torres Strait Islander Australians living on the autism spectrum.

Effects of Atomoxetine in Individuals with Attention-Deficit/Hyperactivity Disorder and Low-Functioning Autism Spectrum Disorder.ATX [atomoxetine] appears to be safe and effective for social withdrawal and ADHD symptoms in children with ASD and ID.” Out of 37 patients 16 (43,2%) were considered responders, 5 (13.5%) stopped medication due to either increased motor activity and talkativeness, irritability, temper outbursts, or increased blood pressure. This is only within 12 weeks. Long-term side effects? Better outcomes can be achieved with dietary modification or targeted supplements, with minimal side effects.

Use of complementary and alternative medicine in children and adolescents with autism spectrum disorder: A systematic review.Approximately half of children and adolescents with autism spectrum disorder use complementary and alternative medicine. Doctors should be aware of this and should discuss complementary and alternative medicine use with patients and their carers, especially as the evidence is mixed and some complementary and alternative medicine treatments are potentially harmful.” It is unfortunate that complimentary medicines that have been shown to be effective are reported as “potentially harmful”, yet pharmacological medications like atomexatine in the study above are reported as appearing to be “safe and effective”.

Preschool to School in Autism: Neuropsychiatric Problems 8 Years After Diagnosis at 3 Years of Age.More than 90 % of children with a preschool diagnosis of ASD have remaining neuropsychiatric problems at 11, despite early intervention.

Omega-3 and Omega-6 Polyunsaturated Fatty Acid Levels and Correlations with Symptoms in Children with Attention Deficit Hyperactivity Disorder, Autistic Spectrum Disorder and Typically Developing Controls. Full text. “Children with ADHD and ASD had low levels of EPA, DHA and AA and high ratio of n-6/n-3 PUFAs and these correlated significantly with symptoms.” Research on omega-3 supplements show inconsistent results. Unfortunately no one actually tests the quality of omega-3 supplements used in the majority of studies. The few studies done on omega-3 supplements have shown that most are of very poor quality.

Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity.The subsample that no longer fulfilled an autism spectrum disorder had full-time jobs or studies (10/11), independent living (100%), and reported having two or more friends (100%). In the stable autism spectrum disorder group, 41% had full-time job or studies, 51% lived independently, and 33% reported two or more friends, and a significant minority had specialized employments, lived with support from the government, or had no friends.

Curcumin in depressive disorders: an overview of potential mechanisms, preclinical and clinical findings.Despite the limited number of reports, preclinical models investigated the potential role for curcumin in anxiety, bipolar disorder, post-traumatic stress disorder and autism spectrum disorders.

Feelings of loss and grief in parents of children diagnosed with autism spectrum disorder (ASD).The core category that explained the feelings of these parents was unexpected child loss, associated with shock, negation, fear, guilt, anger, and/or sadness.

Correctional Management and Treatment of Autism Spectrum Disorder.Currently, there is no universal training on ASD for CJS [criminal justice system] professionals, nor are there service standards for individuals with ASD during incarceration, to support their community re-entry and reduce recidivism.

Antipsychotic Use Trends in Youth With Autism Spectrum Disorder and/or Intellectual Disability: A Meta-Analysis.1 in 6 youth with ASD received antipsychotics. Both proportions increased in later years; however, clinical reasons and outcomes of antipsychotic use in ASD/ID require further study.

Practices and outcomes of self-treatment with helminths based on physicians’ observations.The results strongly support previous indications that helminth therapy can effectively treat a wide range of allergies, autoimmune conditions and neuropsychiatric disorders, such as major depression and anxiety disorders. Approximately 57% of the self-treating patients observed by physicians in the study had autism. Physicians reported that the majority of patients with autism and inflammation-associated co-morbidities responded favourably to therapy with either of the two most popular organisms currently used by self-treaters, Hymenolepis diminuta and Trichuris suis. However, approximately 1% of paediatric patients experienced severe gastrointestinal pains with the use of H. diminuta, although the symptoms were resolved with an anti-helminthic drug.

Neuropathological Mechanisms of Seizures in Autism Spectrum Disorder. Full text. “This manuscript reviews biological abnormalities shared by autism spectrum disorder (ASD) and epilepsy. Two neuropathological findings are shared by ASD and epilepsy: abnormalities in minicolumn architecture and γ-aminobutyric acid (GABA) neurotransmission. Mineral deficiencies can cause glutamate and GABA neurotransmission abnormalities and heavy metals can cause mitochondrial dysfunction which disrupts GABA metabolism.

Iodine Deficiency and Hypothyroidism From Voluntary Diet Restrictions in the US: Case Reports.Recent trends among specific populations of children in the United States include adopting food restrictions, such casein-free and gluten-free diets. We present here 2 cases of iodine deficiency resulting from severe food restriction and associated primary hypothyroidism. ” Iodine status should be assessed in all children regardless of diet as iodine deficiency is prevalent in children and pregnant women in Australia.”

April 2016

Calcium and Vitamin D Supplement Prescribing Practices among Providers Caring for Children with Autism Spectrum Disorders: Are We Addressing Bone Health? Full text. “Twenty-four percent of children in the GFCF group had a documented 25(OH)D level compared to none in the non-GFCF group. The data highlight a gap in calcium and vitamin D supplement prescribing practices among providers caring for children with ASD as well as a gap in the practice of checking 25(OH)D levels.

Regulation of prefrontal cortex myelination by the microbiota.In summary, we believe we demonstrate for the first time that the microbiome is necessary for appropriate and dynamic regulation of myelin-related genes with clear implications for cortical myelination at an ultrastructural level.”

Targeted Nutritional and Behavioral Feeding Intervention for a Child with Autism Spectrum Disorder. Full text. “this study is the first of its kind highlighting the importance of a multidisciplinary approach to address pediatric feeding problems. Additionally, nutritional, medical, and oral motor assessments are critical components of a feeding program

The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder.The findings provide supporting evidence that physical activity interventions involving table tennis training may be a viable therapeutic option for treating children with autism spectrum disorder.

