Simple new urine test can detect autism years sooner than traditional screenings

A simple urine test may be able to detect autism sooner than traditional screening, a new study suggests. 

As autism now affects one in 31 American children – a stark increase from one in 150 in the early 2000s – experts are searching for potential causes and screening tools to catch the condition sooner. 

Doctors typically use questionnaires, observational tests and cognitive screening to detect autism, but the process can take months or even years.

Now, scientists at Arizona State University have created a urine test that screens for 17 microbial metabolites, molecules produced by microorganisms in the gut.

They found as many as nine in 10 children with autism had ‘extremely high’ levels of these metabolites in their urine, which helped them distinguish children with autism from neurotypical children. 

The test was also about 90 percent accurate and only had to be completed once, reducing the need for extensive screening.

The experts believe that the metabolites serve as altered versions of mood-boosting neurotransmitters serotonin and dopamine, which affect mood, cognition and memory, all of which may influence autistic behaviors like social and speech difficulties.

The team said that while more research is needed on larger populations, the findings could help come to an autism diagnosis – which can take years – sooner than traditional methods and improve quality of life at earlier ages. 

‘What we’ve discovered is that 80 to 90 percent of children with autism have extremely high levels of one or more microbially derived metabolites,’ Christina Flynn, first study author and Arizona State University PhD graduate, said.

‘Using this test will tell you which young children are at high risk for being diagnosed with autism, and guide treatment in those who have already been diagnosed to help them lead their best lives.’ 

The new study, published in the journal Molecular Psychiatry, looked at 52 children with autism and 47 neurotypical children from Arizona, Massachusetts, Tennessee and Texas. The majority of kids in both groups were from Arizona, and most autistic children were boys.

Participants ranged from two to 11 years old with an average age of seven. 

The researchers looked at 17 metabolites, six of which were significantly higher in the autistic group compared to neurotypical children. The average difference ranged from 29 to 228 percent higher. 

Eight metabolites derived from tryptophan, an amino acid found in proteins like turkey and tuna, were between 38 and 1,882 percent higher in the autistic group. 

On average, autistic children had three elevated metabolites, while typically developing children had none.

‘What’s really striking about the bacteria is that they make metabolites that are basically altered versions of serotonin and dopamine,’ James Adams, corresponding study author and professor at Arizona State University, said. 

‘These are two key neurotransmitters that affect mood, cognition and memory. This could explain many of the symptoms and co-occurring symptoms in children with autism — their social communication, anxiety, depression and attention.

‘We think reducing the levels of these metabolites may help these children lead healthier and happier lives, and we encourage children to be screened sooner to receive earlier interventions.’ 

The researchers noted that faster autism diagnosis and earlier interventions have been linked to improved behavior, but behavioral assessments can come with long wait times.  

‘We hope there is a reduction in stigma and shame associated with the condition,’ Flynn said. ‘Sometimes diagnostic hesitancy happens because parents feel like they’re not good enough parents and they’re being judged. 

‘But that’s not the case because if we can detect it in urine, it’s a biology-based condition. Hopefully that will prevent any hesitancy on parents’ parts to seek treatment and seek it as early as possible.’

The researchers also noted that the findings point to a possible biological pathway behind autism. The team used the findings to propose a new subtype of autism called ‘ASD associated with microbially-derived metabolites,’ or ASD-MDM, which they believe includes 90 percent of cases of autism. 

Preliminary research suggests microbiota-based therapies, such as fecal transplants and prebiotics and probiotics, may reduce metabolite levels and improve autistic behaviors, but the team suggests more studies are needed. 

‘For many families, one of the biggest challenges is the waiting — the not knowing,’ Flynn said. ‘If this test shortens that gap, even by a little, that’s meaningful because earlier intervention can really help.’