Epigenetics at Birth Links Microbiome to Neurodevelopment, Potentially ASD and ADHD

The results of a study headed by researchers at Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, indicate that the gut microbiome and epigenetics are intertwined, and that both contribute to neurodevelopment.

The researchers showed that epigenetic changes present at birth can impact how an infant’s gut microbiome develops during their first year. They also identified specific epigenetic changes and gut microbes that were associated with signs of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) when the children were three years old.

“Certain bacteria seem to offer protection, which is exciting because it suggests there could be ways to support a child’s development through diet or probiotics in the future,” said research lead and gastroenterologist Francis Ka Leung Chan, MD. Chan is co-senior author of the team’s published paper in Cell Press Blue, titled “Epigenome-microbiome interplay in early life associates with infants’ neurodevelopmental outcomes,” in which they stated, “We showed that epigenetic alterations at birth were associated with early-life microbiome development and that they determine the risks of neurodevelopmental consequences in children.”

The first years of life are critical for brain development and immune system maturation. Though previous studies have shown that both early epigenetic changes and gut microbiome development can impact health in later life, little is known about how these two systems interact. “Recent data suggest that epigenetic programming of gene expression profiles is sensitive to the early-life environment and can impact health outcomes in children,” the authors wrote. “One environmental cue known to trigger host epigenetic modifications is the genes of bacteria, fungi, and viruses inside the human body, collectively known as the microbiome.”

Co-senior author and public health researcher Hein Min Tun, PhD, of The Chinese University of Hong Kong, commented, “We wanted to see how the epigenome and microbiome interact in early life and if their interaction could influence a child’s risk of developing neurodevelopmental conditions like ASD and ADHD.” The authors added, “New understanding of host-microbe-epigenome interactions and mechanisms of epigenetic changes in early life can be leveraged for the prevention, early detection, and novel interventions of common childhood diseases.”

For their study the researchers characterized DNA methylation patterns from the umbilical cord blood of 571 infants. They paired this information with gut microbiome data collected from 969 infants at two, six, and 12 months of age, and from their parents during the third trimester of pregnancy. When the children reached 36 months of age, the researchers used a behavioral questionnaire to assess their neurodevelopment and investigate links between the microbiome, epigenome, and early signs of ASD and ADHD.

“This, to our knowledge, represents the first longitudinal study with multiple sample types to depict the intimate interplay between perinatal exposures, epigenetic hallmarks, and gut microbiome development and neurodevelopmental outcomes within the first three years of life,” the authors stated.

They found that an infant’s epigenome at birth was associated with birth mode, length of gestation, having older siblings, and maternal allergies, but it was not affected by their parents’ gut microbiomes. Microbiome development, on the other hand, was associated with birth mode, antibiotics, having older siblings, and breastfeeding. Infants who were born by Caesarean section (CS) showed different patterns of DNA methylation for several genes involved in immune responses and brain development. “Some of the changes in methylations of immune- and nervous-system-related genes, associated with CS delivery, are linked to neurodevelopmental outcomes,” they noted.

Their reported findings, the team suggested, “… resonate with studies linking CS to increased risks of immune-mediated and neurodevelopmental disorders, providing mechanistic plausibility through epigenomic and microbial dysbiosis.” The team also showed that an infant’s epigenome at birth impacted how their microbiome developed during their first year. Specifically, infants developed less diverse gut microbiomes at 12 months of age when they showed higher rates of DNA methylation in immune genes involved in recognizing pathogens. “We found that methylation rates in the major histocompatibility complex (MHC) region of infants at birth were linked to differences in the diversity of the infant gut microbiome at 12 months,” they commented.

The behavioral survey revealed that signs of ASD and ADHD in three-year-olds were associated with specific epigenetic patterns and the presence of certain gut microbes. “Importantly, we reported that epigenetic modifications were associated with an increased susceptibility to neurodevelopmental conditions in children, and these effects were in part mediated by microbial colonization.”

However, other microbial species seemed to mitigate these effects: infants with epigenetic patterns associated with ASD or ADHD were less likely to show signs of the disorders if they acquired Lachnospira pectinoschiza and Parabacteroides distasonis, respectively, during their first year. “We discovered a kind of conversation happening: a baby’s epigenetic setting at birth can influence their risk for neurodevelopmental disorders, but the presence of certain ‘good’ bacteria in their gut can step in and modify the risk,” Tun reported. “The foundations for brain health are laid very early, even before birth. However, we don’t want people to think this means a child’s developmental path is fixed at birth. These are complex conditions with many causes, and we’ve only uncovered a small piece of a very large puzzle.”