Evaluation of whole blood zinc and copper levels in children with autism spectrum disorder. Zinc (Zn) and copper (Cu) are important trace elements for cognitive development and normal neurological functioning. The results of the present study may be indicative of Zn deficiency in ASD children. Taking into account Zn-mediated up-regulation of metallothionein (MT) gene expression, these findings suggest a possible alteration in the functioning of the neuroprotective MT system.

Associations between joint attention and language in autism spectrum disorder and typical development: A systematic review and meta-regression analysis.Joint attention may be more tightly tied to language in children with ASD as compared to TD [typically developing] children……… children with ASD who exhibit deficits in joint attention develop language contingent upon their joint attention abilities.

The prevalence of symptoms of attention-deficit/hyperactivity disorder in parents of children with autism spectrum disorder.Symptoms of ADHD were present in 10.4% of the mothers of children with a diagnosis of ASD and in 11.3% of the fathers.

Lost at Sea in Search of a Diagnosis: A Case of Unexplained Bleeding.Here, we present a 17-year-old male with autism spectrum disorder and a diet severely deficient in ascorbic acid due to textural aversion and food preferences. He presented with recurrent arthritis, hemarthrosis, bruising, and anemia. His vitamin C level was low, and his symptoms improved promptly after treatment with ascorbic acid.

Bread and Other Edible Agents of Mental Disease. Full text. “Perhaps because gastroenterology, immunology, toxicology, and the nutrition and agricultural sciences are outside of their competence and responsibility, psychologists and psychiatrists typically fail to appreciate the impact that food can have on their patients’ condition.

The basis for folinic acid treatment in neuro-psychiatric disorders...despite normal systemic levels, folate transport to the brain is impaired in the so-called cerebral folate deficiency (CFD) syndromes presenting as developmental and psychiatric disorders. These include infantile-onset CFD syndrome, infantile autism with or without neurologic deficits..” “Infantile CFD syndrome and autism with neurological deficits tend to be characterized by elevated Folate receptor alpha [FRα] antibody titers and low CSF MTHF.” “..therapeutic regimens using high dose folinic acid, corticosteroids and milk-free diet is presented which has proven to be beneficial in providing adequate folate to the brain and decreasing the FRα autoantibody titer in those positive for the antibody.” For more on Cerebral Folate Deficiency click here.

Analysing change in music therapy interactions of children with communication difficulties. Full text. “Music therapy has been found to improve communicative behaviours and joint attention in children with autism…

Autism, mitochondria and polybrominated diphenyl ether exposure.In this review, we propose that PBDE, and possibly other environmental exposures, during child development can induce or compound mitochondrial dysfunction, which in conjunction with a dysregulated antioxidant response, increase a child’s susceptibility of autism.

Sulforaphane treatment of young men with Autism Spectrum Disorder.Sulforaphane, a phytochemical derived from a number of cruciferous vegetables, most notably broccoli sprouts, has metabolic effects that in some ways resemble that of fever. This review paper discusses this “fever effect” and the intracellular effects of sulforaphane as well as the results of our recent clinical trial of sulforaphane in young adults with autism.” For more on sulforaphane click here.

Oxidative Stress and Nitric Oxide in Autism Spectrum Disorder and Other Neuropsychiatric Disorders.The etiology of autism spectrum disorder (ASD) remains unclear; however, the toxic environmental exposure to oxidative stress has been suggested to play an important role in its pathogenesis.

The Potential of Nasal Oxytocin Administration for Remediation of Autism Spectrum Disorders.Administration of oxytocin has been proposed as a treatment for the core symptoms of autism spectrum disorder (ASD), including social-communicative deficit.

Effects of yokusankan, a Japanese kampo medicine, for symptoms associated autism spectrum disorder.Yokukansan (YKS), a traditional Japanese medicine, is composed of seven kinds of dried herbs. It is widely prescribed in clinical situation for treating psychiatric disorders by acting on mainly glutamatergic and serotonergic nervous system. In this review, we introduce the ameliorative effects of YKS on ASDs including pervasive developmental disorder not otherwise specified (PDD-NOS) and Asperger’s disorder in the open-label studies, suggesting that YKS is effective and well tolerated for the treatment of severe irritability/agitation and hyperactivity/noncompliance in subjects with ASD.

Biomarker-guided Strategy for Treatment of Autism Spectrum Disorder (ASD).We outline herein, several ASD-associated basic physiological pathways that can be regulated by the small molecule phytochemical sulforaphane, as an example of a druggable small molecule target for which much in vitro, pre-clinical, and clinical evidence already exists.

Plasma Oxytocin in Children with Autism and Its Correlations with Behavioral Parameters in Children and Parents.Oxytocin (OT) has been implicated to play an important role in autism spectrum disorders (ASD) etiology. Our results support the hypothesis of OT deficiency in autism. The “paradoxical” associations of OT levels and social skills in children with autism indicate disturbances at various levels of OT system.

Service Needs Across the Lifespan for Individuals with Autism.Adults with ASD were less likely to be receiving multiple types of services, and more likely to have a need for services. These findings demonstrate that adults with ASD have more and different needs for services.

Serum levels of SOD and risk of autism spectrum disorder: A case-control study.This study examined the clinical significance of serum superoxide dismutase (SOD) level, a marker of oxidative stress, in children with autism spectrum disorder.” “Levels of SOD increased with decreasing severity of ASD ….decreased serum SOD levels could be implicated in the pathophysiology and progression of autism.

Case 2: Persistent skin discolouration in a child with autism spectrum disorder. Full text. A 3-year old ASD boy described as a “picky eater” presented with orange discolouration of his entire body. He drank 1.36 litres per day of a commercial fruit juice. The diagnosis was hypercarotenemia (elevated serum beta-carotene). Of note was his overall carbohydrate intake of 158 grams per day from juice (130 grams per day is recommended for children).

