The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Table 1

Summary of the studies included.

Study; (reference)	Country	Sample size (A)/(B)	Mean age	Gender; (M : F)	Diagnostic criteria	(A) Experimental intervention	(B) Control intervention	Acupuncture points	Outcomes
Allam et al. 2008; [25]	Egypt	10/10	y	(A) 7 : 3; (B) 5 : 5	DSM-IV; ADI-R; CARS ≥ 30	MA + (B)	Language therapy	GV20, GV26, GV17, 3 temple needles, YNSA cerebrum and aphasia points	Arabic language test
Chen et al. 2014; [26]	China	30/30	5.06 ± 1.32 y	36 : 24	CCMD-3	MA + (B)	Cognitive behavior rehabilitation training	GV20, GV24, EX-HN3, HT7, SP6, HI3, head Anmian point	CSHQ, TER (CSHQ), PTQ
Fan and Li 2016; [27]	China	38/38	(A) 5.21 ± 1.56 y; (B) 4.98 ± 2.05 y	(A) 22 :  16; (B) 20 : 18	NR	MA	Language therapy, guided education, cooperative exchanges, music therapy	Jin’s three needle technique (Sishenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Shouzhizhen, Zuzhizhen, Shesanzhen, Xingshenzhen)	CARS, TER (language ability)
Gao 2015; [28]	Mongolia	50/50	(A) 5.7 ± 0.8 y; (B) 5.4 ± 0.7 y	(A) 29 : 21; (B) 31 : 19	WHO	MA	Physical therapy, cognitive education, language education, behavior modification	Jin’s three needle technique (Sishenzhen, Naosanzhen, Niesanzhen, Zuokeshangsanzhen, Dingshenzhen,; Xingshenzhen, Shouzhizhen, Zuzhizhen, Shesanzhen)	PEP
He 2006; [29]	China	30/30	(A) 7.16 ± 4.26 y; (B) 6.94 ± 3.86  y	(A) 24 : 6; (B) 25 : 5	DSM-IV; ICD-10; CCMD-2R	EA + MA + (B)	Verbal communication training, social communication training, self-care training, cognitive training, motion training	EA (EX-HN1, EX-HN3, PC6, HT7, SP6, KI3), MA (LR3, AT3, TF4)	ABC^2, CARS, ATEC
Li and Liu 2011; [30]	China	30/40	NR	(A) 27 : 3; (B) 33 : 7	DSM-IV; CCMD	EA + (B)	Music therapy and structured teaching	Scalp points (Zhijiuzhen, emotional zone, heart and liver zone)	Clancy Autism Behavior Scale, CARS, ABC^1, GDS
Li et al. 2011; [31]	China	19/19	42.75 ± 2.5 m	36 : 2	DSM-IV	MA + (B)	Behavioral educational intervention	Tongue points (Naozhongxue, Naoshuxue, Naoyuanxue, Bizhongxue)	PEP-revised
Li et al. 2015; [32]	China	53/53	5.1 ± 3.9 y	82 : 24	NR	MA + (B)	Intensive therapy, game therapy, sensory integration training	Jin’s three needle technique; (Shesanzhen, Zuzhizhen, Shouzhizhen, Xingshenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Dingshenzhen, Sishenzhen)	CARS, ABC^1
Liao 2016; [33]	China	30/30	(A) 9.24 ± 1.64 y; (B) 9.51 ± 1.50 y	(A) 19 : 11; (B) 18 : 12	NR	MA + (B)	ABA, language cognitive therapy, sensory integration training	Scalp temporal, frontal, suboccipital, occipital region	CARS, TER (CARS)
Liu and Yuan 2007; [34]	China	33/34	5.41 y	60 : 7	DSM-IV	MA	Sensory integration training	Jin’s three needle technique (Sishenzhen, Niesanzhen, Zhisanzhen, Naosanzhen, Shesanzhen, Shouzhizhen, Zuzhizhen), Siguan	ABC^1, CARS
J. G. Sun and X. R. Sun 2014; [35]	Hong Kong	42/42	(A) 70 m; (B) 65 m	(A) 30 : 12; (B) 29 : 13	DSM-IV	EA + (B)	Behavior therapy, sensory integration training	Tongue points (Naozhongxue, Naoshuxue, Naoyuanxue, Bizhongxue)	CARS, TER (CARS)
