Updated by:
Kimberly B. Marshall, PhD, BCBA-D, University of Oregon
Scott M. Myers, MD, Geisinger Commonwealth School of Medicine

Description

Autism Treatments SummaryCraniosacral therapy (CST), also known as osteopathic cranial manipulative medicine and cranial osteopathy, involves gentle manipulation of the bones in the skull with the goal of changing the flow of cerebrospinal fluid (CSF). The underlying premise for CST is that CSF, the fluid in and around the brain and spinal cord, pulses or flows in a systematic pattern and that in some cases this flow is disrupted or blocked (Zane, 2011). Under these conditions, proponents of CST state that they can feel the disruption, manipulate the cranium using pressure from the hands to change the flow or pulse of the CSF and, hence, alleviate symptoms (Kratz et al., 2016). Practitioners using CST have asserted that it can be used to treat adults and children with a variety of conditions and disabilities including fibromyalgia (chronic pain), attention deficit hyperactivity disorder (ADHD), migraines, and autism spectrum disorder.

Research Summary

There has been very little research conducted on the application of CST for treating people diagnosed with autism spectrum disorder; consequently, we will first share about the broader research that has been conducted on CST. Various research studies, systematic reviews, and meta-analyses have been conducted to evaluate the effectiveness of CST. The results of these studies have presented mixed findings about CST and point to some issues within the CST research base. Moreover, most of these studies focused on conditions other than autism.

Jäkel and Von Hauenschild (2011) conducted a systematic review that included seven randomized controlled trials that evaluated the use of CST with human participants across the age span. The studies looked at various conditions including headaches, general health and well-being, infant crying, irritability, and disturbed sleep. The results of the seven studies were mixed (some outcomes showed statistically significant improvements while others did not) and only one study was rated as having strong methodological quality (meaning that the study was conducted in a way that decreased the likelihood that biases or chance produced the outcome). In a more recent systematic review, Guillaud and colleagues (2016) found similar issues with the quality of the CST research. They found that the CST diagnostic process was unreliable, with CST practitioners disagreeing on the diagnosis of issues with the flow or pulse of CSF. Further, evaluations of CST as an intervention lacked experimental rigor, meaning that the studies were implemented in a way that did not allow the researchers to determine that CST was responsible for changes observed in participants. These flaws meant that there was a major risk of doubt related to the studies that found that CST was clinically effective. The authors concluded that there was insufficient evidence to support the use of cranial osteopathy for the diagnosis or treatment of patients (Guillaud et al., 2016).

A recent meta-analysis of randomized controlled trials evaluating CST as a treatment for chronic pain has provided some emerging evidence (Haller et al., 2020). The researchers identified potential short and long-term effects of CST on pain. However, consistent with the concerns stated above, the researchers expressed apprehension about the quality of study designs (e.g., control groups received no treatment rather than a treatment for CST to be compared to, researchers looked at many potential outcomes making it more likely that at least one of them would show a significant difference) and potential bias within the included studies (e.g., participants and therapists were not consistently blinded to study conditions). Consequently, they indicated that there continues to be a need for higher quality randomized controlled trials to provide further evidence to support the use of CST for pain management. For example, future studies could compare CST with current evidence-based treatments for pain, blind patients to which treatment they are receiving, and look at only the priority outcomes. Overall, the 10 studies included in the meta-analysis were too flawed for any meaningful conclusions to be drawn (see Jarry [2020] for a more detailed critique of Haller et al.).

The research discussed thus far focused on clinical conditions unrelated to autism spectrum disorder (ASD). As stated above, very little research has been conducted evaluating the efficacy of CST with individuals on the autism spectrum. Studies that have been conducted have major flaws including using CST in combination with other treatments (Mishra & Senapati, 2015), making it impossible to determine the effectiveness of the treatment on its own, and measuring effectiveness based on verbal reports (Kratz et al., 2017; Mishra & Senapati, 2015). For example, Kratz et al. (2017) surveyed 84 parents, 6 clients, and 184 therapists about their experiences with CST. Most responses were positive, indicating that the therapy led to improvements in general behavior, communication, and sensory reactivity; however, these comments were anecdotal and were not supported by any measurable data. While anecdotal data, such as how a participant or caregiver feels about a therapy or the outcomes of a therapeutic treatment can certainly be valuable, satisfaction with a treatment does not constitute scientific evidence regarding the therapy’s effectiveness. No CST intervention studies have been implemented with individuals with autism in a way that could demonstrate that changes are due to the treatment.

Task forces that review evidence-based treatments for individuals on the autism spectrum (e.g., National Autism Center, 2015; Hume et al., 2021) have not included CST in their reports. Given the limited research on the use of CST with individuals on the autism spectrum and the poor quality of the research that has been conducted, CST should not be considered an evidence-based treatment for individuals on the autism spectrum.

Recommendations

Though there is some low-quality evidence for the effectiveness of CST with individuals experiencing chronic pain, multiple authors have called for the removal of CST from medical textbooks, since the treatment lacks scientific evidence and may be better characterized as a “belief system” rather than medicine (Hartman & Norton, 2002). Based on the lack of high-quality evidence to support the use of CST in general, and specifically with individuals on the autism spectrum, caregivers and clients are strongly discouraged from considering the use of this treatment and are encouraged to consider evidence-based procedures (e.g., interventions based on applied behavior analysis) when addressing common concerns (e.g., behavior and communication challenges) that CST claims to address.

Systematic Reviews of Scientific Studies

Guillaud, A., Darbois, N., Monvoisin, R., & Pinsault, N. (2016). Reliability of diagnosis and clinical efficacy of cranial osteopathy: A systematic review. PLoS One, 11(12), e0167823.

Haller, H., Lauche, R., Sundberg, T., Dobos, G., & Cramer, H. (2020). Craniosacral therapy for chronic pain: A systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders, 21(1), 1-14.

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders, 51(11), 4013–4032.

Jäkel, A. & Von Hauenschild, P. (2011). Therapeutic effects of cranial osteopathic manipulative medicine: A systematic review. Journal of Osteopathic Medicine, 111(12), 685-693.

National Autism Center. (2015). Findings and conclusions: National Standards Project, phase 2. Author

Selected Scientific Studies

Kratz, S. V., Kerr, J., & Porter, L. (2017). The use of craniosacral therapy for autism spectrum disorders: Benefits from the viewpoints of parents, clients, and therapists. Journal of Bodywork and Movement Therapies, 21(1), 19-29.

Mishra, D. P., & Senapati, A. (2015). Effectiveness of combined approach of craniosacral therapy (CST) and Sensory-Integration Therapy (SIT) on reducing features in children with Autism. Indian Journal of Occupational Therapy, 47(1), 3-8.

Position Statements and Warnings

Hartman, S. E., & Norton, J. M. (2002). Craniosacral therapy is not medicine. Physical Therapy, 82(11), 1146-1147.

Jarry, J. (2020, February 6). Even the best scientific studies can lie: The case of craniosacral therapy. McGill University. https://www.mcgill.ca/oss/article/pseudoscience/even-best-scientific-studies-can-lie-case-craniosacral-therapy

Zane, T. (2011). A review of craniosacral therapy. The Current Repertoire. The Cambridge Center for Behavioral Studies.

Citation for this article:

Marshall, K. B., & Myers, S. M. (2025). A treatment summary of craniosacral therapy. Science in Autism Treatment, 22(01).

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