Further Decreasing Irritability in Children and Adolescents with Autism

Antioxidants and Autism:
The neurobiology and etiology of autism are not clearly known. However, genetic, neurologic, metabolic and immunologic factors are suggested to be involved. It is proposed that there is an imbalance of oxidative stress and anti-oxidant defenses in children with autism. The deficit in antioxidant has been suggested as specific to autism, mediating some behavioural symptoms of ASD.

Glutathione plays a significant role in the defense against oxidative stress in autism. It has been noted that the level of glutathione in the cerebellum and temporal cortex of patients with autism are markedly decreased. Glutathione, which is the most important intracellular defense against oxidative stress, consists of glutamate, glycine and cysteine.

N-acetyl-cysteine (NAC) is an antioxidant precursor to glutathione. NAC restores glutathione levels. NAC improves glutamate homeostasis and decreases the relapse rate in drug-dependent patients.Interestingly, NAC has been shown to be effective, and safe, for treating schizophrenia, bipolar disorder, Alzheimer's disease and nail biting.

Risperidone and NAC:Reducing Irritability

About 75 % of patients with autism respond to risperiodne while the rate for placebo is 11.5 %. Abilify (Aripiprazole) with the effect size of 0.87 is effective too. Nonetheless, recent research has investigated the efficacy and safety of NAC as an adjuvant treatment with risperidone for treating irritability of children and adolescents with ASD.

What is the Outcome?

A randomised, double blind placebo controlled clinical trial (2014), undertaken at the Shiraz University School of Medicine, recently showed that NAC as an adjuvant therapy, more than placebo, decreased irritability scores in children and adolescents with ASD. The results of this study suggest that oral NAC as a supplement may be utilised in order to decrease the level of irritability in children with autistic disorders. Considering the low levels of glutathione in autism, it is indeed possible that NAC may increase the production of glutathione and enhance antioxidant stress system. This most recent study reflects the findings from recently published case reports and pilot studies which have shown that NAC, more than placebo, decreased irritability in children and autism.

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