Levy, E. S., & Hyman, S. L. (2008). Complementary and alternative medicine treatments for children with autism spectrum disorders. Child and Adolescent Psychiatric Clinic of North America, 17,

Relationship between the two articles Both articles looked at effects of Vitamin B 6, a complementary and alternative medicine (CAM) on behaviors of children with autism When Rimland, Callaway, and Dreyfus (1978) withdrew high doses of B 6 in their study, behaviors got worse. Levy and Hyman (2008) further looked at different categories of CAM therapies

Graded therapies Treatments were rated based on a grade in the Levy and Hyman (2008) study. Grade A -randomized controlled trials, review, and/or meta- analyses Grade B -other evidence such as isolated well designed controlled and uncontrolled studies Grade C-case reports or theories

Purpose of follow up article 1.Why families of children with autism use complementary and alternative medicine (CAM) and what does research reveal about their effects? 2.What are the uses for CAM with children who have ASD, and which ones are the most common? 3. What are some challenges with the use of CAM for conventional practitioners?

Description of the follow-up article estimated 50% to 70% or children who have autism are treated with CAM. Families usually choose CAM therapies because they feel the therapies have no side effects and are natural.

Mind-body medicine (used in 30% of families) Yoga (C): There is no study to date that shows the effect of symptom reduction in children with ASD who practice yoga. Music therapy (B): In a limited number of trials it has been shown that music therapy can have promising effects on communication that uses gestures or is vocal verbal. Effects on behaviors have not been documented. C=case reports B=isolated well designed controlled and uncontrolled studies A= randomized controlled trials, review, and/or meta- analyses

Biologically based practices (used in 50% of families) Vitamin B6/Magnesium (B): A recent study noted improvements in symptoms with 33 children with ASD, although there were methodological deficits in the study (Mousain-Bosc et al., 2006) Dimethyglycine (B): Two recent studies have not found any positive effects for ASD. Melatonin (B): Some clinical studies have found that there are irregularities in the production or secretion of melatonin in children who have ASD. positive clinical findings for doses between.75 to 6 mg administered before bedtime (falling, and staying asleep)

Biologically Based Vitamin C (B): Dolske et al. (1993) documented a decrease in stereotypic behaviors in a 30 week (double blind, placebo- controlled) study for 18 children with ASD. This study has not been replicated. Amino acids (C) and carnosine (B): L-carnosine was shown to have positive effects with 31 children with ASD and improve expressive and receptive vocabulary in a 8 week period on a 800 mg/d dose. The effects of carnitine have not been documented to treat motor or behavioral symptoms with children who have autism.

Biologically Based Omega 3 fatty acids (B): critical for brain development and the body cannot create this chemical on its own. recent study found positive results in reduction of challenging behaviors in 13 children with ASD in a randomized, double blind, placebo-controlled 6 week study (Amminger et al., 2007). Folate (C): No randomized controlled studies have looked at its effects. Gluten-free/casein-free (B): It is believed that reducing the amount of gluten proteins (barley, wheat, and rye) and casein (milk products) can improve behaviors in children with ASD. Only anecdotal evidence for its benefits, studies have not found objective difference in behaviors or language developments

Biologically Based Gastrointestinal medications (C): No evidence based studies have looked into this Secretin (A): A Gastrointestinal hormone which is not an effective treatment for symptoms of autism (12 studies). Hyperbaric oxygen therapy (C): Many believe it increases flow and oxygen to the brain and decreases inflammation, although no evidence has been found Chelation (C): Some believe that mercury is not effectively eliminated in children who have autism; therefore they need to be given DMPS or DMSA so that heavy metals such as mercury can be removed from the body. no controlled studies have shown that it is effective for children with autism.

Biologically Based Antibiotics (C): Because of frequent infections in the respiratory and gastrointestinal systems of children with ASD, Sandler et al. (2000) found that a short term change in behaviors were observed when children were given oral vancomysin. No other studies have examined its effects and routine use is cautioned. Antifungal agents (C): No evidence based studies have been reported on its use. This is a popular agent mainly because there are reports that children with autism have an overgrowth of yeast.

Manipulative and body-based practices (used in 25% of families) Chiropractic (C): Peer reviewed studies have not looked at the benefits of chiropractic manipulation for children with autism. Craniosacral massage (C): skull and cervical spines are manipulated. No studies have examined its effect in children with autism. Massage/ therapeutic touch therapies (C): Some families seek massage and aroma therapy although there is no research in this area.

Manipulative and body-based practices Auditory integration (B): Aims to help with auditory processing and to improve concentration by listening through headphones that change sound, music, or voice electronically. Some parents report that there is an improvement in behaviors, although research in this area needs more replication. Energy medicine (no grade): An electromagnetic coil is place on the scalp which produces very low electrical currents in the cerebral cortex. There have been no reports of this technique to reduce symptoms in children with autism.

Summary of conclusions many treatments still need more replication, controlled studies, especially in category C families fail to disclose the use of these therapies. families believe their physicians may judge them and not have knowledge about CAM. CAM therapies have very little side effects on their own but if combined with other medications, should be monitored by a physician. open dialogue with physicians about CAM use and the need for further research.

Additional research Almost all of the CAM treatments except Secretin need more research and are not evidence based practices. Some like Melatonin are promising therapies, but need more follow up research. Further research to see why families continue using CAM therapies despite the lack of support and evidence for their benefits.

Why this article is important Levy and Hyman (2008) shed light on some popular treatments that many families of children with autism opt for. They summarize findings,help families and health professionals to understand the research and findings behind each therapy. They provide a categorical framework to understand where each therapy stands in comparison to one another. They also help readers to get a better sense of why families may use these practices and reveal the importance for further research in this area. They encourage families to disclose CAM practices with their physicians so that there is monitoring for side effects