Autism Spectrum Disorder and Complementary- Integrative Medicine

Most families use Complementary and Integrative Treatment of individuals with autism spectrum disorder. It is prudent that practitioners gain knowledge about the benefits and risks of these interventions to have an open, nonjudgmental conversation with families about their role when creating a comprehensive treatment plan. Due to the perceived safety profile of these interventions, families may fail to recognize and report potential adverse effects and drug interactions. In recent years researchers have focused on conducting randomized placebo-controlled studies on these interven-tions. However, larger and more prolonged-duration studies are needed to establish regular usage. Additionally, it may be beneficial to examine the impact of these treatments on comorbid physical and psychiatric comorbidities that negatively impact the QoL. Elimination diets (gluten and/casein-free) based on the theories that food allergens trigger autoimmunity as well as "opioid excess " are shown to improve gastrointes-tinal symptoms in a subset of children with ASD without benefits on the core symp-toms of autism. The current review of data points toward the potential benefits of omega-3 fatty acids on hyperactivity, irritability, and social behaviors in a subset of autistic children, with favorable side effect profiles. Vitamin supplementations including B6 1 Mg and Vit C have been studied in several randomized controlled trials and have not shown statistically significant improvements in ASD symptom-atology. However, Folinic Acid improved stereotypy, attention, and communication in autistic individuals with folate deficiencies. Additionally, multivitamins seem to be reasonably well tolerated and may be beneficial in autistic children with concerns for nutritional deficiencies. Several studies have looked at the role of vitamins, amino acids, and supplements in targeting commonly seen disruptive symptoms such as irritability and sleep-related problems and found limited benefits. One such agent, NAC, can be beneficial in targeting residual irritability and hyperactivity when used in combination with risperidone, with excellent tolerability in autistic children. Dosages of 1800 to 2400 mg/d may be required. Mild gastrointestinal side effects have been reported. NAC can also be beneficial in comorbid impulse control disorders such as excoriation disorder or trichotilomania. The use of exclu-sion diets continues to be popular in children and youth with autism, but the current data review does not support improvement in core autistic symptoms. There are concerns about nutritional deficiencies arising from some elimination diets in chil-dren with Celiac disease. Insomnia is one of the most common clinical complaints in ASD, which significantly impacts the quality of life of children and caregivers alike. Frequently used sedative-hypnotics and sedative agent studies do not show long-term efficacy and may worsen daytime behaviors. Sleep hygiene techniques and CBT-I are still considered first-line treatments for insomnia in children with ASD. The effectiveness of melatonin in improving sleep efficiency and total sleep duration on both objective and subjective measures has been established in several randomized placebo-controlled trials, in dosages of 3 to 6 mg daily. Melatonin may be effective even in children who fail behav-ioral interventions for insomnia and is tolerated well with minimal side effects, such as nightmares in a minority of children. 91 Folinic acid seems to be emerging as a poten-tially safe treatment to target communication and stereotypy but larger sized trials are needed to establish clinical effectiveness and safety. Among other CIM treatments that continue to gain popularity, medical marijuana seems the most controversial. Currently, no double-blinded placed controlled trials studying its impact on either the core symptoms of autism or its comorbid psychiatric symptoms have been completed. Epidiolex, a cannabinoid agent, is FDA approved for complex, severe seizure syndromes associated with ASD. Treatments such as chelation, long-term us-age of antibiotics immunoglobulins, secretin, and hyperbaric oxygen therapy have proven to be ineffective. These treatments have been ranked in the table below using the USPSTF scale of evidence-based literature (Table 1). In cases whereby specific treatments do not have substantial evidence either way yet, the SECS criteria (safe, easy, cheap, and sensible) have also been used to recommend clinical usage (Table 2).