Pilot Study On The Association Between ASD Severity And Environmental Factors In Children

Objectives:To explore the relationship between the severity of autism spectrum disorder(ASD)children’s symptoms and environmental factors,find the protective factors and risk factors related to ASD symptoms,find out the environmental factors that can be modified,and provide new insights for further clinical intervention of ASD.Methods:From October 2017 to January 2019,512 children(417 males and 95 females)with ASD between 2 and 13 years old who met the ASD diagnostic criteria of dsm-5 in the Department of developmental behavior Pediatrics,the first hospital of Jilin University were analyzed retrospectively.According to the scores of Children Autism Rating Scale(CARS),all children were divided into severe group and light group according to the severity of symptoms In the two groups,socio-economic and demographic factors(gender,age,birth month,birth mode,residence,caregiver,siblings,age of parents during pregnancy,education level of parents,family income,family history of mental illness,vitamin supplement during pregnancy)that may affect the severity of ASD symptoms were analyzed;sleep problems,eating problems,stomach problems were discussed The incidence rate of intestinal problems,attention deficit hyperactivity disorder and the above mentioned comorbid diseases were correlated with the severity of ASD symptoms.The relationship between ASD severity and nutritional factors(serum vitamin A,vitamin D,vitamin E,zinc,iron,copper and lead levels)was evaluated.Logistic regression analysis was used to analyze the social economic,demographic,comorbidity and nutritional factors related to the severity of ASD symptoms.Results:There were 249 children with ASD in the mild group,208 boys(83.5%)and 41 girls(16.5%);263 children with ASD in the severe group,209 boys(79.5%)and 54 girls(20.5%).Among the socio-economic and demographic factors,age(P = 0.01),place of residence(P= 0.034),caregivers(P = 0.046),parents’ education level(P = 0.034,0.008)were related to ASD symptoms.Among the common diseases,the incidence of eating problems was the highest(45.7%),followed by sleep problems(31.2%),gastrointestinal problems(25.6%),attention deficit hyperactivity disorder(11.3%).Gastrointestinal problems(P= 0.03)were associated with ASD symptoms.The total score of ABC(P = 0.026),the score of ABC sensory area(P = 0.019),the total score of ATEC(P=0.020),the health / physiological / behavioral ability of ATEC score(P = 0.003)were higher than those of the children with negative gastrointestinal symptoms.Among the nutritional factors,of the 512 children with ASD,3.1% had vitamin D deficiency,VD insufficiency 62.1% and VD normal 34.8%;The average level of serum copper was 18.4±4.2μg/L,and that of lead was 29.1±15.7μg /L.The levels of vitamin D,copper and lead in serum were associated with ASD symptoms.The level of VD was negatively associated with the score of ATEC expression / language communication area(r =-0.149,P = 0.008);the level of copper was positively associated with the score of ABC communication area(r = 0.159,P = 0.007);the level of lead was positively associated with the total score of ABC(r = 0.173,P = 0.004),the score of ABC sensory area(r = 0.157,P = 0.008),the score of ABC self-care area(r = 0.161),P = 0.007),ABC communication area score(r = 0.128,P = 0.032),CARS total score(r = 0.202,P = 0.001)and ATEC social ability area score(r = 0.139,P = 0.037).Logistic regression analysis showed that maternal education,gastrointestinal problems and blood lead concentration were the risk factors of ASD symptoms.Conclusions:(1)Compared with the mild group,the average age of diagnosis of children in the severe group of ASD is younger,the proportion of living in cities and parents as the main caregivers is lower,the education level of parents is lower,and the incidence of gastrointestinal problems is higher.(2)The decreasement of serum VD level,the increasement of blood lead and copper level are associated with more severe ASD symptoms.(3)The high level of mother’s education is the protective factor of ASD,and the high level of blood lead combined with gastrointestinal problems is the risk factor of ASD.