Autism Spectrum Disorder and Complementary-Integrative Medicine.

Many families (27-88%) of children with autism use complementary treatments like vitamins, special diets, and natural remedies alongside or instead of traditional medications. Parents often choose these treatments because they seem 'natural' and safer than prescription drugs. The most common treatments include multivitamins, elimination diets, and vitamin B12 injections. Parents find sensory therapy, melatonin, and antifungal treatments most helpful.

However, many of these treatments lack strong research evidence for their effectiveness.

This comprehensive review examines complementary and integrative medicine (CIM) use among families of children with autism spectrum disorder. The authors report that 27-88% of families use CIM treatments, with higher usage rates among families dealing with more severe ASD symptoms, comorbidities like irritability and GI issues, and those with higher parental education. The review highlights that no FDA-approved medications target core ASD symptoms, with only risperidone and aripiprazole approved for irritability/agitation but with significant side effects. Popular CIM treatments include multivitamins, elimination diets, and Methyl B12 injections, while sensory integration, melatonin, and antifungals are perceived as most effective.

The authors emphasize the need for healthcare practitioners to improve their knowledge of CIM approaches.

Healthcare providers should develop knowledge about CIM treatments as many families use them. Clinical discussions should address both potential benefits and limitations of various CIM approaches. Providers need to engage constructively with families using CIM rather than dismissing these treatments, while ensuring evidence-based guidance about safety and efficacy.

This is a narrative review rather than systematic analysis. Many CIM treatments discussed have limited or poor quality research evidence. Parent perceptions of effectiveness may not reflect actual clinical efficacy. Sample sizes and specific methodological details are not provided for cited studies.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects 0.6%-1.7% of children. The etiology of autism is hypothesized to include both biological and environmental factors (Watts, 2008). In addition to the core symptoms of social-communication delay and restricted, repetitive interests, co-occurring irritability/aggression, hyperactivity, and insomnia negatively impact adaptive functioning and quality of life of patients and families. Despite years of effort, no pharmacologic agent has been found that targets the core symptoms of ASD.

The only FDA-approved agents are risperidone and aripiprazole for agitation and irritability in ASD, not for core symptoms. Though they effectively reduce irritability/violence, they do so at the expense of problematic side effects: metabolic syndrome, elevated liver enzymes, and extrapyramidal side effects. Thus, it is not surprising that many families of children with ASD turn to nonallopathic treatment, including dietary interventions, vitamins, and immunomodulatory agents subsumed under complementary-integrative medicine (CIM). Per recent studies, 27% to 88% of families report using a CIM treatment.

In an extensive population-based survey of CIM, families of children with more severe ASD, comorbid irritability, GI symptoms, food allergies, seizures, and higher parental education tend to use CIM at higher rates. The perceived safety of CIM treatments as "natural treatment" over allopathic medication increases parental comfort in using these agents. The most frequently used CIM treatments include multivitamins, an elimination diet, and Methyl B12 injections. Those perceived most effective are sensory integration, melatonin, and antifungals.

Practitioners working with these families should improve their knowledge about CIM as parents currently perceive little interest in and poor knowledge of CIM by physicians. This article reviews the most popular complementary treatments preferred by families with children with autism. With many of them having limited or poor quality data, clinical recommendations about the efficacy and safety of each treatment are discussed using the SECS versus RUDE criteria.