A Pilot Study for Understanding the Perceptions of Australian General Practitioners Regarding Psychopharmacology for Children With Autism Spectrum Disorders.GPs reported a lack of experience of these medications, and would often prescribe only under the supervision of specialists. GPs with greater confidence and involvement with children of ASDs prescribed more medications; whereas GP reporting more concerns with regard to medications prescribed less.

Therapeutic potency of bee pollen against biochemical autistic features induced through acute and sub-acute neurotoxicity of orally administered propionic acid.Propionic acid (PA), as a metabolic product of gut microbiota and as a commonly used food additive, has been reported to mediate the effects of autism. Bee pollen was effective in ameliorating the neurotoxic effect of PA.

Vitamin D and Autism Spectrum Disorder: A Literature Review.…serum 25(OH)D level during pregnancy or childhood-we found growing evidence for a relationship between vitamin D and ASD.

What Happened to Paul? Manifestation of Abnormal Pain Response for Individuals With Autism Spectrum Disorder.This article concludes by arguing that professionals across all domains of health care need to begin to see behavior as communicative for those with ASD. This is particularly true of changes in behavior, which can be significant indicators of health care problems rather than something to be dismissed as another manifestation of the condition.

The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities. Research has suggested that individuals who engage in self-injurious behavior may have enhanced expressions of pain ……These results continue to support that individuals with self-injury may have enhanced expressions of pain.”

Urinary 3-(3-Hydroxyphenyl)-3-hydroxypropionic Acid, 3-Hydroxyphenylacetic Acid, and 3-Hydroxyhippuric Acid Are Elevated in Children with Autism Spectrum Disorders. Full text. “Recent studies have shown that some abnormal aromatic metabolites in autism patients are presumably derived from overgrown Clostridium species in gut, which may be used for diagnostic purposes.” This metabolite is included in the Organic Acid Test.

Weight Gain and Metabolic Consequences of Risperidone in Young Children With Autism Spectrum Disorder.Rapid weight gain with risperidone treatment may promote the cascade of biochemical indices associated with insulin resistance and metabolic syndrome. Appetite, weight, waist circumference, liver function tests, blood lipids, and glucose warrant monitoring.

Minocycline as Adjunctive Treatment to Risperidone in Children with Autistic Disorder: A Randomized, Double-Blind Placebo-Controlled Trial.Forty-six children with diagnosis of autistic disorder …… participated in a randomized controlled trial and underwent 10 weeks of treatment with either minocycline (50 mg twice per day) or placebo in addition to risperidone titrated up to 2 mg/day (based on bodyweight). By week 10, 21 (91.3%) patients in the minocycline group and 15 (65.5%) patients in the placebo group achieved at least partial response. Minocycline seems to be a safe and effective adjuvant in management of patients with autistic disorder.” So this seems to be safe and effective, but dietary intervention is not proven and “dangerous”!

Comparison of nutritional status between children with autism spectrum disorder and typically developing children in the Mediterranean Region (Valencia, Spain).Autism spectrum disorder group failed to meet dietary recommendations for thiamin, riboflavin, vitamin C, or calcium. Risk of inadequate intake of fiber, vitamin E, and sodium was lower in children with autism spectrum disorder than typically developing children.

March 2016

Medical Therapy for Inappropriate Sexual Behaviors in a Teen With Autism Spectrum Disorder.

Realizing a diagnosis of autism spectrum disorder as an adult.

Case 3: Regression in an adolescent with autism spectrum disorder. Full text.

Mental Health in Children Born Extremely Preterm Without Severe Neurodevelopmental Disabilities.

Potency of pre-post treatment of coenzyme Q10 and melatonin supplement in ameliorating the impaired fatty acid profile in rodent model of autism. Full text. “Melatonin and coenzyme Q were effective in restoring normal level of most of the impaired fatty acids in PA-intoxicated rats which could help suggest both as supplements to ameliorate the autistic features induced in rat pups.”

Sensory cognitive abnormalities of pain in autism spectrum disorder: a case-control study. Full text.

Association of methylenetetrahydrofolate reductase (MTHFR) gene C677T polymprphism with autism: evidence of genetic susceptibility. “present meta-analysis strongly suggested a significant association of the MTHFR C677T polymorphism with autism.”

Fecal Microbiota Transplantation: Current Applications, Effectiveness, and Future Perspectives. Full text. “The high success rate and safety in the short term reported for recurrent Clostridium difficile infection has elevated FMT as an emerging treatment for a wide range of disorders, including Parkinson’s disease, fibromyalgia, chronic fatigue syndrome, ……and autism.”

Autism and sleep disorders. Full text. Improvement in sleep can make a significant improvement to the quality of life for the ASD individual and their family.

The microbiota-gut-brain axis and its potential therapeutic role in autism spectrum disorder. “Research continues to show that the gut in autistic children is a promising area of treatment. Parents treating their children’s gut issues are seeing some amazing improvements in their children. The US, Canadian and UK Paediatricians have guidelines recommending that all ASD children should have a comprehensive gastrointestinal assessment. Unfortunately, Australian Paediatricians have not adopted similar guidelines.”

Aging and autism spectrum disorder: Evidence from the broad autism phenotype.

Gender Dependent Evaluation of Autism like Behavior in Mice Exposed to Prenatal Zinc Deficiency.

Epilepsy and Autism. “Epilepsy and autistic spectrum disorder frequently coexist in the same individual. Electroencephalogram (EEG) epileptiform activity is also present at a substantially higher rate in children with autism than normally developing children.”

