Gluten and Autism Spectrum Disorder

An expanding body of literature is examining connections between Autism Spectrum Disorder (ASD) and dietary interventions. While a number of specialist diets have been suggested as beneficial in ASD, gluten has received particularly close attention as a potentially exacerbating factor. Reports exist suggesting a beneficial effect of the gluten-free diet (GFD) in ameliorating behavioural and intellectual problems associated with ASD, while epidemiological research has also shown a comorbidity between ASD and coeliac disease. However, both caregivers and clinicians have expressed an uncertainty of the value of people with ASD going gluten-free, and as the GFD otherwise receives considerable public attention a discussion which focuses specifically on the interaction between ASD and gluten is warranted. In this review we discuss the historical context of ASD and gluten-related studies, and expand this to include an overview of epidemiological links, hypotheses of shared pathological mechanisms, and ultimately the evidence around the use and adoption of the GFD in people with ASD.     

Gastrointestinal Symptoms in Autism Spectrum Disorder: A Systematic Review

This systematic review aims to offer an updated understanding of the relationship between gastrointestinal symptoms (GIS) and autism spectrum disorder (ASD) in children and adolescents. The databases PsycINFO, Medline, Cinahl, and ERIC were searched using keywords, and relevant literature was hand-searched. Papers (n = 3319) were systematically screened and deemed eligible if they were empirical studies published in English since 2014 and measured the GIS of individuals with ASD who were under 18 years old. Thirty studies were included in the final review. The study findings were synthesized under eight themes, including the prevalence and nature of GIS and their relationship with developmental regression, language and communication, ASD severity, challenging behavior, comorbid psychopathology, sleep problems, and sensory issues. The review found that GIS were common and that there was contradictory evidence concerning their relationship with co-occurring conditions. It also identified evidence of some causal relationships that support the existence of the gut–immune–brain pathways. Future research needs to use large prospective designs and objective and standardized GIS measurements to provide a nuanced understanding of GIS in the context of ASD.     

The Brain-Gut-Microbiome System: Pathways and Implications for Autism Spectrum Disorder

Gastrointestinal dysfunction is one of the most prevalent physiological symptoms of autism spectrum disorder (ASD). A growing body of largely preclinical research suggests that dysbiotic gut microbiota may modulate brain function and social behavior, yet little is known about the mechanisms that underlie these relationships and how they may influence the pathogenesis or severity of ASD. While various genetic and environmental risk factors have been implicated in ASD, this review aims to provide an overview of studies elucidating the mechanisms by which gut microbiota, associated metabolites, and the brain interact to influence behavior and ASD development, in at least a subgroup of individuals with gastrointestinal problems. Specifically, we review the brain-gut-microbiome system and discuss findings from current animal and human studies as they relate to social-behavioral and neurological impairments in ASD, microbiota-targeted therapies (i.e., probiotics, fecal microbiota transplantation) in ASD, and how microbiota may influence the brain at molecular, structural, and functional levels, with a particular interest in social and emotion-related brain networks. A deeper understanding of microbiome-brain-behavior interactions has the potential to inform new therapies aimed at modulating this system and alleviating both behavioral and physiological symptomatology in individuals with ASD.     

Interventions on Sexuality for Adolescents with Autism Spectrum Disorder: A Systematic Review

Sexuality and intimate relationships are topics of interest to adolescents and young adults with Autism Spectrum Disorder (ASD). Given their relative difficulties to the social dimension, several intervention programs have been developed to meet this demand, but the complexity of the reality experienced by these young people limits the effectiveness of these intervention programs. To find the effects of different intervention programs to influence the development of sexuality and sexual health of adolescents with ASD and determine the impact of these interventions on the parents, through a systematic review. Literature review conducted on November 27, 2019 in the psycINFO, Pubmed, web of science and CINAHL databases. Intervention programs consisting solely of teaching sessions improve the knowledge of the youth. However, when they also included a direct approach or homework, behavioral effects were also observable. Parent-focused intervention programs resulted in a slight increase in parents’ comfort level and ability to interact well with their youth. Intervention programs targeting school-based workers appear to have a limited effect, having good concrete results with youth for some workers and no results for others, while intervention programs targeting health professionals have no conclusive results. The results of the literature review are not very transferable to practice because of the low level of evidence in the articles included, however, they offer an interesting starting point. Further research is needed to equip health professionals to intervene in sexuality after youth with ASD.

