I received an enquiry to suggest any suitable nutritional supplement for a child with Asperger syndrome, a type of neurodevelopment disorder classified within the spectrum of autism.

What is autism?

Autism is a general term for a group of complex disorders due to the impaired development of the brain. The key characteristics of autism include inept social behaviours and deficit in nonverbal interactions such as reduced eye contact, facial expression, and body gestures [1]. A person with autism may exhibit behaviours such as not respond to his/her name, avoid eye contact, have trouble understanding other people’s feeling, have delayed speech and language skills, and get upset by minor changes, etc. Associated symptoms may also include irritability, hyperactivity, aggressiveness, anxiety, and insomnia. The signs and symptoms of autism will start to emerge during early childhood, typically between the age of 2-3 years old [2].

Autism is considered a lifelong condition, however, some children do report to “recover” from it and possess normal communication, attention and behavioural skills [3]. This is not an easy condition to address as it is highly complex and response to treatment is clearly individualised since no two persons with autism are alike.  The primary treatment for autism is behaviour approaches through education and structured activities that target to improve the learning, communication and social skills of children with autism [4]. Natural medicine can be used to complement the behaviour treatment in various aspects.

Detoxification and antioxidants

It is now clear that environmental factors, particularly environmental toxins, in addition to genetics, contribute to the increasing diagnosis of autism worldwide. The environmental toxins implicated in autism include air pollutants, pesticides, polychlorinated biphenyls (PCBs) in plastics, and heavy metals such as cadmium, lead, and mercury. A systematic review of current research found strong evidence linking the exposure to these environmental toxins by the mothers before and during pregnancy and the children during early childhood periods to autism [5]. Children with autism were also found to have higher concentrations of heavy metals in blood, urine, hair, brain or teeth than normal children in many studies [6–8]. This may be due to the reduced ability of the children with autism to remove environmental toxins from their bodies, potentially due to genetics.

Hence, reducing exposure to environmental toxins, improving the body’s ability to detoxify these toxins, and increasing antioxidants level to prevent damage from oxidative stress caused by toxins are suggested to support recovery from autism [5,9]. Among the natural supplements that can assist in detoxification and antioxidants in autism include chlorella, cilantro, garlic, greens (barley, broccoli, etc.), taurine, alpha lipoic acid, N- acetylcysteine, selenium, and vitamin E [10].          

Diet and nutrition

Children with autism may be at risk of developing malnutrition due to improper absorption [11]. The associated symptoms of autism are also thought to be related to the intake of food additives and refined sugar, as well as a certain food allergy or sensitivity [12]. Therefore, parents must pay attention to the diet and nutritional status of children with autism.     

Gluten-free, dairy free diet

One popular diet for autism is the gluten-free, dairy-free diet. The rationale is that children with autism may not be able to digest the gluten and casein (milk protein) properly. The incomplete digest of these protein peptides may impair the nervous system. These protein peptides can also cause gastrointestinal symptoms, bowel inflammation, and abnormal bacteria growth [11]. There are reports that removal of gluten and milk from diet helps to improve the symptoms of autism [13]. Nevertheless, the effects cannot be generalised since research based on randomised controlled trials conducted to-date are unable to find any evidence [14]. The results can be highly individualised. Hence, parents can experiment with removing gluten and milk from the diet to see whether it can help the child’s behaviours.        

Omega-3 fatty acids

Lack of omega-3 fatty acids in the diet has also been suggested as a potential cause of autism. Omega-3 is a type of polyunsaturated fatty acids that are required in the development of the brain. The imbalance between omega-3 and omega-6 fatty acids can cause inflammation, immune reaction, and changes in the brain neurotransmitters. Such disturbances in early childhood can affect the development of the brain and induce abnormal behaviours [15]. Omega-3 fatty acids supplementation in the diet has been shown to improve the attention and social responsiveness of children with autism [16]. Nevertheless, like gluten-free dairy-free diet, the effects of omega-3 can also be highly individualised, the benefit may only be apparent in a subset of the autistic children [17].       

Vitamins, minerals and probiotics

Among the vitamins and minerals supplementation suggested for children with autism include vitamin Bs (especially B12 and folic acid), D, and magnesium [18]. Probiotics and digestive enzymes are also recommended to address complaints of gastrointestinal symptoms such as abdominal pain, gas, bloating, diarrhoea, etc [18].

Sleep

Many children with autism have sleep problems. The causes of sleep problems can be due to neurobiological, medical, or behaviours. Problems with sleep can include insomnia, disturbances in breathing and movement during sleep, sleepwalking, nightmares, etc [19].  Melatonin, a type of neurohormone produced by the pineal gland to induce sleep at night, has been found to be low in children with autism. As such, supplementation with melatonin is recommended. Research in this area is more conclusive. There is evidence for melatonin in autism to improve sleep parameters, which include easier to get into sleep, longer sleep duration, and fewer nightmares. There are also reports of better daytime behaviours [20]. Among all supplements suggested for autism, melatonin has the most supporting evidence from medical research.    

Conclusion

In conclusion, autism is a brain development condition that affects the concentration and behaviours of the children. This is a complex condition and response to treatment is clearly individualised. Exposure to environmental toxins can be a cause of autism, so enhance detoxification and antioxidants with dietary supplements is important. Going on a gluten-free, dairy-free diet may also help to reduce the symptoms of autism. Melatonin can be helpful in improving the sleep of autistic children. Other nutritional supplements that parents may consider include omega-3 fatty acids, vitamin Bs, D, magnesium, probiotics, and digestive enzymes.  

References

[1]        H.R. Park, J.M. Lee, H.E. Moon, D.S. Lee, B.-N. Kim, J. Kim, D.G. Kim, S.H. Paek, A Short Review on the Current Understanding of Autism Spectrum Disorders, Exp. Neurobiol. 25 (2016) 1. doi:10.5607/en.2016.25.1.1.