Plasma phthalate and bisphenol a levels and oxidant-antioxidant status in autistic children. “Phthalates and bisphenol A (BPA) are endocrine disruting chemicals (EDCs) that are suggested to exert neurotoxic effects. Plasma BPA levels of children with PDD-NOS were significantly higher than both classic autistic children and controls.”

People with autism ‘die younger’, warns charity.

Neuro-inflammatory mechanisms in developmental disorders associated with Intellectual Disability and Autism Spectrum Disorder: a neuro-immune perspective.These results may reflect an inappropriate immune response to environmental factors, such as infectious or toxic exposure. The role of microglia as sensors of pre- and post-natal environmental stimuli and its involvement in the regulation of synaptic connectivity, maturation of brain circuitry and neurogenesis has recently emerged.

Alzheimer’s disease and Autistic Spectrum Disorder: Is there any Association? “Modern technology resulting in genetically modified crops and increase in gadgets emitting electromagnetic frequencies have resulted in enhanced risks for neurological dysfunctions and disorders like ASD and AD. Subsequent advances in the psychological, pharmacological, biochemical and nutritional aspects of the disorders have resulted in the development of newer therapeutic approaches.”

Fidgety movements – tiny in appearance, but huge in impact.

Association of current phthalate exposure with neurobehavioral development in a national sample. “…increased phthalate exposure exhibited supralinear associations with social, thought and attention problems in children aged 6-11 years, who showed greater vulnerability to phthalate exposure.”

Multiple inflammasome complexes are activated in autistic spectrum disorders. “…intestinal fatty acid binding protein (IFABP), an index of altered GI permeability, was significantly increased in serum of ASD”

Blocking and Binding Folate Receptor Alpha Autoantibodies Identify Novel Autism Spectrum Disorder Subgroups. Full text. “Folate receptor α (FRα) autoantibodies (FRAAs) are prevalent in autism spectrum disorder (ASD). They disrupt the transportation of folate across the blood-brain barrier by binding to the FRα. Children with ASD and FRAAs have been reported to respond well to treatment with a form of folate known as folinic acid, suggesting that they may be an important ASD subgroup to identify and treat.” This study and the study above indicate that there is a subgroup of children that benefit significantly with the active form of folate.

The impact of caring for an adult with intellectual disability and psychiatric comorbidity on carer stress and psychological distress. “Carers of people with ID and comorbid psychopathology were found to have significantly higher levels of stress and psychological distress than carers of people with ID alone. Autism was found to be the only significant predictor of both stress and psychological distress among measures of psychopathology.”

Stress and Parents of Children with Autism: A Review of Literature. “The daily challenges of caring for the child are endless and effect all aspects of the child’s care as well as the parent’s mental health and ability to manage the needs of the child and family.”

Complementary and Alternative Medicine in Autism: The Question of Omega-3. In this article, we address the role of omega-3 in the treatment of ASD, reviewing the relevant literature highlighted by searches of PubMed from 1949 to the present. According to the criteria of evidence-based medicine (ie, randomized clinical trials), the data do not support the effectiveness of omega-3 treatment in children with ASD. However, based on anecdotal experiences and on nonrandomized trials, we cannot exclude that there might be a subset of people with ASD who do respond to this type of approach.

February 2016

Dysregulated Breastfeeding Behaviors in Children Later Diagnosed With Autism.

Relevance of Neuroinflammation and Encephalitis in Autism. Full text.

Oxytocin for Male Subjects with Autism Spectrum Disorder and Comorbid Intellectual Disabilities: A Randomized Pilot Study. Full text.

Managing Children With Autism Spectrum Disorders in Emergency Departments.

Supplementation of Korean Red Ginseng improves behavior deviations in animal models of autism. Full text.

Prevalence and Correlates of Elopement in a Nationally Representative Sample of Children with Developmental Disabilities in the United States. Full text.

Comorbidity of Atopic Disorders with Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder.

Psychogenic nonepileptic seizures as a manifestation of psychological distress associated with undiagnosed autism spectrum disorder. Full text.

Parent and health care provider perspectives related to disclosure of autism spectrum disorder in pediatric emergency departments.

Maternal experience of Lego Therapy in families with children with autism spectrum conditions: What is the impact on family relationships?

Iodine in autism spectrum disorders.

The effect of ketogenic diet in an animal model of autism induced by prenatal exposure to valproic acid.

Factors Mediating Dysphoric Moods and Help Seeking Behaviour Among Australian Parents of Children with Autism.

Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder.

Language comprehension and brain function in individuals with an optimal outcome from autism.

Environmental exposure to metals, neurodevelopment, and psychosis.

Facing the Unknown: Intolerance of Uncertainty in Children with Autism Spectrum Disorder.

Rates of Autism Spectrum Disorder Diagnosis Under the DSM-5 Criteria Compared to DSM-IV-TR Criteria in a Hospital-Based Clinic.

Oxytocin in the socioemotional brain: implications for psychiatric disorders.

Does Rubella Cause Autism: A 2015 Reappraisal?

A Non-inflammatory Role for Microglia in Autism Spectrum Disorders.

Psychostimulants: Concerns over Long-Term Adverse Side Effects.

Low-level lead exposure and autistic behaviors in school-age children.

Randomized, Placebo-Controlled Trial of Methyl B12 for Children with Autism.

Improvement of autism spectrum disorder symptoms in three children by using gastrin-releasing peptide.

Obesity and associated factors in youth with an autism spectrum disorder.

Early Characteristics of Children with ASD Who Demonstrate Optimal Progress Between Age Two and Four.

Abnormal Pressure Pain, Touch Sensitivity, Proprioception, and Manual Dexterity in Children with Autism Spectrum Disorders. Full text.

Listening to Parents: A Qualitative Look at the Dental and Oral Care Experiences of Children with Autism Spectrum Disorder.

Centrally acting non-narcotic antitussives prevent hyperactivity in mice: Involvement of GIRK channels.