     

Communication on Sexuality Between Parents and Adolescents with Autism Spectrum Disorder: A Systematic Review

The objective of this systematic review was to identify and analyze the information available on sexual communication between parents and adolescents with autism spectrum disorder (ASD). Medline/PubMed, Lilacs, Ebsco, Embase, Scielo, Google Scholar, Scirus and Redalyc databases were used to find articles. The inclusion criteria were studies published in indexed databases in English, Spanish and Portuguese with a quantitative and qualitative approach in full text, studies that include a population of parents of adolescents with ASD and adolescents between 10 and 19 years of age with a diagnosis of ASD, and studies that covered communication about sexuality. Keywords combined with Boolean operators were used. Three topics were identified that covered the communication of parents and adolescents with ASD: sexual issues, parents' romantic expectations, and sexual experiences. This systematic review highlights the need for training of health professionals and sex education programs for parents of adolescents with ASD.

     

Nutrition and Bone Density in Boys with Autism Spectrum Disorder

Background

Boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. Differences in diet and exercise may contribute to low BMD.

Screening and Surveillance for Autism Spectrum Disorder in Research and Practice

Several research studies have attempted to prospectively identify children with autism spectrum disorder (ASD) using screening instruments. While it has been possible to pick up unrecognised cases using screens, no instrument has yet proved sufficiently robust to recommend universal screening. However, autism screens can play an important role in improved surveillance for ASD and other developmental disorders. There are important differences between the development of screening instruments in research studies and the use of screens as part of routine clinical surveillance. Screening for a developmental disorder raises clinical issues for parents and professionals, including those relating to the concept of 'risk status', certainty of diagnosis, advice about management and the availability of appropriate services. One positive by-product of screening studies will be improvements in the training and knowledge of primary care health practitioners about early signs of ASD, hopefully leading to improved clinical decision-making about appropriate referral. Future developments in the field should include consideration of a broader approach to the identification of children with developmental and language disorders alongside the identification of children with ASD, and appropriate research designs to test the specific benefits of early intervention.     

Screening and Surveillance for Autism Spectrum Disorder in Research and Practice

Several research studies have attempted to prospectively identify children with autism spectrum disorder (ASD) using screening instruments. While it has been possible to pick up unrecognised cases using screens, no instrument has yet proved sufficiently robust to recommend universal screening. However, autism screens can play an important role in improved surveillance for ASD and other developmental disorders. There are important differences between the development of screening instruments in research studies and the use of screens as part of routine clinical surveillance. Screening for a developmental disorder raises clinical issues for parents and professionals, including those relating to the concept of 'risk status', certainty of diagnosis, advice about management and the availability of appropriate services. One positive by-product of screening studies will be improvements in the training and knowledge of primary care health practitioners about early signs of ASD, hopefully leading to improved clinical decision-making about appropriate referral. Future developments in the field should include consideration of a broader approach to the identification of children with developmental and language disorders alongside the identification of children with ASD, and appropriate research designs to test the specific benefits of early intervention.     

