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==Overview==
==Overview==
Many medications are used to treat problems associated with ASD.<ref>{{cite journal |journal= Harv Rev Psychiatry |date=2008 |volume=16 |issue=2 |pages=97–112 |title= Pharmacological treatment options for autism spectrum disorders in children and adolescents |author= Leskovec TJ, Rowles BM, Findling RL |doi=10.1080/10673220802075852 |pmid=18415882}}</ref> More than half of U.S. children diagnosed with ASD are prescribed [[psychoactive drug]]s or [[anticonvulsant]]s, with the most common drug classes being [[antidepressant]]s, [[stimulant]]s, and [[antipsychotic]]s.<ref>{{cite journal |journal= J Child Adolesc Psychopharmacol |date=2007 |volume=17 |issue=3 |pages=348–55 |title= Medication use among children with autism spectrum disorders |author= Oswald DP, Sonenklar NA |doi=10.1089/cap.2006.17303 |pmid=17630868}}</ref> Aside from antipsychotics,<ref>{{cite journal |journal= J Clin Invest |date=2008 |volume=118 |issue=1 |pages=6–14 |title= Antipsychotics in the treatment of autism |author= Posey DJ, Stigler KA, Erickson CA, McDougle CJ |doi=10.1172/JCI32483 |pmid=18172517 |url=http://jci.org/cgi/content/full/118/1/6}}</ref> there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.<ref>Lack of research on drug treatments:
Many medications are used to treat problems associated with ASD.<ref>{{cite journal |journal= Harv Rev Psychiatry |date=2008 |volume=16 |issue=2 |pages=97–112 |title= Pharmacological treatment options for autism spectrum disorders in children and adolescents |author= Leskovec TJ, Rowles BM, Findling RL |doi=10.1080/10673220802075852 |pmid=18415882}}</ref> More than half of U.S. children diagnosed with ASD are prescribed [[psychoactive drug]]s or [[anticonvulsant]]s, with the most common drug classes being [[antidepressant]]s, [[stimulant]]s, and [[antipsychotic]]s.<ref>{{cite journal |journal= J Child Adolesc Psychopharmacol |date=2007 |volume=17 |issue=3 |pages=348–55 |title= Medication use among children with autism spectrum disorders |author= Oswald DP, Sonenklar NA |doi=10.1089/cap.2006.17303 |pmid=17630868}}</ref> Aside from antipsychotics,<ref>{{cite journal |journal= J Clin Invest |date=2008 |volume=118 |issue=1 |pages=6–14 |title= Antipsychotics in the treatment of autism |author= Posey DJ, Stigler KA, Erickson CA, McDougle CJ |doi=10.1172/JCI32483 |pmid=18172517 |url=http://jci.org/cgi/content/full/118/1/6}}</ref> there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.<ref>Lack of research on drug treatments:
*{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=9 |pages=741–4 |title= Children and autism—part 1—recognition and pharmacological management |author= Angley M, Young R, Ellis D, Chan W, McKinnon R |pmid=17915375 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200709/200709angley.pdf |format=PDF}}
*{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=9 |pages=741–4 |title= Children and autism—part 1—recognition and pharmacological management |author= Angley M, Young R, Ellis D, Chan W, McKinnon R |pmid=17915375 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200709/200709angley.pdf |format=PDF}}
*{{cite journal |journal=Autism |date=2007 |volume=11 |issue=4 |pages=335–48 |title= Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder |author= Broadstock M, Doughty C, Eggleston M |doi=10.1177/1362361307078132 |pmid=17656398}}</ref> A person with ASD may respond atypically to medications, the medications can have [[Adverse effect (medicine)|adverse effects]], and no known medication relieves autism's core symptoms of social and communication impairments.<ref name=Strock>{{cite paper |author=Strock M |date=2008 |title= Autism spectrum disorders (pervasive developmental disorders) |publisher= National Institute of Mental Health |url=http://nimh.nih.gov/health/publications/autism/complete-publication.shtml |accessdate=2008-03-24}}</ref><ref>{{cite journal |journal= Novartis Found Symp |date=2003 |volume=251 |pages= 235–44; discussion 245–9, 281–97 |title= Why have drug treatments been so disappointing? |author= Buitelaar JK |doi=10.1002/0470869380.ch14 |pmid=14521196}}</ref>
*{{cite journal |journal=Autism |date=2007 |volume=11 |issue=4 |pages=335–48 |title= Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder |author= Broadstock M, Doughty C, Eggleston M |doi=10.1177/1362361307078132 |pmid=17656398}}</ref> A person with ASD may respond atypically to medications, the medications can have [[Adverse effect (medicine)|adverse effects]], and no known medication relieves autism's core symptoms of social and communication impairments.<ref name=Strock>{{cite paper |author=Strock M |date=2008 |title= Autism spectrum disorders (pervasive developmental disorders) |publisher= National Institute of Mental Health |url=http://nimh.nih.gov/health/publications/autism/complete-publication.shtml |accessdate=2008-03-24}}</ref><ref>{{cite journal |journal= Novartis Found Symp |date=2003 |volume=251 |pages= 235–44; discussion 245–9, 281–97 |title= Why have drug treatments been so disappointing? |author= Buitelaar JK |doi=10.1002/0470869380.ch14 |pmid=14521196}}</ref>
==Medical Therapy==
Drugs, supplements, or diets are often used to alter physiology in an attempt to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity that can interfere with education or social adaptation or (more rarely) cause autistic individuals to harm themselves or others.<ref name=Levy/> There is plenty of anecdotal evidence to support medical treatment; many parents who try one or more therapies report some progress, and there are a few well-publicized reports of children who are able to return to mainstream education after treatment, with dramatic improvements in health and well-being. However, this evidence may be confounded by improvements seen in autistic children who grow up without treatment, by the difficulty of verifying reports of improvements, and by the lack of reporting of treatments' negative outcomes.<ref>{{cite book |author= Schreibman L |title= The Science and Fiction of Autism |date=2005 |publisher= Harvard University Press |isbn=0674019318 |chapter= Critical evaluation of issues in autism |chapterurl=http://www.hup.harvard.edu/pdf/SCHSCI_excerpt.pdf}}</ref> Only a very few medical treatments are well supported by scientific evidence using controlled experiments.<ref name=Levy/>


