Monthly Research Review April 2018

This month I have included research into ADHD, vitamin D, as well as the usual ASD research review.

ADHD

Comorbid psychiatric disorders in a clinical sample of adults with ADHD, and associations with education, work and social characteristics: a cross-sectional study. Full article. “Adults with attention-deficit hyperactive disorder (ADHD) report high rates of comorbid disorders, educational and occupational failure, and family instability. In this clinical sample, 53.5% had at least one current comorbid psychiatric disorder. The most prevalent disorders were major depression, substance use disorders and social phobia. Women had more eating disorders than men, whereas men had more alcohol and substance use disorders.”

 Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study.A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.”

Prenatal exposure to bisphenol A and hyperactivity in children: a systematic review and meta-analysis.Based on several relevant studies, we chose to examine bisphenol A (BPA) as a possible contributor to ADHD in humans. BPA is a widespread environmental chemical that has been shown to disrupt neurodevelopment in rodents and humans. We concluded that early life BPA exposure is a presumed human hazard for the development of hyperactivity. Given the widespread exposure of BPA and increasing diagnoses of ADHD, we recommend immediate actions to complete such risk analyses and take next steps for the protection of human health. In the meantime, precautionary measures should be taken to reduce exposure in pregnant women, infants and children.”

Rationale for Dietary Antioxidant Treatment of ADHD. Full article.This review presents scientific findings supporting dietary antioxidant treatment of ADHD and describes substantial alterations in the immune system, epigenetic regulation of gene expression, and oxidative stress regulation in ADHD. Elevated oxidative stress and immune dysfunction, eventually leading to neuronal damage, appear to play a role in the pathophysiological process of neurodevelopmental disorders. Evidence on the association of ADHD with immune and oxidant-antioxidant imbalances offers potential for antioxidant and/or immunomodulatory nutritional supplements (e.g., polyphenols) as ADHD therapy. One example is Pycnogenol®, a herbal, polyphenol-rich extract with potent antioxidant and anti-inflammatory properties, which is considered to have therapeutic benefits in ADHD, as it increased antioxidant levels, reduced oxidative damage and improved neurochemical status.”

 Vitamin D

Role of Magnesium in Vitamin D Activation and Function. Full article. “Magnesium and vitamin D are 2 essential nutrients that are necessary for the physiologic functions of various organs. Magnesium assists in the activation of vitamin D, which helps regulate calcium and phosphate homeostasis to influence the growth and maintenance of bones. All of the enzymes that metabolize vitamin D seem to require magnesium, which acts as a cofactor in the enzymatic reactions in the liver and kidneys. It is therefore essential to ensure that the recommended amount of magnesium is consumed to obtain the optimal benefits of vitamin D.”

 Autism Spectrum Disorder

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.”

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.”

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.”

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.”

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.”

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.”

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.”

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.

 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!