Monthly Research Review July 2016

More research into supplements, as well as nutritional and biochemical abnormalities in ASD. As well as diet, gastrointestinal issues and the quality of life of ASD individuals as they enter adulthood and impact on family life.

Risk factors for ASD

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.

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. 

Diet

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 behavior’s.

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.

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.

Truths, Myths and Needs of Special Diets: Attention-Deficit/Hyperactivity Disorder, Autism, Non-Celiac Gluten Sensitivity, and Vegetarianism. Full Text. “Healthy nutritional habits should be encouraged in all children independently of the existence or non-existence of neurodevelopmental disorders. Restriction of sugar and sweeteners, elimination diet of colorants/preservatives and supplementation of omega-3 fatty acids may be recommended to ADHD patients to improve behavioral and attention performance. The scientific evidence of the use of a diet free of gluten and casein in the treatment of autism is weak and poor. It is proposed that a diet free of gluten and casein should only be administered if a food allergy or gluten intolerance is diagnosed.

I have addressed the research into the gluten and casein free diets recently in the article Why Has Autism Research Been Failing ASD Children & Parents?.

Nutritional and biochemical abnormalities

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.

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. 

Gastrointestinal issues

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].

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.

Environmental issues

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.

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.

Supplements and novel therapies

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.

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.

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.

Pharmaceuticals

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.”

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. 

Quality of life of ASD individuals and their family

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.

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.

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. 

For more research into ASD that your medical professional is not reading. Just follow the link to my Autism page, and scroll down to Current Research – Selected research articles of interest.

Be informed, NOT misinformed!