===Prescription Medication===
Medications are often used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed [[psychoactive drug]]s or [[anticonvulsant]]s, with the most common drug classes being [[antidepressant]]s, [[stimulant]]s, and [[antipsychotic]]s.<ref name=Oswald>{{cite journal |journal= J Child Adolesc Psychopharmacol |date=2007 |volume=17 |issue=3 |pages=348–55 |title= Medication use among children with autism spectrum disorders |author= Oswald DP, Sonenklar NA |doi=10.1089/cap.2006.17303 |pmid=17630868}}</ref> Only the antipsychotics have clearly demonstrated efficacy.<ref name=Posey/>
Research has focused on [[atypical antipsychotics]], especially [[risperidone]], which has the largest amount of evidence that consistently shows improvements in irritability, self-injury, aggression, and tantrums associated with ASD.<ref>{{cite journal |journal= Pediatr Drugs |year=2007 |volume=9 |issue=4 |pages=249–66 |title= Atypical antipsychotics in children with pervasive developmental disorders |author= Chavez B, Chavez-Brown M, Sopko MA Jr, Rey JA |pmid=17705564}}</ref> In the United States, [[risperidone]] is approved for treating symptomatic irritability in autistic children and adolescents aged 5–16 years. In short-term trials (up to 6 months) most adverse events were mild to moderate, with [[weight gain]], [[drowsiness]], and [[high blood sugar]] requiring monitoring. Its long term efficacy and safety have not been fully determined.<ref name=Scott>{{cite journal |journal= Pediatr Drugs |year=2007 |volume=9 |issue=5 |pages=343–54 |title= Risperidone: a review of its use in the treatment of irritability associated with autistic disorder in children and adolescents |author= Scott LJ, Dhillon S |pmid=17927305}}</ref> It is unclear whether risperidone improves autism's core social and communication deficits.<ref name=Posey>{{cite journal |journal= J Clin Invest |date=2008 |volume=118 |issue=1 |pages=6–14 |title= Antipsychotics in the treatment of autism |author= Posey DJ, Stigler KA, Erickson CA, McDougle CJ |doi=10.1172/JCI32483 |pmid=18172517 |url=http://www.jci.org/cgi/content/full/118/1/6}}</ref>
Other drugs are prescribed [[off-label]] in the U.S., which means they have not been approved for treating ASD. Large [[placebo]]-controlled studies of [[olanzapine]] and [[aripiprazole]] were underway in early 2008.<ref name=Posey/> Some [[selective serotonin reuptake inhibitor]]s (SSRIs) and [[dopamine]] blockers can reduce some maladaptive behaviors associated with ASD.<ref name=pharmacotherapy>{{cite journal |journal= Expert Opin Pharmacother |year=2007 |volume=8 |issue=11 |pages=1579–603 |title= The status of pharmacotherapy for autism spectrum disorders |author= Myers SM |doi=10.1517/14656566.8.11.1579 |pmid=17685878}}</ref> The limited data for SSRIs suggest that they may be helpful for obsessions/compulsions, but that children may have a worse response than adults and may suffer more adverse affects, such as suicidal impulses.<ref name=Angley1/> One study found that the psychostimulant [[methylphenidate]] was efficacious against hyperactivity associated with ASD, though with less response than in neurotypical children with ADHD.<ref name=Angley1/> A 1998 study of the hormone [[secretin]] reported improved symptoms and generated tremendous interest, but several controlled studies since have found no benefit.<ref name=Francis/>
There is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.<ref name=Angley1>{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=9 |pages=741–4 |title= Children and autism—part 1—recognition and pharmacological management |author= Angley M, Young R, Ellis D, Chan W, McKinnon R |pmid=17915375 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200709/200709angley.pdf |format=PDF}}</ref> Results of the handful of [[randomized control trial]]s that have been performed suggest that risperidone, the SSRI [[fluvoxamine]], and the typical antipsychotic [[haloperidol]] may be effective in reducing some behaviors, that haloperidol may be more effective than the tricyclic antidepressant [[clomipramine]], and that the opiate antagonist [[naltrexone hydrochloride]] is not effective.<ref name=Broadstock>{{cite journal |journal=Autism |date=2007 |volume=11 |issue=4 |pages=335–48 |title= Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder |author= Broadstock M, Doughty C, Eggleston M |doi=10.1177/1362361307078132 |pmid=17656398}}</ref> A person with ASD may respond atypically to medications, the medications can have adverse side effects, and no known medication relieves autism's core symptoms of social and communication impairments.<ref>{{cite paper |author=Strock M |date=2007 |title= Autism spectrum disorders (pervasive developmental disorders) |publisher= National Institute of Mental Health |url=http://www.nimh.nih.gov/health/publications/autism/complete-publication.shtml |accessdate=2007-10-05}}</ref>
