New research has provided more clarity on the connection between autism and the microbiome.

A SFARI initiated and funded reanalysis of previous studies reveals consistent biological signals in the human microbiome and other physiological signals associated with autism
A SFARI-initiated and funded reanalysis of previous studies reveals consistent biological signals in the human microbiome and other physiological signals associated with autism

The biological roots of autism continue to perplex researchers despite a growing body of studies looking at an increasing array of genetic, cellular and microbial data. Recently, scientists have homed in on a new and promising area of focus: the microbiome. This collection of microbes that inhabit the human gut has been shown to play a role in autism, but the mechanics of this link have remained awash in ambiguity. Taking a fresh computational approach to the problem,sheds new light on the relationship between the microbiome and autism. This research — which originated at the Simons Foundation’s Autism Research Initiative (SFARI) and involved an innovative reanalysis of dozens of previously published datasets — aligns with a recent, long-term study of autistic individuals that centred on a microbiome-focused treatment intervention. These findings also underscore the importance of longitudinal studies in elucidating the interplay between the microbiome and complex conditions such as autism.

“We were able to harmonize seemingly disparate data from different studies and find a common language with which to unite them. With this, we were able to identify a microbial signature that distinguishes autistic from neurotypical individuals across many studies,” says Jamie Morton, one of the study’s corresponding authors, who began this work while a postdoctoral researcher at the Simons Foundation and is now an independent consultant. “But the bigger point is that going forward, we need robust long-term studies that look at as many datasets as possible and understand how they change when there is a [therapeutic] intervention.”

With 43 authors, this study brought together leaders in computational biology, engineering, medicine, autism and the microbiome who hailed from institutions in North America, South America, Europe and Asia. “The sheer number of fields and areas of expertise in this large-scale collaboration is noteworthy and necessary to get a new and consistent picture of autism,” says Rob Knight, the director of the Center for Microbiome Innovation at the University of California San Diego and a study co-author.

Autism is inherently complex, and studies that attempt to pinpoint specific gut microbes involved in the condition have been confounded by this complexity. First, autism presents in heterogeneous ways — autistic individuals differ from each other genetically, physiologically and behaviorally. Second, the microbiome presents unique difficulties. Microbiome studies typically report simply the relative proportions of specific microbes, requiring sophisticated statistics to understand which microbial population changes are relevant to a condition of interest. This makes it challenging to find the signal amongst the noise. Making matters more complicated, most studies to date have been one-time snapshots of the microbial populations present in autistic individuals. “A single time point is only so powerful; it could be very different tomorrow or next week,” says study co-author Brittany Needham, assistant professor of anatomy, cell biology and physiology at the Indiana University School of Medicine.

“We wanted to address the constantly evolving question of how the microbiome is associated with autism, and thought, ‘let’s go back to existing datasets and see how much information we may be able to get out of them,’” says co-corresponding author Gaspar Taroncher-Oldenburg, director of Therapeutics Alliances at New York University, who initiated the work with Morton while he was a consultant-in-residence for SFARI.

In the new study, the research team developed an algorithm to re-analyze 25 previously published datasets containing microbiome and other “omic” information — such as gene expression, immune system response and diet — from both autistic and neurotypical cohorts. Within each dataset, the algorithm found the best matched pairs of autistic and neurotypical individuals in terms of age and sex, two factors that can typically confound autism studies. “Rather than comparing average cohort results within studies, we treated each pair as a single data point, and thus were able to simultaneously analyze over 600 ASD-control pairs corresponding to a de facto cohort of over 1,200 children,” says Taroncher-Oldenburg. “From a technical standpoint, this required the development of novel computational methodologies altogether,” he adds. Their new computational approach enabled them to reliably identify microbes that have differing abundances between ASD and neurotypical individuals.

To the researchers’ surprise, their analysis identified autism-specific metabolic pathways associated with particular human gut microbes. Importantly, these pathways were also seen elsewhere in autistic individuals, from their brain-associated gene expression profiles to their diets. “We hadn’t seen this kind of clear overlap between gut microbial and human metabolic pathways in autism before,” says Morton.

Even more striking was an overlap between microbes associated with autism, and those identified in a recent long-term fecal microbiota transplant study led by James Adams and Rosa Krajmalnik-Brown at Arizona State University’s Biodesign Center for Health Through Microbiomes. “Another set of eyes looked at this, from a different lens, and they validated our findings,” says Krajmalnik-Brown, who was not involved in the study published today.

