This ongoing clinical trial in autism spectrum disorder (ASD) tests a nontoxic approach to therapy of ASD. Background: Direct treatment of underlying mechanisms in ASD is limited. Cellular dysfunction in ASD may involve a number of related metabolic pathways. The “fever effect” in ASD, in which febrile illness dramatically but temporarily ameliorates disordered behavior, offers a clinical clue. Fever stimulates heat shock proteins (HSP) and cellular stress responses that may ultimately lead to improved synaptic function and increased long-range connectivity. The expression of gene transcription by NFE2L2 (Nrf2), which is reduced in ASD, may also increase during fever. Sulforaphane (SF), an isothiocyanate obtained from 3-day-old broccoli sprouts, induces HSP and Nrf2 as well as “cell-protective” responses. SF has several possible modes of action that may benefit ASD through common cellular mechanisms underlying heterogeneous phenotypes. SF crosses the blood-brain barrier and is bioavailable orally. Preliminary data: In a randomized, double-blind, placebo-controlled pilot trial in 44 male adolescents and adults (13-30 years), results showed SF was well tolerated without significant side effects. On average, participants on SF (particularly those with a history of fever effect) showed significantly more improvements in ASD symptoms – including social interaction, aberrant/abnormal behavior, repetitive/stereotypical behavior, and verbal communication – than placebo participants. Current study: Our randomized, double-blind, placebo-controlled phase-2 clinical trial at UMass has three aims: To determine: (1) if orally administered SF has measurable effects in children (ages 3-12 years) with ASD; (2) if treatment with sulforaphane is safe and well tolerated; (3) To elucidate cellular biomarkers that support the mechanisms of action of SF in ASD. We hypothesize that positive effects of SF will be more marked and lasting in the developing brain. To date, 7 participants have completed the trial, and 22 are actively enrolled. Recruitment is ongoing, with a target sample size of 50.

Abstract This clinical trial in autism spectrum disorder (ASD) tests a nontoxic approach to therapy of ASD. Background: Direct treatment of underlying mechanisms in ASD is limited. Cellular dysfunction in ASD may involve a number of related metabolic pathways. A clinical clue may be found in the “fever effect” in ASD, in which febrile illness dramatically but temporarily ameliorates disordered behavior. Fever stimulates heat shock proteins (HSP) and cellular stress responses that may ultimately lead to improved synaptic function and increased long-range connectivity. The expression of gene transcription by NFE2L2 (Nrf2), which is reduced in ASD, may also increase during fever. Sulforaphane (SF), an isothiocyanate obtained from 3-day-old broccoli sprouts, induces HSP and Nrf2 as well as “cell-protective” responses. SF has several possible modes of action that may benefit ASD through common cellular mechanisms underlying heterogeneous phenotypes. SF crosses the blood brain barrier and is bioavailable orally. Preliminary data: In a randomized, double-blind, placebo-controlled pilot trial in 44 male adolescents and adults (13-30 years), results showed SF was well tolerated without significant side effects. On average, participants on SF (particularly those with a history of fever effect) showed significantly more improvements in ASD symptoms than placebo participants. Significant improvements for SF participants included social interaction, aberrant/abnormal behavior, repetitive/stereotypical behavior, and verbal communication. Current study: Our randomized, double-blind, placebo-controlled phase-2 clinical trial at UMass has three aims: To determine: (1) if orally administered SF has measurable effects in children (ages 3-12 years) with ASD; (2) if treatment with sulforaphane is safe and well tolerated; (3) To elucidate cellular biomarkers that support the mechanisms of action of SF in ASD. We hypothesize that SF will have positive effects, and that these effects will be more marked and lasting in the developing – compared to the mature – brain.

Sleep problems are common in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Sleep problems in these disorders may not only worsen daytime behaviors and core symptoms of ASD and ADHD but also contribute to parental stress levels. Therefore, the presence of sleep problems in ASD and ADHD requires prompt attention and management. This article is presented in 2 sections, one each for ASD and ADHD. First, a detailed literature review about the burden and prevalence of different types of sleep disorders is presented, followed by the pathophysiology and etiology of the sleep problems and evaluation and management of sleep disorders in ASD and ADHD.

Comment on: Sulforaphane treatment of autism spectrum disorder (ASD). [Proc Natl Acad Sci U S A. 2014] Uncommon use of common measures in sulforaphane trial. [Proc Natl Acad Sci U S A. 2015]