Monthly Research Review February 2017
This month I have included some research into ADHD, gluten and mental health, as well as the usual ASD research review.
Iron Status in Attention–Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Full pdf. “Iron, an important trace element, is implicated in brain function and dopaminergic activity. Lower serum ferritin rather than serum iron is associated with ADHD in children.”
Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment. Full pdf. “Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD.
Psychiatric Comorbidities in a New Zealand Sample of Adults With ADHD. “Lifetime rates of psychiatric disorders were significantly higher in the ADHD group (83%) versus the control group (52%) with higher rates of major depressive disorder (MDD; 65% vs. 36%), social phobia (31% vs. 11%), substance abuse (26% vs. 8%), and alcohol abuse (32% vs. 14%).”
Bread and Other Edible Agents of Mental Disease. Full pdf. “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. We present the implications for the psychological sciences of the findings that, in all of us, bread (1) makes the gut more permeable and can thus encourage the migration of food particles to sites where they are not expected, prompting the immune system to attack both these particles and brain-relevant substances that resemble them, and (2) releases opioid-like compounds, capable of causing mental derangement if they make it to the brain.”
The Gut-Brain Axis: The Missing Link in Depression. Full pdf. “In the past few years, neuroscientific research has shown the importance of the microbiota in the development of brain systems. Recent studies showed that the microbiota could activate the immune and central nervous systems, including commensal and pathogenic microorganisms in the gastrointestinal tract. Gut microorganisms are capable of producing and delivering neuroactive substances such as serotonin and gamma-aminobutyric acid, which act on the gut-brain axis.”
What Do We Know Now about IgE-Mediated Wheat Allergy in Children? Full pdf. “IgE-mediated wheat allergy is a gluten-related disorder. Wheat is one of the five most common food allergens in children.”
Case of coeliac disease presenting in the psychiatry ward. “An extensive diagnostic study allowed for the diagnosis of coeliac disease and while her state was unresponsive to antidepressants, anxiolytics, antipsychotics and electroconvulsive therapy, the patient improved significantly when a gluten-free diet was started.” This is considered as a rare occurance. However, how many cases are out there that have NOT been tested for coeliac disease or gluten sensitivity. Gluten is becoming increasingly recognised as a cause of a cognitive and mood disorders. Even if doctors test for coeliac disease, the “gold standard” is a trial of strict, gluten elimination and then challenge.
Autism Spectrum Disorder
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.”
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.”
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.”
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.
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).”
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.”
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.”
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.”
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.”
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.”
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.”
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.”
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.”
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!