===Supplements===
Many parents give their children vitamin and other nutritional supplements in an attempt to treat autism or to alleviate its symptoms. The range of supplements given is wide; few are supported by scientific data, but most have relatively mild side effects.<ref name=Levy/><ref name=Angley2/>
Nutritional supplementation with high dose [[pyridoxine]] ([[vitamin B6]]) and [[magnesium]] (HPDM) is claimed to alleviate the symptoms of autism and is one of the most popular complementary and alternative medicine choices for autism. Three small [[randomized controlled trial]]s have studied this therapy; the smallest one (with 8 individuals) found improved verbal IQ in the treatment group and the other two (with 10 and 15 individuals, respectively) found no significant difference.<ref name=Angley2/> Due to the limited data it is difficult to tell whether this treatment approach has effects greater than placebo.<ref name=Francis/> The short-term side effects seem to be mild, but there may be significant long-term side effects, as high doses of pyridoxine cause [[peripheral neuropathy]] in adults,<ref name=Angley2>{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=10 |pages=827–30 |title= Children and autism—part 2—management with complementary medicines and dietary interventions |author= Angley M, Semple S, Hewton C, Paterson F, McKinnon R |pmid=17925903 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200710/200710angley.pdf |format=PDF}}</ref> high doses of magnesium can cause reduced heart rate and weakened reflexes,<ref name=Herbert>{{cite journal |author=Herbert JD, Sharp IR, Gaudiano BA |title=Separating fact from fiction in the etiology and treatment of autism: a scientific review of the evidence |journal=S ci Rev Ment Health Pract |volume=1 |issue=1 |pages=23–43 |year=2002 |url=http://www.srmhp.org/0101/autism.html}}</ref> and high magnesium concentrations are associated with seizures.<ref name=Schechtman/> Magnesium should always be taken along with high doses of pyridoxine to prevent side effects such as irritability and sensitivity to sound.<ref name=Francis>{{cite journal |journal= Dev Med Child Neurol |date=2005 |volume=47 |issue=7 |pages=493–9 |title= Autism interventions: a critical update |author= Francis K |pmid=15991872 |url=http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=313204 |format=PDF}}</ref>
[[Dimethylglycine]] (DMG) is hypothesized to improve speech and reduce autistic behaviors,<ref name=Angley2/> and is a commonly used supplement.<ref name=Levy/> Two double-blind, placebo-controlled studies found no statistically significant effect on autistic behaviors,<ref name=Angley2/> and reported few side effects. No peer-reviewed studies have addressed treatment with the related compound [[trimethylglycine]].<ref name=Levy/>
[[Vitamin C]] decreased stereotyped behavior in a small 1993 study. The study has not been replicated, and vitamin C has limited popularity as an autism treatment. High doses might cause kidney stones or gastrointestinal upset such as diarrhea.<ref name=Levy/>
[[Probiotic]]s containing potentially beneficial [[bacteria]] are hypothesized to relieve some symptoms of autism by minimizing yeast overgrowth in the colon. The hypothesized yeast overgrowth has not been confirmed by [[endoscopy]], the mechanism connecting yeast overgrowth to autism is only hypothetical, and no clinical trials to date have been published in the peer-reviewed literature. No negative side effects have been reported.<ref name=Levy>{{cite journal |journal= Ment Retard Dev Disabil Res Rev |year=2005 |volume=11 |issue=2 |pages=131–42 |title= Novel treatments for autistic spectrum disorders |author= Levy SE, Hyman SL |doi=10.1002/mrdd.20062 |pmid=15977319}}</ref>
[[Melatonin]] is sometimes used to manage sleep problems in developmental disorders. One small open trial found a statistically significant reduction in sleep latency in children with ASD. Adverse effects are generally reported to be mild, including drowsiness, headache, dizziness, and nausea; however, an increase in seizure frequency is reported among susceptible children.<ref name=Angley2/>