Tang et al. 2013; [36]	China	20/18/18	(A1) 4.526 ± 1.623 y; (A2) 4.436 ± 1.520 y; (B) 3.954 ± 1.572 y	(A1) 14 : 6; (A2) 13 : 5; (B) 14 : 4	DSM-IV; CCMD-2R; CARS 36–41	(A1) doing (B) during retention of MA; (A2) MA after (B)	Educational training, behavior modification, sensory integration training, language therapy	Scalp areas according to symptoms	CARS, TER (CARS)
Wang et al. 2006; [37]	China	30/30	NR	(A) 24 : 6; (B) 23 : 7	ICD-10; CCMD-3	EA + (B)	Behavior therapy	GV20, EX-HN1, GV24, GB13, EX-HN3, GV17, GB19, PC6, scalp speech areas 1, 2, 3	Social adaptive quotient, TER (social adaptive quotient)
Wang et al. 2007; [38]	China	30/30	(A) 5.14 ± 1.53 y; (B) 5.46 ± 1.68 y	(A) 24 : 6; (B) 23 : 7	ICD-10; CCMD-3	EA + (B)	Sensory integration training, auditory integration training, language therapy	GV20, EX-HN1, GV24, GB13, EX-HN3, GV17, GB19, PC6, scalp speech areas 1, 2, 3	ABC^1, TER (ABC^1), PPVT
Wang et al. 2015; [39]	China	32/30	(A) 5.12 ± 1.42 y; (B) 5.10 ± 3.4 y	(A) 18 : 14; (B) 15 : 15	NR	MA	Language therapy, guided education, ABA, music therapy	Jin’s three needle technique; (Sishenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Shouzhizhen, Zuzhizhen, Shesanzhen, Xingshenzhen)	CARS, TER (language ability)
Wong; [40]	Hong Kong	18/18	(A) 7.40 ± 2.215 y; (B) 7.62 ± 2.367 y	(A) 17 : 1; (B) 17 : 1	DSM-IV; ADI-R; ADOS	EA + MA + (B)	Conventional educational program	EA (GV20, EX-HN3, HT7, SP6), MA (AT3)	ADOS, ABC^2, ATEC, RFRLRS, WeeFIM, CGI, SPT
Wong and Chen 2010; [41]	Hong Kong	30/25	(A) y; (B) 9.56 ± 4.22 y	(A) 25 : 5; (B) 22 : 3	DSM-IV; ADI-R; ADOS	EA, conventional; educational program	Sham EA, conventional; educational program	EX-HN1, EX-HN3, PC6, HT7, LR3, SP6, AT3, TF4	WeeFIM, PEDI, Leiter-R, CGI, ABC^2, RFRLRS, RDLS, a standardized parental report
Wong and Sun 2010; [42]	Hong Kong	25/25	(A) 6.23 ± 1.8 y; (B) 6 ± 1.99 y	(A) 21 : 4; (B) 23 : 2	DSM-IV; ADI-R; CARS ≥ 30	MA, conventional educational and behavior model	Sham MA, conventional educational and behavior model	Tongue points (Runze, Guanzhu, Tianmen, Diyou)	GMDS, RFRLRS, RDLS, SPT, WeeFIM
Wong et al. 2014; [43]	Hong Kong	16/11; (12/9)	(A) 10.167 ± 3.930 y; (B) 8.750 ± 4.617 y	(A) 16 : 0; (B) 11 : 0	DSM-IV; ADI-R; CARS ≥ 30	MA + (B)	Conventional educational and behavior model	Tongue points (Runze, Guanzhu, Tianmen, Diyou)	ATEC, RDLS, SPT, WeeFIM, CGI, Cerebral FDG metabolism by PET
Wu 2015; [44]	China	40/40	(A) 6.5 ± 2.3 y; (B) 6.2 ± 2.1 y	(A) 28 : 12; (B) 30 : 10	DSM-5	MA	Conventional intervention	Jin’s three needle technique (NR)	Functional development scale
Xiong 2014; [45]	China	32/32	(A) 7.48 ± 3.26 y; (B) 7.56 ± 3.12 y	(A) 18 : 14; (B) 17 : 15	CCMD-3	MA + (B)	Educational training, sensory training, behavior modification, language therapy	Scalp frontal, temporal, occipital, suboccipital, parietal regions	CARS