“What’s significant about this work is not only the identification of major signatures, but also the computational analysis that identified the need for future studies to include longitudinal, carefully designed measurements and controls to enable robust interpretation,” says Kelsey Martin, executive vice president of SFARI and the Simons Foundation Neuroscience Collaborations, who was not involved in the study.

“Going forward, we need more long-term studies that involve interventions, so we can get at cause-and-effect,” says Morton. Taroncher-Oldenburg, who cites the compliance issues often faced by traditional long-term studies, suggests that study designs could more effectively take into account the realities of long-term microbiome sampling of autistic individuals. “Practical, clinical restrictions must inform the statistics, and that will inform the study design,” he says. Further, he points out that long-term studies can reveal insights about both the group and the individual, as well as how that individual responds to specific interventions over time.

Importantly, researchers say these findings go beyond autism. The approach set forth here could also be employed across other areas of biomedicine that have long proved challenging. “Before this, we had smoke indicating the microbiome was involved in autism, and now we have fire. We can apply this approach to many other areas, from depression to Parkinson’s to cancer, where we think the microbiome plays a role, but where we don’t yet know exactly what the role is,” says Knight.

Are food quality issues impacting the higher rates of Autism and ADHD in children in the developed world?

Percentage distribution of American children receiving SPED services by category, 2006 and 2021

U.S. SPED Caseload Percentages By Category, 2006 and 2021 CREDIT Dr. Raquel Crider

In a recent publication released by PubMed, American scientists led by Dr. Dufault at the Food Ingredient and Health Research Institute reported alarming increases in the numbers of children requiring special education services. While student enrollment in US schools remained stable from 2006 to 2021, the percentage of children receiving special education services increased by 10.4%. Among children with autism, the percentage receiving services tripled, jumping from 4% to 11%. Additionally, the caseload percentages for children with developmental delay quadrupled, increasing from 1% to 4%. Children qualifying for special education services under the category of other health impairments, which includes ADHD, jumped from 10% to 16%.

Dr. Dufault’s research team conducted a literature review to identify the epigenetic factors linked to the development of autism and ADHD. Over the past decade, numerous clinical trial data have suggested that dietary exposure to heavy metals and poor nutrition are the primary epigenetic factors that affect gene behavior and the inheritance of autism and/or ADHD in children. The prenatal consumption of ultra-processed foods has been shown to result in poor nutrition and exposure to heavy metals, which can adversely impact infant gene behavior both before and after birth.

The field of research that examines how dietary factors impact gene expression is called nutritional epigenetics. Dr. Dufault has been leading research in this area since 2005. During her time at the Food and Drug Administration, she was the first to identify the issue of inorganic mercury residues in high fructose corn syrup.

There is an ongoing issue with heavy metal residues in the food supply. In 2021, the US Congress released two reports addressing this problem in baby foods. The first report, issued on February 4, 2021, revealed that baby foods contain dangerous levels of arsenic, lead, cadmium, and mercury. The second report, issued on September 29, 2021, confirmed that manufacturers have disclosed new information showing even more baby foods with dangerous levels of heavy metals. These heavy metal exposures may exacerbate the development of autism and ADHD.

A study shows that autistic children exhibit aggression more frequently. What is your lived experience?

Lauren Quetsch.jpg

Lauren Quetsch, University of Arkansas. CREDIT University of Arkansas

“At least half of all children with autism experience some form of aggression, like hitting, kicking, or name-calling, while their parents are responsible for helping them manage and integrate into social settings. However, the frequency and nature of aggressive behaviors throughout the development of autism are not well understood.”

In order to fill this gap in knowledge, the Family and Community Intervention Lab at the University of Arkansas conducted a study comparing the levels of aggressive behaviors in autistic children versus non-autistic children across three crucial developmental periods. The study found that parents of autistic children reported more frequent and intense levels of aggression compared to parents of non-autistic children. to parents of non-autistic children.

“Aggression poses a widespread and serious challenge for autistic youths and their families,” said Lauren Quetsch, assistant professor of psychology and lead author of “Understanding aggression in autism across childhood: Comparisons with a non-autistic sample.”

“While our knowledge about the unique needs of autistic children has expanded significantly over the last few decades, we still have a long way to go,” she said. “Understanding the role aggression plays in the lives of autistic youths can help us better address our gaps in care.”

In the period from December 2020 to March 2021, Quetsch and her colleagues collected both quantitative and qualitative data on 450 autistic and 432 non-autistic children. The data was categorized into three age-matched groups: younger than six, six to 12, and 13 to 17. The children were assessed using various caregiver-reported measures to compare aggressive and disruptive behavior during these important developmental stages.

