Gastrointestinal, Behaviour and Anxiety Outcomes in Autistic Children Following an Open Label, Randomised Pilot Study of Synbiotics vs Synbiotics and Gut-Directed Hypnotherapy.

This study looked at 40 autistic children with gut problems who were given either gut-friendly supplements (prebiotics and probiotics) or the same supplements plus special relaxation therapy. Both treatments helped improve tummy problems for 6 months. However, children who got the relaxation therapy as well had less anxiety and were less irritable. The treatments also improved the good bacteria in their gut.

This randomised pilot study examined 40 autistic children aged 5-11 years who received either synbiotics (prebiotics + probiotics) alone or synbiotics combined with gut-directed hypnotherapy for 12 weeks. Both groups showed significant improvements in gastrointestinal symptoms that persisted at 24-week follow-up. However, the combined treatment group demonstrated additional benefits including reduced anxiety and irritability behaviours, and maintained gastrointestinal pain reduction at follow-up. Gut microbiome changes were observed in both groups, including increases in beneficial bacteria.

The study suggests synbiotics may support standard care for autistic children with gut-brain interaction disorders, with potential added benefits from hypnotherapy.

Synbiotics may be beneficial for autistic children with gastrointestinal symptoms as adjunct to standard care. Adding gut-directed hypnotherapy may provide additional benefits for anxiety and behavioural symptoms. Larger controlled trials needed before routine clinical implementation.

Small sample size (n=40) limits generalisability. Open-label design may introduce bias. Single-centre pilot study requires replication in larger, multi-centre trials. Short follow-up period of 24 weeks limits understanding of long-term effects.

Alterations of the microbiome-gut-brain (MGB) axis have been associated with autism spectrum disorder (ASD) and disorders of gut-brain interaction (DGBI). DGBI are highly prevalent in autistic children and are associated with worsening behaviour and anxiety. Treatments such as probiotics, prebiotics and gut-directed hypnotherapy (GDH) have shown efficacy in improving gut symptoms in children. The primary objective of the study was to compare changes in gastrointestinal (GI) scores following a 12-week intervention of synbiotics (prebiotic + probiotic) +/- GDH with a follow-up at 24 weeks.

Secondary objectives included changes in behavioural and anxiety symptoms, while changes in gut microbiome composition were assessed as an exploratory objective. Children diagnosed with ASD aged 5.00-10.99 years (n = 40) were recruited and randomised (1:1) to a 12-week intervention of either synbiotics (SYN group) or synbiotics + GDH (COM group). Both the SYN and COM group experienced significant reductions in total GI scores post-intervention and at follow-up (p < 0.001), with no superiority of the COM treatment over the SYN treatment. The COM group showed beneficial reductions in anxiety scores (p = 0.002) and irritability behaviours (p < 0.001) which were not present in the SYN group.

At follow-up, only those in the COM group maintained significant reductions in GI pain scores (p < 0.001). There were significant changes in gut microbiota such as increases in Bifidobacterium animalis and Dialister in both groups over time. In conclusion, synbiotics with or without GDH may help support standard care for autistic children who suffer comorbid DGBI. The trial was prospectively registered at clinicialtrials.gov on 16 November 2020 (NCTO4639141).