AbstractFrom the summary:
Given the severe and chronic problems associated with Autism Spectrum Disorders (ASD) and the limitations of available treatments, there exists a large public health need for additional interventions. As more parents are inquiring about complementary and alternative treatments (CATs), both parents and practitioners require up-to-date information about them and whether and how to integrate them into treatment. After presenting data on CAT usage patterns for ASD, we review 13 ingestible (i.e., orally administered) and 6 noningestible (i.e., externally administered) CATs for ASD. For each CAT we briefly describe its definition; rationale for use; current research support, limitations, and future directions; safety issues; and whether we currently recommend, not recommend, or find it acceptable for the treatment of ASD. We conclude this paper with recommendations for future research and ten clinical recommendations for practitioners.
Nineteen CATs were reviewed, including 13 ingestible and 6 noningestible CATs. Research on these CATs is extremely varied, ranging from case studies to double-blind, sham-controlled RCTs, with and without significant results. Their safety, easy of use, sensibility, and expense (SECS) also vary considerably. Currently, we would only recommend two ingestible and one noningestible CAT, melatonin and RDA/RDI multivitamin/mineral (for those with a limited diet and/or poor appetite), and massage therapy, respectively. However, the following CATs are considered acceptable and worth considering for a short, monitored trial, if conventional Txs for ASD and the two recommended CATs have been given a reliable trial and found ineffective. For ingestible CATs: B6 and magnesium, multivitamin/mineral (even without a restricted/idiosyncratic diet and/or poor appetite, as long as no ingredient is above tolerable limit), folic acid, omega-3, L-Carnosine, probiotics and GI medication (only for ASD patients with GI symptoms), iron supplementation (only for those with low serum ferritin), and chelation (only for those with confirmed heavy metal toxicity). For noningestible CATs: Acupuncture, exercise, music therapy, and animal-assisted therapy.
Although published after our literature search, we feel it is important to mention N-Acetylcysteine (NAC) as an ingestible CAT that has great potential. NAC is a glutamatergic modulator and antioxidant and was recently examined in a 12-week, double-blind, randomized, placebo-controlled study in children with autistic disorder . Thirty-three, 3–10 year-olds were randomized and NAC was initiated at 900 mg daily for 4 weeks, then 900 mg twice daily for 4 weeks and 900 mg three times daily for 4 weeks. Oral NAC was well tolerated with limited side effects and compared with placebo, resulted in significant improvements on the ABC irritability subscale (; ; ).