The pediatric psychopharmacology of autism spectrum disorder: A systematic review - Part II: The future

The Pharmacokinetics, Dosage, Preparation Forms, and Efficacy of Orally Administered Melatonin for Non-Organic Sleep Disorders in Autism Spectrum Disorder During Childhood and Adolescence: A Systematic Review

Background: To date, it remains unclear which oral doses and preparation forms of melatonin should be recommended for children and adolescents with non-organic sleep disorders and autism spectrum disorder (ASD). We reviewed the current state of knowledge on this topic based on randomised placebo-controlled trials (RCTs) and diagnosis-related blood melatonin concentrations available in this age group. Method: Two investigators independently searched PubMed, PsycINFO, MEDLINE, and Cochrane CENTRAL on 1 March 2025 for the keywords "melatonin", "autism", and "randomised" in titles and abstracts in all languages, including an evaluation of the references of the reviews, systematic reviews, and meta-analyses published up to that date, some of which were based on searches in numerous databases. Based on this, additional in-depth searches were carried out in PubMed for pharmacokinetic, physiological, and pathophysiological data on melatonin in children and adolescents, with a special focus on ASD. Results: To date, five RCTs on non-organic sleep disorders in children and adolescents with the sole diagnosis of ASD or with subgroup analyses in the presence of several initial diagnoses such as ADHD, epilepsy, Smith-Magenis, or Fragile X syndrome are available. In these studies, rapid-release, non-delayed preparations were administered orally. In one of these studies, the clinical efficacy of a combination preparation with a sustained-release and a non-released active substance component was tested. Pharmacokinetic data with multiple determinations of melatonin concentrations in the blood are only available for children with ASD in the form of a case series (N = 9). Discussion: RCTs comparing the efficacy of delayed melatonin preparations with non-delayed rapid-release oral preparations are not yet available. Physiological data and clinical effects documented in five RCTs indicate that non-delayed melatonin preparations with an initial rapid onset of action are effective for non-organic sleep disorders in children and adolescents with ASD. Conclusions: From a clinical, pharmacokinetic, and physiological point of view, the RCTs available to date and the data on melatonin concentrations in the blood of children with ASD, measured several times over 24 h, suggest that a low oral melatonin dose and a non-delayed preparation with rapid onset should be started in children and adolescents with non-organic sleep disorders in ASD, if sleep hygiene advice and psychotherapeutic interventions have not demonstrated sufficient effects.

Estimated Nutrient Intake and Association With Psychiatric and Sleep Problems in Autistic Youth in the Adolescent Brain Cognitive DevelopmentSM Study

Autistic children often consume less varied diets, experience sleep difficulties, and have higher rates of mental health problems as compared to neurotypical peers. Yet, the direct relationship between all of these domains is not well characterized. We leveraged the Adolescent Brain Cognitive DevelopmentSM study (ABCD study) dataset to explore whether estimated levels of consumption of specific macro- and micronutrients correlated with the severity of mental health and sleep problems in autistic youth. We found that low vitamin B3, B6, C, and iron intake was associated with more severe psychiatric problems in autistic children in the ABCD cohort, though these findings did not reach statistical significance after correction for multiple comparisons. In a post hoc analysis, we found that the severity of sleep difficulties was correlated with estimated levels of Vitamins B3, B6, C, and iron intake and with the severity of anxiety/depressive symptoms and/or thought problems. Our analysis on a large number of nutrients, psychiatric symptoms, and sleep serves as an exploratory, initial analysis to identify specific nutrients and psychiatric symptoms that could be the focus of future (confirmatory) studies on the relationship between nutrition, sleep, and mental health in autistic individuals.

Sulforaphane and Brain Health: From Pathways of Action to Effects on Specific Disorders

The brain accounts for about 2% of the body's weight, but it consumes about 20% of the body's energy at rest, primarily derived from ATP produced in mitochondria. The brain thus has a high mitochondrial density in its neurons because of its extensive energy demands for maintaining ion gradients, neurotransmission, and synaptic activity. The brain is also extremely susceptible to damage and dysregulation caused by inflammation (neuroinflammation) and oxidative stress. Many systemic challenges to the brain can be mitigated by the phytochemical sulforaphane (SF), which is particularly important in supporting mitochondrial function. SF or its biogenic precursor glucoraphanin, from broccoli seeds or sprouts, can confer neuroprotective and cognitive benefits via diverse physiological and biochemical mechanisms. SF is able to cross the blood-brain barrier as well as to protect it, and it mitigates the consequences of destructive neuroinflammation. It also protects against the neurotoxic effects of environmental pollutants, combats the tissue and cell damage wrought by advanced glycation end products (detoxication), and supports healthy glucose metabolism. These effects are applicable to individuals of all ages, from the developing brains in periconception and infancy, to cognitively, developmentally, and traumatically challenged brains, to those in later life as well as those who are suffering with multiple chronic conditions including Parkinson's and Alzheimer's diseases.

Critical Appraisal of Systematic Reviews Assessing Gut Microbiota and Effect of Probiotic Supplementation in Children with ASD-An Umbrella Review

Given the significance of gut microbiota in autism spectrum disorder (ASD), we aimed to assess the quality of systematic reviews (SRs) of studies assessing gut microbiota and effects of probiotic supplementation in children with ASD. PubMed, EMBASE, PsycINFO, Medline, and Cochrane databases were searched from inception to November 2024. We included SRs of randomised or non-randomized studies reporting on gut microbiota or effects of probiotics in children with ASD. A total of 48 SRs (probiotics: 21, gut microbiota: 27) were included. The median (IQR) number of studies and participants was 7 (5) and 328 (362), respectively, for SRs of probiotic intervention studies and 18 (18) and 1083 (1201), respectively, for SRs of gut microbiota studies in children with ASD. The quality of included SRs was low (probiotics: 12, gut microbiota: 14) to critically low (probiotics: 9, gut microbiota: 13) due to lack of reporting of critical items including prior registration, deviation from protocol, and risk of bias assessment of included studies. Assuring robust methodology and reporting of future studies is important for generating robust evidence in this field.