Several other supplements have been hypothesized to relieve autism symptoms, including [[carnosine]], [[cyproheptadine]], [[D-cycloserine]], [[folic acid]], [[glutathione]], [[metallothionein]] promoters, [[oxytocin]], [[polyunsaturated fatty acid]]s (PUFA) such as [[omega-3]] or [[omega-6]] fatty acids, [[tryptophan]], [[tyrosine]], thiamine (see [[#Chelation therapy|Chelation therapy]]), [[vitamin B12]], and [[zinc]]. None of these have reliable scientific evidence of efficacy or safety in treatment of autism.<ref name=Levy/><ref name=Angley2/>
===Diets===
{{see|Gluten-free, casein-free diet}}
Atypical eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;<ref name=Dominick>{{cite journal |journal= Res Dev Disabil |year=2007 |volume=28 |issue=2 |pages=145–62 |title= Atypical behaviors in children with autism and children with a history of language impairment |author= Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S |doi=10.1016/j.ridd.2006.02.003 |pmid=16581226}}</ref> this does not appear to result in [[malnutrition]]. Although some children with autism also have [[gastrointestinal]] (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual;<ref>{{cite journal |journal= J Autism Dev Disord |date=2005 |volume=35 |issue=6 |pages=713–27 |title= Gastrointestinal factors in autistic disorder: a critical review |author= Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ |doi=10.1007/s10803-005-0019-4 |pmid=16267642}}</ref> studies report conflicting results, and the relationship between GI problems and ASD is unclear.<ref name=CCD/>
In the early 1990s it was hypothesized that autism can be caused or aggravated by [[opioid peptide]]s like [[casomorphine]] that are metabolic products of [[gluten]] and [[casein]].<ref>{{cite journal |author= Reichelt KL, Knivsberg A-M, Lind G, Nødland M |title= Probable etiology and possible treatment of childhood autism |journal= Brain Dysfunct |year=1991 |volume=4 |pages=308–19}}</ref> Based on this hypothesis, diets that eliminate foods containing either gluten or casein, or both, are widely promoted, and many testimonials can be found describing benefits in autism-related symptoms, notably social engagement and verbal skills.
Studies supporting these claims have had significant flaws, so the data are inadequate to guide treatment recommendations.<ref name=Christison>{{cite journal |journal= J Dev Behav Pediatr |date=2006 |volume=27 |issue=2 Suppl 2| pages=S162–71 |title= Elimination diets in autism spectrum disorders: any wheat amidst the chaff? |author= Christison GW, Ivany K |pmid=16685183}}</ref>
Other elimination diets have also been proposed, targeting [[salicylates]], [[food dye]]s, [[yeast]], and simple sugars. No scientific evidence has established the efficacy of such diets in treating autism in children. An elimination diet may create nutritional deficiencies that harm overall health unless care is taken to assure proper nutrition.<ref name=Angley2/>
===Chelation Therapy===
Based on the speculation that [[heavy metals|heavy metal poisoning]] may trigger the symptoms of autism, particularly in small subsets of individuals who cannot excrete toxins effectively, some parents have turned to [[alternative medicine]] practitioners who provide detoxification treatments via [[chelation therapy]]. However, evidence to support this practice has been [[anecdote|anecdotal]] and not rigorous. There is strong [[epidemiology|epidemiological]] evidence that refutes links between environmental triggers, in particular [[thimerosal]] containing [[vaccine]]s, and the onset of autistic symptoms. No scientific data supports the claim that the mercury in the vaccine preservative [[thiomersal]] causes autism<ref>{{cite journal |journal= Can J Neurol Sci |date=2006 |volume=33 |issue=4 |pages=341–6 |title= Immunizations and autism: a review of the literature |author= Doja A, Roberts W |pmid=17168158}}</ref> or its symptoms,<ref>{{cite journal |journal= N Engl J Med |volume=357 |issue=13 |pages=1281–92 |year=2007 |title= Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years |author= Thompson WW, Price C, Goodson B ''et al.'' |pmid=17898097 |url=http://content.nejm.org/cgi/content/full/357/13/1281}}</ref> and there is no scientific support for chelation therapy as a treatment for autism.<ref name=Weber>{{cite journal |journal= Pediatr Clin North Am |date=2007 |volume=54 |issue=6 |pages=983–1006 |title= Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism |author= Weber W, Newmark S |doi=10.1016/j.pcl.2007.09.006 |pmid=18061787}}</ref>