Serum Ferritin, Weight Gain, Disruptive Behavior, and Extrapyramidal Symptoms in Risperidone-Treated Youth.

Exploratory Study of Childbearing Experiences of Women With Asperger Syndrome.

Research advances in the role of vitamin D in autism spectrum disorders.

Medical and Behavioral Correlates of Depression History in Children and Adolescents With Autism Spectrum Disorder.

Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders. “Anxiety is one of the most prevalent co-occurring symptoms in youth with autism spectrum disorder (ASD).”

Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis.

Health Care Transition Services for Youth With Autism Spectrum Disorders: Perspectives of Caregivers. “The receipt of transition services was low overall, with rates for individual services ranging from 3% to 33%.” “Regression analyses showed depression to be the only variable significantly associated with service receipt.”

Toward Practice Advancement in Emergency Care for Children With Autism Spectrum Disorder.

Sleep Difficulties and Medications in Children With Autism Spectrum Disorders: A Registry Study. “Medications for sleep were prescribed in 46% of 4- to 10-year-olds given a sleep diagnosis. The most common medication used for sleep was melatonin followed by α-agonists, with a variety of other medications taken for sleep (anticonvulsants, antidepressants, atypical antipsychotics, and benzodiazepines). Children taking medications for sleep had worse daytime behavior and pediatric quality of life than children not taking sleep medications.”

Fit for School: The Samurai School Program.

Frontal networks in adults with autism spectrum disorder. Full text.

Evaluation of Intestinal Function in Children with Autism and Gastrointestinal Symptoms.

Perioperative considerations in children with autism spectrum disorder.

The metabolic basis for developmental disorders due to defective folate transport. Clinically I have been using high dose 5-methyltetrahydrofolate in ASD children with some very good results.

Use of acetaminophen (paracetamol) during pregnancy and the risk of autism spectrum disorder in the offspring.

January 2016

Parent Perceptions of Care Received by Children With an Autism Spectrum Disorder.

Use of Antipsychotic Medications for Nonpsychotic Children: Risks and Implications for Mental Health Services.

Risk factors in autism: Thinking outside the brain.

Interleukin-18 modulation in autism spectrum disorders. Full text.

Commentary: Structural and functional features of central nervous system lymphatic vessels. Full text.

Template to Perpetrate: An Update on Violence in Autism Spectrum Disorder.

The levels of blood mercury and inflammatory-related neuropeptides in the serum are correlated in children with autism spectrum disorder.

Otitis Media and Related Complications Among Children with Autism Spectrum Disorders.

Low oxytocin and melatonin levels and their possible role in the diagnosis and prognosis in Iraqi autistic children.

Abnormal fatty acids in Canadian children with autism. More research showing deficiencies in beneficial omega-3 fatty acids in ASD children. Parents have been giving omega-3 oils to ADHD and ASD children for years. Yet the message is still slow to filter through to the general community.

Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder. Yet another study linking gastrointestinal (GI) issues with behavioural issues (“anxiety problems, somatic complaints, externalizing and total problems”) in ASD children. Parents need to take their ASD child’s GI symptoms seriously and have them treated properly.

Gut microbiota in autism and mood disorders. Full text. The evidence is conclusive that there is an ASD and gut microbiota connection. Hence why many parents are working so hard on their childrens diet to help create a balanced microbiota in their childen’s gut.

Hoarding in Youth with Autism Spectrum Disorders and Anxiety: Incidence, Clinical Correlates, and Behavioral Treatment Response.

Gender dysphoria and autism spectrum disorder: A narrative review.

Effects of propranolol on conversational reciprocity in autism spectrum disorder: a pilot, double-blind, single-dose psychopharmacological challenge study.

A systematic review and meta-analysis of the long-term overall outcome of autism spectrum disorders in adolescence and adulthood. This study shows an estimated 19.7% of ASD adolescents and adults had a good long-term outcome, 31.1% a fair outcome, and 47.7% a poor outcome. Parents need to keep these statistics in mind. The orthodox medical advice given for over 20 years is a recipe for setting children up for long-term failure. Parents need to be proactive when children are younger and consider biomedical treatments at an early age.

Autism and Overcoming Job Barriers: Comparing Job-Related Barriers and Possible Solutions in and outside of Autism-Specific Employment. Full text.

Nutritional and Therapeutic Characteristics of Camel Milk in Children: A Systematic Review.

Nutritional and Metabolic Biomarkers in Autism Spectrum Disorders: An Exploratory Study. Another study validating what biomed parents have been doing for years to address their ASD child’s underlying issues.

Maladaptive Behavior and Gastrointestinal Disorders in Children with Autism Spectrum Disorder. Full text. This study only found significant gastrointestinal issues in severe maladaptive behaviour.

Integrative Approaches to Caring for Children with Autism.

Clinical improvement following vitamin D3 supplementation in Autism Spectrum Disorder.

Adolescent boys with autism spectrum disorder growing up: follow-up of self-reported sexual experience.

How Sensory Experiences Affect Adolescents with an Autistic Spectrum Condition within the Classroom.

Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics: A Systematic Review and Meta-analysis. Full text.

From Autism to Eating Disorders and More: The Role of Oxytocin in Neuropsychiatric Disorders. Full text.

From molecules to neural morphology: understanding neuroinflammation in autism spectrum condition. Full text.

The Effects of Rhythm and Robotic Interventions on the Imitation/Praxis, Interpersonal Synchrony, and Motor Performance of Children with Autism Spectrum Disorder (ASD): A Pilot Randomized Controlled Trial. Full text.

Autism in Toddlers Born Very Preterm.

An investigation of the ‘female camouflage effect’ in autism using a computerized ADOS-2 and a test of sex/gender differences. Full text.

Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review.

Decreased Brain Levels of Vitamin B12 in Aging, Autism and Schizophrenia. Full text.

An update on the comorbidity of ASD and ADHD: A focus on clinical management.

