Complementary Alternative Medicine

The Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi provides evidence based practices to parents of children with autism, so that they are empowered to take informed decisions. The following focuses on the Complementary Alternative Medicine for management of Autism.

What is complementary Alternative Medicine?

Complementary Alternative Medicine is defined as a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems of a particular society or culture in a given historical period.

Why do families turn to Complementary Alternative Medicine?

Families of children with autism may turn to therapies that are not based in the realm of conventional medical practice.

• Conventional medicine is directed at the goals of diagnosis, treatment, and when possible, cure, of disease states, whereas CAM practices add promotion of health and involvement of the patient in a process of healing
• Parents think that they are natural/not associated with side effects
• They desire for multiple approaches/”let‘s try this one” attitude/ information in internet

What are the CAM practices which have definite evidence base?

Currently, there are no CAM practices, which have strong evidence to be recommended for children with autism.

What is the evidence for Omega 3 fatty acids?

Oral supplementation with polyunsaturated fatty acids (omega-3 FA) has become popular for children with developmental differences including autism and ADHD.

A recent double-blind, placebo-controlled trial revealed no statistically significant differences on Aberrant Behavior Checklist subscale scores between small groups of children with ASDs who were given omega- 3 fatty acids and those who were given placebo.

It is important for patients and families to understand that there are significant differences in the quality of the various types of omega- 3 fatty acids available over-the-counter. In addition, researchers have yet to determine the optimal dose of omega-3 fatty acids or the optimal ratio of the two essential components of these supplements (eicosapentanoic acid, or EPA, and docosahexanoic acid, or DHA) in the treatment of those with autism. In light of this, further study is needed before experts can make reliable recommendations.

What is the evidence for casein – gluten free diet?

Many parents of children with ASD report that behavior improves when their children eat a diet free of the proteins gluten and casein. Gluten is found primarily in wheat, barley and rye; casein, in dairy products.  In 2010, a randomized clinical trial on the use of casein- and gluten- free diets found insufficient evidence of clear benefit. However, this was a relatively small study (with just over 50 children), and it is possible that subgroups of children may benefit. The authors called  for more studies to be conducted, and these are now underway.

Certainly, dietary changes can be worth investigating and trying, especially if there are other family members that have had difficulties tolerating gluten and/or casein in foods. And as mentioned, some, but not all, parents report improvements in behavior. If parents do decide to place their child on a casein- and gluten-free diet, it is important to take extra steps to ensure they do so in a safe and reliable manner.

1. Consult with a dietary counselor such as a nutritionist or dietician. Although it’s easy to find casein-gluten-free dietary plans on the Internet, few lay people – or physicians – have the experience  and knowledge to determine whether a restrictive diet is providing all the necessary nutritional requirements. This is particularly important for supporting normal growth and development in children. Keep in mind that foods containing gluten and casein are major sources of protein as well as essential vitamins  and  minerals such as vitamin D, calcium and zinc.
2. Bring the nutritionist or dietician a 3- to 5-day dietary history (writing down what was eaten and how much) and have this reviewed to determine whether there is a risk for nutritional deficiency. The nutritionist or dietician can then work with you to add foods or supplements that address potential gaps in nutrition.
3. Set up a reliable way to measure your or your child’s response. This should start before the diet is begun, with a list of the specific symptoms and/or behaviors that you would like to improve.
4. If you reach a consensus that improvements are occurring, continuing the diet may be worth the cost and effort.

What is the available evidence for various CAM practices?

What is the role of stem cell therapy for autism?

Stem cell therapy in autism is a promising option, but it is only in the research stage. At this juncture, stem cell therapy cannot be recommended. Further research is warranted.

Summary for CAM in autism

• Some CAM practices have evidence to reject their use, such as secretin
• Some CAM practices have emerging evidence to support their  use in traditional medical practice, like melatonin.
• Most treatments, however, have not been adequately studied and do not have evidence to support their use.
• We encourage families to share all interventions that they are pursuing, whether or not prescribed or endorsed, by conventional practice.
• CAM interventions should be discussed in an open dialogue, nonjudgmental manner
• Treating  physician  should  provide "balanced advice about therapeutic options" and information about potential risks.
• Discuss the importance of continuing pharmacologic or other therapeutic interventions while CAM therapy is being used.

Source : Autism Awareness: Bringing them in the mainstream