Chelation therapy can be hazardous. In August 2005, botched chelation therapy killed a 5-year-old autistic boy, a nonautistic child died in February 2005 and an nonautistic adult died in August 2003. These deaths were due to [[cardiac arrest]] caused by [[hypocalcemia]] during chelation therapy.<ref name=hypocalcemia>{{cite journal |journal=Pediatrics |date=2006 |volume=118 |issue=2 |pages=e534-6 |title= Deaths resulting from hypocalcemia after administration of edetate disodium: 2003–2005 |author= Brown MJ, Willis T, Omalu B, Leiker R |doi=10.1542/peds.2006-0858 |pmid=16882789 |url=http://pediatrics.aappublications.org/cgi/content/full/118/2/e534}}</ref>
[[Thiamine]] tetrahydrofurfuryl disulfide (TTFD) is hypothesized to act as a chelating agent in children with autism. A 2002 pilot study administered TTFD rectally to ten [[autism spectrum]] children, and found beneficial clinical effect.<ref>{{cite journal |author=Lonsdale D, Shamberger RJ, Audhya T |title=Treatment of autism spectrum children with thiamine tetrahydrofurfuryl disulfide: a pilot study |journal=Neuro Endocrinol. Lett |volume=23 |issue=4 |pages=303–8 |year=2002 |pmid=12195231 |url=http://www.nel.edu/pdf_w/23_4/NEL230402A02_Lonsdale_rw.pdf |format=PDF |accessdate=2007-08-10}}</ref> This study has not been replicated and a 2006 review of thiamine by the same author did not mention thiamine's possible effect on [[autism]].<ref>{{cite journal |journal= Evid Based Complement Alternat Med |date= 2006 |volume= 3 |issue= 1 |pages= 49–59 |title= A review of the biochemistry, metabolism and clinical benefits of thiamin(e) and its derivatives |author= Lonsdale D |10.1093/ecam/nek009 |pmid= 16550223 |url=http://ecam.oxfordjournals.org/cgi/content/full/3/1/49}}</ref> There is not sufficient evidence to support the use of thiamine (vitamin B1) to treat autism.<ref name=Angley2/>
===Craniosacral Therapy===
[[Craniosacral therapy]] is based on the theory that restrictions at [[cranial sutures]] of the skull affect rhythmic impulses conveyed via [[cerebrospinal fluid]]. Practitioners, who include physical therapists, chiropractors, dentists, osteopaths, medical, and naturopathic physicians, hypothesize that gentle pressure on external areas can improve the flow and balance of the supply of this fluid to the brain, relieving symptoms of many conditions.<ref name=Green/> There is no scientific support for major elements of the underlying model,<ref>{{cite journal |author= Hartman SE, Norton JM |year=2002 |title= Interexaminer reliability and cranial osteopathy |journal= Sci Rev Alt Med |volume=6 |issue=1 |pages=23–34 |url=http://faculty.une.edu/com/shartman/sram.pdf |format=PDF |accessdate=2007-10-08}}</ref> there is little scientific evidence to support the therapy, and research methods that could conclusively evaluate the therapy's effectiveness have not been applied.<ref name=Green>{{cite journal |journal=Complement Ther Med |year=1999 |volume=7 |issue=4 |pages=201–7 |title= A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness |author= Green C, Martin CW, Bassett K, Kazanjian A |doi=10.1016/S0965-2299(99)80002-8 |pmid=10709302}} An earlier version of the paper is available without a subscription: {{cite paper |title= A systematic review and critical appraisal of the scientific evidence on craniosacral therapy |author= Green C, Martin CW, Bassett K, Kazanjian A |url=http://www.chspr.ubc.ca/files/publications/1999/bco99-01J_cranio.pdf |format=PDF |date=1999 |accessdate=2007-10-08 |version= BCOHTA 99:1J |publisher= British Columbia Office of Health Technology Assessment}}</ref>
===Hyperbaric Oxygen Therapy===
[[Hyperbaric oxygen therapy]] (HBOT) can compensate for decreased blood flow by increasing the oxygen content in the body. It has been postulated that HBOT might relieve some of the core symptoms of autism.<ref>{{cite journal |journal= Med Hypotheses |year=2007 |volume=68 |issue=6 |pages=1208–27 |title= Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism |author= Rossignol DA |doi=10.1016/j.mehy.2006.09.064 |pmid=17141962}}</ref> However, scientific evidence is lacking for the use of HBOT to treat autism.<ref name=Schechtman>{{cite journal |journal= Pediatr Ann |year=2007 |volume=36 |issue=8 |pages=497–8, 500–2, 504–5 |title= Scientifically unsupported therapies in the treatment of young children with autism spectrum disorders |author= Schechtman MA |pmid=17849608 |url=http://www.pediatricannalsonline.com/showPdf.asp?rID=23083 |format=PDF}}</ref>
===Stem Cell Therapy===
[[Mesenchymal stem cells]] and [[cord blood]] [[CD34]]+ cells have been proposed to treat autism, but this proposal has not been tested.<ref>{{cite journal |journal=J Transl Med |year=2007  |volume=5 |issue=30 |title= Stem cell therapy for autism |author= Ichim TE, Solano F, Glenn E ''et al.'' |doi=10.1186/1479-5876-5-30 |pmid=17597540 |url=http://www.translational-medicine.com/content/5/1/30}}</ref>
==References==
==References==


