Kelley L. Harrison, MA, BCBA, LBA-KS
Thomas Zane, PhD, BCBA-D
Department of Applied Behavioral Science, University of Kansas
Biomedical complementary treatment approaches, most commonly known as complementary alternative medicine (CAM), are commonly used to treat the behavioral symptoms of autism (e.g., aggression, irritability, hyperactivity; Hendren, 2013). In fact, Hӧfer, Hoffman, & Bachmann (2017) conducted a systematic review of the literature to determine the prevalence of CAM use and found that 50% of the children with autism spectrum disorder (ASD) used some form of a CAM treatment. CAM may include, but is not limited to, natural products (e.g., vitamins, minerals, melatonin, digestive enzymes), procedures (e.g., neurofeedback, chelation), conventional medications (e.g., antifungals, memantine), or diets (e.g., food restrictions or food products that claim to provide health and medical benefits; Hendren, 2013).
The majority of healthcare providers suggest early intensive behavioral interventions to treat symptoms of ASD as opposed to CAM treatments (Lindly, Thorburn, Heisler, Reyes, & Zuckerman, 2017). In fact, many physicians report a knowledge gap about CAM and its use with ASD (DeFilippis, 2018). However, CAM treatments may be cheaper than other interventions and are often purported to have more immediate and positive effects than other interventions (e.g., behavioral interventions; Lindly et al., 2017).
What Is The Conceptual Link Between ASD And Complementary Alternative Medicine?
The cause of ASD is not completely understood. However, some suggest that ASD has a strong genetic origin and specifically may be caused by a gene environment interaction (Hendren, 2013). This hypothesis often leads researchers to search for biochemical or physiological differences between individuals with and without ASD that may be responsible for the development of ASD.
There have been several biochemical and physiological differences suggested to correlate with ASD such as hormonal abnormalities, immune abnormalities, inflammation, oxidative stress, mitochondrial dysfunction, and free fatty acid metabolism. CAM treatments claim to treat the behavioral symptoms of ASD by correcting the biochemical or physiological state of the individual with ASD (Hendren, 2013). For example, some research suggests that individuals with ASD may produce abnormal levels of melatonin, a neurohormone that cause drowsiness and sets the body’s sleep clock (Rossignol & Frye, 2011). Often, individuals with ASD experience sleep problems, and so a common CAM treatment is an increased intake of melatonin (Hendren, 2013).
What Is The Scientific Evidence Of Complementary Alternative Medicine Use For Autism?
Research on CAM treatments for ASD is still in its very early stages, with some treatments beginning to show promise, others beginning to appear ineffective, and still others associated with serious medical risks (Hendren, 2013). The National Center for Complementary and Integrative Health (NCCIH) was established in 1991 under the National Institute of Health (NIH) to promote the scientific study of CAM treatments (Levy & Hyman, 2015). NCCIH’s mission is to “define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care” (NCCIH, 2016). Overall, NCCIH reports the following findings with respect to some popular CAM treatments:
- No cure has been identified for ASD, but intensive behavioral therapy and early intervention can greatly improve a child’s development.
- There is very little high quality research on CAM for ASD.
- Melatonin may help with sleep problems in people with ASD.
- It is unclear if omega-3 fatty acids, acupuncture, mindfulness-based practices, massage therapy, special diets, and hormone oxytocin improve ASD symptoms, and therefore (these) should not be used in place of conventional treatments.
- There is no scientific evidence that secretin, hyperbaric oxygen, chelation, or antifungal agents improve ASD symptoms and these treatments may be dangerous (NCCIH, 2017).
In addition to the NCCIH, the Food and Drug Administration (FDA) has also released statements concerning the use of CAM treatments for ASD. Specifically, the FDA attempts to stop companies from making false claims about their products use as a treatment or cure for ASD, stating, “There is no cure for autism. So, products or treatments claiming to “cure” autism do not work as claimed…Some may carry significant health risks” (U.S. Food and Drug Administration, 2017). The FDA has approved some drugs to help manage symptoms of ASD. Specifically, the use of antipsychotics such as risperidone and aripiprazole has been approved to treat irritability. Additionally, the FDA specifically warns against the use of chelation therapy, hyperbaric oxygen therapy, and detoxifying clay baths because of the improper claims about these products and the significant health risks associated with these products (U.S. Food and Drug Administration 2017). Finally, it should be noted that no drug has FDA’s approval for the treatment of autism itself or for the core symptoms of autism (i.e., social communication deficits, restricted/repetitive behaviors); rather, the approved drugs treat behavioral symptoms correlated with ASD (e.g., irritability; DeFilippis, 2018).
Overall, the experimental validity for any CAM treatment ranges. Some treatments appear promising (e.g., melatonin for sleep), while others can be outright rejected as an effective treatment (e.g., secretin, hyperbaric oxygen). Most, however, simply have insufficient evidence available to determine validity (e.g., modified diets, immune therapy, vitamin and fatty acid supplements). Therefore, there is a clear need for more methodologically rigorous studies to understand the effects of CAM treatments and provide guidance for families and clinicians (Whitehouse, 2012).
