Children with Disabilities| August 01 1999 Autism and Secretin AAP Grand Rounds (1999) 2 (2): 15–16. https://doi.org/10.1542/gr.2-2-15-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Autism and Secretin. AAP Grand Rounds August 1999; 2 (2): 15–16. https://doi.org/10.1542/gr.2-2-15-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: autistic disorder, secretin Source: Horvath K, Stefanatos G, Sokolski KN, et al. Improved social and language skills after secretin administration in patients with autistic spectrum disorders. J Assoc Acad Minor Phys. 1998;9:9–15. Approximately 400,000 Americans are affected with autism, the etiology of which remains undefined. Gastrointestinal symptoms are present in a significant number of patients with this disorder. Horvath et al report 3 autistic children who, while being treated with secretin for chronic diarrhea, showed marked improvement of their behavior, manifested by increased eye contact, alertness, communication and expressive language. They also had hypersecretion of pancreaticobiliary fluid. The authors detail the gastrointestinal changes effected by the use of secretin and offer several explanations for the improvement in patients’ behavior. They suggest that gastrointestinal and brain dysfunction may be associated in autistic patients. Secretin, an intestinal peptide hormone secreted from the upper crypt to the villus tip, affects the pancreas, the bile duct and may, as well, affect the hypothalamus and hippocampus. Autism is a psychiatric disorder affecting preschool children in which emotional attachment and language fail to develop appropriately.1 The child shows a markedly restricted repertory of behaviors and interests, engaging in repetitive, stereotypic play and self-stimulatory activities (such as spinning, hand-flapping, and/or rocking). When initially described by Kanner in 1924, autism was considered a rare disorder, affecting 4-5/10,000 children. Since the introduction of the third edition of the Diagnostic and Statistical Manual by the American Psychiatric Association in 1980, the criteria for the disorder became somewhat more broadly interpreted. Consequently, prevalence in the United States now hovers between 1–2/1,000. Secretin belongs to a family of gut hormones (the hypocretins) that are taken up in the brain and include secretin, glucagon, gastric inhibitory polypeptide vasoactive intestinal polypeptide, and pituitary adenyl cyclase-activating polypeptide (PACAP). The hypocretins appear to be actively transported into the brain and bind to G-protein coupled receptors that have an anatomically discrete distribution. Their role in neuronal regulation of vegetative body functions (hunger, thirst, sleep, and arousal) make them likely candidates for further exploration of brain function, and especially in autism in which disturbances in these functions are evident. The validity of Horvath et al’s clinical observations can only be established by blinded, placebo-controlled trials. A similar case report of 3 children with autism responding to fenfluramine created a wave of clinical interest in this anorexic agent in the 1980s.2 Parents and the media seized upon the report and sought out clinicians willing to provide off-label treatment. However, in the multi-center, placebo-controlled fenfluramine trials that followed, a placebo response rate of 40% accounted for all the effects of treatment. Moreover, the neurotoxicity of fenfluramine upon serotonergic neurons, subsequently described in animal studies, was a sobering discovery to clinicians and parents alike. Whenever one encounters a report such as this one, it is almost impossible not to speculate on how the agent might affect behavior: Many incidental clinical observations have generated hypotheses that have led to advances in science and medicine. Within the next year,... You do not currently have access to this content.