Amy Sadek


BACKGROUND- Children with Autism Spectrum Disorder (ASD) demonstrate a physiological imbalance between free radicals, resulting from oxidative stress, and antioxidants. Oxidative stress is linked to the pathogenesis of this neurocognitive disorder. The objectives of this pilot feasibility study: 1) to examine the effect of consumption of high concentration antioxidant cacao on behavior of children as perceived by the child’s teacher and 2) as perceived by the child’s parent. METHODS- This clinical trial was a prospective experimental study. Participants consumed 8 squares (or 16 grams) per day of the dark chocolate which had a concentration of 70% cacao and 30% organic cane sugar (total antioxidant concentration was 8,320 μmoles / 100 grams. The two main behavioral measures were the Aberrant Behavior Checklist- 2nd Edition (ABC-2) and the Autism Spectrum Rating Scale (ASRS) which were completed by the child’s teacher at baseline and end of week four; and by the child’s parent at baseline, week two, and week four. RESULTS- Twelve teachers and children with ASD (9 males, 3 females, mean age of 10.9 ±3.9 years) participated in this study. Teachers noted significant improvements on the Autism Spectrum Rating Scales of Social/Communication (p=0.03,

η2=0.79), Unusual Behaviors (p=0.02, η2=0.70), and Self-Regulation (p=0.04, η2=0.59). No significant changes were noted on any of the Aberrant Behavior Checklist-2 subscales (p>.05). For the second study, sixteen parents and children with ASD participated in the study (12 males, 4 females, aged 4 to 17 years). Parent reports showed significant improvements on the ABC-2 subscales of Irritability (p= .03, η2 = 0.25), Social Withdrawal (p=.01, η2 = 0.29), Stereotypic Behavior (p=.05, η2 = 0.13), Hyperactivity/Noncompliance (p=.04, η2 = 0.20), and Inappropriate Speech (p=.05, η2 = 0.16). Significant improvements were noted on the ASRS scales of Social/Communication (p=.04, η2 = 0.25), Unusual Behaviors (p=.003, η2 = 0.20), Self-Regulation (p=0.02, η2=0.32), and Total Scores (p<.001, η2=0.54). CONCLUSION- Results from this study support the therapeutic benefit of antioxidants in improving social communication, unusual behaviors, and self-regulation behaviors of children with ASD. Further robust randomized controlled trials are necessary to elaborate the validity of these finding.

LLU Discipline

Rehabilitation Sciences


Rehabilitation Sciences


School of Allied Health Professions

First Advisor

Berk, Lee S.

Second Advisor

Daher, Noha S.

Third Advisor

Mainess, Karen

Fourth Advisor

Randall, Kiti Freier

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Antioxidants -- Physiology; Cacao -- Physiology; Child; Autistic Disorder; Autism in Children

Subject - Local

Autism Spectrum Disorder; Free Radicals; Oxidative Stress; Neurocognitive Disorder



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website


Loma Linda University. Del E. Webb Memorial Library. University Archives