Revision as of 00:31, 11 February 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Many medications are used to treat problems associated with ASD.[1] More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics.[2] Aside from antipsychotics,[3] there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.[4] A person with ASD may respond atypically to medications, the medications can have adverse effects, and no known medication relieves autism's core symptoms of social and communication impairments.[5][6]

Medical Therapy

Drugs, supplements, or diets are often used to alter physiology in an attempt to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity that can interfere with education or social adaptation or (more rarely) cause autistic individuals to harm themselves or others.[7] There is plenty of anecdotal evidence to support medical treatment; many parents who try one or more therapies report some progress, and there are a few well-publicized reports of children who are able to return to mainstream education after treatment, with dramatic improvements in health and well-being. However, this evidence may be confounded by improvements seen in autistic children who grow up without treatment, by the difficulty of verifying reports of improvements, and by the lack of reporting of treatments' negative outcomes.[8] Only a very few medical treatments are well supported by scientific evidence using controlled experiments.[7]

Prescription Medication

Medications are often used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics.[9] Only the antipsychotics have clearly demonstrated efficacy.[10]

Research has focused on atypical antipsychotics, especially risperidone, which has the largest amount of evidence that consistently shows improvements in irritability, self-injury, aggression, and tantrums associated with ASD.[11] In the United States, risperidone is approved for treating symptomatic irritability in autistic children and adolescents aged 5–16 years. In short-term trials (up to 6 months) most adverse events were mild to moderate, with weight gain, drowsiness, and high blood sugar requiring monitoring. Its long term efficacy and safety have not been fully determined.[12] It is unclear whether risperidone improves autism's core social and communication deficits.[10]

Other drugs are prescribed off-label in the U.S., which means they have not been approved for treating ASD. Large placebo-controlled studies of olanzapine and aripiprazole were underway in early 2008.[10] Some selective serotonin reuptake inhibitors (SSRIs) and dopamine blockers can reduce some maladaptive behaviors associated with ASD.[13] The limited data for SSRIs suggest that they may be helpful for obsessions/compulsions, but that children may have a worse response than adults and may suffer more adverse affects, such as suicidal impulses.[14] One study found that the psychostimulant methylphenidate was efficacious against hyperactivity associated with ASD, though with less response than in neurotypical children with ADHD.[14] A 1998 study of the hormone secretin reported improved symptoms and generated tremendous interest, but several controlled studies since have found no benefit.[15]

There is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.[14] Results of the handful of randomized control trials that have been performed suggest that risperidone, the SSRI fluvoxamine, and the typical antipsychotic haloperidol may be effective in reducing some behaviors, that haloperidol may be more effective than the tricyclic antidepressant clomipramine, and that the opiate antagonist naltrexone hydrochloride is not effective.[16] A person with ASD may respond atypically to medications, the medications can have adverse side effects, and no known medication relieves autism's core symptoms of social and communication impairments.[17]

Supplements

Many parents give their children vitamin and other nutritional supplements in an attempt to treat autism or to alleviate its symptoms. The range of supplements given is wide; few are supported by scientific data, but most have relatively mild side effects.[7][18]

Nutritional supplementation with high dose pyridoxine (vitamin B6) and magnesium (HPDM) is claimed to alleviate the symptoms of autism and is one of the most popular complementary and alternative medicine choices for autism. Three small randomized controlled trials have studied this therapy; the smallest one (with 8 individuals) found improved verbal IQ in the treatment group and the other two (with 10 and 15 individuals, respectively) found no significant difference.[18] Due to the limited data it is difficult to tell whether this treatment approach has effects greater than placebo.[15] The short-term side effects seem to be mild, but there may be significant long-term side effects, as high doses of pyridoxine cause peripheral neuropathy in adults,[18] high doses of magnesium can cause reduced heart rate and weakened reflexes,[19] and high magnesium concentrations are associated with seizures.[20] Magnesium should always be taken along with high doses of pyridoxine to prevent side effects such as irritability and sensitivity to sound.[15]

Dimethylglycine (DMG) is hypothesized to improve speech and reduce autistic behaviors,[18] and is a commonly used supplement.[7] Two double-blind, placebo-controlled studies found no statistically significant effect on autistic behaviors,[18] and reported few side effects. No peer-reviewed studies have addressed treatment with the related compound trimethylglycine.[7]

Vitamin C decreased stereotyped behavior in a small 1993 study. The study has not been replicated, and vitamin C has limited popularity as an autism treatment. High doses might cause kidney stones or gastrointestinal upset such as diarrhea.[7]

Probiotics containing potentially beneficial bacteria are hypothesized to relieve some symptoms of autism by minimizing yeast overgrowth in the colon. The hypothesized yeast overgrowth has not been confirmed by endoscopy, the mechanism connecting yeast overgrowth to autism is only hypothetical, and no clinical trials to date have been published in the peer-reviewed literature. No negative side effects have been reported.[7]

Melatonin is sometimes used to manage sleep problems in developmental disorders. One small open trial found a statistically significant reduction in sleep latency in children with ASD. Adverse effects are generally reported to be mild, including drowsiness, headache, dizziness, and nausea; however, an increase in seizure frequency is reported among susceptible children.[18]

Several other supplements have been hypothesized to relieve autism symptoms, including carnosine, cyproheptadine, D-cycloserine, folic acid, glutathione, metallothionein promoters, oxytocin, polyunsaturated fatty acids (PUFA) such as omega-3 or omega-6 fatty acids, tryptophan, tyrosine, thiamine (see Chelation therapy), vitamin B12, and zinc. None of these have reliable scientific evidence of efficacy or safety in treatment of autism.[7][18]

Diets

Further information: Gluten-free, casein-free diet

Atypical eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;[21] this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual;[22] studies report conflicting results, and the relationship between GI problems and ASD is unclear.[23]

