Three studies shed light on effectiveness of autism treatments

April is Autism Awareness Month

For parents raising children with autism, there always seems to be more questions than answers. And with as many as one in every 110 children in the United States being diagnosed with an autism spectrum disorder (ASD), more questions are being asked everyday. Unfortunately, much about ASDs remain a mystery. For starters, researchers don’t know what causes autism. Current theories suggest it may be caused by environmental, biologic and genetic factors, or a combination of all three, but so far no one can prove anything definitively.

And the confusion doesn’t end with the origins of autism. Its treatment can be puzzling as well because there’s no guarantee an intervention that helps one child on the spectrum will work for someone else.

To help clinicians and families better understand the benefits of some ASD interventions, the medical journal Pediatrics recently published three different studies on the effectiveness of certain ASD treatment methods. The use of medication, behavioral interventions and the introduction of a digestive hormone called secretin were all individually examined and reviewed based on their methodology and success in treating ASDs.

The first study noted that medication is used fairly often to treat ASDs, even though there’s little scientific evidence to support the practice. Based on medicine’s current inability to help most children on the autism spectrum, Leonard Rappaport, MD, MS chief of the Division of Developmental Medicine at Children’s Hospital Boston, says he believes they should be used less frequently than they are now. “We have learned that clinicians should use evidence-based treatments in ASD as much as possible, because treatments with poor evidence of efficacy are a waste of valuable time,” he says. “At this time, there is no medication for the core symptoms of ASD. The two medications shown in this study to have efficacy are for a smaller group of children with ASD and helps with their extreme irritability and aggressive behaviors. They are incredibly helpful for some children, but also have significant side effects and should be used with caution under the guidance of physicians who are experienced in their use.”

Leonard Rappaport, MD, MS

Behavioral interventions, or the process of continually using positive reinforcement to encourage good behaviors, may show the most promise for helping children on the autism spectrum, but the second study published in Pediatrics says current data on the subject are too varied to pinpoint which are the most effective. The lack of a definitive list of successful interventions may be frustrating for parents and clinicians looking for concrete answers, but isn’t surprising considering the wide range of behaviors that fall under the ASD banner.

Each child on the autism spectrum is different; a behavioral intervention that helps one child could be totally useless for another, even if they exhibit similar symptoms. Plus, when you account for outside factors that can influence an intervention’s success, like family participation, educational support and severity of the condition, creating a universal list of “what works” as an ASD treatment becomes very hard.

The third ASD study was far more definitive. It says that injecting kids on the autism spectrum with a digestive hormone called secretin is completely ineffective in managing their ASD symptoms. The idea that digestion and ASD are related stems from the fact that many children on the autism spectrum also have gastrointestinal problems, so some people believe there is a connection between the two disorders. With that theory in mind, researchers looked at studies that showed secretin’s ability to affect the digestive function and the central nervous system of animals, and wanted to know if it could do the same for people.

A single, non-blinded study of the use of secretin to control some ASD behaviors yielded positive results, and stirred interest in its potential as a medical treatment for autism. However, after an extensive review, researchers have determined it is not effective for improving the language, behavior or cognition of children with autism. In addition to its proven ineffectiveness as an ASD intervention, Rappaport says there is a lack of data proving that the hormone is entirely safe, which could lead to problems in the future.

“I am personally unaware of bad side effects of secretin, except for its cost, but [high cost] is often true of a fairly rare treatment,” he says. “We find out about negative effects as data accumulate. Clearly anyone using secretin should also be utilizing intensive behavioral interventions.”

These three studies may not give the definitive answers many people are looking for, but they contribute to a growing amount of evidence-based data on the disorder. That may seem like small gains to some, but when studying a condition as complex as ASD, every bit of quality information gathered is an important step forward.