The researchers are continuing to follow the children who participated in the study to see how these early-life factors relate to their health as they grow. They note that laboratory experiments are needed to confirm the associations between gut microbes and neurodevelopment. In their discussion, the team wrote, “In conclusion, our findings revealed dual alterations to the neonatal epigenome and gut microbiome by perinatal factors and highlight the role of the ‘holo-epigenome’—the integrated host epigenome and microbiome—as a key mediator of neuro-immune outcomes. Interventions targeting microbial restoration or epigenetic modulation during critical developmental windows may mitigate risks of neurodevelopmental disorders.”

First author and gastroenterologist Siew Chien Ng, MD, PhD, added, “The ultimate goal is to develop safe, non-intrusive early interventions such as specific probiotics or live biotherapeutics, that could help nurture a healthy gut microbiome and potentially reduce the risk of neurodevelopmental challenges.”

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The efficacy and safety of transcranial direct current stimulation in patients with ADHD: a systematic review and meta-analysis

ObjectiveThis meta-analysis evaluated the efficacy and safety of transcranial direct current stimulation (tDCS) for treating Attention-Deficit/Hyperactivity Disorder (ADHD).MethodsFollowing PRISMA guidelines, we analyzed 28 randomized controlled trials (RCTs) involving 1,864 participants. Outcomes encompassed core ADHD symptoms, hot and cold executive functions (EFs)—including inhibitory control, working memory, and cognitive flexibility—as well as safety profiles based on adverse events. A multilevel meta-analysis was performed using a random-effects model. Subgroup analyses and meta-regressions were conducted to explore potential moderating factors.ResultsCompared to sham stimulation, tDCS did not significantly improve core ADHD symptoms (standardized mean difference (SMD) = –0.29, 95% CI [–0.59, 0.01], p= 0.05). Similarly, no significant overall effects were observed for cold EFs: inhibitory control (Hedges’ g(g)= –0.11, 95% CI [–0.26, 0.05], p=0.19), working memory (g= 0.13, 95% CI [–0.06, 0.32], p= 0.26), or cognitive flexibility (SMD = –0.42, 95% CI [–1.13, 0.29], p= 0.24). The effect on hot EFs was also non-significant (g = 0.27, 95% CI [–0.14, 0.70], p = 0.19). Exploratory analyses indicated that anode placement at Fp2 was associated with improvement in both inhibitory control (g= –0.52, 95% CI [–0.93, –0.11], p=0.01) and working memory (g = 0.72, 95% CI [0.22, 1.22], p = 0.004), although the overall test for interaction was not significant for inhibitory control (p= 0.19). The most common adverse reactions were mild and transient local skin symptoms, such as itching and redness (RR = 1.42, p=0.04).ConclusiontDCS was well-tolerated but did not demonstrate significant overall efficacy for core ADHD symptoms or executive functions. Anodal stimulation at Fp2 showed potential selective benefits warranting further investigation. tDCS is not currently recommended as a standalone treatment for ADHD. Future research should optimize stimulation protocols and explore combined interventions with behavioral or cognitive therapies.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42024612055.

Strength of Evidence to Support Decision-Making on the Use of Digital Mental Health Technologies in NICE Evaluations: Cross-Sectional Analysis of Studies

Background: Digital mental health technologies (DMHTs) are playing an increasing role in mental health services. The quality of evidence for DMHTs is variable, and there are concerns that evidence is not sufficient to support decision-making. Objective: This study used a cross-sectional analysis of evidence supporting DMHTs included in National Institute for Health and Care Excellence (NICE) evaluations to examine the strength of evidence available for decision-making. Methods: We identified all NICE evaluations relating to DMHTs by reviewing details of published NICE evaluations on the NICE website. From each of these evaluations, we identified included DMHTs and reviewed committee documentation to identify studies that provided supporting evidence for each of these technologies. We extracted information on a series of items relating to study quality and summarized the characteristics of evidence both at the level of individual studies and across the package of evidence from multiple studies supporting DMHTs. We also identified key evidence gaps in available evidence. Results: We included nine NICE evaluations relating to anxiety, depression, psychosis, insomnia, attention deficit hyperactivity disorder (ADHD), and tic disorders. These evaluations included 30 DMHTs and referenced 78 supporting studies. We identified common evidence gaps relating to effectiveness compared to relevant comparators, use of appropriate outcomes, including health-related quality of life, cost of delivery, and impact on resource use, and reporting of adverse events. Conclusions: Our study highlights that some DMHTs have been supported by high-quality studies and that evidence to support DMHTs is likely to be developed across a series of studies. However, there are often key evidence gaps that need to be addressed to provide a stronger case for adoption. Developers should ensure that they consider these gaps while planning evidence generation, and where possible, address them earlier in the product lifecycle.
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Associations between adult ADHD core symptoms, cognitive flexibility, and emotional eating: a case-control study

