Complementary medicine is used frequently in autism, …probably more so than conventional therapy! Research suggests that between 30 and 95% of children with autism receive some type of complementary therapy.  Considering the lack of effective treatments for this condition, complementary approaches represent a popular option for many parents.  Typically both physicians and patients have access to the same information and have similar questions as to their safety, effectiveness, and use.

Complementary medicine is evidence-based, meaning that it integrates clinical experience with recommendations for judicious use based on recommendations derived from available clinical and research reports.  Complementary interventions are often used as   primary treatment or in conjunction with conventional treatment.  There are 2 main subgroups: 1) natural products like botanicals, minerals, vitamins and probiotics, and 2) mind and body practices like yoga and hypnotherapy.

Complementary medicine differs from alternative medicine in that the latter lacks sufficient evidence of efficacy and is therefore used as an optional treatment.  During the last few years there has been an effort to merge the practice of complementary and alternative medicine into a single field.  The convergence of these approaches into integrative medicine emphasizes a holistic, patient-focused approach to health care.  For the purpose of our discussion, we now abbreviate the terms for complementary and alternative medicine as CAM.

The use of CAM therapy has been increasing within our society. At this very moment, approximately 1 in 3 adults and 1 in 10 children use some type of CAM therapy. People of all backgrounds use CAM; however, its use among adults is greater among women and those with higher education/incomes. This is specially so, if the patient has had a large number of visits to physicians during the proceeding years.  In the US, African American and Hispanic families are the least likely to use CAM.

There are a number of reasons as to why people use CAM therapy.  In some cases, these may include family beliefs and fear of adverse drug effects from conventional therapy (e.g., in the case of chemotherapy).  Some interventions offer comfort and relaxation as patients receive satisfaction from the touch, talk and time offered by the therapist.  For many parents of autistic individuals, CAM therapy fulfills a desire to improve the health of their children at a time when conventional options are few or nonexistent.

Unfortunately, most CAM research is cluttered by studies that have small sample size and can’t sustain definite conclusions. In autism, there is also a problem with confounding variables as patients usually receive multiple interventions. In addition, there is a publication bias that may color the interpretation of clinical trials that us complementary therapies. Indeed, negative studies are more likely to be published in well known journals, while positive studies are more likely to appear in foreign language journals. Also, CAM studies are usually centered around adults, with little information derived regarding their use in children.

Dietary supplements are possibly the most common CAM intervention in autism.  According to the Dietary Supplements Health and Education Act of 1994, a dietary supplement is a product intended to enhance the diet. It may contain vitamins, minerals, herbs or amino acids. It is intended for ingestion and not used as a conventional food. The FDA can only demonstrate safety of a supplement after it reaches market and relies on voluntary reporting system to learn about possible side effects or problems with the product.  Labeling can not include any claims to prevent, treat, or cure a specific disease, but it can make statements about the structure/function or general “well-being” of the body. When such statements are made, the FDA requires a further disclosure: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease”. The nutritional label must also include the name and quantity of each ingredient.

When discussing CAM treatment with parents I would like them to be the primary decision makers and to always keep in mind what is in the best interest of the child. The physician obligation is to maintain an open mind and be nonjudgmental. However, physicians need to be knowledgeable and to educate themselves about potential harms and benefits of complementary treatments. Basically, if it is safe and effective, physicians can recommend using CAM, especially in cases where a cure is not available with conventional therapies.

References

Casanova MF. Autism Updated: Symptoms, Treatments and Controversies. Amazon Publishing.

Cortical Chauvinism: Do you believe in magic? The sense and nonsense of alternative medicine

Cortical Chauvinism: Cannabidiol (CBD)

Cortical Chauvinism: Neurofeedback and Autism

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