Autism Treatments Scrutinized in Study

[Guest guest]

By SHIRLEY S. WANG

Three new studies conclude that many widely used behavioral and medication

treatments for autism have some benefit, one popular alternative therapy doesn't

help at all, and there isn't yet enough evidence to discern the best overall

treatment.

Parents of children with autism-spectrum disorder often try myriad treatments,

from drugs to therapy to nutritional supplements. The studies being published

Monday and funded by the federal Agency for Healthcare Research and Quality,

were part of the effort to examine the comparative effectiveness of treatments

in 14 priority disease areas, including autism-spectrum disorders.

Autism and related disorders, conditions marked by social and communication

deficits and often other developmental delays, have become more common over the

years and now affect 1 in 110 U.S. children, according to estimates from the

U.S. Centers for Disease Control and Prevention.

The most conclusive evidence in Monday's reviews, being published in the journal

Pediatrics, showed that secretin, a gastrointestinal hormone that is used to

treat ulcers, yielded no benefit for children with these disorders. It is

unclear how many doctors and families advocate its use, but a 1998 case report

of three children stirred excitement by suggesting the children showed social,

cognitive and communication improvement after receiving two infusions of

secretin.

In the past 10 years, however, a number of high-quality studies showed there was

no effect of secretin on autism symptoms, a conclusion borne out by researchers

from Vanderbilt University who reviewed these studies in aggregate. " There's

good evidence that it's not working, " said Zachary Warren, a study author and

director of Vanderbilt's Treatment and Research Institute for Autism Spectrum

Disorders.

Their findings were more positive when it came to two other types of popular

treatments: intensive behavioral intervention and medication. Early intensive

behavioral treatments can involve multiple hours of practicing skills with a

therapist each week for years. Experts have long advocated their use for

improving cognitive and social symptoms, but research to assess their value has

been difficult to conduct.

Monday's report included 34 studies of these treatments, 23 of which the

reviewers rated as poor quality. Still, there was enough evidence to suggest

that these therapies improved IQ, language skills and day-to-day skills in some

children with autism-spectrum disorders, the researchers said. Overall, however,

more and better-quality research was needed, Dr. Warren said. " Our ability to

say this one specific approach should be utilized for the child in front of

me—we're not quite there yet, " he said.

Fred Volkmar, an autism researcher and physician at the Yale Child Study Center

who wasn't involved with the studies, said the findings weren't surprising but

were a solid follow-up to previous work. " There's an increase and growing body

of evidence that early intervention and diagnosis can make a long-time impact "

in autism-spectrum disorders. He said the behavioral treatment literature was

last systematically reviewed in 2001.

Antipsychotic medications, meanwhile, showed some benefit in treating what are

known as " challenging behaviors, " such as aggression and disruptive or

repetitive behaviors, but not the core symptoms of autism such as lack of social

interaction. Again, the researchers pointed to an overall lack of high-quality

research.

Drugs can be beneficial for some children, particularly if the challenging

behaviors get in the way of kids' learning, say experts. But, the often potent

side effects, particularly of antipsychotic drugs, mean that doctors and parents

should exercise " significant caution " when deciding to use these for children,

Dr. Warren said.

To make the reports' findings understandable to parents, caregivers and clinical

providers, the Agency for Healthcare Research and Quality will put out

" translation guides " about them and the strength of the evidence in the

literature, according to Slutsky, director of the Center for Outcomes and

Evidence at the agency.

Write to Shirley S. Wang at shirley.wang@...