autism spectrum disorders ( asd ) , according to the diagnostic and statistical manual of mental disorders 5 edition ( dsm-5 ) , are neurodevelopmental pathologies impairing both social competencies and patterns of behavior . until today
it is probably also for this reason that in the last decades complementary and alternative medicine ( cam ) has spread widely among families of asd children , although apart from melatonin , there is no scientific evidence of their effectiveness .
one of the most commonly used cam practices in asd children is the supplementation of omega-3 that are essential fatty acids present in the following foods : fish , seafood , meat , eggs , vegetable oils , cereal - based products .
we describe the case of a child with asd who seemed to respond to omega-3 supplementation in a relevant and lasting manner .
family history was positive for asd in two first - degree paternal cousins ; previous language delay in the paternal line .
the boy came to our observation for the first time at the age of 2 years 10 months . already at that time
, there were qualitative anomalies in terms of intersubjectivity ( limited exchange capacity ) , communication ( lacking both the verbal and nonverbal ) , and interests ( perseverative activities such as hitting objects against each other ) , so as to justify a diagnosis of asd , according to the dsm-5 criteria .
autism diagnostic observation schedule , module 1 , showed an overall result above the cutoff for autism , with a score above the cutoff for autism in language and communication , as well as in reciprocal social interaction . the childhood autism rating scale 2 edition 
standard version ( cars2-st ) showed results consistent with mild to moderate symptoms of asd ( see later ) .
after obtaining an informed consent , at the age of 4 years 11 months an oral treatment with omega-3 at the dosage of 1 g a day was started . since then , significant improvements were observed in the clinical picture .
the child appeared more active and responsive to solicitations , verbal ( comprehension and expression ) and nonverbal communication skills increased , personal autonomy improved , oppositional behaviors as well as hyperactivity and inattention decreased .
these improvements have been quantified through cars2-st [ figure 1 ] : while the total score was 36.5 ( cutoff for the presence of mild to moderate symptoms of asd = 30 ) before omega-3 treatment start , it decreased to 33 at the most recent assessment , 22 months after omega-3 treatment start . according to cars2-st , improvement of scores
involved the following items : relating to people ; visual and listening response ; verbal and nonverbal communication ; activity level ; and general impression [ figure 1 ] . therefore , omega-3 supplementation seemed to have a favorable impact on the quality of life of the child .
it should be noted that the applied behavior analysis intervention , already underway when the treatment with omega-3 was started , was not subsequently modified .
various attempts to suspend the omega-3 supplementation during the 22 months of follow - up failed because of significant symptom worsening ( restlessness , agitation , decrease of responsiveness to teaching ) , which then disappeared after the resumption of the treatment .
there were no side effects attributable to omega-3 . at the time of the most recent evaluation , at the age of 6 years and 9 months
profile of the scores of the 15 items included in the childhood autism rating scale , 2 edition 
standard version , respectively before ( black horizontal bars ) and 22 months after ( white horizontal bars ) the start of omega-3 treatment .
note that score 1 corresponds to the normal behavior , while score 4 corresponds to the most atypical behavior
the interesting hypothesis of van elst et al . seems to be a good theoretical basis for treatment with omega-3 supplementation in children with asd .
they speculated that the increase in asd prevalence during the last decades is related to dietary modifications of fatty acid composition , characterized by a higher ratio omega-6/omega-3 .
in particular , the omega-3 deficit , especially in the early stages of life , may cause changes of myelination , neurogenesis , synaptogenesis , neurotransmitter turnover , brain connectivity , cellular differentiation and development , inflammatory reactions , cognitive functioning , and behavior .
but so far , based on the results of randomized clinical trials , evidence - based medicine negates the effectiveness of omega-3 in asd children in particular on symptoms such as deficits in social interaction and communication , hyperactivity , stereotypies .
the empirical value of a case report like ours is obviously not comparable to that of a randomized clinical trial , primarily due to the risk of mistakenly considering a placebo effect as a real effect of the drug . we were aware of this possible bias when describing our case
nevertheless , considering anecdotal experiences , including that of our patient , and nonrandomized trials , the presence of a subgroup of asd patients who are really responders to omega-3 can not be excluded .
these responders might not appear when evaluating the omega-3 effects in a sample taken as a whole .
further , considering the high heterogeneity of asd phenotypes and etiologies , it seems to be very unlikely that a given treatment produces the same results in all affected individuals .
we believe that the question about the effectiveness of omega-3 in asd is still open and that it requires carrying out studies that check for the possible presence of a subgroup of asd individuals responders to this treatment . should the actual presence of these responders be determined
, it would surely be very important to identify what the characteristics are that distinguish them from nonresponders .
 one of the most commonly used complementary and alternative practices in children with autism spectrum disorder ( asd ) is the supplementation of omega-3 . 
 we describe the case of a child with asd who seemed to respond to omega-3 supplementation in a relevant and lasting manner . 
 so far , based on the results of randomized clinical trials , evidence - based medicine negates the effectiveness of omega-3 in asd children . nevertheless , 
 considering anecdotal experiences , including that of our patient , and nonrandomized trials , the presence of a subgroup of asd patients who are really responders to omega-3 can not be excluded . 
 these responders might not appear when evaluating the omega-3 effects in a sample taken as a whole . 
 studies that check for the possible presence of this subgroup of asd individuals responders to omega-3 are necessary . 
Introduction
Case Report
Discussion
Conclusion
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