Adapting the ELEAT: Early Life Exposure Assessment Tool) to Portugal - a pilot study to tackle gene-environment interactions in Autism Spectrum Disorder

Abstract

BackgroundAutism Spectrum Disorder (ASD) is a pervasive and clinically heterogeneous neurodevelopmental disorder characterized by deficits in social communication and interaction skills, and repetitive and stereotyped behaviours. It is known that ASD has a strong genetics component, but heritability estimates of 50-80% suggest that modifiable non-genetic factors may play an important role in the onset of the disorder. Recently, pre-, peri and post-natal exposure to a variety of environmental factors has been implicated in ASD. Yet, the comprehensive assessment of environmental exposures in this pathology, using large population datasets, is still lacking. The objective of this study was to pilot an environmental exposure assessment tool in Portugal.\n\nMethodsTo examine environmental exposures in a population of Portuguese children with ASD, we translated, adapted and piloted the Early Life Exposure Assessment Tool (ELEAT). The ELEAT was originally developed to assess environmental factors in studies of neurodevelopmental disorders. It is a questionnaire filled by mothers of children with ASD, enquiring about Demographic Information, Maternal Conditions/Medical Interventions, Breastfeeding and Child Diet, Maternal Diet, Supplements, Lifestyle, Home and Environment, Environment, Occupation and Exposures. The ELEAT gathers information about environmental exposure along key phases for early neurodevelopment, from 3 months prior to conception, pregnancy, labor and delivery to the first year of life of the child. Two focus groups were realized, one with mothers of typically-developing children and another with mothers of children with ASD, in order to discuss the mothers opinion regarding the tool comprehensiveness and relevance.\n\nResultsThe large majority of mothers were sure about their answers for all modules, with a small fraction of the group reporting difficulties for the Occupations/Exposures module. Most mothers considered the ELEAT to be a little too long, but generally found that the instructions were clear and, most importantly, agreed that the questions were important.\n\nConclusionsIntegration of the pilot feedback will allow us to enhance the tool and optimize its usage in Portuguese-speaking communities, improving its capacity to assemble accurate environmental data from diverse cultural settings, and to be extended to larger population datasets. Combined with genetic and clinical data, the ELEAT will contribute to the identification of modifiable lifestyle and environmental risk factors for ASD. Such evidence may eventually provide the opportunity for disease prevention or reduced severity by mitigating exposure when genetic susceptibility is identified early in life.