The researchers analyzed the data and found that autistic children displayed higher levels of verbal aggression and disruptive behavioral intensity compared to non-autistic children across all three stages of development. Children with autism who were younger than six exhibited more physical aggression than their non-autistic peers, but as they grew older, these levels became equal to those of non-autistic children.

In the qualitative study, non-autistic children more frequently expressed anger in a controlled manner, according to parents, whereas autistic children were more apt to quickly lose their temper.

“We surmise that this can be attributed to several factors,” Quetsch said. “Frustration from regularly being misunderstood, challenges with recognizing emotions in others or expressing their own emotions to others, sensory overstimulation, and even co-occurring health challenges, such as physical discomfort from gastrointestinal issues and exhaustion due to irregular sleeping patterns, all likely contribute to aggression.”

Sensory-adapted dental rooms can significantly reduce physiological and behavioural stress in autistic children during teeth cleanings.

Sensory adaptations ease dental care for autistic children

In the SADE research clinic at Children’s Hospital Los Angeles, sensory adaptations to the environment were found to significantly reduce autistic children’s physiological and behavioral stress during dental cleanings. CREDIT: Phil Channing/USC

New research conducted by USC researchers at Children’s Hospital Los Angeles reveals that creating a sensory adapted dental clinic environment can significantly reduce the distress experienced by autistic children during oral care.

“According to lead author Leah Stein Duker, assistant professor at the USC Chan Division of Occupational Science and Occupational Therapy, our research has demonstrated that utilizing a combination of carefully selected visual, auditory, and tactile adaptations can significantly reduce behavioral and physiological distress in autistic children during dental cleanings. These adaptations are easy to implement, relatively inexpensive, and do not require specialized training to use.”

Autistic children often face more difficulties with oral health care compared to their typically developing peers. These challenges are often linked to heightened responses to sensory input. The dentist’s office can be overwhelming for them due to bright fluorescent lighting, loud electric hand tools, and reclining chairs. Stein Duker and the Sensory Adapted Dental Environments (SADE) research team, along with colleagues from the Ostrow School of Dentistry of USC, are working on identifying and testing novel approaches to help address these challenges and improve access to effective oral care.

This study involved providing dental cleanings to autistic children in both a standard clinic environment and an adapted one. In the adapted setting, the dentist wore a surgical loupe with an attached lamp, blackout curtains were hung over the windows, and a slow-motion visual effect was projected onto the ceiling. The children could choose between a “Finding Nemo” underwater scene or lava lamp-style abstract colors. Additionally, a portable speaker played calming nature sounds and quiet piano music. To provide deep pressure and a hugging sensation, a traditional lead X-ray bib was placed on the child’s chest, and a “butterfly” wrap was secured around the dental chair, from shoulder to ankle, which has been shown to calm the nervous system.

Electrodes were placed on the child’s fingers to measure electrodermal activity, which is a physiological marker of sympathetic nervous system activation, similar to the fight-or-flight response. The researchers also noted the frequency and duration of distressed behaviors displayed by the child during the cleaning, such as pulling away from the dentist, clenching the jaw, attempting to bite the dentist or prevent tools from entering the mouth, crying, and screaming.

The researchers found no differences in the quality of care provided in the adapted environment compared to the regular environment. They also did not find significant differences in the amount of time required to get the child seated and ready for the cleaning, demonstrating that adaptations do not create logistical hurdles.

“So many interventions try to change the person,” Stein Duker said. “Instead, this intervention sees children for who they are. It does not try to fix or change them. The focus of the intervention is to modify problematic environmental factors in order to empower the child and family to successfully engage in occupation.”

Adaptations can make all the difference

This publication is the most recent output from the SADE research project, which is led by Principal Investigator Professor Sharon Cermak and has been ongoing since 2011. The SADE intervention has been tested in pilot studies with various populations in several countries. However, Stein Duker noted that this study is the first to have a sample size large enough to achieve full statistical power.

“Because it’s a fully-powered study, we were able to identify some other very exciting findings,” Stein Duker said. “For example, our data showed that children’s Did you mean “physiological”?stress dropped as soon as they entered the adapted dental cleaning room before the actual cleaning even began, and that level of physiological stress predicted behavioral distress during the cleaning.”

The researchers also identified factors predicting the success of the intervention for each participant: Younger age, lower IQ, and/or lower expressive communication level were each associated with a greater reduction in participants’ stress.

“My daughter cannot even hear the word ‘dentist,’” said one participant’s parent. “But after being in the [SADE] room for a bit, she was able to have her teeth looked at for the first time in over a year.”