Predictors for Work Participation in Individuals with an Autism Spectrum Disorder: A Systematic Review

Introduction Research shows that only about 25% of people with autism are employed. Method We conducted a systematic review on factors facilitating or hindering work participation of people with autism in longitudinal studies. An extensive search in biomedical and psychological databases yielded 204 articles and 18 satisfied all inclusion criteria. We assessed the methodological quality of included studies using an established criteria list. Results Seventeen factors were identified and categorized as disease-related factors, personal factors or external factors. Limited cognitive ability was the only significant predictor consistently found for work outcome. Functional independence and institutionalization were both reported by one study to be significantly related to work outcome. Inconsistent findings or non significant findings were reported for the other fourteen factors. Conclusion These findings emphasize the need for more high quality cohort studies focussing on work participation as the main outcome among people with Autism.     

Proposed Changes to the American Psychiatric Association Diagnostic Criteria for Autism Spectrum Disorder: Implications for Young Children and Their Families

The American Psychiatric Association has revised the diagnostic criteria for their DSM-5 manual. Important changes have been made to the diagnosis of the current (DSM-IV) category of Pervasive Developmental Disorders. This category includes Autistic Disorder (autism), Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-5 deletes Asperger’s Disorder and PDD-NOS as diagnostic entities. This change may have unintended consequences, including the possibility that the new diagnostic framework will adversely affect access to developmental interventions under Individuals with Disabilities Education Act (IDEA) programs, Early Intervention (for birth to 2 years olds) and preschool special education (for 3 and 4 years olds). Changing the current diagnosis of PDD-NOS to a “Social Communication Disorder” focused on language pragmatics in the DSM-5 may restrict eligibility for IDEA programs and limit the scope of services for affected children. Young children who meet current criteria for PDD-NOS require more intensive and multi-disciplinary services than would be available with a communication domain diagnosis and possible service authorization limited to speech-language therapy. Intensive behavioral interventions, inclusive group setting placements, and family support services are typically more available for children with an autism spectrum disorder than with diagnoses reflecting speech-language delay. The diagnostic distinction reflective of the higher language and social functioning between Asperger’s Disorder and autism is also undermined by eliminating the former as a categorical diagnosis and subsuming it under autism. This change may adversely affect treatment planning and misinform parents about prognosis for children who meet current criteria for Asperger’s Disorder.     

The Lunchbox Study: A Pilot Examination of Packed Lunches of Children with Autism Spectrum Disorder

Background: This study examined foods packed and consumed by children with autism spectrum disorder (ASD) and calculated the percentage of packed school lunches meeting National School Lunch Program (NSLP) standards. Fruit and vegetable (FV) consumption was further examined by investigating its association with the number and type of foods packed. Methods: Participants included 59 private school students observed for five school meals. Servings of foods and beverages packed and consumed and the percentages of correspondence between food packed and consumed were calculated. Next, the percentages of lunches meeting NSLP guidelines were calculated. Finally, mealtime means were calculated for the number of foods packed, FVs packed, and FVs consumed. Results: There was a high correspondence between foods packed and consumed. Fresh fruits and sugar-added drinks were most often packed and consumed. The percentage of meals meeting NSLP guidelines was higher than previous non-ASD samples. More FV consumption was associated with more FVs packed and fewer total foods packed. FV consumption was highest with 4 < 5 foods packed, including 2+ FVs. Conclusions: Future studies should compare foods packed and consumed by children with and without ASD. The FV consumption findings suggest parents may increase children’s FV consumption by packing approximately four total foods with two FVs.     

Implementation of a school-based Fitbit program for youth with Autism Spectrum Disorder: A feasibility study

BackgroundSchool settings may be optimal for physical activity interventions for youth with Autism Spectrum Disorder (ASD). Additionally, consumer-based fitness trackers may encourage youth with ASD to increase their physical activity levels, however, no studies have examined whether a fitness tracker program would be feasible in youth with ASD.ObjectiveTo examine the feasibility of a 12-week school-based Fitbit© program for youth with ASD.MethodsSix classroom teachers and their students (n = 45) were provided with Fitbit fitness trackers to wear over 12-weeks. Classroom teachers monitored student tracker use and completed open-ended surveys to describe both their experience and their students’ experience with the fitness trackers.ResultsOut of the 45 eligible students, 42 (94%) opted to participate in the study. All six teachers and 32 (76%) of the 42 students wore the fitness tracker daily over 12 weeks. Teachers reported that students were most interested in tracking their daily steps, and the short batter life, and account set-up were the biggest challenges to students. All six teachers felt that this program could have long-term sustainability, especially if tracker use could be incorporated into school curriculum and classroom activities.ConclusionsA school-based Fitbit program appears to be both feasible, and well-accepted by students with ASD. Future work should evaluate the preliminary efficacy of this type of program.     

