Autism and Complementary Therapies

Autism, or autism spectrum disorder (ASD), refers to a range of conditions characterized by challenges with social skills, repetitive behaviours, speech and nonverbal communication. There is not one type of autism, instead there are many types, caused by different combinations of genetic and environmental influences and each individual with ASD will present differently.

The term “spectrum” reflects the wide variation in challenges and strengths possessed by each person with ASD.  Signs of ASD typically appear between 2 and 3 years of age, however, in some cases, it can be diagnosed as early as 18 months.

What is Complementary Alternative Medicine (CAM)?

Complementary alternative medicine is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional western medicine.

Different types of CAM typically fall into five areas which are as follows:

• Mind– body therapies. These include meditation, yoga, and mental healing.
• Biologically based practices. These treatments include nutraceuticals which are herbs, vitamins, minerals, amino acids.
• Manipulative and body-based practices. These include chiropractic and massage therapy.
• Energy medicine. These include reiki, kinesiology, therapeutic touch, cranio-sacral therapy, homoeopathy, acupuncture and emotional freedom technique.  
• Whole medical systems. This final type incorporates all four of the domains listed. An example here is naturopathic medicine.

Why would parents seek alternative treatments for ASD?

Currently there is no standard medication used for the treatment of ASD, instead medication is offered to patients to help with specific symptoms associated with ASD. These medications have a very limited role in improving symptoms and carry an array of side effects. Medicines that are often prescribed to help with behaviours related to ASD include selective serotonin reuptake inhibitors (SSRIs), otherwise known as anti-depressants and anti-psychotics.

• SSRIs are prescribed for depression, anxiety, and obsessive behaviours. The associated side-effects include weight gain, insomnia, increased agitation and increased risk for suicide.
  
• Antipsychotic medicines work by changing the effects of brain chemicals and so help decrease problem behaviours such as tantrums, aggression, and self-harming behaviour. However, anti-psychotics have many side-effects which include sleepiness/drowsiness, tremors, weight gain, dry or watery mouth, restlessness, trembling, muscle stiffness, dizziness, eyesight problems, nausea, constipation, increased sweating and suicidal tendencies.

It is these side effects that see parents turning to CAM treatments for ASD as they are considered safe, effective and free from side effects. Parents who use CAM treatments like to self-educate and feel perhaps they have more control over the medical decision-making process for their child. Parents with ASD children are also actively seeking alternatives to medications simply because they can access a multitude of testimonials from other parents who have used CAM treatments and have had positive results.

Common CAM treatments used for ASD

Melatonin

Melatonin is a naturally occurring hormone made by the pineal gland that helps regulate the sleep-wake cycle. The pineal gland is the size of a pea and is located just above the middle of the brain. During the day the pineal gland is inactive but when the sun goes down and darkness occurs, the pineal gland is turned on and it begins to actively release melatonin in to the blood stream.  As a result, melatonin levels begin to rise and stay elevated for approximately 12 hours before the light of a new day when they fall back to low daytime levels by about 9 am.

More than half of all children with ASD have a sleep disorder, with insomnia being the most common.

It is a deficiency in melatonin than can prevent sleep and cause disruptions in sleep patterns, further depleting the body of melatonin. The body needs adequate amounts of vitamin B6 and tryptophan to make melatonin so checking there isn’t a deficiency in either of these two nutrients is a good starting place. 

Studies have found that when melatonin is taken regularly each night it can help children with insomnia to fall asleep faster. Each child may require a different dose which generally varies between 1-6mg and can take up to one week to show its full potential. No reports have been noted of any side effects with supplemental melatonin and parents have also reported improvements in children’s behaviour during the day. 

Omega-3 Fatty Acids

Omega-3 fatty acids (DHA and EPA) are essential for the normal development and function of the brain and eye’s and are also critical to keep the brain working at optimal capacity throughout life. 

• DHA is the most important omega-3 for normal brain development and functioning and is the most abundant fat in the brain. 
• EPA has a bigger impact on behaviour and moods. It is for these reasons that Omega-3 fatty acids have been researched and used extensively amongst those with ASD. Additionally omega-3 fatty acids help to treat major depression.

Studies have suggested that omega-3 fatty acid supplements may reduce ASD related symptoms such as repetitive behaviour and hyperactivity, as well as improve socialization and mental skill such as thinking, remembering, and learning. Eating coldwater fish is the ideal way to supplement with omega-3 fatty acids but it can be hard to get children to eat fish. Fish oil capsules are a guaranteed way to increase levels of omega-3

Vitamin B12

The purpose of vitamin B12 in the body is to enhance brain and nervous system functioning. It does so by stimulating the biological pathway that provides energy to the brain. B12 also helps with cell production, a process known as methylation. Methylation works to produce DNA and RNA, control the immune system, remove heavy metal toxins from the body, and produce proteins. The absence of vitamin B12 causes significant difficulties with cell production and functioning in the brain and body.

