AAAP Today

Sulforaphane

Recent findings from a randomized clinical trial offer hope that a promising treatment may be on the threshold. A chemical derived from broccoli sprouts, called sulforaphane, was tested in a placebo-controlled clinical trial that entered 44 young men (aged 13-27) with Autism Spectrum Disorder (ASD) They were treated with sulforaphane (29 men) or placebo (15 m3n) for 18 weeks , then followed up for another 4 weeks.

The behavioral outcome measures included social responsiveness and aberrant behaviors associated with ASD.

Results: Participants who received the sulforaphane showed significantly greater improvements than those who received the placebo for the core ASD symptoms of stereotypy, hyperactivity, irritability, lethargy, and deficits in communication, motivation, and awareness.

These improvements were observed as early as 4 weeks after treatment, and throughout the trial, including at the end of the 18 week treatment, and when measured 4 weeks after the end of treatment.

The drug showed low toxicity. None of the blood laboratory results were outside the normal range throughout the trial. Adverse events were observed during the trial, but the frequency was not significantly different among those who received the sulforaphane or the placebo treatment. Seizure occurred in two of the 29 men who received sulforaphane, both of whom had a history of seizures. Thus, while suggesting the need for clinical monitoring, it is not clear that these events were consequences of sulforaphane.

Significance: Autism research has yet to identify treatments that successfully target the core clinical features (difficulties in social interaction and repetitive, stereotypical behavior) and the fundamental biochemical abnormalities of ASD. Existing treatments ameliorate troublesome associated features, but not the central diagnostic features of ASD. (These treatments include early behavioral intervention through Adaptive Behavioral Analysis and the medications risperidone and aripiprazole.)

Although the findings are promising, this sulforaphane trial is only one study and the sample size of 44 men is small. Much more research must be done to find out how the trial’s results will apply across the heterogeneous spectrum of persons with autism, and in females with ASD. Still, the observed clinical improvements in behaviors central to ASD offer leads for further investigations into the underlying pathophysiology of ASD and the discovery of new drugs for treating and possibly preventing ASD.

Read the full trial report in the Proceedings of the National Academy of Science (PNAS), October 13, 2014. Authors: K Singh, SL Connors, EA Macklin, KD Smith, JW Fahey, P Talalay & AW Zimmerman.

Reductions in adaptive behaviors are often seen when persons with autism age out of school, particularly in situations when stimulating educational or work activities are no longer present.

A study was conducted to test whether a different outcome, that is, improvements in behavior will be seen when adults with autism engage in vocational or educational activities when no longer in school. Participants were 153 adults with ASD (average age=30.2 years). Data were collected at two time points 5.5 years apart.

Result: It was found that “greater vocational independence was related to subsequent reductions in autism symptoms and maladaptive behaviors, and improvements in activities of daily living”. That is, vocational independence at Wave 1 predicted improved behavioral outcomes measured 5.5 years later. This dynamic is similar to that usually seen for adults without disabilities.

The contrary direction, that is, behavioral symptoms outcomes at Wave 1 predicting vocational independence at five years later, was not seen. Providing work activities in vocational or employment settings should be an integral component in the adult life of persons with autism.

Reference: “Engagement in Vocational Activities Promotes Behavioral Development for Adults with Autism Spectrum Disorders”. Authors: Julie Lounds Taylor •Julie Lounds Taylor • Leann E. Smith •Marsha R. Mailick, J Autism Developmental Disorders (2014) 44:1447–1460

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Leading autism expert Dr. Catherine Lord offers advice for families of autistic children

April 1, 2014

Posted in: Mental Health, Patient Care, Pediatrics

MARCH, 2014 – In recognition of Autism Awareness Month, Dr. Catherine Lord, director of the Center for Autism and the Developing Brain at NewYork-Presbyterian Hospital and a national authority on autism spectrum disorders (ASD), offers families guidance and tips for coping with a child’s diagnosis.

• Have hope. Every day we learn more about how to help people with ASD.
• Remember that your child is an individual. Your child is first and foremost his or her own unique person, then a child, then a child with strengths and difficulties, and only then a child with ASD.
• Build a strong support system. Find people you can trust to support you as an individual, and then to support you as a parent of a child with autism.
• Find credible sources. You will hear many contradictory and unfounded pieces of information. Find professionals and resources in which you have faith.
• Enjoy each other. Do things every day that you and your child can enjoy together. While opportunities for learning are important, shared enjoyment is even more important in a family.
• Set goals. Try to concentrate on setting small, reasonable goals for your child and figuring out how to accomplish those goals. These goals should be something that you can see happening as a next step, not miles down the road.
• Make time for your partner. Set aside some time, even just a few minutes, to focus on each other and not the child. Listen to each other’s needs and perspectives as you consider what you will do for your child.
• Be involved. Children with ASD who have families that devote time to learning and playing with them show more improvement than families who are less involved.
• Have reasonable expectations for your child’s behavior. Do not let your child do things that you would not let another child of the same age do, such as biting people or climbing on counters. Do not punish, but respond quickly and offer a distraction if things are not going well.
• Find the resources in your community. Other parents can be important sources of information, but every child with ASD is different. Stand up for what you think are the needs of your child.

About Dr. Catherine Lord

Dr. Catherine Lord is the director of the Center for Autism and the Developing Brain at NewYork-Presbyterian Hospital, a joint center with Weill Cornell Medical College and Columbia University Medical Center.