Research Roundup is a monthly newsletter from N of One’s UK-based science writer, Paul Whiteley, PhD. Each month we summarize a few research papers on a variety of topics in one simple, easy-to-read paragraph. It’s our hope that by skimming these each month, you will broaden your knowledge topics currently being explored by researchers and perhaps find information helpful in your journey of navigating a complex autism landscape.
A probiotic for depression and anxiety accompanying autism? A trial result says, "Why not?"
Pitting the probiotic formulation Lactobacillus plantarum PS128 against a placebo (sham intervention) resulted in significant reductions in scores of depression and anxiety for a group of 70+ young children diagnosed with an autism spectrum disorder (ASD) according to new research from Taiwan. Following other research by this group that already observed important positive effects from this known psychobiotic ( a probiotic that can affect psychology and behavior), researchers zoomed in on a younger age group in light of their previous study results. Research participants showed improvements in symptoms after 2 months of supplementation. Further investigation is still required on the specific mechanisms of effect within the context of the continued rise of the gut-brain axis for at least some autism. But such work adds to the voluminous literature suggesting that alongside important observations on the types of gut bacteria inhabiting the gut of people with ASD, there may be ways to alter the bacterial balance, with important knock-on effects for presented symptoms.
FDA Clinical Trial Alert!
Digestive (pancreatic) enzyme replacement therapy for irritability in preschool autism: the science says yes.
Curemark’s CM-AT compound - a “high-protease pancreatic replacement” - has cleared yet another scientific hurdle on its way to becoming an evidence-based treatment for particular maladaptive behaviours in young children diagnosed with ASD. Reporting results for nearly 200 preschool children with ASD under gold- standard scientific conditions (double-blind, placebo-controlled), predefined statistically significant improvements in irritability were noted following weeks of taking CM-AT. Importantly too, authors reported “no emergent safety concerns or related serious adverse events noted.” These results have been a long time coming given that study recruitment began in 2015. They mark an important milestone with such therapy, which draws on the idea that various intrinsic enzymes, particularly chymotrypsin, used to metabolise food may not be working optimally in some people with ASD. The results pave the way for regulatory authorisation and hopefully, further studies into why digestive enzymes may be suboptimal in cases of autism, and how this ties into other elements of the ‘gut-brain axis’ such as use of dietary interventions in the context of autism.
[Note from J. Rodakis: While it might seem surprising that a digestive enzyme could create broad benefit in an autism clinical trial, many parents havereported improvementswith digestive enzymes. One possible explanation, yet to be fully explored, is that the digestive enzyme is changing the nutrient balance in the gut (even in the absence of a pancreatic insufficiency) and thereby also shifting the microbiome. This idea was discussed in the working group paper from N of One’s First International Autism Microbiome Conference in 2013:Approaches to studying and manipulating the enteric microbiome to improve autism symptoms.]
Media consumption and self-diagnosis of autism: a complicated connection?
Keeping in mind the old science adage that ‘correlation is not the same as causation’ (just because two things are related doesn't mean one causes the other) a recent study out of Austria suggests that more attention may need to be paid to the role of media consumption and the issue of self-diagnosis in the context of autism. Detailing what happened when nearly 350 participants were quizzed about their media watching habits specifically including those series where autism was represented, authors asked their cohort to grade how much they felt they were affected by autism, as well as providing them with a proxy measure for possible autism based on deciphering facial expressions. Their results suggested a possible connection between media consumption depicting autistic characters and self-diagnosis of autism. The authors stress that their work is preliminary and requires further studying. But considering the already widely discussed effects of social media on the presentation of tic-like behaviors for example, it would be unwise to discount how our very media-orientated world may well influence some people to self-diagnose with one or more of a myriad of conditions including autism.
Meta-analyzing vitamin B12 levels in autism (and the implications)
Vitamin B12 - sometimes called cobalamin - levels are typically lower in those diagnosed with ASD compared to asymptomatic controls. That was one of the findings from a recent review from Chinese researchers of the existing peer-reviewed scientific literature covering vitamin B12 levels across a range of different behavioral and psychiatric diagnoses. The pre-registered review looked at over 50 studies including over 35,000 people where vitamin B12 levels were measured. The results for those with autism were particularly notable; authors also concluded that intake of vitamin B12 seemed also to correlate with a lower risk of general behavioral problems and depressive symptoms. Vitamin B12 is an important nutrient, not least because of its role as cofactor in some important biological reactions, notably those linked to the conversion of the amino acid homocysteine to methionine and onwards the ability to methylate DNA (affecting gene expression). Other independent research has also correlated low levels of vitamin B12 with an elevated risk of chronic inflammation in some groups; another potentially important finding related to autism and its various immune system correlates. Where vitamin B12 levels are low, supplementation would be indicated.
[Note from J. Rodakis: B12 is one of the most commonly used supplements in the so-called “mito-cocktail” used by metabolic medicine specialists use for individuals with mitochondrial deficiencies (which many children with ASD have been documented to have)]
Noninvasive brain stimulation techniques for autism? Yes but more data is needed.
Brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are potentially promising when used in the context of ASD but more rigorous research is required. That was the conclusion reached in a summary paper written by researchers at the US National Institutes of Health (NIH). Authors detailed what was good and not-so-good about the existing research base on such brain stimulation techniques, focusing on the need for more blinded trials, encompassing neuroimaging and other biomarker.
Predicting challenging behavior in autism? Possible (and you might want to include day-to-day data on things like bowel issues too)
Artificial intelligence (AI) models, when given access to various strands of data, show promise in being able to potentially predict episodes of challenging behavior in autistic adults according to a recent study from researchers out of New York, USA. Allowing AI models to trawl through various kinds of historical data gathered for some 80 adults with ASD, including that related to behavior, sleep, gastrointestinal (GI) variables alongside environmental data on variables like weather, provided some important real-world predictions for many participants’ future behaviors with a respectable degree of accuracy. Authors specifically noted that the presence of GI issues was a consistently important marker of future challenging behavioral episodes; sleep and the presence of allergies predicted behavior for some but not all participants. Alongside demonstrating how AI models can aid autism research and practice, such findings also point to the value of data collection when it comes to challenging behaviors such as aggression and self-injury and its almost forensic analysis. That GI issues show a connection with behavior is not necessarily novel but reiterates the need to examine the gut-brain axis and how physiological factors can influence psychology and behavior.
Full-text: https://www.mdpi.com/2075-4426/13/10/1513
And finally…
‘Person with autism’ or ‘autistic person’? The common sense approach, yet again, is to just ask.
“Results found no consistent trends in language preference, indicating best practice may be to alter language use based on individual preferences when interacting with autistic individuals.”
Need we say anymore?
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