Mitochondrial response to the BCKDK-deficiency: Some clues to understand the positive dietary response in this form of autism. Mitochondrial dysfunction can be picked up by the urinary markers in the Organic Acid Test.

Sleep and Behavioral Problems in Children with Autism Spectrum Disorder. Sleep problems were significantly associated with physical aggression, irritability, inattention, and hyperactivity.

The opioid effects of gluten exorphins: asymptomatic celiac disease. The opioid theory in ASD is considered unsubstantiated. However gluten exorphins have resurfaced as having a role in coeliac disease.

Elevated plasma levels of glutamate in children with autism spectrum disorders.

Autism traits: The importance of “co-morbid” problems for impairment and contact with services. Data from the Bergen Child Study.

The relationship between tics, OC, ADHD and autism symptoms: A cross- disorder symptom analysis in Gilles de la Tourette syndrome patients and family-members.

The two fold role of oxytocin in social developmental disorders: A cause and a remedy? Article discusses recent evidence suggesting a link between oxytocin labor induction and developmental social impairments such as autism spectrum disorders (ASD).


December 2015

The plausibility of maternal toxicant exposure and nutritional status as contributing factors to the risk of autism spectrum disorders.

Locus ceruleus neurons in people with autism contain no histochemically-detectable mercury.

Assessing early implementation of state autism insurance mandates.

Therapeutic and Ethical Dilemma of Puberty and Menstruation Problems in an Intellectually Disabled (Autistic) Female: a Case Report.

Neurological disorders and celiac disease.

How does environmental enrichment reduce repetitive motor behaviors? Neuronal activation and dendritic morphology in the indirect basal ganglia pathway of a mouse model.

Therapeutic Targets for Neurodevelopmental Disorders Emerging from Animal Models with Perinatal Immune Activation. Full text.

Maternal polycystic ovary syndrome and the risk of autism spectrum disorders in the offspring: a population-based nationwide study in Sweden.

Perinatal Phosphatidylcholine Supplementation and Early Childhood Behavior Problems: Evidence for CHRNA7 Moderation. This is a very interesting study. If there is a family history of autism, supplementation with phosphatidylcholine may be warranted.

Use and Perceived Effectiveness of Complementary and Alternative Medicine to Treat and Manage the Symptoms of Autism in Children: A Survey of Parents in a Community Population. Anectdotal evidence continues to confirm that Complementary and Alternative Medicine (CAM) is beneficil in dealing with the health and behavioural issues in ASD children. These are most effective while they are still young and building the foundation for their future years.

Hair Heavy Metal and Essential Trace Element Concentration in Children With Autism Spectrum Disorder. This helps validate why chelation therapy has been reported, via the ARI parent survey, to be beneficial for up to 73% of ASD children.

Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition.

Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children.

A reply to Wang T, Shan L, Du L, Feng J, Xu Z, Staal WG, Jia F. Serum concentration of 25-hydroxyvitamin D in autism spectrum disorder: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2015; doi: 10.1007/s00787-015-0786-1.

Behavioral phenotypes of autism spectrum disorder patients and their parents.

Zn/Cu Levels in the Field of Autism Disorders: A Systematic Review and Meta-analysis. Full text. Measuring zinc and copper levels in ASD children has been one of the most basic tests that is performed by biomedical practitioners treating ASD children. Although this study refers to Zn/Cu ratios, more typically they are expressed as Cu/Zn ratios. Again parents should take note that the research is validating what the biomedical community has been doing for years.

Epigenetic effects of casein-derived opioid peptides in SH-SY5Y human neuroblastoma cells. Full text. Opioid peptides (casein) again are being implicated as causative factors in gastrointestinal dysfunction and neurological conditions. Although this is a “test-tube” study, it does add to the growing evidence that a casein free diet may benefit a sub-group of ASD chidren.

DUF1220 copy number is associated with schizophrenia risk and severity: implications for understanding autism and schizophrenia as related diseases.

Sleep problems are more frequent and associated with problematic behaviors in preschoolers with autism spectrum disorder.

Testosterone in relation to behavioral problems in pre-pubertal boys with autism spectrum disorders. Full text.

Driving Simulator Performance in Novice Drivers with Autism Spectrum Disorder: The Role of Executive Functions and Basic Motor Skills.

A clinicomicrobiological study to evaluate the efficacy of manual and powered toothbrushes among autistic patients.

Maternal use of acetaminophen during pregnancy and risk of autism spectrum disorders in childhood: A Danish national birth cohort study.

Atypical sympathetic arousal in children with autism spectrum disorder and its association with anxiety symptomatology.

Targeting Glia with N-Acetylcysteine Modulates Brain Glutamate and Behaviors Relevant to Neurodevelopmental Disorders in C57BL/6J Mice. Full text.

Dietary docosahexaenoic acid alleviates autistic-like behaviors resulting from maternal immune activation in mice.

Beneficial action of resveratrol: How and why?

Reduced GABAergic Action in the Autistic Brain. Full text.

New Therapeutic Options for Autism Spectrum Disorder: Experimental Evidences. Full text.

Is Oxytocin Application for Autism Spectrum Disorder Evidence-Based? Full text.

The psychophysiological impact of childhood autism spectrum disorder on siblings.

Developmental Neurotoxicity of Inhaled Ambient Ultrafine Particle Air Pollution: Parallels with Neuropathological and Behavioral Features of Autism and Other Neurodevelopmental Disorders.

Increased ω-3 polyunsaturated fatty acid/arachidonic acid ratios and upregulation of signaling mediator in individuals with autism spectrum disorders.

November 2015

Relationship Between Self-Reported Health and Stress in Mothers of Children with Autism Spectrum Disorders.

Obesity and Autism.

Premature mortality in autism spectrum disorder.

Acetylcysteine for treatment of autism spectrum disorder symptoms.

