D-Cycloserine Enhances Social Skills Training in Children with Autism Spectrum Disorder

by | Jun 19, 2019 | 2017, Autism, Brain Health

Written by Angeline A. De Leon, Staff Writer. The findings of this study suggest that DCS may be a safe and effective strategy to help youth with ASD to maintain the skills gained during short-term social skills training.

infant and children's healthFor individuals with autism spectrum disorder (ASD), social skills training is crucial for helping to improve social and communication skills 1. Unfortunately, while immediate behavioral improvements are evident during treatment, longer-term maintenance of acquired skills is largely limited 1,2. To address this issue, researchers have recently looked at the use of D-cycloserine (DCS, an analogue of the amino acid D-alanine capable of affecting certain receptors in the brain) to strengthen the response of behavioral therapy 3. DCS appears to be most effective when administered intermittently prior to behavioral conditioning or psychotherapy sessions 4. Studies looking at the effects of DCS on ASD have generally focused on short-term intervention programs and have yet to produce consistent evidence of sustained improvement in ASD features 5. A recent study by Mishawi and colleagues involving a randomized trial of low-dose DCS administered half an hour prior to weekly social skills training in ASD youths for 11 weeks found improvement in social functioning in the ASD group, but no statistically significant difference from placebo at the end of treatment 6. In a follow-up investigation 7 to that study, researchers evaluated the impact of DCS on treatment response durability, looking at the effects of DCS in both groups 11 weeks following active treatment.

A total of 60 children (aged 5 to 11 years) with ASD (diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder, not otherwise specified) completed a randomized, double-blind, placebo-controlled trial in which they received single doses of DCS (50 mg) or placebo 30 minutes prior to group social skills training once a week for 10 weeks. At the end of the 10-week active treatment portion, blinded follow-up assessments were conducted at Week 11 and Week 22, primarily using the parent-rated social responsiveness scale (SRS), to evaluate durability of treatment response.

As noted, findings at the end of the 10-week active treatment program indicated that mean SRS total raw score was reduced in both groups, with no apparent significant between-group difference. Follow-up analysis at Week 22 revealed that SRS total raw score from Week 11 to Week 22 was significantly decreased for the DCS group vs. placebo (mean estimate = 85.1 +/- 7.3 vs. 91.5 +/- 7.6, p = 0.042), indicative of increased durability of treatment effects for the active drug group. A secondary analysis of the SRS subscales showed that the greatest difference between the two groups was on the social cognition subscale (p = 0.003). Finally, the addition of a pilot eye-tracking measure at Week 22 was completed by 38 subjects and indicated that children in the DCS group spent a longer percentage of time looking at pictures of faces as a whole, as compared to placebo (p < 0.0001).

The first known study looking at the efficacy of combining social skills training in ASD with adjuvant medication, the present trial reports enhanced durability of treatment response in ASD youth through the use of DCS. Preservation of improved social skills was evident based on parent-documented reports of social responsiveness, as well as from pilot eye-tracking data showing DCS-treated children as more successful at eye gaze to face (a specific skill trained as part of program) at follow-up. Overall, results suggest that DCS may significantly augment the durability of therapeutic effects produced in patients with ASD. Primary limitations of the study involve the employment of a social skills training curriculum that has not yet been validated and the enrollment of ASD youth who showed a relatively high level of communication and functioning at the start of the study. Replication of current observations would be critical at a larger scale, ideally with the inclusion of additional investigations into the underlying mechanism associated with DCS’ effects at the biological level.

Source: Winke LK, Minshawi NF, Shaffer RC, et al. D-Cycloserine enhances durability of social skills training in autism spectrum disorder. Molecular Autism. 2017; 8: 2. DOI: 10.1186/s13229-017-0116.

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

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Posted June 19, 2019.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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