Appendix C: Summary of Evidence - Intervention
Intensive Behavioral and Educational Intervention Programs
Summary Conclusions
Intensive behavioral and educational intervention programs involve systematic use of behavioral teaching techniques and intervention procedures, intensive direct instruction by the therapist, and extensive parent training and support.
- Articles screened for this topic: The literature search found 232 articles that reported using behavioral and educational approaches in children with autism as well as 68 articles from a comprehensive review article on single-subject design studies.
- Articles meeting criteria for evidence: 5
Several studies done by independent groups of researchers have evaluated the use of intensive behavioral intervention programs for young children with autism. The four studies that met criteria for evidence about efficacy all compared groups of young children with autism who received either an intensive behavioral intervention, a comparison intervention, or no intervention. In all four of the studies reviewed, groups that received the intensive behavioral intervention showed significant functional improvements compared to the control groups.
While none of the four studies used random assignment of subjects to groups, there did not appear to be any evidence of important bias in group assignment. Within each study, the groups receiving different interventions had equivalent subject characteristics. Furthermore, all studies showed similar and consistent results.
Since intensive behavioral programs appear to be effective in young children with autism, it is recommended that principles of applied behavior analysis and behavioral intervention strategies be included as an important element of any intervention program.
It is recommended that intensive behavioral programs include a minimum of 20 hours per week of direct instruction by the therapist. The precise number of hours of behavioral intervention may vary depending on a variety of child and family characteristics. Considerations include age, severity of autistic symptoms, rate of progress, other health considerations, tolerance of the child for the intervention, and family participation. It is recommended that the number of hours be periodically reviewed and revised when necessary. Monitoring of progress may lead to a conclusion that hours need to be increased or decreased.
It is recommended that all professionals and paraprofessionals providing therapy to the child as part of an intensive behavioral program receive regular supervision from a qualified professional.
It is important that parents be included as integral members of the intervention team. It is recommended that parents be trained in behavioral techniques and be encouraged to provide additional hours of instruction to the child. It is also recommended that training of parents in behavioral methods for interacting with their child be extensive and ongoing, and that it include regular consultation with the primary therapist.
Although some of the intensive behavioral intervention programs that were effective included use of physical aversives (such as a slap on the thigh), other programs reported good outcomes without the use of any physical aversives. The panel does not recommend the use of physical aversives, especially given the small physical size and vulnerability of young children in the age group from birth to age three years.
Summary Advantages and Limitations
Advantages
- demonstrated to produce positive gains in young children with autism.
- extensive grounding in scientifically validated principles of behavior and learning
- encourages monitoring and tracking of behaviors
- can be used outside of the university setting and can be provided in a variety of settings. These interventions often begin in the home setting and are extended to community settings such as preschools as the child improves
- can be applied not only by professionals but also by trained paraprofessionals, parents, and others
- parents can be trained in using behavioral methods and can function as active participants in the intervention process. After implementation of intensive behavioral therapy programs, parents' stress levels can actually decrease
- can be combined with other methods
Limitations
- require a large number of well-trained individuals to administer the intervention
- require a high degree of coordination and supervision of the individuals administering the intervention
- can be disruptive to the family
- expensive
Basic Principles of Specific Behavioral Intervention Techniques
Summary Conclusions
Many different specific behavioral and educational techniques have been used as part of interventions for individual children with autism. Their term "behavioral technique" refers to specific procedures aimed at teaching new skills and behavior.
- Articles screened for this topic: For practical reasons, the panel chose not to undertake an exhaustive literature search for studies to evaluate specific behavioral and educational intervention techniques for children with autism. As an alternative, the panel chose to review 68 articles published after 1980 that were listed in a recent comprehensive review of single-subject design studies of behavioral and educational interventions for autism (Matson, et al., 1996).
- Articles meeting criteria for evidence: 19
Applied behavior analysis strategies have been demonstrated to be effective in young children with autism. There are many specific behavioral techniques. These techniques are not used in isolation, but in combination.
The effectiveness of the specific techniques for an individual child depends on many factors. The behavioral approach is based on ongoing monitoring of progress and modification of the specific techniques as appropriate.
There are several types of reinforcers. It has been demonstrated to be useful to conduct a reinforcer assessment and to vary the reinforcers.
A continuum of intervention strategies is important as the child progresses. Gradual fading of high level of support or prompts may facilitate generalization of new behavior and skills to more complex environments. The basic procedures for effective behavioral interventions can be utilized in improving maladaptive behaviors, communication, and social interaction for children with autism.
