In a study of just 18 children with both autism and gastrointestinal complaints, researchers transplanted healthy stool from donors into the children and observed some improvement in both gut complaints and behavior.
The story wisely includes a warning from a researcher that results are very preliminary and may have been influenced by a placebo effect.
However, the story also relies heavily on the news release, with no independent sources, no disclosure of conflicts of interest among the researchers, and no discussion of costs or harms.
Autism is a frequent diagnosis in the United States, with estimates of children affected as high as one in every 68. Some children with autism also have severe problems with digestion.
In this new study, the headline may confuse some parents into thinking the transplant of feces could solve behavioral problems. In closer reading of the original press release, it appears most of the benefit seen was in easing gastrointestinal problems, although there was some reporting of behavior improvement as well. The link between gut and behavior is not well understood.
This small study does not prove much except that more research is needed.
The short story does not discuss the costs of the experimental fecal transplant. In some patients, the donor stool material is introduced using a colonoscopy or other mechanical procedure, which can cost $2,000. This story does not explain how the stool was given to the children, so the costs are further confused by that.
Here is what the story offered for the benefits:
“On average, the score on a scale for ranking gastrointestinal symptoms dropped 82 percent from the beginning to the end of treatment, while average developmental age increased by 1.4 years, according to the release. Researchers also asked the children’s doctors to perform pre- and post-diagnostic evaluations, which suggested lasting benefits.”
This is not enough information to assess the scope of the potential benefits. For example, related to the 82% drop, what was the average number on the scale before the study and after? If it wasn’t that high to begin with, then an 82% drop isn’t very notable.
There are risks to introducing a donor’s stool into a recipient. No mention of risk was included. A donor could have undetected disease or infection before donating.
The story specified that this is a “small” study and results could be suspect because of a placebo effect, meaning the parents who were answering questions about their children knew which children received the donation of stool. This is enough to signal that the treatment is still experimental.
The story didn’t have any information on what autism is, nor how many people it affects in the U.S.
There is no independent source quoted in the story.
Upon further investigation of the original journal publication on the study, we found a statement about several of the authors holding patents related to fecal transplantation. These seven authors have “pending/approved patents related to the use of FMT and or probiotics” for a variety of conditions, including autism. Five authors have received research funding from Crestovo and several are advisors for Crestovo. None of these were quoted in the story. Crestovo is a for-profit biotech company.
The story and the news release should both have made note of these conflicts.
The story does not include any information on other ways to manage gastrointestinal issues for children and teens with autism, which may include changes in diet. The story also does not mention cognitive behavioral therapies that are common for this diagnosis.
Just to clarify, while some children with autism have gut problems, some do not. The diagnosis of autism may not include gut distress. Treating children for their gut symptoms may or may not have any influence on their behavior.
The story could have been more explicit about how this treatment is nowhere ready for widespread use, but it did indicate the study was small, and it included the warning that “researchers cautioned that families should not try to replicate the treatment at home.”
The story provides some context with this statement: “The researchers built off of previous findings that children with autism typically have fewer types of important bacteria in their guts and less bacterial diversity overall.”
The story appears to rely heavily on the news release, but it does at least cite the news release and provide a link to it. The news release includes this statement, which appears repeated almost word-for-word in the story.
From the news release:
“We have to be mindful of the placebo effect and we have to take it with a grain of salt,” said Sullivan, an associate professor of microbiology at Ohio State. “But it does give us hope.”
The passage as it ran in the news release:
“We have to be mindful of the placebo effect, and we have to take [the findings] with a grain of salt,” Matthew Sullivan, an associate professor of microbiology at The Ohio State University, said in the release. “But it does give us hope.”