Oliver Wendell Holmes Sr. once said, “Beware how you take away hope from another human being.” How many physicians, caring for autistic children, have said to the parents, “there is nothing that can be done,” thus taking away hope. Wise physicians use complementary and alternative medicine (CAM) in treating autism, as too often that is the only thing that will not take away hope.
Recently, five autism experts, who must have read Holmes, reviewed the treatment options for children with autism. The authors included Professor Robert Hendren, Director of Child and Adolescent Psychiatry at UCSF and was written by Dr. Nicholas Lofthouse of Ohio State University. The paper is open access and I recommend anyone interested in autism download and read it.
First, they emphasized the importance of behavioral modification, language therapy, and occupational therapy. They also noted that such treatment is expensive and often takes 30-40 hours per week for several years. Therefore, they reviewed the scientific literature on less costly alternatives, such as alternative medication and supplements. They discussed the following points:
- Up to 50% of autistic children are on off-label psychiatric medications, such as Ritalin, antidepressants, and mood stabilizers, although evidence for their usefulness is lacking in the medical literature. However, such medicines can be useful as are the atypical antipsychotics, like Risperdal, in some cases.
- The use of complementary and alternative medicine (CAM) in autism is as high as 80%.
- Melatonin is the best studied complementary and alternative treatment (CAT) in autism, and the authors recommend its use.
- More than 25 studies have looked at magnesium and B6, with varying results. The authors suggest the use if B6 doses are less than a gram a day and if magnesium doses are less than 300 mg/day. I have found magnesium very useful in the children who also responded to vitamin D.
- Multivitamins and minerals have been studied and the authors recommend their use.
- Omega-3 fatty acids have also been studied in six trials and the authors recommend their use.
- They also recommend a trial of probiotics, as they are safe and there is increasing evidence for a gut-brain connection.
- Iron is only recommended for children with low ferritin levels.
- Chelation is only recommended if heavy metal toxicity is confirmed.
- Five trials of massage therapy exist, including a review, and thus massage therapy by the parents is recommend as it safe and cheap and probably improves the parent child relationship.
- Things such as pets, music, and exercise probably help and are recommended.
- While only one randomized controlled trial exists using N-Acetylcysteine, it was strongly positive (P<.001) for improving irritability and the authors are clearly encouraged by the study.
As the authors conclude, “Although current research on CATs for autism is limited, the treatment needs of individuals cannot always wait for science to improve.” I wish they had included the recent study in the Journal of Neuroinflamation showing that autism rating scales (and levels of an anti-neural antibody) were very strongly (R>-.85) correlated with vitamin D levels. This study strongly supports the idea that high dose vitamin D will help symptoms.
The authors conclude by making ten well thought out and reasonable clinical recommendations, and I again recommend this paper to anyone interested in treating autism. The paper is free in its entirety to download and read. The only advice I would add is to obtain and maintain high normal vitamin D levels, and for the same reasons they outlined in their conclusions, it is safe and it may help. As Holmes once said, physicians have many rights, but the right to take away hope is not among them.