Summary Advantages and Limitations
Advantages
- many different behavioral techniques have been shown to be effective in young children with autism. Effective behavioral interventions include a variety of techniques, such as modeling, prompting, shaping, fading, task analysis, and differential reinforcement, along with precise behavior quantification and frequent measurement
- demonstrated effectiveness in a wide range of areas across all three core deficits that define autism (maladaptive behavior, communication, social interactions)
- use of functional analysis of behavior incorporates ongoing monitoring of progress and encourages modification of techniques as needed
Limitations
- unless specific techniques are used to train for generalization, skills acquired with specific techniques may not generalize to the child's interactions within his or her usual environments
Behavioral and Educational Intervention Techniques for Maladaptive Behaviors
Summary Conclusions
Maladaptive behaviors are a defining characteristic of autism and may include such things as stereotypic behavior, disruptive behavior, aggression, and noncompliance.
- Articles screened for this topic: 68 articles single-subject design studies.
- Articles meeting criteria for evidence: 3 single-subject design studies
Maladaptive behaviors are a defining characteristic of autism and often interfere with the child's learning or socialization or present a hazard to the child or others. For this reason reducing inappropriate behaviors is usually one of the highest priorities for parents and is often the first target of behavioral intervention programs.
Behavioral techniques and strategies have been shown in several studies to be effective for reducing the frequency of a variety of maladaptive behaviors and increasing the frequency of substitute appropriate behaviors. Most of these techniques involve performing a functional analysis of the child's behaviors and the systematic use of consequences (reinforcers and/or punishers).
In evaluating the evidence presented above, it is useful to recognize that the specific behavioral techniques are not used in isolation, but are often combined with interventions to improve communication, social interactions, and other skills as part of an overall intensive behavioral intervention program. Specific training of parents in techniques to reduce inappropriate behaviors and increase appropriate or adaptive behaviors is usually an important component of such programs.
Summary Advantages and Limitations
Advantages
- demonstrated their effectiveness in reducing maladaptive behaviors and increasing substitute appropriate behaviors in children with autism
Limitations
- limitations depend on specific program elements and the total intervention program
Behavioral and Educational Intervention Techniques to Improve Communication
Summary Conclusions
Specific language and communication training is often an important component of the curriculum in intervention programs for children with autism.
- Articles screened for this topic: 232 group studies and 68 single-subject design studies
- Articles meeting criteria for evidence: 1 group study and 3 single-subject design studies
Because communication deficits are a core element defining autism, behavioral or educational intervention techniques to improve communication are an important component of intervention programs for young children with autism. It is particularly important to concentrate on the functional aspects of language development (use of language in context and social aspects of communication).
Various behavioral or educational strategies have been found to be effective in increasing spontaneous language and teaching communication skills. It is often useful to involve peers and parents in language training.
Language training using various modes of presentation may be effective. For some children with autism, sign language or visual communications systems may be useful tools in facilitating verbal language development. It is important that parents not view using sign language and visual augmentative communication methods and systems as giving up on verbal language development.
Summary Advantages and Limitations
Advantages
- many behavioral strategies have been found to be effective in improving communication for young children with autism
- behavioral strategies can be easily adapted to an individual child's situation
Limitations
- limitations depend on specific program elements and the total intervention program
Behavioral and Educational Intervention Techniques to Improve Social Interactions
Summary Conclusions
Behavioral techniques are often applied to increase a child's social initiations and appropriate responses, particularly with other children.
- Articles screened for this topic: 232 group studies and 68 single-subject design studies
- Articles meeting criteria for evidence: No group studies and 7 single-subject design studies
Because deficits in social interaction are a core element defining autism, behavioral intervention techniques to improve social skills are an important component of intervention programs for young children with autism. It is particularly important to concentrate on a child's ability to initiate social interactions with other children and to respond appropriately to their social initiations.
Various behavioral strategies have been found to be effective in increasing reciprocal social interactions between children with autism and other children. It is often useful to train peers with age appropriate development to interact with a child with autism. Peers, some as young as preschool age, have been trained to model correct responses as well as provide prompts and reinforcements for young children with autism.
