A Review of Complementary and Alternative Treatments for Autism Spectrum Disorders

Table 1

Commonly used complementary and alternative treatments (CATs) for autism spectrum disorders (ASD).

Name	Rationale/mechanism	Data type	Significant improvements and; clinical indications	Potential adverse effects	SECS	Recommendation*
Ingestible
Melatonin	↑ sleep	5 DB PBO; RCT x-overs	Sleep duration and, overall sleep, sleep onset latency,	Minimal to none	S, E, C, S	R for sleep
B6/Mg	Correct deficiency	6 DB PBO; RCT x-overs	Social interaction, communication, and repetitive behavior (in some but not all RCTs)	>200–300 g neuropathy diarrhea	S for <200 mg,; E, C, S	A
B12	Correct deficiency	1 DB RCT	Some functioning and behavior	None reported	S, S but not C, E	NR b/c not E and sparse data
Multivitamin/mineral	Nutritional status associated with ASD sxs	2 DB PBO; RCTs,; 1 open label	Sleep, gastrointestinal, functioning, hyperactivity, tantrums, and self-injury	None reported	S (if RDA/RDI); E, C, S	R for RDA/RDI if poor diet;
Folic acid	Genetic abnormality	1 open label	Receptive and expressive language	None reported	S, E, C, S	A
Omega-3	Correct deficiency	2 DB RCTs; 4 open trials	Stereotypy, hyperactivity, and inappropriate speech	None reported	S, E, C, S	A
Probiotics and GI  medication	Remove toxins; ↑ immune function	1 DB PBO; RCT	None	None reported	Safe, E	A when GI problems
Iron supp.	Correct deficiency	Open trial	Restless sleep	None reported	S (only if low Fe); E, C, S	A if iron deficiency confirmed
Chelation	↓ toxic heavy metals	1 DB PBO; RCTs	Language, cognition, and sociability	Renal/hepatic toxicity, fatigue, diarrhea	Sometimes not safe; not cheap	A if heavy metal toxicity confirmed
L-Carnosine	Neuroprotective; ↑ frontal lobe functioning	1 DB PBO; RCT x-over	ASD sxs and receptive/expressive language	Hyperactivity and excitability	E, Sensible	Possibly A
Ascorbic acid (vit C)  90 mg/kg	Corrects redox balance	1 DB PBO; RCT x-over	Repetitive behavior	Can interfere with B12 absorption	E, C, S	NR in these doses
Cyproheptadine	High 5-HT levels	1 DB PBO; RCT	ASD sxs	None reported	Some risk	NR b/c some risk and sparse data
Immune therapies	Immune deficiencies	6 open label	Some ASD sxs	None reported	Some risk	NR b/c some risk
Noningestible
Massage	↑ attachment and; ↓ overarousal	5 RCTs; all SB	ASD sxs, sleep, social relatedness, social communication, speech rate, receptive language and ADHD sxs, sensory issues repetitive beh., anxiety, disruptive beh.	Not examined	S, E, C, S	R
Acupuncture	Unblocking flow of energy (“qi”)	3 RCTs**; (1 DB, 2 SB)	Attention, receptive language, overall functioning, self-care, and communication	Few or mild possible infection, bleeding	S, E, S	A
Exercise	↓ hyperactive and; repetitive behavior	8 within-sub.	Self-stimming and academic scores	Not examined	S, E, C, S	A
Music therapy	↑ verbal and nonverbal communication and engagement	2 randomized counterbalan.; designs	Imitating signs and words, eye-contact turn-taking, joint attention, and nonverbal communication	Not examined	S, E, S	A
Animal-assisted; therapy	↑ attachment	1 RCT; 3 multiple case studies	Playful mood, focus, language use and social-awareness, interaction and motivation	Not examined; possible bites, scratches, accidents	S, E, S	A b/c may not be C
Neurofeedback	EEG changes	3 RCTs; 1 SB, 1 DB	Attention, set-shifting, speech/language, sociability, health/physical behavior, reciprocal social interaction, communication, sensory cognitive awareness ↑ EEG mu suppression and ↓ EEG theta	Not examined	S, S	NR b/cnot C

Note. SECS: safe, easy, cheap, and sensible; *recommendations for an individual and monitored patient trial following procedure reported in study: R: recommended, A: acceptable, NR: not recommended; DB: double blind; PBO: placebo controlled; RCT: randomized clinical trial; X-over: crossover; sxs: symptoms; SB: single blind; **3 English-language articles that we could review thoroughly but 9 RCTs in Chinese only also exist.