Yang 2012; [46]	China	20/20	(A) 5.6053 ± 2.2582 y; (B) 4.2778 ± 1.8249 y	(A) 16 : 4; (B) 14 : 6	DSM-IV	MA	Behavior therapy, sensory integration training	Jin’s three needle technique (Sishenzhen, Dingshenzhen, Zhisanzhen, Yansanzhen, Naosanzhen, Shesanzhen, Shousanzhen, Shouzhizhen, Zusanzhen, Zuzhizhen), CV12, CV4, CV6, GV14, BL20, GV4	CARS, TER (CARS), EEG, attention value
Zeng et al. 2014; [47]	China	30/25	(A) 3.51 ± 1.48 y; (B) 3.49 ± 1.47 y	(A) 18 : 12; (B) 14 : 11	ICD-10	MA + (B)	ABA, TEACCH, PCI, sensory integration training, auditory integration training, language cognitive therapy	Jin’s three needle technique (Sishenzhen, Naosanzhen, Niesanzhen, Zhisanzhen, Shesanzhen, Dingshenzhen, Shouzhizhen, Zuzhizhen)	TER (CARS), TER (PEP)
Zeng et al. 2016; [48]	China	60/25	(A)  y; (B) 3.60 ± 1.52 y	(A) 36 : 24; (B) 16 : 9	ICD-10	MA + (B)	ABA, TEACCH, PCI, sensory integration training, language cognitive therapy, music therapy	Jin’s three needle technique (Naosanzhen, Niesanzhen, Zhisanzhen, Shesanzhen, Dingshenzhen, Shouzhizhen, Zuzhizhen)	TER (CARS), TER (PEP3)
Zhao et al. 2015; [49]	China	30/30	NR	NR	ICD-10	EA + (B)	Special education	Group 1: GV20, Sishenzhen, GV24, GB13; Group 2: ST8, GV23, Dingshenzhen, GV17, GB19; use group 1 or 2 alternately every other week	ABC^1, TER (ABC^1)
Zhao et al. 2015; [50]	China	35/30	(A) 3.5 y; (B) 3.2 y	(A) 28 : 7; (B) 25 : 5	DSM-IV; ICD-10	MA + (B)	Risperidone 0.5–2 mg/d	Jin’s three needle technique (Dingshenzhen, Zhisanzhen, Sishenzhen, Niesanzhen), GV17, transport point mainly pericardium, heart, or liver meridian	TER (improvement of abnormal behavior)
Zhen and Jin 2016; [51]	China	68/68; (63/65)	(A) 4.2 y; (B) 4.5 y	(A) 56 : 12; (B) 53 : 15	DSM-IV	MA + (B)	Speech training and structured teaching	Jin’s three needle technique (Esanzhen, Niesanzhen, Zhensanzhen), EX-HN1	PEP-3

ABA, Applied Behavior Analysis; ABC¹, Autism Behavior Checklist; ABC², Aberrant Behavior Checklist; ADI-R, Autism Diagnostic Interview-Revised; ADOS, Autism Diagnostic Observation Scale; ATEC, Autism Treatment Evaluation Checklist; CARS, Childhood Autism Rating Scale; CCMD, Chinese Classification of Mental Disorder; CGI, Clinical Global Impression; CSHQ, Children’s Sleep Habits Questionnaire; DSM, Diagnostic and Statistical Manual of Mental Disorders; EA, electroacupuncture; EEG, electroencephalography; FDG, fluorodeoxyglucose; GDS, Gesell Development Schedules; GMDS, Griffiths Mental Developmental Scale; ICD, International Classification of Diseases; MA, manual acupuncture; NR, not recorded; PCI, Play and Cultural Intervention; PEDI, Pediatric Evaluation of Disability Inventory; PEP, Psychoeducational Profile; PET, positron emission tomography; PPVT, Peabody Picture and Vocabulary Test; PTQ, Parent Temperament Questionnaire; RDLS, Reynell Developmental Language Scales; RFRLRS, Ritvo-Freeman Real Life Rating Scale; SPT, Symbolic Play Test; TEACCH, Treatment and Education of Autistic and Related Communication Handicapped Children; TER, Total Effective Rate; WeeFIM, Functional Independence Measure for Children; WHO, World Health Organization; YNSA, Yamamoto New Scalp Acupuncture; trial. The rest are parallel studies.