From Our 2007 Archives

Caution Urged for Autism Treatments

Researchers Say 'Fad Therapies' for Autism Are on the Rise

By Kathleen Doheny
WebMD Medical News

Reviewed by Louise Chang, MD

Aug. 20, 2007 -- Unproven treatments for autism have increased as the number of children with autism and related disorders has grown dramatically, according to a team of Ohio State University researchers.

"Fad treatments have grown as the numbers have gone up," says James Mulick, PhD, a professor of pediatrics and psychology at Ohio State University, Columbus, who led a symposium on the topic at the 115th annual convention of the American Psychological Association (APA) in San Francisco.

Today, one in 150 children has autism or an autism spectrum disorder (ASD), which encompasses several related disorders, Mulick tells WebMD. In the 1970s, the commonly held belief was that three in every 10,000 children had autism. Autism and related problems, such as Asperger's syndrome or childhood disintegrative disorder, are all complex developmental disabilities that affect the development of social skills, communication skills, and behavior.  Genetic vulnerability is suspected, and abnormal brain development during an infant's first months may also contribute.

As more parents hear these diagnoses, they are searching, understandably, for a way to make their children's lives better.  "They desperately want their children to have a future," Mulick says.

"The average parent has tried seven different therapies," Mulick says, citing the results of a survey his research team found on the Internet.

Unproven treatments are often marketed aggressively, he tells WebMD, and information often includes testimonials from other parents, making them difficult to resist. As a result, he says, it's sometimes difficult for parents to evaluate the treatment objectively and to avoid totally unproven approaches. The unproven treatments can escape oversight from the FDA, says Mulick, because many are not drugs or devices.

Fad Treatments Abound

Among the autism treatments that Mulick and his colleagues cautioned against at the APA convention:

  • Facilitated communication. A facilitator holds the hands of those with autism over a keyboard and helps them to communicate. Or a facilitator helps the person with autism communicate by pointing at letters, images, or symbols that represent messages. The goal is independent expression, according to advocates. "In no case was it shown to be a valid communication" for the autistic person, Mulick says.

  • Chelation therapy. A chemical that binds to heavy metals -- believed by some to cause autism -- is given orally, rectally, or infused intravenously, Mulick says. "The chemical binds to heavy metals and allows the heavy metals to be excreted, and the belief is it will cure autism."  But chelation therapy is unproven for autism, Mulick says.

  • Dolphin therapy. Advocates believe swimming with dolphins can help an autistic child improve interpersonal relationships. Says Mulick: ''There is no evidence it supports any effect except recreation."

  • Auditory integration therapy. Developed by an ear-nose-throat doctor, this therapy originally was meant to help those with hypersensitive hearing. The theory is that the person is overstimulated and the hearing is overly sensitive at specific frequencies.  The therapy involves listening to music at different frequencies to normalize the hearing response across all frequencies within the normal hearing range. "This is based on the theory that kids with autism will often hold their ears," Mulick says, and that they are overly sensitive to sound. "They do hold their ears, but they don't have greater hearing acuity."

  • Dietary interventions. The gluten-free, casein-free diet, or GFCF diet, is another approach. Casein is a protein found in milk and cheese, and gluten is a protein found in wheat, barley, and rye. The theory, says Mulick, is that in autistic children these proteins result in an overproduction of opiates in the brain, in turn contributing to social awkwardness and thwarting brain maturation. Scientific studies on the effectiveness of the GFCF diet are lacking, he says. "And very few people adhere to the diet."

Autism Treatment: What Works?

An intensive approach using behavior therapy, often called applied behavior analysis, is uniformly recommended by experts, including a recommendation by the U.S. surgeon general. The basic research for this approach was done years ago at the University of California, Los Angeles. This program is intensive -- one-on-one for 40 hours a week. Similar programs are offered in major metropolitan areas around the country, Mulick says.

The goal of these types of programs is to reinforce desirable behavior and decrease undesirable ones. For instance, the child is taught to perform tasks in a series of simple steps and is given a predictable schedule. The treatment is continued at home.

"Occupational therapy is often given in combination," Mulick says.

The downside of the behavior therapy, he says, is its expense. At Columbus Children's Hospital, for instance, he estimates the cost of behavior therapy for autism is about $65,000 a year -- and it's typically not covered by insurance.

For specific symptoms, medication may help, Mulick says. For instance, the FDA approved Risperdal in 2006 for the treatment of irritability in children and teens with autism. Short attention spans can sometimes be improved, he says, with stimulant drugs.

SOURCES: James Mulick, PhD, professor of pediatrics and psychology, Ohio State University, Columbus. 115th annual convention of the American Psychological Association, San Francisco. News release, CDC.

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