Abstract Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder, becoming the most common condition among mental disabilities due to its recent increase in incidence. The serotonin system depends on vitamin A, which plays a crucial role in the nervous system. As a result, children's neurodevelopment and the emergence of ASD can be significantly impacted by vitamin A deficiency (VAD) The Aim We aimed in this study to evaluate vitamin A, and serotonin levels in a group of Egyptian ASD patients under the age of 8 years before and after vitamin A supplementation. In addition, we aimed to evaluate their association with ASD symptoms. Material and Methods The first part of this two-stage study is a controlled cross-sectional analysis, and the second stage is an interventional analysis that includes a clinical trial and an open-label design. Children Between the ages of 1 year and 8 years, with ASD diagnosis according to (DSM-V) criteria were included, as well as healthy controls. Results We included 30 ASD children and 30 normal children in the control group with a mean age and SD of 5.33±1.7 years. We observed that 33.3% of ASD patients had a family history of similar cases. According to Childhood Autism Rating Scale of the patients at baseline, 73.3% had mild to moderate ASD symptoms, while 26.7% had severe symptoms. Moreover, we observed a statistical decrease of Vitamin A level in the study group compared to the control group with a mean of 133.85 mmol/L, and 207.43 mmol/L, respectively. ASD patients with low vitamin A level had a mean and SD of 51.27±25 mmol/L. This was increased significantly after vitamin A supplementation to be 81.18±21.652 mmol/L with P Value = 0.04. Furthermore, serotonin level before supplementation in ASD patients was with a mean value of 590.59±163.32 ng/ml. This level was decreased Significantly after vitamin A supplementation to be with a mean value of 496.5±192.12 ng/ml with P Value = 0.015. subsequently, Autism Treatment Evaluation Chicklist (ATEC), which is used to assess the effect of the intervention on patients ASD symptoms, was decreased significantly with P Value of 0.001. The mean and SD of ATEC was 77.77±22.236 before vitamin A supplementation, while after Vitamin A supplementation was with a Mean and SD of 72.38±19.104. Furthermore, we found no statistically significant correlation between vitamin A and serotonin levels with different patients’ demographics, or anthropometric measures. Conclusion and Implications ASD children exhibited lower levels of vitamin A than normal children, even though vitamin A deficiency is common in Egypt. Children with ASD who had low serum vitamin A levels received vitamin A supplements, which not only helped lower the children's serotonin levels but also markedly reduced their autistic symptoms.
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