Complementary and Alternative Medicine (CAM) in Autism

Autism is a behavioral expression of a very complex neurobiological (genetic)/ developmental disorder and there is far more we have yet to know about its etiology, pathophysiology, and treatment. In light of all this uncertainly, it often happens that families of individuals with autism get frustrated when conventional medical practice or treatments become unsatisfactory or ineffective. They may turn to Complementary and Alternative Medicine (CAM) for answers. In fact, CAM has been increasing substantially (Hyman & Levy, 2005).

The true prevalence of use of CAM for families with individuals with Autism Spectrum Disorder (ASD) has been estimated between 32% to 92% (Levy et al., 2003; Hansonetal, 2006, 2007). An online, self-administered survey of adolescents revealed lifetime rates of CAM use of 79% and current use of 48.5% (Wilson et al., 2006). According to a study conducted by Christon and colleagues (2009), the majority of families was well educated and with access to the internet and 70% used at least one CAM treatment with their children. Some studies have hypothesized that the families of individuals with Autism Spectrum Disorder based their selection of CAM therapies on their perception of safety or less side effects and their feelings that CAM therapies area "natural" or they can have more control over the treatment (Hyman & Levy, 2011; 1-Lanson et al., 2007; Rhee et al., 2004).

One of the challenges of CAM supporters and researchers is how to establish their products in evidence-based medicine. Susan L. Hyman and Susan E. Levy (2011) reviewed several considerations regarding CAM therapies such as characterization of the population of the study, standard dosage, study design, statistical analysis among others. Despite of these methological and principles challenges, CAM supporters are encouraging researchers to present evidence-based examinations.

Hyman & Levy (2011) and Akin and colleagues (2010) review the evidence of more common type of CAM use such as biological therapies [vitamin supplements and gluten-free & casein-free diet (GFCF), immune mediated treatments, Chelation Therapy, Hyperbaric Oxygen Therapy, Manipulative and Body-Based Therapies, Mind-Body therapies and Energy Healing Therapy.

Gluten-free, Casein-free therapy is one of the most common CAM used. Anecdotal reports and a single-blind study of gluten-free, casein-free (GFCF) diet suggested improvement in features of Autism Spectrum Disorder (ASD) after 1 year (Knivsberg et al., 2002). However, due to the limitation of this study, more evidences are needed (Milward, et al., 2008).

Melatonin, which is a hormone secreted by the pineal gland, has been found to be safe and effective in reducing sleep onset latency in children with some primary and secondary sleep disorders. Adverse reactions are not common (Buscemi, et al., 2006; El-Sherif, et al., 2003; Andersen, et al., 2008).

The efficacy of Vitamin C is not clear in Autism Spectrum Disorder (ASD) (Akin, et al., 2010).

Secretin, one of the most studied treatments in Autism Spectrum Disorder, has been found no effective in treating autistic symptoms (Williams, et al., 2005). Moreover, there is no evidence that Vitamin B6 and Magnesium will be effective in reducing symptoms of hyperactivity and obsessive-compulsive-like behaviors.

Carnitine (amino acid), essential fatty acids (Omega-3 fatty acids) and Methyl B12 (methylcobalamine) have also been used for autism, and are safe and well tolerated, but studies are not conclusive about their efficacy in symptoms of Autistm Spectrum Disorder (Akin, et al., 2010).

Chelation Therapy has become popular despite no evidence of its benefit. Research studies have not found significant differences in randomized groups (control group and experimental group) using Hyperbaric Oxygen Therapy (HBO2T). Anxiety symptoms and ear pain have been reported in individual using HBO2T.

There is no evidence-based data (inclusive efficacy) to support the benefits of the Chiropractic manipulation, energey-healing therapy, Acupuncture, Mind-Body-based therapies (music therapy, Yoga, self-regulation techniques), craniosacral manipulation and massage, and therapeutic touching for symptoms of Autism Spectrum Disorder (ASD) (Hyman & Levy, 2011).

Since we are expecting an increase in the use of CAM, it seems that more research studies are needed to assess the impact of CAM therapies in the treatment of Autism Spectrum Disorder (ASD). I would like to recommend to families and clinicians the recent publication by Reichow et al. (2011, Eds). Evidence-Based Practices and Treatments for Children with Autism.

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According to the National Center for Complementary and Alternative Medicine, CAM is " a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."