Low levels of vitamin B12 have been found in the brains of people affected with ASD.  These Low B12 levels may help to explain why patients experience neurological and neuropsychiatric symptoms because of the role that B12 plays in healthy brain function. CAM treatment with B12 involves injections of the vitamin methyl B12. Studies have found that B12 injections have improved social behaviours, language and communication in ASD.

Casein and Gluten Free Diets

The gut has its own nervous system which is referred to as the enteric nervous system. This system is closely related to the development of the central nervous system, including the brain. The theory most commonly associated with the use of the casein and gluten free diet relates to the differences in the functioning of the gut of individuals with ASD.  

It is thought that a majority of individuals with ASD have what is referred to as a “leaky gut.” This is where the intestines are more permeable than normal which allows molecules to enter the bloodstream that should not otherwise be there.

As a result both casein and gluten proteins have the ability to trigger the body's immune response, causing inflammation of the gastro intestinal tract and in turn, have a direct effect on the brain through the enteric nervous system. 

The incomplete breakdown of casein and gluten crosses the blood-brain barrier and disrupts brain function and development.

There are a number of undesirable foods and chemicals that can reach the brain via the bloodstream due to faulty digestion and inadequate absorption.Two things that seem to have a particularly negative impact and aggravate ASD symptoms are casein and gluten. Gluten is found primarily in wheat, barley and rye. Casein is found in all dairy products. When following this elimination diet, all foods containing gluten and casein are removed from the child's daily food intake. Studies suggest that there is improvement in social symptoms, communication and repetitive behaviours as assessed on ASD behavioural scales.

Probiotics

Gastrointestinal dysfunction has been reported in a substantial number of children with ASD and patients experience significantly more gastrointestinal symptoms, including diarrhoea, constipation and abdominal pain.  It is this presence of gastro intestinal dysfunction that is often associated with increased irritability, tantrums, aggressive behaviour, and sleep disturbances.

Probiotics can influence microflora composition and intestinal barrier function and alter mucosal immune responses. By modulating the gut bacteria, reducing inflammation, and restoring the epithelial barrier function there may be an improvement in behavioural symptoms. Eye contact and correct recognition of human emotion have been noted as two very important outcomes in children who have been supplemented with a probiotic.  

Vitamins

Vitamin supplementation is very popular amongst ASD patients. The rationale for this treatment is based on the frequently observed dietary deficiencies of vitamins and micronutrients in children with ASD. These children introduce less than recommended amounts of calcium, vitamin D, vitamin K, vitamin A, Vitamin E, vitamin B6, B12, zinc and folic acid. These deficiencies are the result of food selectivity and/or gastrointestinal absorption. Significant improvements in language production, social communication, activity of daily living, and irritability have been noted with vitamin supplementation amongst ASD children. 

There are many more CAM therapies that can be used in ASD. Unfortunately many of these therapies do not have the necessary research to confirm that they are effective and worthwhile using in those with ASD. Perhaps it would be advantageous for parents to join numerous ASD forums and read testimonials from other parents and see what CAM treatments have worked for others. Anecdotal evidence is sometimes an important factor when medical and well researched options are not optimal.   

References

1. Complementary and Alternative Therapies for Autism Spectrum Disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439475/
2. “Complementary and Alternative Medicine Treatments for Children with Autism Spectrum Disorders” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597185/
3. Melatonin for Sleep in Children with Autism: A Controlled Trial Examining Dose, Tolerability, and Outcomes  https://link.springer.com/article/10.1007%2Fs10803-011-1418-3
4. A pilot randomized controlled trial of omega-3 fatty acids for autism spectrum disorder https://www.ncbi.nlm.nih.gov/pubmed/20683766
5. Pilot study of a moderate dose multivitamin/mineral supplement for children with autistic spectrum disorder https://www.ncbi.nlm.nih.gov/pubmed/15673999
6. https://www.ncbi.nlm.nih.gov/pubmed?term=Pilot%20Study%20of%20the%20Effect%20of%20Methyl%20B12%20Treatment
7. The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders https://www.ncbi.nlm.nih.gov/pubmed/20406576
8. Gluten- and casein-free dietary intervention for autism spectrum conditions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540005/
9. Lavender and the Nervous System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612440/
10. https://www.autismspeaks.org/science/science-news/small-study-finds-b12-injections-ease-autism-symptoms-some-children
11. https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-11-111
12. The potential role of probiotics in the management of childhood autism spectrum disorders https://www.ncbi.nlm.nih.gov/pubmed/22114588
13. Holford, P. Colson, D. (2006). Optimum Nutrition for Your Child’s Mind. Great Britain: Piatkus Books Ltd.
14. Evans, A.M (2014). Autism Treated and Cured. USA:Card Cataloging.