In the early 1990s it was hypothesized that autism can be caused or aggravated by opioid peptides like casomorphine that are metabolic products of gluten and casein.[24] Based on this hypothesis, diets that eliminate foods containing either gluten or casein, or both, are widely promoted, and many testimonials can be found describing benefits in autism-related symptoms, notably social engagement and verbal skills. Studies supporting these claims have had significant flaws, so the data are inadequate to guide treatment recommendations.[25]

Other elimination diets have also been proposed, targeting salicylates, food dyes, yeast, and simple sugars. No scientific evidence has established the efficacy of such diets in treating autism in children. An elimination diet may create nutritional deficiencies that harm overall health unless care is taken to assure proper nutrition.[18]

Chelation Therapy

Based on the speculation that heavy metal poisoning may trigger the symptoms of autism, particularly in small subsets of individuals who cannot excrete toxins effectively, some parents have turned to alternative medicine practitioners who provide detoxification treatments via chelation therapy. However, evidence to support this practice has been anecdotal and not rigorous. There is strong epidemiological evidence that refutes links between environmental triggers, in particular thimerosal containing vaccines, and the onset of autistic symptoms. No scientific data supports the claim that the mercury in the vaccine preservative thiomersal causes autism[26] or its symptoms,[27] and there is no scientific support for chelation therapy as a treatment for autism.[28]

Chelation therapy can be hazardous. In August 2005, botched chelation therapy killed a 5-year-old autistic boy, a nonautistic child died in February 2005 and an nonautistic adult died in August 2003. These deaths were due to cardiac arrest caused by hypocalcemia during chelation therapy.[29]

Thiamine tetrahydrofurfuryl disulfide (TTFD) is hypothesized to act as a chelating agent in children with autism. A 2002 pilot study administered TTFD rectally to ten autism spectrum children, and found beneficial clinical effect.[30] This study has not been replicated and a 2006 review of thiamine by the same author did not mention thiamine's possible effect on autism.[31] There is not sufficient evidence to support the use of thiamine (vitamin B1) to treat autism.[18]

Craniosacral Therapy

Craniosacral therapy is based on the theory that restrictions at cranial sutures of the skull affect rhythmic impulses conveyed via cerebrospinal fluid. Practitioners, who include physical therapists, chiropractors, dentists, osteopaths, medical, and naturopathic physicians, hypothesize that gentle pressure on external areas can improve the flow and balance of the supply of this fluid to the brain, relieving symptoms of many conditions.[32] There is no scientific support for major elements of the underlying model,[33] there is little scientific evidence to support the therapy, and research methods that could conclusively evaluate the therapy's effectiveness have not been applied.[32]

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) can compensate for decreased blood flow by increasing the oxygen content in the body. It has been postulated that HBOT might relieve some of the core symptoms of autism.[34] However, scientific evidence is lacking for the use of HBOT to treat autism.[20]

Stem Cell Therapy

Mesenchymal stem cells and cord blood CD34+ cells have been proposed to treat autism, but this proposal has not been tested.[35]