Summary Advantages and Limitations
Advantages
- various behavioral intervention techniques have been found to be effective for improving social interactions in children with autism
- other adults and peers can be trained to implement the intervention techniques
Limitations
- limitations depend on specific program elements and the total intervention program
Parent Training as Part of Behavioral and Educational Programs
Summary Conclusions
Many intervention programs include a component of parent training. The specific behavioral strategies taught to parents vary depending upon the particular program.
- Articles screened for this topic: 232 group studies and 68 single-subject design studies
- Articles meeting criteria for evidence: 2 group studies and 1 single-subject design study
Parent training is an important component of intervention programs. Training parents (and siblings) of children with autism may be useful because it: 1) involves the parents in choosing target behaviors on which to focus; 2) teaches parents particular strategies to help them provide additional hours of intervention to their child; 3) helps improve the interaction between the parents and the child with autism; and 4) improves generalization of skills and behaviors to other settings.
One useful method may be to train parents to focus on multiple cues from the child and use natural reinforcers in response to the child's attempts. This more naturalistic approach may be more effective in reducing parent stress and increasing parent happiness than more directive methods that train parents to teach their child one response at a time in discrete trials.
Summary Advantages and Limitations
Advantages
- can be effective in helping to achieve positive outcomes for both the child and the family
- parental involvement improves generalization of skills to the home and family environment of the child
- certain types of parent training may reduce parent stress and increase parent satisfaction siblings can be trained in behavioral procedures
Limitations
- may not be possible or effective in all family situations
- expectations associated with parent training may increase parental stress
Interventions Based on the Developmental, Individual Difference, Relationship (DIR) Model
Summary Conclusions
The developmental, individual difference, relationship model is used as the basis for a comprehensive intervention approach emphasizing the child's affect and relationships, developmental level, and individual differences.
- Articles screened for this topic: 1
- Articles meeting criteria for evidence: 0
Intervention approaches based on the DIR model are used extensively in some clinical practice settings. However, there is currently no adequate scientific evidence (based on controlled studies using generally accepted scientific methodology) that demonstrates the effectiveness of DIR-based interventions for young children with autism. Therefore, the use of these approaches cannot be recommended as a primary intervention method for young children with autism. Furthermore, it is important to recognize that approaches based on the DIR model can be time intensive for both professionals and parents, and may take time away from other therapies that have been demonstrated to be effective.
Summary Advantages and Limitations
Advantages
- some aspects of the DIR model may be consistent with the common elements of interventions shown to be effective for children with autism in other programs and studies
Limitations
- there are no reports in the literature of adequate controlled trials that have evaluated the efficacy of intervention approaches based on the DIR model for treating young children with autism
- it is important to recognize that approaches based on the DIR model can be time intensive for both professionals and parents and may take time away from other therapies that have been demonstrated to be effective
Sensory Integration Therapy
Summary Conclusions
The stated goal of sensory integration therapy is to "facilitate the development of the nervous system's ability to process sensory input in a more normal way."
- Articles screened for this topic: 29
- Articles meeting criteria for evidence: 0
Sensory integration is sometimes used as an intervention for children with autism. There is currently no adequate scientific evidence (based on controlled studies using generally accepted scientific methodology) that demonstrates the effectiveness of sensory integration for young children with autism. Therefore, the use of this method cannot be recommended as a primary intervention method for young children with autism.
If sensory integration is considered as an intervention for a child, it is essential to coordinate across interventions and to develop a specific treatment plan. It is important that sensory integration activities be provided in such a way that they do not inadvertently reinforce serious maladaptive behaviors, such as self-injury and aggression.
Summary Advantages and Limitations
Advantages
- some therapists and parents report that children with autism appear to benefit from sensory integration therapy in ways that include being less averse to touch and being calmer
- if sensory integration methods are helpful for children with autism, it may be due to certain elements of sensory integration approaches such as physical exercise, redirection of attention and having pleasurable interactions with adults. These elements are also sometimes part of other therapeutic interventions.
- sensory integration procedures can be used in conjunction with other more intensive therapeutic approaches
Limitations
- there are no reports in the literature of adequate controlled trials that have evaluated the efficacy of sensory integration for treating young children with autism
Touch Therapy
Summary Conclusions
Touch therapy is a particular method of massage that involves specific sequences of rubbing the body using moderate pressure and smooth stroking movements.
- Articles screened for this topic: 4
- Articles meeting criteria for evidence: 1
The one study which met review criteria on use of touch therapy in young children with autism reported modest reduction in some behaviors in subjects who were older than three and already had experience in a special preschool. Both the touch therapy group and the control group received individual attention and physical contact from an adult as part of the study, and both groups showed improvement from pre- to post-test. However, these changes were small and may not have been clinically relevant or useful.
