Autism Intervention Research Network Research Articles

Dietary Intake and Plasma Levels of Choline and Betaine in Children with Autism Spectrum Disorders

Abnormalities in folate-dependent one-carbon metabolism have been reported in many children with autism. Because inadequate choline and betaine can negatively affect folate metabolism and in turn downstream methylation and antioxidant capacity, we sought to determine whether dietary intake of choline and betaine in children with autism was adequate to meet nutritional needs based on national recommendations. Three-day food records were analyzed for 288 children with autism (ASDs) who participated in the national Autism Intervention Research Network for Physical Health (AIR-P) Study on Diet and Nutrition in children with autism. Plasma concentrations of choline and betaine were measured in a subgroup of 35 children with ASDs and 32 age-matched control children. The results indicated that 60–93% of children with ASDs were consuming less than the recommended Adequate Intake (AI) for choline. Strong positive correlations were found between dietary intake and plasma concentrations of choline and betaine in autistic children as well as lower plasma concentrations compared to the control group. We conclude that choline and betaine intake is inadequate in a significant subgroup of children with ASDs and is reflected in lower plasma levels. Inadequate intake of choline and betaine may contribute to the metabolic abnormalities observed in many children with autism and warrants attention in nutritional counseling.

Editors’ Note and Prologue

* Abbreviations: AIR-P — : Autism Intervention Research Network on Physical Health ATN — : Autism Treatment Network CAAI — : Combating Autism Act Initiative MCHB — : Maternal Child Health Bureau After the Combating Autism Act of 2006, the Health Resources and Services Administration/Maternal Child Health Bureau (MCHB) in 2008 developed a program covering several research, guideline development, and training activities (the Combating Autism Act Initiative [CAAI]). Two autism intervention research networks received funding through this initiative, as did both Leadership Education in Neurodevelopmental and Related Disabilities and developmental/behavioral pediatrics training programs. MCHB also initiated several research projects in autism intervention through a request for proposals. One of the research networks, the Autism Intervention Research Network on Physical Health (AIR-P), expanded on an already existing network, the Autism Treatment Network (ATN), which had initial (and continuing) infrastructure support from Autism Speaks. Overall activities of the AIR-P are described later in this supplement. This network also took on leadership in developing the current supplement, to describe a number of … Address correspondence to James M. Perrin, MD, Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, 100 Cambridge St #1542, Boston, MA 02114. E-mail: jperrin{at}partners.org

The Autism Treatment Network and Autism Intervention Research Network on Physical Health: Future Directions

* Abbreviations: AIR-P — : Autism Intervention Research Network on Physical Health ASD — : autism spectrum disorder ATN — : Autism Treatment Network CER — : comparative effectiveness research CTSAs — : Clinical Translational Science programs Autism spectrum disorders (ASDs) represent complex neurodevelopmental disorders with multiple etiologies.1 The resulting variability of behavioral, medical, and developmental concerns that affect individuals with ASDs has made it extremely difficult to predict which treatments work best for which individuals. Developing effective treatments and improving care for individuals with ASDs throughout the life span remain urgent priorities. Comprehensive coordinated care for individuals with ASDs will require further advances in our knowledge of medical and behavioral interventions and a health care system that can deliver them consistently. Over the past 7 years, the Autism Speaks Autism Treatment Network (ATN) and more recently the Autism Intervention Research Network on Physical Health (AIR-P) have significantly increased understanding of the prevalence, nature, and treatment of medical conditions in children with ASDs, such as gastrointestinal conditions, sleep disorders, metabolic disorders, and seizures. The network has pioneered in standardizing the clinical evaluation of children with ASDs, based on a comprehensive, multidisciplinary model of care. The network has also developed key partnerships that have helped the field move from limited consensus toward evidence-based autism-specific guidelines in key areas of medical concern, and has acquired the infrastructure and expertise to develop more targeted treatment studies that can help move the most effective therapies through the research pipeline and into the hands of consumers. The ATN has led in the application of quality improvement methods to autism care and in systematic efforts to bring the experience and lessons of the network to broader communities of professionals and parents. This effort, led by Autism Speaks, has allowed strong synergy among research, clinical, and family communities. Key areas of continued growth for the research activities of network include (1) on-going enhancement of research infrastructure, including increased availability of biological samples; (2) expansion of the research agenda to include more focused research … Address correspondence to James M. Perrin, MD, Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, 100 Cambridge St, #1542, Boston, MA 02114. E-mail: jperrin{at}partners.org

Leadership in Health Care, Research, and Quality Improvement for Children and Adolescents With Autism Spectrum Disorders: Autism Treatment Network and Autism Intervention Research Network on Physical Health

* Abbreviations: AIR-P — : Autism Intervention Research Network on Physical Health ASD — : autism spectrum disorder ATN — : Autism Treatment Network FAC — : Family Advisory Committee GI — : gastrointestinal HRSA — : Health Resources and Services Administration NICHQ — : National Initiative for Children’s Healthcare Quality Autism spectrum disorders (ASDs) are a group of highly prevalent, lifelong neurodevelopmental disorders affecting social, communicative, and behavioral functioning. Recent studies estimate the prevalence of ASDs as 1 in 88,1,2 indicating the public health importance of the disorders and making the development of effective care and treatment of ASD an urgent priority. Among the health care concerns for children and youth with ASD is a major need to strengthen awareness and treatment of associated medical conditions with standardized, comprehensive approaches to evaluation, treatment, and monitoring. Many individuals with ASD have symptoms associated with underlying medical conditions, including seizures, sleep problems, gastrointestinal (GI) disorders, psychiatric conditions, nutritional deficiencies, and metabolic conditions; when left untreated, these conditions may not only compromise general health but also have clear effects on behavior, development, and educational outcomes for individuals with ASD. The problems that many children with ASD have with communication make the diagnosis and monitoring of medical conditions more challenging. Furthermore, the underlying biology of ASD may change the manifestations of various medical conditions and their response to treatment. Thus, special attention to these conditions is crucial for improving the quality of life for individuals with ASD. Children and adolescents with ASD encounter difficulties obtaining appropriate and necessary health care services. They have decreased access to medical specialists,3–5 coupled with increased medical expenditures and unmet needs, compared with other children with special health care needs and typically developing children.6,7 Autism Speaks and its predecessor, Cure Autism Now, have recognized the significant unmet medical needs among children and adolescents with ASD as well as the many gaps in knowledge among providers regarding the general health care challenges of individuals with ASD. Parents shared their frustrations and all too familiar tales of having to travel far distances … Address correspondence to James M. Perrin, MD, Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, 100 Cambridge St #1542, Boston, MA 02114. E-mail: jperrin{at}partners.org

Modest size RCT indicates that short-term joint attention and symbolic play intervention improves shared positive affect in social interactions for preschool children with autism

This review provides a summary and appraisal commentary on the treatment review by Lawton, K., & Kasari, C. (2012). Brief report: Longitudinal improvements in the quality of joint attention in preschool children with autism. Journal of Autism and Developmental Disorders, 42, 307–312. Source of funding and disclosure of interest: This study was supported by NIH grant HD035470, the CPEA network, the Autism Intervention Research-Network funded by U.S. Dept. of Health and Human Services HRSA, Maternal and Child Health Branch, Grant # UA3MC11055, as well as a center grant (1-P50-HD-055784) from NIH/NICHD. The original authors of this research report no conflicts of interest.