Review of treatments for autism offers guidance

Parents of autistic children look for anything and everything to help their children lead more normal lives. Many have tried diet changes without success while others have sought help from alternative providers and have gone so far as to use a potentially dangerous process called chelation to rid their child of toxins. What is clear from this is that parents are desperate to try anything that could potentially help their child. What has been missing at times is scientific guidance about what works and what doesn’t. As the alternative approaches including diet changes and chelation have been debunked scientifically and seen to be ineffective in practice by parents, more parents have been interested and willing to try potent pharmaceuticals to help their children along.

In the May 2011 issue of Pediatrics (available online April 4), three review articles shed some light on what works, what doesn’t and what still needs more study when it comes to managing and treating autism. With April being National Autism Awareness month, here’s a summary of what the research has shown.

Secretin doesn’t work. In the 1990s an intestinal enzyme called secretin was thought to be deficient in children with autism and as a result, their digestive tracts weren’t processing foods properly leading to ‘toxin’ build up and autistic symptoms. Providing secretin as a supplement was suggested and after exhaustive research it has been shown to be completely ineffective at helping the symptoms of autism. No further study of this approach is needed given the strong and definitive weight of evidence.

SSRIs like prozac may help some children with autism but the data is mixed and as such cannot be definitively recommended as a mainline therapy as of yet. Some kids with autism will appear to be very anxious and have behaviors that appear to be compulsive. Some children in this subgroup have shown some benefit from SSRIs but even among them the evidence isn’t strong that it makes a dramatic difference. Bottom line: may be worth a try for a small subgroup but parents need to understand the pros and cons of the medication and that the benefits appear to be small at best.

Stimulant medications like ritalin may help some children with autism but much more study is needed. Like the SSRIs, some children with autism who appear hyperactive or impulsive may show some improvement with the use of stimulant medications but the benefits are small. Like SSRIs, stimulants have side effects of their own. Bottom line: may be worth a try for a small subgroup but parents need to understand the pros and cons of the medication and that the benefits appear to be small at best.

Behavior modification drugs like risperidone and aripiprazole have been shown to work well in children with aggressive or destructive behavior patterns and those with severe repetitive behavior patterns and hyperactivity, but the side effects are significant. Huge weight gain (25 pounds or more) and sedation are common. Bottom line: use these antipsychotic medications only in the most severe cases to modify very disturbing behavior when nothing else has worked.

Intensive behavior therapy at a young age works. A couple of different applied behavioral therapy approaches have been shown to work to improve language, socialization, and behavior in children with autism. The programs are intense (30-40 hours a week for 8-12 weeks) and require parent participation for most of this time. The goal is to teach parents how to do the behavior modification techniques and to continue this approach at home even after the intense program is complete. This approach has definitely been shown to have significant improvements for the children. Its downside is cost (greater than $10,000 typically for the therapy), its lack of insurance reimbursement so that the majority of the cost falls to the family, and the intense time commitment requiring a parent to take an extended leave of absence from work to do it. Bottom line: it works if you can afford to do it.