The study aims to address oral care disparities experienced by autistic children, with a focus on narrowing ethnic disparity gaps. 72% of enrolled children’s parents identified as Hispanic. Data shows that 52% of Hispanic youth aged 2-19 have dental caries, the highest prevalence compared to other ethnic groups. Bilingual team members ensured the full participation of Spanish-speaking participants.

Stein Duker and her Tailored Environmental Modifications lab will next study the effectiveness of a modified SADE for typically developing children with dental fear and anxiety, a major challenge in pediatric dentistry experienced by approximately 20 percent of all US children. In the near future, she is also planning to collect preliminary data studying adolescents and adults with intellectual developmental disabilities and/or autism, populations she gets frequently asked about at dental conferences and research meetings.

“Stein Duker advises dental professionals and parents to collaborate and use cost-free adaptations like weighted X-ray bibs, sunglasses, or a beanie hat to improve the clinic experience for those with sensory sensitivities.”

“New Study: Link Found Between Neighborhood Conditions and ADHD Signs in Autistic Children”

Study finds poverty, lack of services may play a role
A study suggests that poverty and the lack of services may have an impact.

Children with autism who were born in underprivileged neighbourhoods are more likely to exhibit more significant symptoms of attention deficit hyperactivity disorder (ADHD) than those born in more affluent communities, according to a new study led by researchers at the UC Davis MIND Institute.

This groundbreaking study is the first of its kind to explore the relationship between neighbourhood factors and ADHD in both autistic and non-autistic children. The research offers new perspectives on mental health conditions and could play a key role in shaping public policy changes to enhance health equity.

“We discovered that certain neighbourhood factors are closely linked to ADHD symptoms in autistic children”” stated Catrina Club, the primary author of the study. Calub is a postdoctoral researcher working in the laboratory of Julie Schweitzer, who is a professor in the Department of Psychiatry and Behavioral Sciences and the MIND Institute.

“In our study, we found that this effect was only present in autistic children and not in typically developing kids or in kids with other developmental disabilities. It suggests that when autistic children live in neighbourhoods with fewer resources, they tend to exhibit more pronounced ADHD symptoms,” explained Club.

ADHD symptoms may include higher rates of inattention, hyperactivity, and impulsive behavior. It is associated with:

  • Challenges in school performance and relationships with friends
  • Lower self-esteem and greater risk for anxiety and depression
  • Higher potential for substance use disorders and accidents
  • Emotional dysregulation and conduct problems

Study expands findings from long-term research

The researchers utilized data from two studies: the long-running Childhood Autism Risks from Genetics and the Environment (CHARGE) study led by Irva Hertz-Picciotto at the MIND Institute and the ReCHARGE follow-up project.

The research team examined 246 children with autism, 85 with developmental delays but not autism, and 193 neurotypical children. They then used the Child Opportunity Index, which utilizes census data to analyze over 30 neighbourhood characteristics. These characteristics include socioeconomics, access to green spaces, single-parent households, and the presence of early childhood education centres.

The index encompasses education, health and environment, and social and economic resources. Higher scores are linked to better childhood health. Of the three domains, the scores for education and social and economic resources were most strongly related to ADHD symptoms.

The analysis showed the Child Opportunity Index scores at birth were a strong predictor for ADHD symptoms in adolescence in autistic children but not in the other groups. Calub noted that the finding was unexpected.

“These results are quite concerning,” Calub said. “Those with both autism and ADHD are already more likely to have additional challenges—behaviorally, cognitively, emotionally, and socially. Being born in a low-income neighbourhood puts them at an even greater disadvantage. This adds to the evidence that more resources are needed for underserved areas and specifically for those who have conditions like autism.”

The need for a larger, more diverse sample

Calub pointed out that more research is needed to determine if the obtained results are conclusive.

apply to a larger group.

“It will be important for future studies to be larger and more diverse. This will help us learn whether neighbourhood conditions might also influence ADHD symptoms in other groups, such as youth without autism, or in Black, Asian, and Native American individuals, who were underrepresented in our sample,” Caleb added.

These findings also provide insights on how to target preventive strategies to reduce the risk of increased ADHD symptoms, as noted by Schweitzer, who was also a co-author on the study.

“ADHD is highly prevalent in the general population and is common in autistic youth. If we can find ways to increase resources in these neighborhoods, we have the potential to improve academic, social, mental, and physical health outcomes, particularly for autistic youth, and also decrease long-term economic costs,” Schweitzer explained.

Calub and Schweizer assert the study’s findings should motivate policymakers to allocate more resources for underserved communities. Furthermore, they suggest that incorporating the Child Opportunity Index and other neighborhood metrics could yield fresh insights for future studies to guide policy.