Research on only one treatment is rigorous enough to earn an A grade
By Nancy Shute
Parents who research treatments for autism are confronted with a bewildering array of options, almost all of which have never been tested for safety and effectiveness. Organizations like The Cochrane Collaboration, which reviews the quality of evidence for medical treatments, are putting more effort into evaluating popular alternative treatments.
So far, the most comprehensive review of alternative autism treatments comes from two pediatricians: Susan Hyman of the University of Rochester School of Medicine Golisano Children’s Hospital at Strong and Susan Levy, a clinical professor of pediatrics at the University of Pennsylvania School of Medicine and The Children’s Hospital of Philadelphia. Their 2008 analysis gave each treatment a letter grade for the quality of the research conducted up to that point; the mark, however, is not a ranking of the treatment’s safety or effectiveness.
The two pediatricians based the grades on the amount of testing done on the treatments, which in most cases was skimpy at best. Research that got an “A” grade included randomized control trials, the gold standard for medical research, and meta-analyses, which compare research from different labs. A “B” went to treatments that had been studied in “well-designed controlled and uncontrolled trials,” according to Hyman. The “C” grades, the lowest category (there were no “D”s or “F”s), were based on case reports, theories and anecdotes, which are not considered acceptable for mainstream medical research.
Research on just one treatment, secretin, was good enough to earn an A. In short, there is a lot more work that needs to be done toward testing popular alternative treatments and getting more potential treatments into development at research institutions and pharmaceutical companies.
Dietary supplements
B6/Mg++—Grade: B
Vitamin B6 and magnesium have been a popular treatment for autism over the past 20 years. The Cochrane Review identified three studies that compared outcomes of B6 and magnesium treatment with those for placebo or no treatment, but just 28 subjects were treated altogether. One study found no improvements; another reported improvement in IQ and social behaviors. But all the studies suffered methodological weaknesses aside from the small sample size.
DMG—Grade: B
Dimethylglycine (DMG), an antioxidant and derivative of the amino acid glycine, is marketed as an immune system booster. Two small double-blind studies of DMG found it had no effect on autism symptoms.
Melatonin—Grade: B
Melatonin is a hormone produced by the pineal gland that regulates sleep. Melatoninsupplements are popular for self-treating insomnia or jet lag. Many people with autism-spectrum disorders report sleeping problems, and at least one study has found improvements in falling asleep and staying asleep.
Vitamin C—Grade: B
Vitamin C, an antioxidant, is often part of vitamin supplements given to children with autism. One study reported less repetitive behavior in a double-blind, placebo-controlled trial of vitamin C in 18 children with autism.
Amino Acids—Grade: C; L-Carnosine—Grade: B
Neurotransmitter abnormalities have long been a focus of autism research. Some amino acids act as neurotransmitters or prompt their production, so amino acids like tryptophan have been tried as alternative treatments. No trials have studied the benefits of supplementation with tryptophan, taurine, lysine or GABA. L-carnosine, a molecule made of two amino acids that has antioxidant properties, is marketed as an anti-aging remedy. One double-blind, placebo-controlled trial of L-carnosine in 31 children with autism found improved expressive and receptive vocabulary.
