What Works to Treat Autism?

April 4, 2011 -- For children diagnosed with autism, hope comes in many forms -- stimulants, hormone therapy, vitamins, powerful antipsychotic medications, intensive behavioral therapies, and strict diets.

It is harder, however, to find treatments that have been scientifically proven to help.

Now three government-funded studies, published in the journal Pediatrics, have examined the evidence behind common medical and behavioral treatments for autism spectrum disorders (ASDs). They concluded that there’s little proof that some therapies actually work. And although some medications may ease disruptive and aggressive behaviors, they can have significant side effects.

“I think we are making slow progress,” says Lynne C. Huffman, MD a developmental-behavioral pediatrician and associate professor in the Center for Health Policy at the Stanford University School of Medicine.

“It’s like treating the cough in the child who has pneumonia, if you don’t know what’s causing the pneumonia,” Huffman says. She recently published a similar but separate review of medical and complementary and alternative treatments for autism. She was not involved in the current research.

Part of the reason there’s so little consistent evidence about what works for treating autism, Huffman says, has to do with how variable the symptoms can be.

“Given that, we have this very heterogeneous group of kids who have this great big range in terms of how impairing their symptoms are, and we’ve got some medications that have been pretty well studied and show some effect in some targeted areas,” she says.

What the Studies Found

An interdisciplinary team of researchers from Vanderbilt University, funded by the U.S. Agency for Healthcare Research and Quality, reviewed the evidence behind three types of treatment currently used for children with autism: drugs, intensive behavioral therapies, and injections of the hormone secretin.

“The most important finding from the reviews that were conducted is that there’s still a lot of work to be done to understand how specific treatments affect specific children so that we can tailor recommendations to maximizing improvements and gains,” says Zachary Warren, PhD, director of the treatment and research institute for autism spectrum disorders at Vanderbilt’s Kennedy Center in Nashville.

All of the studies included in the reviews had been published between 2000 and May 2010 and included children 12 or younger.

Medications

In the study that looked at medications, researchers reviewed studies of antipsychotics, serum serotonin reuptake inhibitors (SSRIs), and stimulant medications, which are generally used to decrease symptoms like aggression, repetitive behaviors, self-injury, and severe tantrums.

They found good evidence that two antipsychotic drugs, Risperdal and Abilify, decreased “challenging” behaviors like irritability, agitation, crying, hyperactivity, and noncompliance, compared to placebos.

But there were significant side effects reported with the use of these medications, including weight gain, drowsiness, and symptoms such as tremors, involuntary movements, and rigidity.

Though trials of the SSRI Prozac and the stimulant Ritalin showed potential positive effects on repetitive behaviors and hyperactivity, the reviewers declared current evidence to be insufficient to recommend their use.