The Role of Vitamin D Supplementation in Children with Autism Spectrum Disorder: A Narrative Review

Children with autism spectrum disorder (ASD) present with persistent deficits in both social communication and interactions, along with the presence of restricted and repetitive behaviors, resulting in significant impairment in significant areas of functioning. Children with ASD consistently reported significantly lower vitamin D levels than typically developing children. Moreover, vitamin D deficiency was found to be strongly correlated with ASD severity. Theoretically, vitamin D can affect neurodevelopment in children with ASD through its anti-inflammatory properties, stimulating the production of neurotrophins, decreasing the risk of seizures, and regulating glutathione and serotonin levels. A Title/Abstract specific search for publications on Vitamin D supplementation trials up to June 2021 was performed using two databases: PubMed and Cochrane Library. Twelve experimental studies were included in the synthesis of this review. Children with ASD reported a high prevalence of vitamin D deficiency or insufficiency. In general, it was observed that improved vitamin D status significantly reduced the ASD severity, however, this effect was not consistently different between the treatment and control groups. The variations in vitamin D dose protocols and the presence of concurrent interventions might provide an explanation for the variability of results. The age of the child for introducing vitamin D intervention was identified as a possible factor determining the effectiveness of the treatment. Common limitations included a small number of participants and a short duration of follow-ups in the selected studies. Long-term, well-designed randomized controlled trials are warranted to confirm the effect of vitamin D on severity in children with ASD.     

Palmitoylethanolamide and Its Biobehavioral Correlates in Autism Spectrum Disorder: A Systematic Review of Human and Animal Evidence

Autism spectrum disorder (ASD) pathophysiology is not completely understood; however, altered inflammatory response and glutamate signaling have been reported, leading to the investigation of molecules targeting the immune-glutamatergic system in ASD treatment. Palmitoylethanolamide (PEA) is a naturally occurring saturated N-acylethanolamine that has proven to be effective in controlling inflammation, depression, epilepsy, and pain, possibly through a neuroprotective role against glutamate toxicity. Here, we systematically reviewed all human and animal studies examining PEA and its biobehavioral correlates in ASD. Studies indicate altered serum/brain levels of PEA and other endocannabinoids (ECBs)/acylethanolamines (AEs) in ASD. Altered PEA signaling response to social exposure and altered expression/activity of enzymes responsible for the synthesis and catalysis of ECBs/AEs, as well as downregulation of the peroxisome proliferator activated receptor-α (PPAR-α) and cannabinoid receptor target GPR55 mRNA brain expression, have been reported. Stress and exposure to exogenous cannabinoids may modulate ECBs/AEs levels and expression of candidate genes for neuropsychiatric disorders, with implications for ASD. Limited research suggests that PEA supplementation reduces overall autism severity by improving language and social and nonsocial behaviors. Potential neurobiological underpinnings include modulation of immune response, neuroinflammation, neurotrophy, apoptosis, neurogenesis, neuroplasticity, neurodegeneration, mitochondrial function, and microbiota activity, possibly through peroxisome proliferator-activated receptor-α (PPAR-α) activation.     

