Treating Autism Spectrum Disorder

MANILA, Philippines - Parents of persons with autism and individuals with autism who have the capacity to make treatment decisions on their own are ever watchful for treatments that can help ameliorate the many and various difficulties associated with the disorder. This article summarizes current knowledge regarding established treatments that have produced substantial positive evidence from scientific research, complementary and alternative treatments that have shown considerable promise but have not been fully tested, and treatments that received attention and were popularized but have failed to show reliable results across multiple controlled trials. 

Established treatments

The best evidence showing improvements in ASD symptoms comes from the combination treatment involving supportive educational programming, communication training including speech and language therapy, social skills support, and behavioral training.

Behavior modification, most prominently Applied Behavioral Therapy (ABA), has the best evidence for a single treatment, with improvements documented in language, social, play, and academic skills, and reduction in behavioral problems.

Two medications — risperidone (Risperdal) and aripiprazole (Abilify) — are approved by the US Federal Drug Administration (FDA) for the treatment of irritability in children with ASD. These medications have not been approved as treatment for the core ASD symptoms (deficits in social interaction, communication, and stereotypical and repetitive behavior).

In their 2012 article reported in the journal Autism Research and Treatment, Lofthouse and colleagues report their review of 19 CATs for Autism Spectrum Disorder that reported some positive results (even if negative results have also been reported). The review covered 13 orally administered treatments and six non-oral treatments.

Here are the recommended CATs:

• Melatonin — orally administered. The five RCT studies found improvements in sleep duration and time to sleep, but did not change the number of nighttime awakenings.   Side effects were minimal to none. The authors are supportive of melatonin treatment for persons with ASD who suffer from mid- and late-insomnia. 

• Multivitamin/mineral supplements — orally administered.  Although most persons with autism have normal levels of multivitamin and mineral levels, biomarkers of nutritional status have been found to correlate with autism severity.

• Massage therapy.  Manipulation of superficial layers of muscle and connective tissue to enhance bodily functioning, relaxation, and well-being.

Here are the acceptable CATs:

• Vitamin B6 and magnesium.  These are dietary supplements that presumably correct  metabolic deficiency in persons with ASD.  Improvements in social interactions, communication, and repetitive behaviors have been noted in multiple studies, but negative studies showing lack of benefit have been reported as well.

• Folic acid.  An open trial of folic acid combined with vitamin B12 given to children with ASD showed significant improvement in expressive and receptive language. This treatment has not been associated with adverse side effects; thus, passes the safety test.

• Omega-3 fatty acids. These acids are essential to brain development and have been found to produce benefits for cardiovascular health, ADHD, and mood disorders.

• Probiotics and gastrointestinal (GI) medication.  Many persons with ASD also suffer GI disorders.    Probiotics are microorganisms thought to improve digestive health. Enzyme treatment and probiotics have been proposed to help reduce self-stimulation, stereotypes, aggression, and hyperactivity, and to improve socialization and GI symptoms.

• Iron supplementation. Low iron intake and low iron blood level have been reported in some children with ASD.   An eight-week open trial found that iron level increased significantly in the study sample of ASD children but more evidence with a large sample size and experimental control  is needed.

• L-Carnosine. This chemical compound is considered  a potential CAT for autism because of its protective neurological effects. An eight-week double-blind trial with 31 children found significantly better results with the compound than with placebo on the total score of autism symptoms rating scales, and in subscores for behavior, socialization, and communication; however, hyperactivity and excitability were observed.

• Chelation. Chelation therapy removes heavy metals from the blood and is driven by the theory that ASD is caused by heavy metal toxicity.  Evidence from anecdotal studies of several types of therapies for ASD has shown the highest percentage of positive responders and lowest percentage of adverse responders with chelation trials.

• Acupuncture. Based on traditional Chinese medicine, acupuncture involves the systematic insertion and manipulation of thin needles into the body to improve health of body/mind by unblocking the flow of qi (energy). Results from RCTs conducted with ASD children found improvements in attention, receptive language, self-care, language, overall functioning, and communication.

• Exercise. In children with ASD, exercise may reduce hyperactive and repetitive behavior through the release of neurotransmitters such as acetylcholine or beta-endorphins.

• Music therapy. This treatment involves structured and unstructured individual and group sessions, may occur with or without a leader, and involves playing or listening to music. Trials conducted with ASD children have reported significant improvement in imitating signs and words, longer and more eye contact and turn-taking, nonverbal communication, more “joy,” emotional synchronicity, initiating social engagement , and compliant behavior.

• Animal-assisted therapy (AAT).  The animal is seen as a transitional object for bonding before generalizing the attachment to people.  Results in studies with ASD children included significant improvement in playful mood, focus, awareness of social environment, use of language, social interaction, and motivation to interact with the environment.

• Ascorbic acid (vitamin C). Supplementation with ascorbic acid in large doses. 

* * *

This article contains notes and excerpts from “ A Review of Complementary and Alternative Treatments for Autism Spectrum Disorder” by Lofthouse N, Hendren R, Hurt E, Arnold LE, Butter E.  published in “Autism Research and Treatment,” Volume 2012, Article ID 870391.

* * *

Editor’s note: Lirio Sobrevinas Covey, Ph.D. is president of the Association for Adults with Autism, Philippines.  www.adultautismphil.wordpress.com. She is a professor of Clinical Psychology in Psychiatry at the Columbia University Medical Center and a research  scientist  with the New York State Psychiatric Institute. E-mail her at liriocovey@gmail.com.