For some outcome measures, there was a difference between the groups in favor of the touch therapy group, but for other outcome measures, including touch aversion, there was no difference between the touch therapy group and the touch control group.
There is insufficient evidence to make a recommendation in favor of touch therapy as an effective intervention for young children with autism. Further research would be needed to replicate the effects of this study and to make a recommendation for the use of this intervention approach in young children with autism.
Summary Advantages and Limitations
Advantages
- the study reviewed found that children with autism who received touch therapy had significantly greater decreases in stereotypic behaviors and in orienting to irrelevant sounds than did the control group
Limitations
- the study reviewed found no differences between the children in the intervention group and those in the control group for outcome measures of touch aversion and off-task behavior.
- while the touch therapy group showed statistically significant improvement in some outcomes, these changes were small and may not have been clinically relevant or useful
- the age range of children in the study was not given, but the study did not appear to have any children under the age of three, and the children had been in a special preschool for two years so the applicability of the method for younger children who have not been in preschool is not known
- some parents might find the specific procedures used in touch therapy unacceptable
- relatively inexpensive per session, but the total cost may be relatively expensive since a course of therapy usually involves multiple sessions
Music Therapy
Summary Conclusions
For children with autism, music therapy (as a separate, discrete therapy) involves using some aspect of music, although the particular procedures used in music therapy vary and were not well defined in the literature reviewed.
- Articles screened for this topic: 5
- Articles meeting criteria for evidence: None of the articles were found to meet the established criteria for evidence about efficacy. However, information from two general articles was reviewed because of its use in the past regarding music therapy.
Because of the lack of demonstrated efficacy for using music therapy as a separate, discrete therapy, it cannot be recommended as a specific intervention method for young children with autism.
Summary Advantages and Limitations
Advantages
- no advantages were found for using music therapy (as a separate discrete intervention) in children with autism
Limitations
- music therapy (as a separate, discrete intervention method) has not been demonstrated to have efficacy in a controlled study using generally accepted scientific methodology
Auditory Integration Training (AIT)
Summary Conclusions
Auditory integration training involves listening to electronically modulated music through earphones. The modifications in the music are based on an individual's response to an audiogram.
- Articles screened for this topic: 16
- Articles meeting criteria for evidence: 1
The one study that met criteria for evidence about efficacy found no differences in children receiving auditory integration training and children listening to unmodified music. Because of the lack of demonstrated efficacy and the expense of the intervention, it is recommended that auditory integration training not be used as an intervention for young children with autism.
Summary Advantages and Limitations
Advantages
- there are no advantages to using auditory integration training in young children with autism
Limitations
- some side effects were reported for both groups
- a randomized controlled trial with an adequate sample size found no differences in children receiving auditory integration training as compared with those listening to the same music which had not been modified. Both groups showed significant improvements in behavior and showed a decrease in severity of autism
- relatively expensive
Facilitated Communication
Summary Conclusions
Facilitated communication involves a "facilitator" who supports the child's hand on a keyboard or letter while the child types or spells messages.
- Articles screened for this topic: 8
- Articles meeting criteria for evidence: None of the articles were found to meet the established criteria for evidence about efficacy. However, information from two articles was reviewed because of its use in the past regarding facilitated communication.
Because of the lack of evidence for efficacy and possible serious harms of using facilitated communication, it is strongly recommended that facilitated communication not be used as an intervention method in young children with autism.
Summary Advantages and Limitations
Advantages
- there are no proven advantages of facilitated communication, especially in young children under three years of age
Limitations
- there is no adequate evidence that facilitated communication is an effective intervention method for young children with autism
- there are potential serious harms in accepting at face value any of the communications produced by facilitated communication
Psychoactive Medications
Summary Conclusions
Psychoactive medications are drugs that exert significant effects on mental functioning or behavior by altering the chemical makeup of the central nervous system. These medications have been developed primarily to treat a variety of neurological and psychiatric conditions.
- Articles screened for this topic: 99
- Articles meeting criteria for evidence: 12
Some psychoactive medications have been shown to be effective in reducing maladaptive behaviors in children with autism. However, most of these psychoactive medications have also been found to be associated with relatively high rates of side effects. The efficacy for reducing maladaptive behaviors and the risks for side effects both vary depending upon the medication.
