1. Alternative treatments in ASD
Dr Teresa Carter
Consultant community paediatrician

2. Alternative/complementary treatments
Doctors’ responsibility
Do no harm
critical appraisal – check for bias, complicating factors, placebo effect
Reason we need good studies
Dealing with a moving target
The dangers of anecdotal evidence
Useful books - Bad Science – Ben Goldacre
Defeating Autism: A Damaging Delusion Paperback by Michael Fitzpatrick 2

3. What’s the problem and what does it mean?
ASD is not one condition
Common genetic variants
Rare genetic variants
Genetic syndromes
Metabolic conditions*
Mitochondrial disorders*
Learning potential/style
Social Anxiety
Use of Language
How to communicate
Routines/Restricted
Sensory/Repetitive
ASD
Marc Woodbury-Smith, Stephen Scherer Progress in the genetics of autism spectrum disorder
Dev Med Child Neurol May;60(5):

4. Nutrition & supplements
Iron deficiency – high rates in ASD, which persist beyond preschool years, not just in children with restricted diets
B12 – no good studies, no evidence it is implicated and no need for supplements
B6 & Mg – many studies but only two were well controlled, these showed no benefit
Dosman CF et al (2007, Mar) Children with autism: effect of iron supplementation on sleep and ferritin Pediatr Neurol. 36(3):
Sidrak S, Yoong T, Woolfenden Iron deficiency in children with global developmental delay and autism spectrum disorder. J Paediatr Child Health 2014 May;50(5): 4

5. Nutrition & supplements
Probiotics – no evidence of benefit or harm
Omega 3 Fatty Acids – no evidence of benefit in 2017 review of evidence
Gluten Casein free diet – 1 in 100 people have coeliac disease and up to 1 in 10 may have some gluten intolerance, so there will be overlap, casein intolerance affects children less than 2 years usually, 7% white population lactose intolerant
Allergy elimination – same as for general population
Oxytocin – studies are inconclusive
Antioxidants - these may be of benefit in a sub group of children with metabolic disorders
Sathe et al. Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review Pediatrics June 2017, VOLUME 139 / ISSUE 6 5

6. Alternative Treatments
Chelation therapy – there is no evidence that chelation works, a trial in US was stopped early because of safety concerns, there have been deaths associated with the treatment
Hyperbaric oxygen treatment - the 1st study suggested it worked, but it was poorly designed and it was biased. Later well designed studies show no effect
Craniosacral Therapy – no evidence it works but it is not harmful
Chiropractic manipulation – no evidence of benefit
Acupuncture – recent review 2018 inconclusive 6

7. Alternative Treatments
Cannabis
THC (9-tetrahydrocannabinol)
Stays in body several days
Psychotropic
Effects vary by person and dose
Deceased anxiety, sedation
Euphoria
Heightened perception
Increased sociability
Sensation of time slowing
Increased appetite
Decreased pain
Paranoia
Anxiety
Irritability
Worsened short-term memory
Poor attention
Altered awareness of the passage of time
Impaired judgment
Decreased coordination and balance
Distorted spatial perception
Medical Marijuana: Review of the Science and Implications for Developmental-Behavioral Pediatric Practice SE Hadland, J R. Knight, SK. HarrisJ Dev Behav Pediatr 36:115–123, 2015 7

8. Alternative Treatments
Cannabis - in medicine, cannabinoids useful for increased muscle tone and central pain. Used in US for drug resistant epilepsy in children. Also, used for nausea and appetite stimulation there in adults and children.
Cannabidiol example of a non psychoactive compound. Increasing interest in this substance but it remains poorly understood
Conflicting evidence in mice
Stockings E, Zagic D, Campbell G, et al. Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. J Neurol Neurosurg Psychiatry Mar 8

9. Why else? Conflicting evidence
Endocannabinoid areas of the brain are involved in brain development
Conflicting evidence

10. Thanks for listening!