Could Nutritional Supplements Impact Autism Symptoms in Toddlers Born Preterm?

Could Nutritional Supplements Impact Autism Symptoms in Toddlers Born Preterm? 150 150 Rachael Hardison

Supplementing with omega-3 and -6 fatty acids impacts language development in preterm toddlers at risk for developing autism.

Delay in language development is often an early indicator in children at risk for developing autism spectrum disorder (ASD), yet clinicians are still trying to understand the best practices for how and when to implement early intervention strategies.

A team of researchers at Nationwide Children’s Hospital found in a pilot study, recently published in the Journal of Autism and Developmental Disorders, that supplementation with omega-3 and -6 fatty acids positively effects language development in preterm toddlers at risk for developing ASD.

Omega-3 and -6 fatty acids are important for normal metabolism and brain development. Because humans are unable to synthesize these fatty acids, omega-3 and -6 must be obtained through diet or supplementation. During pregnancy, these fatty acids accumulate in the neonatal brain, particularly in the third trimester. Babies who are born preterm may miss this crucial period of omega-3 and -6 accumulation and could benefit from supplementation.

Based on this hypothesis, Sarah Keim, PhD, principal investigator in the Center for Biobehavioral Health at Nationwide Children’s and associate professor of Pediatrics and Epidemiology at The Ohio State University, and her team looked at changes in word and gesture use in 31 preterm toddlers at risk for ASD following supplementation with omega-3 and omega-6.

“Omega supplements have become increasingly popular among families of children with autism,” says Dr. Keim. “There’s also some evidence for use of omega supplements in infants born preterm, so our goal was to determine if this population might be especially well suited to benefit from omega-3 and -6 supplementation as toddlers.”

This study, termed Preemie Tots, was a pilot, single-site, double-blinded randomized clinical trial. Children 18–38 months old who were born before 30 completed gestational weeks received either an oral combined omega-3 and -6 supplement or a placebo oil for three months.  The trial used a unique supplement that contained docosahexaenoic acid (DHA) as the omega-3 component. For the omega-6 component, researchers used gamma-linolenic acid in place of the more commonly used linoleic acid, in an effort to assess its effectiveness as an omega-6 supplement. Over the course of the study, each child’s primary caregiver completed a set of questionnaires to assess the child’s language and behavior, including the MacArthur-Bates Communication Development Inventory.

“We are very interested in trying intervention with omega-3 and -6 supplementation earlier,” says Dr. Keim, “Our approach to this clinical trial was unique because prior studies have focused on children who have been officially diagnosed with autism by a medical professional instead of also relying on reports of early symptoms by caregivers.”

The authors found a general increase in the use of gestures in children who had received the omega-3 and omega-6 supplement compared to the placebo group. Specifically, they observed increases in the use of social gestures by children who were taking the fatty acid supplements. Gestures used by children are generally classified into two groups: functional and social. Functional gestures are used to indicate a need or desire, such as gesturing for food or a toy. Social gestures, such as blowing kisses from across the room, are used in expressing emotion or feeling. At the end of the study, children who received the omega-3 and -6 supplement had increased their use of social gestures.

“Gestures are an important part of communication and an indicator of language development that both develops earlier and will be useful in children who, if they were to develop autism, might not ever become verbal,” says Kelly Sheppard, PhD, a postdoctoral research scientist in the Keim Lab and the lead author on this study.

There is evidence that children diagnosed with autism do not engage socially as much as other children, says Dr. Sheppard, so the increase in social gesture use by children at risk for ASD who received the supplement suggests that these gestures might be an even earlier indicator of whether supplementation could be used to intervene in delay of language development.

One of the goals for this study is to move toward more specific recommendations for supplementation.  Previous recommendations for fatty acid supplementation have been conflicting. While early literature demonstrates the importance of omega-3 for brain development, supplementation with the omega-3 fatty acid alone has not consistently shown significant benefits. Because omega-3 and omega-6 are metabolized together, researchers are starting to investigate if combined supplementation will provide the most benefit.

The results of this pilot study paved the way for an upcoming, expanded clinical trial with 66 young children to further investigate the best practice for omega-3 and -6 interventions in children with diagnosed ASD.

“This planned study is exciting because it will allow us to determine broad effects of omega -3 and -6 supplementation with children diagnosed with autism, and it will move us closer to standardizing dosages for supplementation in these populations,” says Dr. Keim. The future study is funded by the National Institutes of Health.

Additional outcomes, such as the effect of omega-3 and -6 supplementation on autism symptoms other than language, were investigated in the Preemie Tots trial and are the subject of two additional upcoming publications from Dr. Keim’s group.

The Preemie Tots pilot study was funded in part by the Marci and Bill Ingram Fund for Autism Spectrum Disorders Research.



Sheppard KW, Boone KM, Gracious B, Klebanoff MA, Rogers LK, Rausch J, Bartlett C, Coury DL, and Keim SA. Effect of Omega-3 and -6 Supplementation on Language in Preterm Toddlers Exhibiting Autism Spectrum Disorder SymptomsJournal of Autism and Developmental Disorders. 2017 July 26. [Epub ahead of print]

About the author

Rachael is a PhD candidate in Biomedical Sciences at The Ohio State University and is completing her graduate studies at The Research Institute at Nationwide Children’s Hospital in the Center for Microbial Pathogenesis. She contributes to Pediatrics Nationwide and PediatricsOnline, an online newsletter for specialists.