Identifying the lost generation of adults with autism spectrum conditions.

Potential role of organochlorine pesticides in the pathogenesis of neurodevelopmental, neurodegenerative, and neurobehavioral disorders: A review.

Effects of therapeutic horse riding on gait cycle parameters and some aspects of behavior of children with autism.

Minocycline ameliorates prenatal valproic acid induced autistic behaviour, biochemistry and blood brain barrier impairments in rats.

Obsessive-Compulsive Disorder and Autism Spectrum Disorders: Longitudinal and Offspring Risk. Full pdf

Autism: Pathophysiology and promising herbal remedies.

Prescription Use among Children with Autism Spectrum Disorders in Northern New England: Intensity and Small Area Variation.

Role of oats in celiac disease. Full pdf

A Comparison of PECS and iPad to Teach Requesting to Pre-schoolers with Autistic Spectrum Disorders.

Neurotoxic syndrome induced by clomipramine plus risperidone in a patient with autistic spectrum disorder: serotonin or neuroleptic malignant syndrome? Full pdf

Autism Characteristics in Older Adults with Depressive Disorders.

The Effect of Karate Techniques Training on Communication Deficit of Children with Autism Spectrum Disorders.

Behavioral Benefits of Camel Milk in Subjects with Autism Spectrum Disorder. Full pdf

The effect of sung speech on socio-communicative responsiveness in children with autism spectrum disorders.

Nutritional Status of Individuals with Autism Spectrum Disorders: Do We Know Enough?

Sodium Butyrate attenuates social behavior deficits and modifies the transcription of inhibitory/excitatory genes in the frontal cortex of an autism model.

Brief Report: Scurvy as a Manifestation of Food Selectivity in Children with Autism.

Management of mental ill health in people with autism spectrum disorder.

Impact of repeated vaccination on vaccine effectiveness against influenza A(H3N2) and B during 8 seasons. Full pdf

Cerebro-cerebellar circuits in autism spectrum disorder. Full pdf

Autism spectrum disorders and neuropathology of the cerebellum. Full pdf

Multifocal atrial tachycardia caused by risperidone.

Gluten Sensitivity. Full pdf.

Detection of gluten immunogenic peptides in the urine of patients with coeliac disease reveals transgressions in the gluten-free diet and incomplete mucosal healing.

The plausibility of maternal toxicant exposure and nutritional status as contributing factors to the risk of autism spectrum disorders.

October 2015

Nutritional Impact of a Gluten-Free Casein-Free Diet in Children with Autism Spectrum Disorder.

Evaluation of Classroom Active Engagement in Elementary Students with Autism Spectrum Disorder.

Oxytocin and vasopressin: linking pituitary neuropeptides and their receptors to social neurocircuits.

The Impact of Neuroimmune Alterations in Autism Spectrum Disorder.

Xerophthalmia and vitamin A deficiency in an autistic child with a restricted diet.

Mitochondrial enzyme dysfunction in autism spectrum disorders; a novel biomarker revealed from buccal swab analysis.

Neonatal brain abnormalities associated with autism spectrum disorder in children born very preterm.

Microbiota-Gut-Brain Axis: Yeast Species Isolated from Stool Samples of Children with Suspected or Diagnosed Autism Spectrum Disorders and In Vitro Susceptibility Against Nystatin and Fluconazole.

The Costs and Benefits of Employing an Adult with Autism Spectrum Disorder: A Systematic Review.

Increased Serum Phthalates (MEHP, DEHP) and Bisphenol A Concentrations in Children With Autism Spectrum Disorder: The Role of Endocrine Disruptors in Autism Etiopathogenesis.

Prevalence of School Bullying Among Youth with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis.

Factors Associated with Stress Among Parents of Children with Autism.

Assessment of sleep problems and related risk factors observed in Turkish children with Autism spectrum disorders.

Viewpoints on Factors for Successful Employment for Adults with Autism Spectrum Disorder.

Acid glycosaminoglycan (aGAG) excretion is increased in children with autism spectrum disorder, and it can be controlled by diet.

Association between Prenatal Environmental Factors and Child Autism: A Case Control Study in Tianjin, China.

Multiple Antipsychotic Medication Use in Autism Spectrum Disorder.

The mental health of individuals referred for assessment of autism spectrum disorder in adulthood: A clinic report.

Brief Report: Burden of Care in Mothers of Children with Autism Spectrum Disorder or Intellectual Disability.

Epigenetics in Clinical Practice: Characterizing Patient and Provider Experiences with MTHFR Polymorphisms and Methylfolate.

Enjoyment, Barriers, and Beliefs About Physical Activity in Adolescents With and Without Autism Spectrum Disorder.

Beneficial Effects of Palmitoylethanolamide on Expressive Language, Cognition, and Behaviors in Autism: A Report of Two Cases.

Respite Care for Single Mothers of Children with Autism Spectrum Disorders.

Altered kynurenine pathway metabolism in autism: Implication for immune-induced glutamatergic activity.

The effect of oxytocin nasal spray on social interaction deficits observed in young children with autism: a randomized clinical crossover trial.

A trial of an iPad™ intervention targeting social communication skills in children with autism.

Motivation for everyday social participation in cognitively able individuals with autism spectrum disorder.

Violent Fantasies in Young Men With Autism Spectrum Disorders: Dangerous or Miserable Misfits? Duty to Protect Whom?

Anxiety in high-functioning autism: A pilot study of experience sampling using a mobile platform.

Serum concentration of 25-hydroxyvitamin D in autism spectrum disorder: a systematic review and meta-analysis.

Subclinical autism spectrum symptoms in pediatric obsessive-compulsive disorder.

Do Children with Autism Overutilize the Emergency Department? Examining Visit Urgency and Subsequent Hospital Admissions.

Methodological approach to brain derived neurotrophic factor in children with autism spectrum disorder.

