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Complementary/Alternative Medicine and Autism Spectrum Disorders (ASD)

Autism spelego-286232_640ctrum disorders (ASD) are extraordinarily complex and are comprised of core areas of impairment including social interaction deficits, language difficulties, repetitive behaviors, which present early in development1.  In addition to the core areas there can be auxiliary symptoms ranging from anxiety and depression to cognitive impairment, and sensory dysfunction.  These symptoms present in different combinations and vary drastically in severity making each case unique.  This means that the treatment plans for these patients need to be carefully tailored to each person’s individual
symptoms rather than a standardized, cookie-cutter approach.  There is currently no treatment to cure ASD or that targets its core symptomatology, but there are treatments available to improve some individual’s ability to function as well as address some of the auxiliary symptoms1.  It has been demonstrated that a multifaceted, interdisciplinary team of health care providers (HCP) is the most effective approach and utilizing early intervention services can drastically improve a child’s development.  Even with all of the HCPs involved in treating ASD many patients still seek out complementary and alternative medicines (CAM) in an effort to improve quality of life.  The lack of reliable safety and efficacy data on these products, diets, and treatments could result in patient harm, which is especially concerning when a recent study, surveying the use of CAM products among ASD patients, revealed that more than 30% of those surveyed were using some CAM products and 9% were using a potentially harmful one2.  This paper is a short review of some CAM products used for ASD and the data supporting or disproving their efficacy and safety.

Massage has been mentioned in many articles as a probable CAM treatment for those ASD patients who have sensory dysfunction4,5,6.  These studies were small and had some drawbacks but found that massages, in conjunction with standard therapies, improved sensory impairments, social and language skills, as well as hyperactivity more than just the standard therapies alone4,5,6.  Better designed, larger scale trials on this treatment are still needed but current literature is tentatively pointing at massage as a potentially effective, nonpharmacological treatment4,5,6.

While some CAM treatments are considered relatively safe and effective, others have been proven to be harmful and/or ineffective in treating ASD, such as secretin and chelation therapy.  Secretin is a peptide naturally found in the gastrointestinal tract once believed to be a cure for autism, which has subsequently been discredited7,8.  A meta-analysis done looking back at 16 trials using secretin to treat ASD found that neither single nor multiple dose secretin therapy results in improvement of any of ASDs core symptoms8.  Chelation was and occasionally still is done by people who believe that heavy metals, from vaccines or other sources, is the cause of ASD symptoms.  It is a procedure that comes with risks of health complications and studies showed that there was no benefit from the procedure so it is not recommended in the absence of medically confirmed heavy metal toxicity8,9.

These are just a few of the many CAM options that are being used for those with ASD.  Clearly there is some promising areas as well as therapies that have already been disproved.  Overall CAM products are still fairly popular and with ~30% of ASD patients using them, more research is needed to evaluate the safety and efficacy of these products to prevent potentially harmful or lethal outcomes from occurring due to a lack of available evidence.  Healthcare practitioners need to be actively involved in discussing what CAM therapies, if any, their patients are using while keeping up on new literature.

 

References:

  1. Autism Spectrum Disorders. Centers for Disease Control and Prevention 2015. Available at: http://www.cdc.gov/ncbddd/autism/treatment.html. Accessed February 6, 2016.
  2. Sturmey P. Secretin is an ineffective treatment for pervasive developmental disabilities: a review of 15 double-blind randomized controlled trials. Research in Developmental Disabilities2005;26(1):87–97.
  3. Mandell L, Merhnar, Ittenbach, Pinto-Martin, Hanson, et al. Result Filters. National Center for Biotechnology Information. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14671475. Accessed February 5, 2016.
  4. Silva LMT, Cignolini A, Warren R, Budden S, Skowron-Gooch A. Improvement in Sensory Impairment and Social Interaction in Young Children with Autism Following Treatment with an Original Qigong Massage Methodology. The American Journal of Chinese Medicine Am. J. Chin. Med.2007;35(03):393–406.
  5. Silva LMT, Schalock M, Ayres R, Bunse C, Budden S. Qigong Massage Treatment for Sensory and Self-Regulation Problems in Young Children With Autism: A Randomized Controlled Trial. American Journal of Occupational Therapy2009;63(4):423–432.
  6. Piravej K, Tangtrongchitr P, Chandarasiri P, Paothong L, Sukprasong S. Effects of Thai Traditional Massage on Autistic Children’s Behavior. The Journal of Alternative and Complementary Medicine2009;15(12):1355–1361.
  7. Lingren S, Doobay A. http://www.innspub.net/wp-content/uploads/2013/12/IJB-V4No1-p158-166.pdf. International Journal of Biosciences (IJB) Int. J. Biosci.2011;4(1):158–166.
  8. Williams K, Wray JA, Wheeler DM. Intravenous secretin for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews Reviews2012.
  9. Adams JB, Baral M, Geis E, et al. Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A – Medical results. BMC Clinical Pharmacology BMC Clin Pharmacol2009;9(1):16.
Written by Kristen Kas, PharmD Candidate, Class of 2016, at the University of Maryland Eastern Shore School of Pharmacy.