When all available evidence is taken together, there are no CAM treatments that are ready for general use (Hendren, 2013). In order for CAM treatments to be safely, efficiently, and effectively used, future research is necessary. This research should be experimentally rigorous and empirically sound. That is, research should be peer-reviewed, methods should exclude biases (e.g., double blind, single-subject design), consistent dosing should be used across participants, and outcome measures should be valid (i.e., measure what they intend to measure). Additionally, research should take into account other treatments that are implemented concurrently with the CAM treatment such that effects of the treatment can be isolated from the CAM treatment in question and not attributable to other outside treatments. Finally, because CAM treatments target abnormal biochemical and physiological processes (which are not present in all individuals with ASD and may only be present for a given period of time for a particular individual), research should utilize participants whose biomarkers match the purpose of the CAM treatment to be sure the intervention is targeting an active biomedical process (Hendren, 2013). For example, when evaluating the use of melatonin for sleep problems, participants should include individuals who do not produce enough melatonin naturally. Only when substantial empirical evidence suggests a CAM treatment is safe and effective should parents or caregivers consider its use, and even then parents and caregivers should always work closely with medical practitioners to select and evaluate an appropriate treatment.
Parents, consumers, and caregivers should also explore treatments alternative to CAM. There are many evidenced-based strategies that exist for a myriad of learning, social, and behavioral issues related to ASD (e.g., early intensive behavioral intervention; Klintwall, Eldevik, & Eikeseth, 2015). Consumers should first consider which of these methods could be tried before contemplating CAM.
What Is The Bottom Line?
The current state of research surrounding CAM treatments is sparse, with most treatments requiring more indepth study, and others demonstrated to be ineffective and/or dangerous (Levy & Hyman, 2015). Therefore, parents, caregivers, physicians, and clinicians should be extremely cautious when using or recommending CAM treatments.
Conceptually, CAM treatments usually have a clear physiological rationale such as an increased intake of melatonin to correct sleep problems. However, as with any treatment, caregivers should always consider the literature available surrounding a given treatment. They should ask, “Is the information available from peer-reviewed scientific sources or is it anecdotal in nature?” “Are the methods for testing described in detail such that it can be determined if any biases exist?” “Are the outcome measures of treatment effects valid (i.e., do they measure what they say they measure)?” Although the conceptualization surrounding a given treatment may be sound, the treatment itself may be ineffective and could potentially be dangerous (Levy & Hyman, 2015).
As with any treatment, medical monitoring is very important. Caregivers should always consult a health care professional before implementing a CAM treatment and inform their child’s primary physician of all CAM treatments they are implementing. Unfortunately, in a 2015 survey on the use of CAM treatments for children with ASD, families reported that they rarely ask physicians for information on CAM treatments. Instead, almost two-thirds of the families reported finding internet-based communities and websites as their first source for medical information. When the families were asked why they do not report CAM treatments to physicians, the most common responses included a perception of a lack of knowledge by the physician, a lack of time for discussion, not seeing the necessity of reporting these treatments, and a concern regarding disapproval by the physician (Levy & Hyman, 2015). This finding is even more concerning because physicians often report a knowledge gap concerning CAM treatments and their use with ASD, as well as a concern about potential conflicts between themselves and parents surrounding different beliefs about the use of CAM treatments for ASD (DeFilippis, 2018). However, both of these findings (i.e., family’s tendencies to rely on internet-based information and physician’s hesitation to discuss CAM treatments) further suggest the need for future research before implementation of CAM treatments is considered.
Finally, parents and caregivers should be suspicious of products that claim to treat a wide range of diseases, avoid personal testimonials, be weary of “quick fixes” and “miracle cures,” and instead seek scientific evidence (U.S. Food and Drug Administration, 2017).
DeFilippis, M. (2018). The use of complementary alternative medicine in children and adolescents with autism spectrum disorder. Psychopharmacology Bulletin, 48, 40-63.
Hendren, R. L. (2013). Biomedical complementary treatment approaches. Child and Adolescent Psychiatric Clinics of North America, 22, 443-456.
Hӧfer, J., Hoffmann, F., & Bachmann, C. (2017). Use of complementary and alternative medicine in children and adolescents with autism spectrum disorder: A systematic review. Autism, 21, 387-402.
Klintwall, L., Eldevik, S., & Eikeseth, S. (2015). Narrowing the gap: Effects of intervention of developmental trajectories in autism. Autism, 19, 53-63.
Levy, S. E., & Hyman, S. L. (2015). Complementary and alternative medicine treatments for children with autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 24, 117-143.
Lindly, O. J., Thorburn, S., Heisler, K., Reyes, N. M., & Zuckerman, K. E. (2017). Parents’ use of complementary health approaches for young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(5), 1-16.
National Center for Complementary and Integrative Health. (2016, June). Complementary, alternative, or integrative health: What’s in a name? Retrieved from: https://nccih.nih.gov/health/integrative-health.
National Center for Complementary and Integrative Health. (2017, September). Autism. Retrieved from: https://nccih.nih.gov/health/autism
Rossignol, D. A., & Frye, R. E. (2011). Melatonin in autism spectrum disorders: A systematic review and meta-analysis. Developmental Medicine and Child Neurology, 53(9), 783-792.
U.S. Food and Drug Administration. (2017, April). Autism: Beware of potentially dangerous therapies and products. Retrieved from: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm394757.htm
Whitehouse, J. O. (2013). Complementary and alternative medicine for autism spectrum disorders: Rationale, safety, and efficacy. Journal of Pediatrics and Child Health, 49(9), 438-442.
Citation for this article:
Harrison K. L., & Zane, T. (2018). Is there science behind that? Autism and complementary alternative medicine. Science in Autism Treatment, 15(2), 10-13.