References

  1. ↑ Leskovec TJ, Rowles BM, Findling RL (2008). "Pharmacological treatment options for autism spectrum disorders in children and adolescents". Harv Rev Psychiatry. 16 (2): 97–112. doi:10.1080/10673220802075852. PMID 18415882.
  2. ↑ Oswald DP, Sonenklar NA (2007). "Medication use among children with autism spectrum disorders". J Child Adolesc Psychopharmacol. 17 (3): 348–55. doi:10.1089/cap.2006.17303. PMID 17630868.
  3. ↑ Posey DJ, Stigler KA, Erickson CA, McDougle CJ (2008). "Antipsychotics in the treatment of autism". J Clin Invest. 118 (1): 6–14. doi:10.1172/JCI32483. PMID 18172517.
  4. ↑ Lack of research on drug treatments:
  5. ↑ Template:Cite paper
  6. ↑ Buitelaar JK (2003). "Why have drug treatments been so disappointing?". Novartis Found Symp. 251: 235–44, discussion 245–9, 281–97. doi:10.1002/0470869380.ch14. PMID 14521196.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Levy SE, Hyman SL (2005). "Novel treatments for autistic spectrum disorders". Ment Retard Dev Disabil Res Rev. 11 (2): 131–42. doi:10.1002/mrdd.20062. PMID 15977319.
  8. ↑ Schreibman L (2005). "Critical evaluation of issues in autism" (PDF). The Science and Fiction of Autism. Harvard University Press. ISBN 0674019318.
  9. ↑ Oswald DP, Sonenklar NA (2007). "Medication use among children with autism spectrum disorders". J Child Adolesc Psychopharmacol. 17 (3): 348–55. doi:10.1089/cap.2006.17303. PMID 17630868.
  10. ↑ 10.0 10.1 10.2 Posey DJ, Stigler KA, Erickson CA, McDougle CJ (2008). "Antipsychotics in the treatment of autism". J Clin Invest. 118 (1): 6–14. doi:10.1172/JCI32483. PMID 18172517.
  11. ↑ Chavez B, Chavez-Brown M, Sopko MA Jr, Rey JA (2007). "Atypical antipsychotics in children with pervasive developmental disorders". Pediatr Drugs. 9 (4): 249–66. PMID 17705564.
  12. ↑ Scott LJ, Dhillon S (2007). "Risperidone: a review of its use in the treatment of irritability associated with autistic disorder in children and adolescents". Pediatr Drugs. 9 (5): 343–54. PMID 17927305.
  13. ↑ Myers SM (2007). "The status of pharmacotherapy for autism spectrum disorders". Expert Opin Pharmacother. 8 (11): 1579–603. doi:10.1517/14656566.8.11.1579. PMID 17685878.
  14. ↑ 14.0 14.1 14.2 Angley M, Young R, Ellis D, Chan W, McKinnon R (2007). "Children and autism—part 1—recognition and pharmacological management" (PDF). Aust Fam Physician. 36 (9): 741–4. PMID 17915375.
  15. ↑ 15.0 15.1 15.2 Francis K (2005). "Autism interventions: a critical update" (PDF). Dev Med Child Neurol. 47 (7): 493–9. PMID 15991872.
  16. ↑ Broadstock M, Doughty C, Eggleston M (2007). "Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder". Autism. 11 (4): 335–48. doi:10.1177/1362361307078132. PMID 17656398.
  17. ↑ Template:Cite paper
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 Angley M, Semple S, Hewton C, Paterson F, McKinnon R (2007). "Children and autism—part 2—management with complementary medicines and dietary interventions" (PDF). Aust Fam Physician. 36 (10): 827–30. PMID 17925903.
  19. ↑ Herbert JD, Sharp IR, Gaudiano BA (2002). "Separating fact from fiction in the etiology and treatment of autism: a scientific review of the evidence". S ci Rev Ment Health Pract. 1 (1): 23–43.
  20. ↑ 20.0 20.1 Schechtman MA (2007). "Scientifically unsupported therapies in the treatment of young children with autism spectrum disorders" (PDF). Pediatr Ann. 36 (8): 497–8, 500–2, 504–5. PMID 17849608.
  21. ↑ Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S (2007). "Atypical behaviors in children with autism and children with a history of language impairment". Res Dev Disabil. 28 (2): 145–62. doi:10.1016/j.ridd.2006.02.003. PMID 16581226.
  22. ↑ Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ (2005). "Gastrointestinal factors in autistic disorder: a critical review". J Autism Dev Disord. 35 (6): 713–27. doi:10.1007/s10803-005-0019-4. PMID 16267642.
  23. ↑
  24. ↑ Reichelt KL, Knivsberg A-M, Lind G, Nødland M (1991). "Probable etiology and possible treatment of childhood autism". Brain Dysfunct. 4: 308–19.
  25. ↑ Christison GW, Ivany K (2006). "Elimination diets in autism spectrum disorders: any wheat amidst the chaff?". J Dev Behav Pediatr. 27 (2 Suppl 2): S162–71. PMID 16685183.
  26. ↑ Doja A, Roberts W (2006). "Immunizations and autism: a review of the literature". Can J Neurol Sci. 33 (4): 341–6. PMID 17168158.
  27. ↑ Thompson WW, Price C, Goodson B; et al. (2007). "Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years". N Engl J Med. 357 (13): 1281–92. PMID 17898097.
  28. ↑ Weber W, Newmark S (2007). "Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism". Pediatr Clin North Am. 54 (6): 983–1006. doi:10.1016/j.pcl.2007.09.006. PMID 18061787.
  29. ↑ Brown MJ, Willis T, Omalu B, Leiker R (2006). "Deaths resulting from hypocalcemia after administration of edetate disodium: 2003–2005". Pediatrics. 118 (2): e534–6. doi:10.1542/peds.2006-0858. PMID 16882789.
  30. ↑ Lonsdale D, Shamberger RJ, Audhya T (2002). "Treatment of autism spectrum children with thiamine tetrahydrofurfuryl disulfide: a pilot study" (PDF). Neuro Endocrinol. Lett. 23 (4): 303–8. PMID 12195231. Retrieved 2007-08-10.
  31. ↑ Lonsdale D (2006). "A review of the biochemistry, metabolism and clinical benefits of thiamin(e) and its derivatives". Evid Based Complement Alternat Med. 3 (1): 49–59. PMID 16550223. Text "10.1093/ecam/nek009 " ignored (help)
  32. ↑ 32.0 32.1 Green C, Martin CW, Bassett K, Kazanjian A (1999). "A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness". Complement Ther Med. 7 (4): 201–7. doi:10.1016/S0965-2299(99)80002-8. PMID 10709302. An earlier version of the paper is available without a subscription: Template:Cite paper
  33. ↑ Hartman SE, Norton JM (2002). "Interexaminer reliability and cranial osteopathy" (PDF). Sci Rev Alt Med. 6 (1): 23–34. Retrieved 2007-10-08.
  34. ↑ Rossignol DA (2007). "Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism". Med Hypotheses. 68 (6): 1208–27. doi:10.1016/j.mehy.2006.09.064. PMID 17141962.
  35. ↑ Ichim TE, Solano F, Glenn E; et al. (2007). "Stem cell therapy for autism". J Transl Med. 5 (30). doi:10.1186/1479-5876-5-30. PMID 17597540.

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