الفهرس 
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Abstract
Autism spectrum disorder is a neurodevelopmental syndrome encompassing impairments in social interaction, language, communication, and imaginative play described by Lasting problems with social communication and social interaction in different settings, repetitive behaviors and/or not wanting any change in daily routines. The effects of autism and the severity of symptoms are different in each person. Early signs and symptoms of ASD can be detected in some children during the first year of life with diagnoses often possible before age 3 depending on CARS and ATEC assessment that have been used in this study. The exact cause of ASD is unknown, but it’s thought that several complex genetic and environmental factors are involved or perinatal or maybe dietary.Nowadays it’s highly prevalent, it has significantly increased in the last few decades. In 2016 the World Health Organization estimated that 1 in 160 has autism.
Autism spectrum disorder can be treated by approaches including behavioral and communication approaches, as well as medication,or other strategies for treatmentbased on nutritional supplements including vitamins as vitamin D or by different types of diet.Vitamin D3 seems to play a significant role in the etiology of ASD because this vitamin is important for brain development. Lower concentrations of vitamin D3 may lead to increased brain size, altered brain shape, and enlarged ventricles, which have been observed in patients with ASD, it regulates more than 200 different genes, directly or indirectly.
The body can produce its own vitamin D when exposing skin to sunlight but its deficiency is a global health problem caused mainly by insufficient exposure to sunlight. Some food items that naturally contain reasonable amounts of vitamin D include oily fish such as salmon, mackerel and blue fish and also present in small quantities in vegetables, meat and egg yolks.
At present, the recommended daily intakes of vitamin D is 400 IU/day in infants less than 1 year and 600 IU/day in children more than 1 year.
Aim of the study was to study the impact of vitamin D supplements intake on control of autistic symptoms in children with autism spectrum disorders.
Thestudy is a Randomized controlled group study, and was conducted on children of both sexes, between 4 and 11 years of age, suffering from autism from the clinics of Alexandria University Specialized Children’s Hospital and rehabilitation centers dealing with children with ASD. The intervention group received a daily dose of 300 IU/kg not exceeding daily 5000 IU for three months,while Control group received daily 0.5 ml of saline as placebo.
Parents of the children underwent an interview about their sociodemographic data as children’s age, sex,birthorder, education, residence,parent’s education, occupation, positive family history and consanguinity.And a 24 hour recall questionnaire were done at baseline and repeated three months after supplementation to assess children’s food consumption. Anthropometrics including weight, height and BMI for age zscore was collectedand compared to WHO anthropometrics.
Serum vitamin D level, CARS and ATEC assessments were performed for all children cases and controls at the beginning of the study and after 3 months at the end of the trial, oral vitamin D supplementation was supplemented for three months to autism children cases and controls took placebo.
Results of the study showed that the majority of children were males (62.5%) and the females were(37.5%). There was no statistically significant difference between cases and controls in age, birthorder, education, residence, parents education and occupation.
35% of total sample had positive family history of consanguinity and 27.5% had other autistic family members.
There was no statistically significant difference between cases and controls in weight, height and BMI for ageZscore.Children who received the recommended daily dose of vitamin D had significant increase in weight by 6.55±7.21, increased in height by 1.06±0.90and increased in BMI for age Zscore by mean 1.88 ± 1.37 to 2.25 ± 1.29.
The serum vitamin D level increased significantly by 157.26±173.10% in cases and decreased by 19.39±20.04 % in controls.
Our study showed that increase in serum vitamin D level caused significant decrease in ATEC by 21.13±15.55 and CARSby11.24±18.82 in cases.On the other hand, there was no major improvement in the severity of autistic features in the control group receiving the placebo.
Serum vitamin D level in cases after Vitamin D supplementation shows significant negative intermediate correlation (r= -0.454, p= 0.044) with CARS score and negative weak correlation with ATEC score (r= -0.375, p=0.103), although this relation was not statistically significant.
There was a statistically significant difference between cases and controls in total energy intake, protein, fat, omega 3,vitamin B3,biotin and selenium. The energy intake was borderline in cases 83.21% and inadequate in controls 72.48%, the protein intake was twice adequacy in cases 256.77% and controls 220.01%, CHO intake was inadequatein both cases 76.49% and controls 70.39%, fat intake was adequate in cases 106.47% but borderline in controls 88.78% from the beginning of the study. Energy, protein, fat, CHO,omega3,vitamin B6 and biotin increased significantly after supplementation with vitamin D by (11.75 ± 20.35, 8.27 ± 9.80, 5.69 ± 13.60,10.51 ± 30.37,35.48 ± 64.08, 25.71 ± 43.40, 11.74 ± 28.87 respectively ).