In practice, psychoactive medications are rarely administered to children with autism who are under three years of age for the following reasons: (1) the younger the child, the greater the concern about the risk of side effects; and (2) the severe behavioral problems frequently seen in young children with autism are often manageable using interventions other than medication. Therefore, most physicians have limited experience using these psychoactive medications to treat autism in children under three years old. More physicians probably have experience using medications to treat conditions associated with autism (such as seizure disorders) in children in this age group.
It is common practice in medicine that, when medications have not been sufficiently studied in a young population, physicians look at studies in older individuals and try to extrapolate the results to younger populations. It is then a matter of clinical judgment to decide if a medication should be tried in a younger patient (if there is good reason to think that it will be effective without exposing the child to significant risk of side effects).
There are some young children with autism who manifest severe sleep and behavioral problems that do not respond to behavioral techniques. Some of these children might benefit from a trial of psychoactive medication such as stimulants, alpha agonists, SSRI's, neuroleptics or mood stabilizers. Other medications that have been used to induce sleep and are considered relatively safe include dephenhydramine, chloral hydrate, and some benzodiazepines.
In children who regress in their development, psychoactive medications may sometimes be used to treat an associated medical condition suspected of precipitating the regression. Psychoactive medications may also be effectively administered to treat other specific disorders that may coexist with autism.
Summary Advantages and Limitations
Advantages
- in some children, there may be a beneficial effect in reducing maladaptive autistic or associated behavioral problems for which other interventions have not been effective
Limitations
- the short term and long term efficacy and safety of most medications currently used to treat autism in very young children have not been demonstrated in double-blind, placebo controlled studies. Haloperidol is an exception, but its usefulness is limited because of the possible induction of dyskinesia
- we have less experience using these
medications in this
age group; thus there is little or no knowledge about the efficacy and risk level in this population. Even less is known about the toxicity of drug combinations - the younger the child, the more concern there is of the risk of side effects
- the severe behavioral problems that young children with autism sometimes manifest may be manageable without medication. Sometimes behavioral techniques are effective and sufficient to lessen the problematic behaviors.
Hormone Therapies
Summary Conclusions
Hormones are complex chemicals naturally produced in the human body that aid in regulating many normal physiological functions. Some hormone replacement therapies have been proposed as possible treatments for autism.
- Articles screened for this topic: 16
- Articles meeting criteria for evidence: 1 on (ACTH)
Hormone therapies such as ACTH and secretin have not been found to be effective for treating autism. There was only one study that evaluated use of hormone therapy for treating autism in children and met criteria for in-depth review. In this study, ACTH was reported to be effective for treating manifestations of autism, but the effectiveness of ACTH to treat autism in children has not been replicated. In addition, the biological basis for using ACTH or secretin to treat autism is not clear.
There are well-known adverse health effects from treating young children with ACTH or other hormone medications. The potential side effects from treatment with secretin are unknown. Unless a child clearly has a deficiency or other condition known to be helped by hormone therapy, it appears that the risks associated with the use of hormone therapies to treat autism outweigh the possible benefits.
Summary Advantages and Limitations
Advantages
- in one recent controlled trial, adrenocorticotropin hormone (ACTH) was reported to be effective in reducing some manifestations of autism in children
Limitations
- the effectiveness of ACTH to treat autism in children has not been replicated in multiple well-designed research studies
- there are well-known adverse health effects from treating young children with ACTH or other hormone medications unless the child clearly has a hormone deficiency or other condition known to be helped by such treatment
- there is no adequate evidence that secretin is effective for treating autism in children, and the potential harms of using secretin as a treatment are not known
Immunologic Therapies
Summary Conclusions
Immune or immunologic therapies, including treatment with intravenous immune globulin, have been suggested as a possible treatment for children with autism.
- Articles screened for this topic: 5
- Articles meeting criteria for evidence: 0
A systematic and thorough review of the scientific literature found no adequate evidence that the use of IVIG or any other type of immune therapy is effective treating autism. There were only two articles found that presented information on behavioral and functional outcomes for children with autism after treatment with immune therapies. Both of these studies had serious methodological flaws and cannot provide acceptable scientific evidence about the efficacy of immune therapies for treating children with autism. The article by Gupta (1996) did not present any outcome data for the comparison group and presented a non-standardized method for measuring improvement. The article by Singh (1988) had an inadequate description of the intervention and the method for outcome assessment and presented no actual outcome data for behavioral and functional outcomes for either treatment or control group.
