If your child has been diagnosed with autism spectrum disorder (ASD), you may have heard doctors mention a blood test called the FRAT test or a condition called Cerebral Folate Deficiency (CFD). For many Indian parents, this is new territory — confusing, emotional, and overwhelming.
This guide is written specifically for Indian parents and caregivers. We explain what Cerebral Folate Deficiency is, how the FRAT test works, what a positive result means for your child, and how to get tested anywhere in India.
What Is Cerebral Folate Deficiency (CFD)?
Cerebral Folate Deficiency (CFD) is a condition where the brain does not receive enough folate (Vitamin B9) — even though the folate levels in the blood may appear completely normal.
This happens because autoantibodies (proteins produced by the immune system) attack the folate receptors on the blood-brain barrier. These receptors act like “doors” that allow folate to pass from the blood into the cerebrospinal fluid (the fluid that feeds the brain). When these doors are blocked, the brain becomes starved of folate — and folate is essential for brain development, neurotransmitter production, and cell repair.
What Is the Connection Between FRAT Test and Autism?
Multiple research studies have found that a significant proportion of children with autism spectrum disorder carry folate receptor autoantibodies (FRAAs). Research led by Dr. Richard Frye and colleagues, published in peer-reviewed journals, found that folate receptor autoantibodies were present in approximately 47–75% of children with autism depending on the study population and methodology.
This does not mean that CFD causes autism. However, it does mean that in many children with autism, untreated CFD may be making symptoms worse — affecting communication, behaviour, cognition, and development. And importantly, CFD is treatable.
Symptoms That May Suggest CFD in a Child with Autism
If your child has autism and shows any of the following, it may be worth discussing the FRAT test with your paediatric neurologist:
- Severe speech delay or very limited or no verbal communication
- Regression — the child had words or skills and then lost them
- Difficulty with social interaction beyond what is typical for autism
- Hyperactivity, irritability, or self-stimulatory behaviours
- Poor response to standard autism interventions and therapies
- Seizures or epilepsy alongside autism
- Poor sleep patterns
- Repetitive movements or ataxia (poor balance and coordination)
- Significant gut problems (as the gut microbiome affects folate absorption)
The FRAT Test: How It Is Done
The FRAT (Folate Receptor Autoantibody Test) is a blood test. Here is exactly what happens:
- A small blood sample (2–3 ml) is collected from your child
- The sample is processed in a specialised laboratory using an ELISA-based assay
- The lab measures levels of two types of antibodies: blocking FRAAs and binding FRAAs
- Results are reported as positive or negative, with antibody levels quantified
- A qualified doctor or neurologist interprets the report in the context of your child’s clinical history
Important: Fasting and Diet Before the Test
For accurate results, the following guidelines are recommended before the FRAT test:
- Fast for at least 4–6 hours before the blood draw (water is allowed)
- Avoid all dairy products (milk, cheese, yogurt, butter, ghee, paneer) for at least 3–4 days before the test. Dairy contains casein, which can temporarily elevate FRAA levels and lead to false positives
- If your child is on any folate or folic acid supplements, consult your doctor about whether to continue them before testing
What Does a Positive FRAT Test Mean?
A positive FRAT result means that your child’s immune system is producing antibodies that are blocking folate from reaching the brain. This is a treatable biological finding. It does not change the autism diagnosis, but it opens the door to a specific treatment that many families in India and worldwide have found beneficial.
Treatment for FRAT-Positive Children
- Leucovorin (Folinic Acid): High-dose leucovorin is the primary treatment. Unlike regular folic acid, leucovorin uses a different transport pathway into the brain and can bypass the blocked folate receptors. Clinical trials have shown improvements in language, social behaviour, attention, and stereotypy in children with autism who are FRAT-positive and treated with leucovorin.
- Casein-free diet: Removing dairy from the diet helps reduce FRAA levels over time. Many families in India follow this as part of GFCF (gluten-free, casein-free) dietary protocols.
- Regular retesting: FRAA levels can change over time, especially with dietary changes and treatment. Retesting every 6–12 months is recommended to monitor response.
A 2013 double-blind, placebo-controlled trial published in Molecular Psychiatry found significant improvements in verbal communication, attention, stereotypy, and hyperactivity in children with autism treated with leucovorin. This remains one of the strongest pieces of clinical evidence supporting FRAT testing and treatment.
How to Get the FRAT Test Done in India
Until recently, the FRAT test was only available in a small number of specialised labs abroad, forcing Indian families to send samples overseas at significant cost and delay. Today, the FRAT test is available within India through select specialised diagnostic laboratories.
Altus Lab Chandigarh offers the FRAT test for patients across India through our Pan India Home Collection and Courier Kit service. Here is how it works for families outside Chandigarh:
- Contact Altus Lab and register your child’s details
- A specially designed sample collection kit is couriered to your address anywhere in India (Delhi, Mumbai, Bengaluru, Hyderabad, Chennai, Pune, Kolkata, Jaipur, Ahmedabad, and more)
- A trained phlebotomist in your city is coordinated to collect the blood sample at your home
- The sample is packaged with cold packs and couriered to Altus Lab in Chandigarh under temperature-controlled conditions
- The test is processed and a detailed report is sent digitally within 10–15 working days
You can also visit us directly in Chandigarh if you are in the Tricity region (Chandigarh, Mohali, Panchkula). Read more about our FRAT Test Kit Pan India service or learn about what the FRAT test is and why it matters.
FRAT Test Cost in India: What to Expect
The cost of the FRAT test in India is significantly lower than sending samples abroad, which used to cost upwards of ₹20,000–₹30,000 including courier charges and international lab fees. Altus Lab’s FRAT test pricing for India is competitive and accessible. Contact us for current pricing — please note that courier kit charges may apply for pan-India orders.
Questions Indian Parents Often Ask About the FRAT Test
My child already takes folic acid supplements. Will that affect the test?
Folic acid (the synthetic form of folate) should ideally be stopped a few days before testing as it can interfere with results. However, do not stop any prescribed medication without consulting your doctor. Discuss this with your child’s neurologist before booking the test.
Is leucovorin available in India?
Yes, leucovorin calcium (folinic acid) is available in India by prescription. It is used in oncology and is manufactured by several Indian pharmaceutical companies. Your treating paediatrician or neurologist can prescribe it after reviewing your child’s FRAT test results.
How long before we see improvements after leucovorin treatment?
Most families and clinical studies report seeing initial improvements within 3–6 months of starting leucovorin. The most commonly reported improvements are in language and communication, attention span, social engagement, and sleep. Results vary between children, and not all children show the same degree of improvement.
Does a negative FRAT test rule out cerebral folate deficiency?
A negative FRAT test means antibody-mediated CFD is unlikely. However, CFD can also be caused by genetic mutations in the FOLR1 gene (not detected by FRAT). If clinical suspicion remains high, cerebrospinal fluid folate levels (via lumbar puncture) remain the definitive diagnostic test. Your neurologist will guide you on whether additional testing is needed.
Can the FRAT test be done for adults?
Yes. While most FRAT testing is done in children with neurodevelopmental conditions, folate receptor autoantibodies have also been found in adults with conditions like schizophrenia, treatment-resistant depression, and spastic paraplegia. Adults can also be tested through Altus Lab.
Every child with autism deserves a complete biological workup. The FRAT test is one of the most important — and most overlooked — tests available today. If you are an Indian parent looking to get your child tested, Altus Lab is here to help. Contact us today or visit altuslab.in to learn more about our pan-India FRAT test service.