Two different mutations in the FMR1 gene may lead to autism. The full mutation (>200 CGG repeats in the 5’end of FMR1) leads to hypermethylation and transcriptional silencing of FMR1, resulting in absence or deficiency of the FMR1 protein product, FMRP. Deficiency of FMRP in the brain causes fragile X syndrome (FXS). Autism occurs in approximately 30% of those with FXS, whereas PDD-NOS occurs in an additional 30%. FMRP is an RNA binding protein that modulates receptor-mediated dendritic translation, and deficiency leads to dysregulation of many proteins important for synaptic plasticity. Group I metabotropic glutamate receptor (mGluR1/5)-activated translation is up-regulated in FXS and new targeted treatments that act on this system include mGluR5 antagonists and GABA agonists which may reverse the cognitive and behavioral deficits in FXS. Matrix metalloproteinase-9 (MMP-9) is one of the proteins elevated in FXS and minocycline reduces excess MMP-9 activity in the fmr1 knockout mouse model of FXS. Both minocycline and mGluR5 antagonists are currently being evaluated in patients with FXS through controlled treatment trials. The premutation (55–200 CGG repeats) may also contribute to the mechanism of autism in approximately 10% of males and 2–3% of females. Premutations with <150 repeats exert cellular effects through a different molecular mechanism involving elevated levels of FMR1-mRNA and CGG-mediated toxicity to neurons, early cell death, and fragile X-associated tremor/ataxia syndrome (FXTAS), although lowered levels of FMRP also occur in those with large premutations (150–200).

Our findings suggest that ethnic differences in autism causal beliefs and treatment choices may exist. Future research should be conducted to specifically confirm the findings, to understand parental motivation behind their service and treatment choices, and to gain more insight into the types, usage, and sources of CAM treatments. Clinicians can use parental autism causal beliefs in discussions about treatment recommendations.