March 31, 2016Anand Viswanathan

Therapies for Autism- A Spectrum of Uncertain Effectiveness

Anand Viswanathan

 

It’s World Autism Awareness Day on 2nd April. The United Nations is setting sights on goals and targets for sustainable development by the year 2030 for improving the lives of people with autism, with a “promise to leave no one behind”. Back in the real world, a plethora of interventions are being offered as treatments for persons diagnosed with Autism Spectrum of Disorders (ASD). How scientific are all these treatments?

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The Search

15 published Cochrane reviews were found while searching the Cochrane Library for “Autism” (results as on 31 March 2016).(1-15) These reviews included assessment of pharmacological and non-pharmacological interventions. Only three of the reviews were updated within the last two years.

 

What do these reviews conclude? Does anything work?

No reliable evidence to make any decision on the utility of : chelation; SSRIs; tricyclic antidepressants; omega-3 fatty acid supplementation; IV secretin;  acupuncture; auditory integration training; mind cognitive model;  combined vitamin B6-magnesium.

There might be some benefits in a few aspects of Autism Spectrum Disorders with : music therapy; parent-mediated early intervention; intensive behavioral interventions; social skills groups; and Aripiprazole. All these interventions need further good quality research to prove clinical efficacy.

 

What does this mean?

The quality of evidence for most of the treatment options for Autism Spectrum Disorder is generally inadequate to make trusted decisions. Most of these systematic reviews need updating with recent and better research for them to be really relevant. With only these in the armory to achieve the health targets  set by the UN for the next 15 years for persons with autism, it looks like the “promise to leave no one behind” might not be easy to keep.

 

*These blog posts are personal opinions of the author, and do not necessarily reflect the official views of the organization he represents. These are not intended to be directly used as healthcare guidelines. Reader discretion, as always, is recommended.

References

1. James S, Stevenson SW, Silove N, Williams K. Chelation for autism spectrum disorder (ASD). Cochrane Database Syst Rev. 2015 May 11;5:CD010766.
2. Geretsegger M, Elefant C, Mössler KA, Gold C. Music therapy for people with autism spectrum disorder. Cochrane Database Syst Rev. 2014;6:CD004381.
3. Fletcher-Watson S, McConnell F, Manola E, McConachie H. Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD). Cochrane Database Syst Rev. 2014;3:CD008785.
4. Williams K, Brignell A, Randall M, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2013;8:CD004677.
5. Oono IP, Honey EJ, McConachie H. Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2013;4:CD009774.
6. Williams K, Wray JA, Wheeler DM. Intravenous secretin for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;4:CD003495.
7. Reichow B, Steiner AM, Volkmar F. Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;7:CD008511.
8. Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;10:CD009260.
9. Hurwitz R, Blackmore R, Hazell P, Williams K, Woolfenden S. Tricyclic antidepressants for autism spectrum disorders (ASD) in children and adolescents. Cochrane Database Syst Rev. 2012;3:CD008372.
10. Ching H, Pringsheim T. Aripiprazole for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;5:CD009043.
11. Sinha Y, Silove N, Hayen A, Williams K. Auditory integration training and other sound therapies for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2011;(12):CD003681.
12. James S, Montgomery P, Williams K. Omega-3 fatty acids supplementation for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2011;(11):CD007992.
13. Cheuk DK, Wong V, Chen WX. Acupuncture for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2011;(9):CD007849.
14. Jesner OS, Aref-Adib M, Coren E. Risperidone for autism spectrum disorder. Cochrane Database Syst Rev. 2007;(1):CD005040.
15. Nye C, Brice A. Combined vitamin B6-magnesium treatment in autism spectrum disorder. Cochrane Database Syst Rev. 2005;(4):CD003497.

 

 

Competing interests: Anand Viswanathan, a rehabilitation physician, currently works full time in a research position at Cochrane South Asia, Christian Medical College, Vellore- India. He could be reached at @anandtmc .

 

 Cochrane is a global, not-for-profit, independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane is engaged in gathering and summarizing the best evidence from research in the form of ‘Cochrane systematic reviews’, which represent an international gold standard for high quality, trusted information to make healthcare decisions better. Cochrane Systematic Reviews can be accessed free from anywhere in India, thanks to funding by the Indian Council of Medical Research. http://www.cochranelibrary.com/

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