Prenatal Vitamins and the Risk of Offspring Autism Spectrum Disorder: Systematic Review and Meta-Analysis

Prenatal nutrition is associated with offspring autism spectrum disorder (herein referred to as autism), yet, it remains unknown if the association is causal. Triangulation may improve causal inference by integrating the results of conventional multivariate regression with several alternative approaches that have unrelated sources of bias. We systematically reviewed the literature on the relationship between prenatal multivitamin supplements and offspring autism, and evidence for the causal approaches applied. Six databases were searched up to 8 June 2020, by which time we had screened 1309 titles/abstracts, and retained 12 articles. Quality assessment was guided using Newcastle–Ottawa in individual studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) for the body of evidence. The effect estimates from multivariate regression were meta-analysed in a random effects model and causal approaches were narratively synthesised. The meta-analysis of prenatal multivitamin supplements involved 904,947 children (8159 cases), and in the overall analysis showed no robust association with offspring autism; however, a reduced risk was observed in the subgroup of high-quality observational studies (RR 0.77, 95% CI (0.62, 0.96), I² = 62.4%), early pregnancy (RR 0.76, 95% CI (0.58; 0.99), I² = 79.8%) and prospective studies (RR 0.69, 95% CI (0.48, 1.00), I² = 95.9%). The quality of evidence was very low, and triangulation was of limited utility because alternative methods were used infrequently and often not robustly applied.     

中国国家出生队列孤独症谱系障碍亚队列建设概况

孤独症谱系障碍作为儿童神经发育障碍的代表性疾病,发病率呈现不断上升的趋势,给家庭和社会带来巨大压力和经济负担,探讨其病因及发病机制意义重大。本研究依托中国国家出生队列开展孤独症谱系障碍亚队列建设,并利用该出生队列采用的辅助生殖和自然妊娠同期纳入并随访的平行设计,评价辅助生殖技术对子代神经行为发育的影响,并结合队列采集的...     

Instructing children with Autism Spectrum Disorder: Examining swim instructors' knowledge building experiences

BackgroundAlthough there has been a notable increase in Autism Spectrum Disorder (ASD) diagnoses over the past twenty years, children with ASD continue to be underrepresented in physical activity opportunities. Swimming lessons have been suggested as an ideal form of physical activity for this population, but studies exploring instructors' experiences gaining knowledge specific for instructing these swimmers remains limited. Research in this area is warranted, as drowning is a leading injury cause of death for persons with ASD.ObjectiveThe purpose of this brief report was to examine swim instructors' preferred knowledge sources for building their individual swimming lessons, catered to swimmers with ASD. Moreover, this study aimed to provide context specific insights for instructors and instructor educators to increase new and future instructors' preparedness for meeting the needs of this population.MethodsThree recreational swim instructors were recruited for this qualitative study. Data were collected using a demographic questionnaire, observations, and semi-structured interviews. Analysis was completed using Braun & Clarke's guide for thematic analysis.ResultsThe results indicated that swim instructors' sources for building knowledge included: learning from peers/mentors, receiving support from parents/caregivers, and participating in additional certification programs or training.ConclusionWith a more extensive understanding of instructors' knowledge building experiences, instructor educators may integrate this knowledge into future development programs to prepare a greater number of trained individuals to facilitate physical activities for children with ASD.     

Division of Labor in Families of Children and Adolescents with Autism Spectrum Disorder

Couples who have a child or adolescent with autism spectrum disorder (ASD) are faced with the difficult decision of how to divide child care responsibilities and paid employment. The authors examined the division of labor and its relation to parenting stress and marital adjustment in 73 married couples who have a child or adolescent with ASD. Mothers and fathers independently reported on their global level of parenting stress and marital adjustment and then completed a 7‐day online daily diary of time spent in child care, time spent in paid employment, and satisfaction with the time that one's spouse spent in child care. Overall, couples demonstrated a pattern of partial role specialization in which mothers engaged in more child care and fathers engaged in more paid employment. Child age was negatively related and degree of disability was positively related to role specialization. Time spent in paid employment and satisfaction with the time that one's spouse spent in child care had important associations with parenting stress and marital adjustment.