Any purported changes in immunologic tests or other lab tests as a result of immunologic therapy are not considered to be important outcomes by the panel. Lab test changes by themselves are considered intermediate outcomes, which can only be considered important if they have been convincingly shown to be associated with an important functional outcome. There is no adequate scientific evidence that children with autism have any type of immunologic problems or that they have any immunologic test results that are significantly different than results for the general population (as discussed in Chapter III, Assessment Methods).
In conclusion, it is recommended that intravenous immune globulin (IVIG) and other immunologic therapies not be used for children with autism, since these types of therapies have not been shown to be efficacious as treatments for autism and since these treatments pose significant health risks.
Summary Advantages and Limitations
Advantages
- there are no advantages to IVIG therapy or any other type of immune therapy for treating young children with autism
Limitations
- the efficacy of IVIG therapy for treating behavioral manifestations of autism has not been demonstrated in any well-designed controlled trials.
- there is no adequate evidence in the scientific literature that any type of immune therapies (including IVIG) is efficacious for treating autism.
- long term side effects of IVIG therapy are not known
- IVIG therapy presents a risk for potential infection with blood borne infectious agents which can cause serious or potentially fatal illnesses (such as the AIDS virus, and Hepatitis B and C)
- IVIG therapy presents a risk for allergic reactions to the injected material
Anti-Yeast Therapies
Summary Conclusions
Various anti-yeast therapies have been proposed as intervention for children with autism. These interventions typically involve administration of oral anti-fungal medication or special diets that include foods purported to have anti-fungal properties.
- Articles screened for this topic: 2
- Articles meeting criteria for evidence: 0
It has not been demonstrated that anti-yeast therapies, including anti-yeast medications and special diets, are effective in treating autism. The use of anti-yeast medications is also associated with health risks. In addition, the biological basis for using anti-yeast therapy relies on a theory about the cause of autism that is not generally accepted by most experts on autism.
The panel concluded that there was no adequate evidence that the use of anti-yeast medications was of benefit for treating children with autism. The use of these medications was also considered potentially harmful.
Summary Advantages and Limitations
Advantages:
- there are no known advantages to anti-yeast therapies
Limitations:
- there is no scientific basis for believing anti-yeast therapies would be effective, and they have not been studied in the scientific literature as a treatment for autism
- there are potential side effects and health risks from the use of this therapy
Vitamin Therapies
Summary Conclusions
Vitamin therapy as it has been used for treatment of autism involves administration of high-dosage B6-magnesium.
- Articles screened for this topic: 17
- Articles meeting criteria for evidence: 2 articles met the established criteria for evidence about efficacy. The panel also considered a review article on the use of B6-magnesium in the treatment of autism and a review on controversial therapies for young children with developmental disabilities.
There is insufficient evidence to recommend the use of vitamin B6 (pyridoxine) and magnesium therapy as an intervention for young children with autism. Studies of the efficacy of this treatment method have mixed results. Although short term side effects are reported to be mild, side effects are not known for young children who are treated with high doses of vitamin B6 and magnesium over long periods of time.
There were no other studies that met criteria for in-depth review that evaluated the use of vitamin therapy for the treatment of autism.
If a child has a documented vitamin or trace mineral deficiency, it is recommended that the deficiency be treated, if appropriate. However, vitamin therapy with pyridoxine and magnesium is not a recommended intervention for autism.
Summary Advantages and Limitations
Advantages:
- side effects of pyridoxine and magnesium over the short term seem to be mild
Limitations:
- results on efficacy of high-dosage B6-magnesium are mixed. The studies reporting positive findings have methodological shortcomings, including possible repeat use of the same subjects in multiple studies. The Findling (1997) study found no difference between the HDPM and placebo, but the sample size was small.
- long term side effects in young children treated with pyridoxine and magnesium are not known
Diet Therapies
Summary Conclusions
Diet therapies, especially those that involve the elimination of milk or wheat products from the diet, have been proposed for the treatment of autism in children.
- Articles screened for this topic: 16
- Articles meeting criteria for evidence: 1
Special diets, including elimination diets, are not recommended as a treatment for autism in young children.
Summary Advantages and Limitations
Advantages
- there are no known advantages to special elimination diets for children with autism
Limitations
- special elimination diets are an unproven therapy. They may cause the child to get inadequate nutrition and can be expensive.
