Changes in adaptive behavior, gut microbiota and fecal metabolites following an integrative intervention in children with autism spectrum disorder

Emerging research suggests a link between gut microbiota, gut-derived metabolites, and autism spectrum disorder (ASD)-related behaviors and gastrointestinal issues. However, the clinical effectiveness and potential interactions of integrative interventions remain poorly understood. This pilot study compared TABAM, an integrative treatment, with conventional therapy for adaptive behavior in children aged 3–7 years with ASD. Participants received either TABAM or conventional therapy for 12 months. Adaptive behavior and autism symptom severity were assessed at baseline and follow-up using VABS-II and CARS2-ST. Stool samples were collected at both time points for gut microbiota profiling using 16 S rRNA amplicon sequencing and targeted metabolomics. Sixteen of 22 enrolled children completed the study (TABAM n = 10; control n = 6). VABS-II scores improved within the TABAM group, but the change did not differ significantly between groups. In the TABAM group, fecal serotonin increased and citrulline decreased; fecal propionate showed a significant between-group difference, decreasing in the TABAM group relative to controls. Other metabolite changes did not remain significant after correction for multiple comparisons. Gut microbiota beta diversity did not differ significantly between groups or over time, whereas the TABAM group was comparatively associated with the preservation of phylogenetic diversity, and some compositional changes, particularly an increase in Bifidobacterium . These exploratory findings suggest that TABAM may be associated with improvements in adaptive functioning and concurrent changes in gut microbiome composition and metabolite profiles, supporting larger studies to clarify its potential clinical benefit and explore possible gut-brain axis mechanisms.