IntroductionAttention-deficit/hyperactivity disorder (ADHD) in adults often co-occurs with eating disorders (EDs), potentially through shared difficulties in emotional regulation, and executive functions. This study explored the associations between cognitive flexibility as a component of executive functions, core adult ADHD symptom dimensions and emotional eating-related eating behaviorsin adults with ADHD and healthy controls, within the framework of executive functions.MethodsThis case-control study included 76 adults with ADHD and 69 healthy controls. Participants completed the Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS), Emotional Eating Questionnaire (EEQ), Hospital Anxiety and Depression Scale, Cognitive Control and Flexibility Questionnaire (CCFQ), and Berg’s Card Sorting Test. Group differences were tested with t-tests, correlations with Spearman’s ρ, and hierarchical regression (Approval No: I11-798-23).ResultsThe ADHD group had significantly higher EEQ scores (t = 5.39, p =0.001). The ADHD group also showed lower CCFQ total score (t (125) = –5.52, p <0.001). EEQ scores were positively correlated with SR-WRAADDS Attention Deficit (ρ =0.331, p =0.003), and CCFQ Cognitive Control over Emotion (ρ = −0.256, p =0.02). Regression analysis identified attention deficit as the only significant predictor of the EEQ total scorein the ADHD group.DiscussionOur findings suggest that impairments in executive functioning—including cognitive flexibility, attentional regulation, and emotion-related control mechanisms—may play a more central role in the relationship between ADHD and emotional eating-related eating behaviors. Longitudinal studies are warrented to further elucidate these mechanisms.

Relatix Health Applies for ARIA Funding to Build Digital Trust for Neurodiverse Communities

We’re proud to share that Relatix Health has applied for funding from the UK’s Advanced Research and Invention Agency (ARIA) under its Trust Everything, Everywhere programme. This initiative explores how trust can be built across the digital and physical worlds, and we believe that conversation must include people whose minds work differently.

Our proposal focuses on one of the most pressing and least understood challenges of the digital age: how people with neurodevelopmental and neurodiverse conditions, including autism, ADHD, schizophrenia, borderline traits, and psychopathy, experience, interact with, and build trust in AI systems. In a world increasingly mediated by algorithms, the ways these systems interpret, respond to, and store our most personal thoughts and data matter profoundly.

Throughout history, individuals living with stigmatized neurocognitive conditions have been marginalized or misrepresented by institutions, by society, and now, potentially, by AI. Some may over-trust technology that feels neutral or supportive; others may under-trust it because of past harm or bias. We want to ensure that digital systems meet people where they are, building trust rather than eroding it, while protecting privacy and supporting quality of life, health, and wellbeing.

Through this work, Relatix Health aims to lead the way in ethical and inclusive neuro-AI design: protecting privacy, reducing stigma, and helping define standards for responsible data handling in the era of AI. Our goal is to make sure that the next generation of AI-driven tools, from chatbots to diagnostics, truly serves everyone, regardless of how their brain is wired.

We know how often things have already gone wrong, from chatbots unintentionally encouraging depressive or paranoid thoughts, to credit and gambling platforms optimizing for addiction or impulsive behaviour. These systems were not built with sufficient safeguards for people with neurodevelopmental conditions, who may react differently to AI-optimized interactions. Many respond by disengaging digitally, and may feel that an AI-driven world is a minefield because it was not built for them.

Join us in shaping a radically different future where cognitive diversity and digital trust can coexist, and AI tools are built to truly support and empower. To learn more about our mission or to collaborate, contact our team.