Are Integrative Approaches to Autism Care Effective?

As many as 1 in 54 children receives a diagnosis of autism. There’s no cure, per se, for the condition, but there are many treatment options to manage symptoms and improve functional skills. Approximately 70% of families try some type of alternative nonmedical treatment, known as “integrative approaches.” But “natural” does not always equal safe. Amanda E. Bennett, MD, MPH, Medical Director at the Center for Autism Research at Children's Hospital of Philadelphia (CHOP), explains what’s known about the safety and effectiveness of the most common integrative approaches.

Why might families explore alternative autism therapies?

Several reasons cause families to consider integrative approaches to autism care. First, children who have autism also often have other medical and/or behavioral health issues, so “We’re already using multiple integrated treatments for these children to address their range of needs,” says Dr. Bennett. Second, the standard of care can be difficult to access and can be costly. And third, there are not many FDA-approved medications for autism, and the ones that exist have significant side effects. It’s no wonder families look for alternatives.

What’s known about common integrative therapies?

CBD products: “There is a lot to learn from a research perspective about using CBD products,” says Dr. Bennett. One trial resulted in slight improvements in self-injury behavior in children with autism but nothing else. These products can possibly cause stress on the liver and changes in appetite. “Right now, almost everything about CBD is inconclusive, so we don’t recommend it until we have more research.”

Safety: There is limited data about the safety of CBD, particularly its long-term effect on the developing brains of children.

Equine therapy: Some studies found that interacting with horses improved behavior and socialization, but a major obstacle can be cost. One problem with assessing the usefulness of this therapy is that there was no consistency in the type of interaction between the child and the horses, which ranged from brushing to riding. In addition, different types of people were facilitating the interaction — for example, some sessions were led by an occupational therapist, and it could be that the therapist, not the horse, was the key element. With that many variables, it’s difficult to draw any definitive conclusions.

Safety: With correct supervision, interacting with horses can be safe, although riding them of course involves risk.

Gluten-free diet: For a child with autism but without a diagnosis of celiac disease, there’s limited evidence at this point supporting the usefulness of a gluten-free diet. Blinded randomized trials resulted in weak or nonexistent evidence that a gluten-free diet improves autism symptoms. Some improvements might be seen if a child has co-occurring gastrointestinal issues. In addition, a gluten-free diet can be expensive and challenging to follow.

Safety: A gluten-free diet is safe, but if a child already won’t eat a wide range of foods, a gluten-free diet could further narrow food selection and possibly impact nutrition.

Melatonin supplements: A common symptom of autism is poor sleep. Melatonin is a hormone released by the pineal gland at night and has long been associated with control of the sleep–wake cycle. “I recommend melatonin very early in my relationship with a patient with sleep concerns,” says Dr. Bennett. Trials have shown demonstrated improvement in child’s ability to fall and stay asleep.

Safety: Melatonin is safe in low doses up to 6 milligrams.

Music therapy: A few studies found that music therapy might improve communication skills and socialization.

Safety: Music therapy is safe but often not covered by insurance.

Omega-3 fatty acid supplements: Adults with cardiac problems are known to benefit from fish oil supplements. Several trials related to autism found small improvements in behavior and repetitive movements but no improvement in global functional abilities.

Safety: Fish oil supplements are generally safe.

Social skills training: “This is a standard recommendation, with training through school services or early intervention,” says Dr. Bennett, “but the problem is that there’s no established, set curriculum.” One curriculum, called the Program for the Education and Enrichment of Relational Skills (PEERS), has been tested in adolescents and adults and has shown to have positive results in those populations. “It’s a promising start toward standardization.”

Safety: Social skills training is safe.

Vitamin supplements: “If you have a kid who’s a picky eater, whether they have autism or not, it’s not a bad idea to supplement their diet with a general multivitamin,” explains Dr. Bennett. One trial saw some parent-reported improvements in gastrointestinal and sleep symptoms in children with autism. There’s no evidence that it’s beneficial to give specific vitamins or high doses of them

Safety: Multivitamins are safe when given in the recommended doses.

What about invasive interventions?

Invasive interventions are not technically integrative therapies, but some families might hear of them, and it’s important to address the problems with these approaches. Invasive interventions include chelation therapy, in which a synthetic solution is injected into the bloodstream to remove heavy metals and/or minerals from the body; intravenous immunoglobulin (IVIg) therapy, which is used for people with weakened immune systems to help fight off infections; and hyperbaric oxygen, a treatment for decompression sickness. “This is an area that is really quite concerning to me,” says Dr. Bennett. “They all come with very significant risks. We know of one child who died during chelation treatment.”

Safety: None of these interventions is safe for children with autism.

Additional resources

Families that want to learn more about integrative or alternative therapies for children with autism can visit CHOP’s Integrative Health Program website. The nonprofit Autism Speaks has an extensive online resources guide. Families should always talk to their child’s healthcare providers when considering integrating different types of approaches into a care plan.

Listen to this episode of CHOP’s “Primary Care Perspectives” podcast for more on this topic.