Monthly Research Review March 2018

Due to the sheer volume of research over the last few months, this research review focuses mostly on nutritional intervention and gut related issues in ASD. Do go to the autism page of the website and look at the research. There is so much that has been published on infections in ASD, folate in pregnancy, mitochondrial dysfunction, relationship issues, glyphosate, and the list of topics goes on.

Autism Spectrum Disorder

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.”

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.”

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.”

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.”

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.”

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.”

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.”

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.”

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.”

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.”

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.”

Association between behavioral problems and gastrointestinal disorders among children with autism spectrum disorder. Article in Chinese. “Children with ASD have higher risk of [gastrointestinal disorders] 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.”

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 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.”

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.”

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.”

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.”

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.”

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.”

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.”

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.”

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.” 

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!