الفهرس 
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Abstract
Immune system and neuroinflammation appear to play a fundamental role in ASD development, despite some concern about whether it causes ASD onset or regulates ASD pathogenesis and symptomatology (Bjørklund et al., 2016). Kočovská et al. (2017) suggested that altered immune responses in ASD may be related to the severity of behavioral impairment and other developmental outcomes. Vitamin D is one of environmental factors potentially modulating brain development and functioning. Vitamin D3 deficiency during pregnancy and early childhood is suggested to be one of several risk factors for development of ASD in genetically predisposed individuals (Cieślińska et al., 2017). The aim of this work was to study the adjuvant effect of vitamin D supplementation on inflammatory cytokine (IL4) and habilitation outcome in children with Autism Spectrum Disorder in order to evaluate its efficiency as a treatment option based on correction of immune dysfunction. The present study was conducted on 80 ASD children who attended the Mansoura phoniatric unit. After conducting the assessment protocol for ASD children, blood samples were collected from all studied participants for assessment of serum vitamin D. They were randomly assigned to one of two groups. group I (intervention) consisted of 40 children who received habilitation in addition to vitamin D supplementation at a daily dose of 300IU/ kg not exceeding 5000 IU daily. group II (control) consisted of 40 children who received habilitation only. Only 70 children completed the study duration (34 children in group I and 36 in group II). All ASD children were subjected to a protocol of assessment (language, CARS, DSM5), and serum vitamin D and IL4 assessment using the ELISA technique. Assessment of serum vitamin D among ASD children revealed that about 60% of ASD children have vitamin D insufficiency, about 31.4% of ASD children had vitamin D deficiency. After vitamin D supplementation there is statistical significant improvement in language parameters (total language age, language deficit and language improvement quotient) in group I than in group II. Also, there is statistical significant difference between both groups as regard CARS and DSM-V levels of severity. Interestingly there is significant statistical significant elevation of serum IL4 in group I than in group II. The present study shows no statistically significant correlation between serum vitamin D (before therapy) and assessment parameters, e.g., IQ, language age, CARS, and language deficit (before therapy). However, it shows a significant positive moderate correlation between post-therapy serum vitamin D and post-therapy serum IL-4 concentration. Significant positive weak correlation between post-therapy serum vitamin D and post-therapy language age. Also, a significant negative, weak correlation exists between post-therapy serum vitamin D and post-therapy CARS total score and language deficit. However, a significant positive weak correlation exists between post-therapy serum IL-4 concentration and post-therapy language age and language improvement quotient. On the other hand, no statistically significant correlation exists between serum IL4 and post-therapy language age, CARS, language deficit, and language improvement quotient in the control group. Vitamin D supplementation improves language and decreases severity besides the habilitation program. A significant improvement in language was observed over a short period of duration. Interestingly, vitamin D increases the serum level of anti-inflammatory cytokine IL4, which is well-known to have a beneficial effect on the brain