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Autism Treatments Scrutinized in Study

By SHIRLEY S. WANG

Three new studies conclude that many widely used behavioral and medication treatments for autism have some benefit, one popular alternative therapy doesn't help at all, and there isn't yet enough evidence to discern the best overall treatment.

Parents of children with autism-spectrum disorder often try myriad treatments, from drugs to therapy to nutritional supplements. The studies being published Monday and funded by the federal Agency for Healthcare Research and Quality, were part of the effort to examine the comparative effectiveness of treatments in 14 priority disease areas, including autism-spectrum disorders.

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Ben Schwenker, shown in 2008, has received treatment for autism.

Autism and related disorders, conditions marked by social and communication deficits and often other developmental delays, have become more common over the years and now affect 1 in 110 U.S. children, according to estimates from the U.S. Centers for Disease Control and Prevention.

The most conclusive evidence in Monday's reviews, being published in the journal Pediatrics, showed that secretin, a gastrointestinal hormone that is used to treat ulcers, yielded no benefit for children with these disorders. It is unclear how many doctors and families advocate its use, but a 1998 case report of three children stirred excitement by suggesting the children showed social, cognitive and communication improvement after receiving two infusions of secretin.

In the past 10 years, however, a number of high-quality studies showed there was no effect of secretin on autism symptoms, a conclusion borne out by researchers from Vanderbilt University who reviewed these studies in aggregate. "There's good evidence that it's not working," said Zachary Warren, a study author and director of Vanderbilt's Treatment and Research Institute for Autism Spectrum Disorders.

Their findings were more positive when it came to two other types of popular treatments: intensive behavioral intervention and medication. Early intensive behavioral treatments can involve multiple hours of practicing skills with a therapist each week for years. Experts have long advocated their use for improving cognitive and social symptoms, but research to assess their value has been difficult to conduct.

Monday's report included 34 studies of these treatments, 23 of which the reviewers rated as poor quality. Still, there was enough evidence to suggest that these therapies improved IQ, language skills and day-to-day skills in some children with autism-spectrum disorders, the researchers said. Overall, however, more and better-quality research was needed, Dr. Warren said. "Our ability to say this one specific approach should be utilized for the child in front of me—we're not quite there yet," he said.

Fred Volkmar, an autism researcher and physician at the Yale Child Study Center who wasn't involved with the studies, said the findings weren't surprising but were a solid follow-up to previous work. "There's an increase and growing body of evidence that early intervention and diagnosis can make a long-time impact" in autism-spectrum disorders. He said the behavioral treatment literature was last systematically reviewed in 2001.

Antipsychotic medications, meanwhile, showed some benefit in treating what are known as "challenging behaviors," such as aggression and disruptive or repetitive behaviors, but not the core symptoms of autism such as lack of social interaction. Again, the researchers pointed to an overall lack of high-quality research.

Drugs can be beneficial for some children, particularly if the challenging behaviors get in the way of kids' learning, say experts. But, the often potent side effects, particularly of antipsychotic drugs, mean that doctors and parents should exercise "significant caution" when deciding to use these for children, Dr. Warren said.

To make the reports' findings understandable to parents, caregivers and clinical providers, the Agency for Healthcare Research and Quality will put out "translation guides" about them and the strength of the evidence in the literature, according to Jean Slutsky, director of the Center for Outcomes and Evidence at the agency.