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 and perhaps find information helpful in your journey of navigating a complex autism landscape.
Review of clinical trials for various pharmacological and nutraceutical compounds tested in autism. Includes otc compounds such as: N-acetylcysteine, folinic acid, l-carnitine, coenzyme Q10, and sulforaphane.
“... a small subset of compounds, including N-acetylcysteine, folinic acid, l-carnitine, coenzyme Q10, sulforaphane, and metformin may already be considered, with due caution, for clinical use, because there is promising evidence of efficacy and a high safety profile.” So concluded a review of over 100 studies looking at various pharmacological compounds with various potential indications for use related to childhood autism spectrum disorder (ASD). Part of a series of ‘best practice’ reviews by European researchers, the authors concluded that there is already enough evidence-based support for the selective usage of certain pharmacological and nutraceutical compounds, with the need for further studies on who may be best responders and more analysis of longer-term effects. Such work follows other such reviews that cautiously overlap based on the science currently available. Further studies are required on the mode of actions of various compounds, and as particularly exemplified by the use of folinic acid, whether associated screening for underlying conditions that clinically indicate such usage, are present and to what degree in the context of autism.
Increasing prevalence of autism in the US stretches across years
Further evidence, if it is needed, that there has been a massive growth in the numbers of people receiving a diagnosis of ASD has recently been published by US researchers. Drawing on data from electronic healthcare and insurance claims across the US Mental Health Research Network (MHRN), researchers analyzed data for over 9 million people between 2011 and 2022 looking for evidence of a diagnosis of autism using either ICD-9 or ICD-10 diagnostic criteria codes. Allied to other similar datasets, they reported a massive increase in diagnosed autism equivalent to a 175% increase: “from 2.3 per 1000 persons to 6.3 per 1000 persons.” They also noted that the prevalence of autism was highest among children aged 5-8 years old and “declined with age”. The male:female ratio also came in at 3:1 across the full cohort. Young adults showed the greatest relative increase in cases over the study period and there was evidence for more girls and women receiving a diagnosis as time went on. There is ample data highlighting a growth in the numbers of people being diagnosed with autism. Childhood diagnoses are still driving the increase. Further studies are required to detail what factors are important to the increase outside of the frequently tired explanations of just ‘better awareness’ and expanding diagnostic criteria.
[Note from J. Rodakis – It is shocking that despite the overwhelming body of data, there are still many who hold influential roles in allocating autism funding that continue to deny that the prevalence is rising.]
The gut microbiome “for aiding diagnosis of autism spectrum disorders”
Researchers from Hong Kong add to the huge expanse of science suggesting that looking at the gut microbiome - the collected bacteria that inhabit the human gastrointestinal (GI) tract - in the context of autism might be useful for lots of different reasons. This time around the science reflects on how early diagnosis of autism may benefit from looking at gut bacteria and a model “comprising 5 bacterial taxa and 44 microbial MAG [metagenome-assembled genome] markers” which both correlated well with diagnosis (or not) in two cohorts as well as core symptoms based on “Social Responsiveness Scale-2 (SRS-2)” measurements. Important, too, that the reported results crossed various important comorbidities including whether or not gastrointestinal (GI) issues accompanied autism and whether conditions such as attention-deficit hyperactivity disorder (ADHD) or anxiety were also present alongside autism.
[Note from J. Rodakis: Whether the microbiome can be harnessed as a diagnostic is still unclear, but there is massive body of evidence that it is involved in the physiology of autism at this point]
Assessing and managing elopement behaviors in the context of autism
[Elopement definition: The act of wandering or running away from a safe or supervised environment without permission]
2024 was another heart-breaking year for several families of children (and adults) with autism who wandered from home or care and subsequently died, in many cases drowning. A recent paper from US researchers provides welcome information on a small cohort of children with autism in an inpatient setting who all presented with elopement as “a behavior of clinical concern” and what might work in reducing such an issue. Various types of behavioral intervention were used across the children included for analysis, most centered on the principle of applied behavior analysis (ABA). Upwards of 80% of the personalized interventions used were deemed to have met treatment goals around reducing elopement attempts. There is still much to do in this area in determining the cause(s) of elopement behavior, who it affects most and what can be done to reduce harmful consequences when it does occur.
Different trajectories of mental health issues accompanying autism. Can “friendships" help?
Early mental health issues seem to be predictive of later mental health challenges in relation to autism was one of the conclusions reached in recent work looking at the collected studies on trajectories of issues like anxiety and depression. Researchers from the University of California Los Angeles undertook a review of the available research in this area and turned up some important trends. Highlighting how variable such mental health issues are when comorbid to autism, they also observed that good peer relationships at school age seemed to some degree to be protective particularly against depression providing evidence for the biopsychosocial context of some autism comorbidity. Such work adds to other findings on how academic success is only one part of the school experience, alongside the ‘socialising’ value of friends and school and out of school activities during the education years. There are many biopsychosocial influences pushing and pulling on risk of mental ill-health across both autistic and non-autistic groups. Identifying early correlates of such issues and presenting a suite of potential intervention options is a primary goal for good mental health and wellbeing.
Full-text: https://www.mdpi.com/2076-3425/14/10/1033
[Note from J. Rodakis: While social impairment is a core feature of ASD and may make the development of friendships difficult, the above research points to the importance of continuing to try and foster and facilitate them]
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