Monthly Research Review March 2016

The previous month in the Monthly Research Review highlighted studies showing the benefits of supplements that parents are commonly using to supplement their ASD children. I was surprised to find more studies being published in the month of February on trials of supplements and an interesting study on the herb Korean Red Ginseng.

Supplements

Supplementation of Korean Red Ginseng improves behavior deviations in animal models of autism. Full text. Although this study is in a valproic acid (VPA)-exposed mice model of ASD, it did show Korean red ginseng (KRG) improved some ASD behaviours. These included “reversing social impairments”, “long-term KRG treatment normalized … hyperactivity”, decreased repetitive behaviour, and increases seizure threshold. Before parents consider purchasing Korean red ginseng, based on this study, or any herb for that matter, be sure of the quality of the supplement.

Iodine in autism spectrum disorders. “Concentration of iodine in urine was negatively associated with clinician’s general impression for children between 11 and 17 years. Emotional response, adaptation to environmental change, near receptor responsiveness, verbal communication, activity level, and intellectual functioning are more associated with UI than other symptoms listed in CARS.” Iodine is one of the nutrients that I assess children, for as iodine deficiency is quite prevalent in Australia especially in the south-eastern states. A recent study found low iodine in children to be associated with hyperactivity, comprehension, perception, attention and learning issues.

Research advances in the role of vitamin D in autism spectrum disorders. This study adds to previous studies evaluating the risk of low vitamin D and ASD.

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.

Randomized, Placebo-Controlled Trial of Methyl B12 for Children with Autism. Although this study did not see any benefit in behaviour, there was a significant benefit in methylation capacity. Parents using methyl B12 injections have seen short and long-term benefits from methyl B12.

Gastrointestinal Issues

Evaluation of Intestinal Function in Children with Autism and Gastrointestinal Symptoms. Interesting study to which I do not have access to the full article. This study compared ASD children with gastrointestinal symptoms to non-ASD children with gastrointestinal symptoms. The abstract implies that there is no difference in “leaky gut”, gastrointestinal inflammatory markers (calprotectin and lactoferrin) and disaccharidase activity. This only means that the intestinal markers were not significantly higher. Remember that there is a higher incidence of gastrointestinal issues in ASD children, as compared to non-ASD children. This I believe is under reported as many children DO NOT have a gastrointestinal evaluation in Australia, whereas in the USA, Canada and UK guidelines NOW recommend that all ASD children should have a comprehensive gastrointestinal evaluation. We still hear of behaviour related to gut issues being dismissed as “autistic traits”. Of note in the abstract was the statement “Some autistic children had mild levels of mucosal inflammation on intestinal biopsy.”So there is obviously more going on in the gut than we are lead to believe. As always if you don’t go looking for it you won’t find it!

Hospital Care and Transition Services

More research is emerging that is looking at the hospital and in particular the emergency department environment and what we can do to make their experience more comfortable. Also at transition services from adolescence to adulthood.

Managing Children With Autism Spectrum Disorders in Emergency Departments. “..autism spectrum disorders will increase the demand for hospital and outpatient services for these children, necessitating education of health care professionals and system adaptations”.

Parent and health care provider perspectives related to disclosure of autism spectrum disorder in pediatric emergency departments. This paper discusses the dilemma for parents of whether to notify health care professionals of an ASD diagnosis, especially in the presence of the child that has not been told of their diagnosis. Children and youth with autism spectrum disorder presenting in emergency departments face potential cognitive, sensory, and behavioral challenges, and it is crucial for providers to be aware of their unique needs.” “Encouraging understanding, expediting service, and preparing health care providers for working with children with autism spectrum disorder were identified as benefits of disclosure. Risks related to disclosure included potential negative attributions toward the children and parental discomfort in disclosing a diagnosis in front of the children.”

Exploratory Study of Childbearing Experiences of Women With Asperger Syndrome. “Clinicians can provide sensitive, individualized care by asking women with Asperger syndrome about their specific sensory experiences, counseling them about coping strategies for sensory intrusions, providing targeted support, and modifying the clinical environment to decrease distressing stimuli.”