[Frequency of overweight and obesity in children and adolescents with autism and attention deficit/hyperactivity disorder].

September 2015

The Gluten-Free/Casein-Free Diet: A Double-Blind Challenge Trial in Children with Autism.

Evaluating Function-Based Social Stories™ With Children With Autism.

Clinical and neural effects of six-week administration of oxytocin on core symptoms of autism.

Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders – a pilot study.

Prevalence and Predictors of Complementary and Alternative Medicine Use in a Large Insured Sample of Children with Autism Spectrum Disorders.

Maternal Anti-Fetal Brain IgG Autoantibodies and Autism Spectrum Disorder: Current Knowledge and its Implications for Potential Therapeutics.

Oxytocin enhances attentional bias for neutral and positive expression faces in individuals with higher autistic traits.

An epigenetic basis for autism spectrum disorder risk and oral contraceptive use.

Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation.

Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders – a pilot study.

Music therapy: An effective approach in improving social skills of children with autism.

Psychosocial Functioning and Life Satisfaction in Adults With Autism Spectrum Disorder Without Intellectual Impairment.

Neuropsychopharmacotherapeutic efficacy of curcumin in experimental paradigm of autism spectrum disorders.

Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach.

Risk Factors for Depression in Children and Adolescents with High Functioning Autism Spectrum Disorders.

Children with autism spectrum disorders, who improved with a luteolin-containing dietary formulation, show reduced serum levels of TNF and IL-6.

Gluten-free and casein-free diets in the therapy of autism.

Comparison of Fecal Microbiota in Children with Autism Spectrum Disorders and Neurotypical Siblings in the Simons Simplex Collection.

Autism spectrum disorder symptoms in children with ADHD: A community-based study.

August 2015 July 2015

Gluten and casein supplementation does not increase symptoms in children with autism spectrum disorder.

Developmental neurotoxic effects of two pesticides: Behavior and neuroprotein studies on endosulfan and cypermethrin.

Influence of sleep disorders on the behavior of individuals with autism spectrum disorder.

Abnormal transsulfuration metabolism and reduced antioxidant capacity in Chinese children with autism spectrum disorders.

Substance-use disorder in high-functioning autism: clinical and neurocognitive insights from two case reports.

Psychiatric Symptoms in Youth with a History of Autism and Optimal Outcome.

Maternal Chemical and Drug Intolerances: Potential Risk Factors for Autism and Attention Deficit Hyperactivity Disorder (ADHD).

Children with Autism Spectrum Disorder and Patterns of Participation in Daily Physical and Play Activities.

Early-onset anorexia nervosa in girls with Asperger syndrome.

Decreased levels of serum oxytocin in pediatric patients with Attention Deficit/Hyperactivity Disorder.

Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis.

Oxytocin in General Anxiety and Social Fear: A Translational Approach.

Mealtime behaviors associated with consumption of unfamiliar foods by young children with autism spectrum disorder.

Violations of Personal Space in Young People with Autism Spectrum Disorders and Williams Syndrome: Insights from the Social Responsiveness Scale.

Brain “fog,” inflammation and obesity: key aspects of neuropsychiatric disorders improved by luteolin.

Immune mediators in the brain and peripheral tissues in autism spectrum disorder.

Substance use disorder in Asperger syndrome: An investigation into the development and maintenance of substance use disorder by individuals with a diagnosis of Asperger syndrome.

Prenatal exposure to common environmental factors affects brain lipids and increases risk of developing Autism Spectrum Disorders.

Prevalence of Inflammatory Bowel Disease Among Patients with Autism Spectrum Disorders.

Lipopolysaccharide Exposure Induces Maternal Hypozincemia, and Prenatal Zinc Treatment Prevents Autistic-Like Behaviors and Disturbances in the Striatal Dopaminergic and mTOR Systems of Offspring.

Autism spectrum disorder prevalence and proximity to industrial facilities releasing arsenic, lead or mercury.

Breast Milk Protects Against Gastrointestinal Symptoms in Infants at High Risk for Autism During Early Development.

June 2015

Enteric short-chain fatty acids: microbial messengers of metabolism, mitochondria, and mind: implications in autism spectrum disorders.

Hyperhomocysteinemia: Impact on Neurodegenerative Diseases.

Vitamin/Mineral Supplements for Children and Adults with Autism.

Sleep in Autism Spectrum Disorders.

Gut-Microbiota-Brain Axisand Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation.

Potential Etiologic Factors of Microbiome Disruption in Autism.

Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation.

Association of maternal report of infant and toddler gastrointestinal symptoms with autism: evidence from a prospective birth cohort.

Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive.

Environmental Enrichment as a Therapy for Autism: A Clinical Trial Replication and Extension.

Dietary glycemic index modulates the behavioral and biochemical abnormalities associated with autism spectrum disorder.

Melatonin Treatment in Children with Developmental Disabilities.

Autism Spectrum Disorder and Amplified Pain.

Complementary and Alternative Therapies for Autism Spectrum Disorder.

Increased homocysteine levels correlate with the communication deficit in children with autism spectrum disorder.

Sleep Disturbances and Associated Factors in Chinese Children with Autism Spectrum Disorder: A Retrospective and Cross-Sectional Study.

Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder.

Selected vitamin D metabolic gene variants and risk for autism spectrum disorder in the CHARGE Study.

The Role of Epigenetic Change in Autism Spectrum Disorders.

Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority.

Effect of intranasal oxytocin administration on psychiatric symptoms: A meta-analysis of placebo-controlled studies.

Treatment Resistant Epilepsy in Autism Spectrum Disorder: Increased Risk for Females.

Ineffective degradation of immunogenic gluten epitopes by currently available digestive enzyme supplements.

Fermented foods, neuroticism, and social anxiety: An interaction model.

Melatonin in Children with Autism Spectrum Disorders: How Does the Evidence Fit Together?

May 2015