[2]        What Is Autism?, Autism Spectr. Aust. (n.d.). https://www.autismspectrum.org.au/content/what-autism (accessed May 8, 2018).

[3]        M. Barnevik Olsson, J. Westerlund, S. Lundström, M. Giacobini, E. Fernell, C. Gillberg, “Recovery” from the diagnosis of autism – and then?, Neuropsychiatr. Dis. Treat. 11 (2015) 999–1005. doi:10.2147/NDT.S78707.

[4]        M. DeFilippis, K.D. Wagner, Treatment of Autism Spectrum Disorder in Children and Adolescents., Psychopharmacol. Bull. 46 (2016) 18–41. http://www.ncbi.nlm.nih.gov/pubmed/27738378 (accessed May 8, 2018).

[5]        D.A. Rossignol, S.J. Genuis, R.E. Frye, Environmental toxicants and autism spectrum disorders: A systematic review, Transl. Psychiatry. 4 (2014) e360-23. doi:10.1038/tp.2014.4.

[6]        D.A. Geier, J.K. Kern, P.G. King, L.K. Sykes, M.R. Geier, Hair toxic metal concentrations and autism spectrum disorder severity in young children., Int. J. Environ. Res. Public Health. 9 (2012) 4486–97. doi:10.3390/ijerph9124486.

[7]        J. Adams, D.P. Howsmon, U. Kruger, E. Geis, E. Gehn, V. Fimbres, E. Pollard, J. Mitchell, J. Ingram, R. Hellmers, D. Quig, J. Hahn, Significant Association of Urinary Toxic Metals and Autism-Related Symptoms-A Nonlinear Statistical Analysis with Cross Validation., PLoS One. 12 (2017) e0169526. doi:10.1371/journal.pone.0169526.

[8]        F.E.B. Mohamed, E.A. Zaky, A.B. El-Sayed, R.M. Elhossieny, S.S. Zahra, W. Salah Eldin, W.Y. Youssef, R.A. Khaled, A.M. Youssef, Assessment of Hair Aluminum, Lead, and Mercury in a Sample of Autistic Egyptian Children: Environmental Risk Factors of Heavy Metals in Autism., Behav. Neurol. 2015 (2015) 545674. doi:10.1155/2015/545674.

[9]        A. Alabdali, L. Al-Ayadhi, A. El-Ansary, A key role for an impaired detoxification mechanism in the etiology and severity of autism spectrum disorders., Behav. Brain Funct. 10 (2014) 14. doi:10.1186/1744-9081-10-14.

[10]      M.E. Sears, M.E. Sears, Chelation: Harnessing and Enhancing Heavy Metal Detoxification – A Review, Sci. World Journal, Sci. World J. 2013, 2013 (2013) e219840. doi:10.1155/2013/219840, 10.1155/2013/219840.

[11]      A. Kawicka, B. Regulska-Ilow, How nutritional status, diet and dietary supplements can affect autism. A review., Rocz. Państwowego Zakładu Hig. 64 (2013) 1–12. doi:2013;64(1):1-12.

[12]      L.F. Marti, Dietary interventions in children with autism spectrum disorders – an updated review of the research evidence., Curr. Clin. Pharmacol. 9 (2014) 335–49. http://www.ncbi.nlm.nih.gov/pubmed/24050740 (accessed May 8, 2018).

[13]      P. Whiteley, Nutritional management of (some) autism: A case for gluten- and casein-free diets?, Proc. Nutr. Soc. 74 (2015) 202–207. doi:10.1017/S0029665114001475.

[14]      A. Piwowarczyk, A. Horvath, J. Łukasik, E. Pisula, H. Szajewska, Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review, Eur. J. Nutr. 57 (2018) 433–440. doi:10.1007/s00394-017-1483-2.

[15]      K. van Elst, H. Bruining, B. Birtoli, C. Terreaux, J.K. Buitelaar, M.J. Kas, Food for thought: Dietary changes in essential fatty acid ratios and the increase in autism spectrum disorders, Neurosci. Biobehav. Rev. 45 (2014) 369–378. doi:10.1016/j.neubiorev.2014.07.004.

[16]      Y.P. Ooi, S.J. Weng, L.Y. Jang, L. Low, J. Seah, S. Teo, R.P. Ang, C.G. Lim, A. Liew, D.S. Fung, M. Sung, Omega-3 fatty acids in the management of autism spectrum disorders: Findings from an open-label pilot study in Singapore, Eur. J. Clin. Nutr. 69 (2015) 969–971. doi:10.1038/ejcn.2015.28.

[17]      A. Posar, P. Visconti, Complementary and Alternative Medicine in Autism: The Question of Omega-3, Pediatr. Ann. 45 (2016) e103–e107. doi:10.3928/00904481-20160129-01.

[18]      Y.-J. Li, J.-J. Ou, Y.-M. Li, D.-X. Xiang, Dietary Supplement for Core Symptoms of Autism Spectrum Disorder: Where Are We Now and Where Should We Go?, Front. Psychiatry. 8 (2017) 155. doi:10.3389/fpsyt.2017.00155.

[19]      O.J. Veatch, A.C. Maxwell-Horn, B.A. Malow, Sleep in Autism Spectrum Disorders., Curr. Sleep Med. Reports. 1 (2015) 131–140. doi:10.1007/s40675-015-0012-1.

[20]      D.A. Rossignol, R.E. Frye, Melatonin in autism spectrum disorders., Curr. Clin. Pharmacol. 9 (2014) 326–34. http://www.ncbi.nlm.nih.gov/pubmed/24050742 (accessed May 8, 2018).