Toward Practice Advancement in Emergency Care for Children With Autism Spectrum Disorder. “Participants identified the ED (Emergency department) and its delivery of care as insufficient to meet the unique needs of children with ASD.”

Perioperative considerations in children with autism spectrum disorder. “Children with autism often present a challenge to the anesthesiologist. This review summarizes the current experiences and recommendations for the perioperative management of this unique group of patients”

Health Care Transition Services for Youth With Autism Spectrum Disorders: Perspectives of Caregivers. “The receipt of transition services (to adult 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.” 

Mental Wellbeing in Children and Adults

Last month I reviewed the research that is showing the long-term outlook for ASD children as they transition to adulthood as being very poor. More research is confirming this outcome. More reason parents need to listen to the research and put it into practice.

Factors Mediating Dysphoric Moods and Help Seeking Behaviour Among Australian Parents of Children with Autism. Confirming other studies on parents with ASD children, Australian parents have high levels of anxiety, depression and a general dissatisfaction with life. Autism is treatable. Early treatment results in a child that is able to achieve their optimal outcome in life and an improved quality of life for the child and their parents.

Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults 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).”

Facing the Unknown: Intolerance of Uncertainty in Children with Autism Spectrum Disorder. In clinic I am finding there is considerable underlying anxiety in ASD children. This anxiety is continuing into adulthood. Treat the anxiety in children and it is less of an issue as these children transition into adulthood.

Pharmacology

Psychostimulants: Concerns over Long-Term Adverse Side Effects. “There is much information in human and animal studies to question the wishful thinking that using mind altering drugs in children is the right thing to do. There are risks, and there are benefits. In this case, the risks are less obvious, cloaked in the inadequacy of our current state of knowledge, potentially threatening the quality of the lives we seek to enhance.”

Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis.

Serum Ferritin, Weight Gain, Disruptive Behavior, and Extrapyramidal Symptoms in Risperidone-Treated Youth. “Body iron stores are inversely related to risperidone-induced weight gain, even after extended treatment and despite adequate iron intake. Low iron stores are associated with poorer treatment response.”

Use of acetaminophen (paracetamol) during pregnancy and the risk of autism spectrum disorder in the offspring. “…a 12.7-year follow-up found that gestational exposure to acetaminophen was associated with an increased risk of autism spectrum disorder, but only when a hyperkinetic disorder was also present. In the light of existing data associating acetaminophen use during pregnancy and subsequent risk of attention-deficit/hyperactivity disorder..” Although this study did not find an association between paracetamol and ASD, it did for ADHD. Since ADHD is also associated with ASD, this is not an insignificant finding. It is important to consider parent’s quality of life in having a child just with ASD or having a child with ASD and ADHD, and the pressure that parents may be under to medicate their child.

Heavy Metals

Low-level lead exposure and autistic behaviors in school-age children. “Even low blood lead concentrations at 7-8years of age are associated with more autistic behaviors at 11-12years of age, underscoring the need for continued efforts to reduce lead exposure.” Last month I wrote that lead is still quite prevalent in our environment. The consensus is that there is NO safe lead levels in children.

More Research

Language comprehension and brain function in individuals with an optimal outcome from autism. Full text. Early intensive learning and experience may normalize behavioral language performance in OO (Optimal Outcome), but some brain regions involved in language processing may continue to display characteristics that are more similar to ASD than typical development, while others show characteristics not like ASD or typical development.”

Oxytocin in the socioemotional brain: implications for psychiatric disorders. Full text. The present paper gives a short overview of these lines of research and shows how OXT has become a promising target for novel treatment approaches for mental disorders characterized by social impairments.”

A Non-inflammatory Role for Microglia in Autism Spectrum Disorders. Full text. In this review, we highlight research demonstrating the importance of microglia to the development of normal neural networks, review recent studies demonstrating abnormal microglia in autism, and discuss how the relationship between these processes may contribute to the development of autism and other neurodevelopmental disorders at the cellular level.”

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.”