Effects of intravenous secretin on language and behavior of children with autism and gastrointestinal symptoms: a single-blinded, open-label pilot study.
BACKGROUND
Autism is a severe developmental disorder with poorly understood etiology. A recently published case series describes 3 autistic children with gastrointestinal symptoms who underwent endoscopy and intravenous administration of secretin and were subsequently noted by their parents to demonstrate improved language skills over a 5-week period. This report sparked tremendous public interest, and investigators at several sites moved quickly to design controlled trials to test the efficacy of secretin as a therapy for autistic children. However, this is the first effort specifically designed to replicate the initial reported findings in terms of patient age, presenting symptoms, and drug administration.


OBJECTIVE
To rigorously apply the scientific method by assessing the reproducibility of the reported effects of intravenous secretin on the language of young children with autism and gastrointestinal symptoms.


METHODS
We performed a single-blinded, prospective, open-label trial by conducting formal language testing and blinded behavioral rating both before and repeatedly after a standardized infusion of secretin. We selected autistic children who were similar in age and profile to those described in the published retrospective case review. Inclusion criteria for study participation included age (3-6 years), confirmed diagnosis of autism, and reported gastrointestinal symptoms (16 had chronic diarrhea, 2 had gastroesophageal reflux, and 2 had chronic constipation). Twenty children (18 male) were admitted to the Pediatric Clinical Research Center at the University of California, San Francisco after administration of the Preschool Language Scale-3 (PLS-3). A 3 CU/kg dose of secretin (Secretin-Ferring) was administered intravenously (upper endoscopy was not performed). Behavioral ratings were derived using the Autism Observation Scale applied to a 30-minute time sample of the child's behavior consisting of a videotape of the PLS-3 (structured setting) and a second free play session with a standard set of developmentally appropriate toys. Participants then returned for follow-up evaluations, with readministrations of the PLS-3 at 1, 2, 3, and 5 weeks' postinfusion, and videotaping of each session for later blinded review by 2 independent observers using the Autism Observation Scale, uninformed about week of posttreatment. We also surveyed parents of our study children about their impressions of the effects of secretin using a 5-point Likert scale for parents to rate changes seen in their child.


RESULTS
With a total study completion rate across all participants of 96%, repeated measures analyses of variance revealed no significant increases in children's language skills from baseline across all 5 study time periods after a single infusion of secretin. Similarly, neither significant decreases in atypical behaviors nor increases in prosocial behaviors and developmentally appropriate play skills emerged. Furthermore, no relationship was found between parental reports of change and observable improvement in the sample. Despite the objective lack of drug effect, 70% of parents in our study reported moderate to high change in their child's language and behavior. Furthermore, 85% of parents reported that they felt that their child would obtain at least some additional benefits from another infusion of secretin.


CONCLUSIONS
The results of our pilot study indicate that intravenous secretin had no effects in a 5-week period on the language and behavior of 20 children with autism and gastrointestinal symptoms. The open-label, prospective design of our study with blinded reviews of patients both before and after secretin administration follows the scientific method by seeking to reproduce an observed phenomenon using validating and reliable outcome measures. Pilot studies remain a mandatory step for the design of future randomized, clinical trials investigating potential treatments for children with autism.
Lightdale
J R
JR
Combined Program in Pediatric Gastroenterology and Nutrition, Harvard Medical School, Boston, Massachusetts, USA.
Hayer
C
C
Duer
A
A
Lind-White
C
C
Jenkins
S
S
Siegel
B
B
Elliott
G R
GR
Heyman
M B
MB
D000704:Analysis of Variance; D001321:Autistic Disorder / Q000188:drug therapy*; D002648:Child; D002652:Child Behavior / Q000187:drug effects*; D002663:Child Language; D002675:Child, Preschool; D003248:Constipation / Q000188:drug therapy; D003967:Diarrhea / Q000188:drug therapy; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010290:Parents; D010865:Pilot Projects; D015203:Reproducibility of Results; D012633:Secretin / Q000008:administration & dosage / Q000627:therapeutic use*; D016037:Single-Blind Method
D005765:Gastrointestinal Agents; D012633:Secretin