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Autism spectrum disorder in children and adolescents: Complementary and alternative therapies

Laura Weissman, MD
Carolyn Bridgemohan, MD
Section Editors
Marilyn Augustyn, MD
Marc C Patterson, MD, FRACP
Deputy Editor
Mary M Torchia, MD


Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disorder characterized by impairments in two major domains: 1) deficits in social communication and social interaction and 2) restricted repetitive patterns of behavior, interests, and activities [1]. ASD encompasses disorders previously known as autistic disorder (classic autism, sometimes called early infantile autism, childhood autism, or Kanner's autism), childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified, and Asperger disorder (also known as Asperger syndrome). (See "Autism spectrum disorder: Diagnosis", section on 'Diagnostic criteria' and "Asperger syndrome (a specific autism spectrum disorder): Clinical features and diagnosis in children and adolescents" and "Asperger syndrome (a specific autism spectrum disorder): Management and prognosis in children and adolescents".)

The discussion that follows will focus on complementary and alternative therapies for ASD. Related topics are presented separately:

(See "Autism spectrum disorder: Clinical features".)

(See "Autism spectrum disorder: Diagnosis".)

(See "Autism spectrum disorder in children and adolescents: Overview of management".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 5, 2015.
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  1. American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.50.
  2. National Center for Complementary and Alternative Medicine. Expanding horizons of healthcare: five year strategic plan 2001-2005. US Department of Health and Human Services, Washington DC, 2000.
  3. Hanson E, Kalish LA, Bunce E, et al. Use of complementary and alternative medicine among children diagnosed with autism spectrum disorder. J Autism Dev Disord 2007; 37:628.
  4. Levy SE, Hyman SL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2008; 17:803.
  5. Perrin JM, Coury DL, Hyman SL, et al. Complementary and alternative medicine use in a large pediatric autism sample. Pediatrics 2012; 130 Suppl 2:S77.
  6. Wong HH, Smith RG. Patterns of complementary and alternative medical therapy use in children diagnosed with autism spectrum disorders. J Autism Dev Disord 2006; 36:901.
  7. Salomone E, Charman T, McConachie H, et al. Prevalence and correlates of use of complementary and alternative medicine in children with autism spectrum disorder in Europe. Eur J Pediatr 2015; 174:1277.
  8. Weber W, Newmark S. Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism. Pediatr Clin North Am 2007; 54:983.
  9. Al-Gadani Y, El-Ansary A, Attas O, Al-Ayadhi L. Metabolic biomarkers related to oxidative stress and antioxidant status in Saudi autistic children. Clin Biochem 2009; 42:1032.
  10. James SJ, Cutler P, Melnyk S, et al. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr 2004; 80:1611.
  11. Giulivi C, Zhang YF, Omanska-Klusek A, et al. Mitochondrial dysfunction in autism. JAMA 2010; 304:2389.
  12. Mitchell RH, Goldstein BI. Inflammation in children and adolescents with neuropsychiatric disorders: a systematic review. J Am Acad Child Adolesc Psychiatry 2014; 53:274.
  13. Kazdin AE. Evidence-based assessment for children and adolescents: issues in measurement development and clinical application. J Clin Child Adolesc Psychol 2005; 34:548.
  14. Lilienfeld SO. Scientifically unsupported and supported interventions for childhood psychopathology: a summary. Pediatrics 2005; 115:761.
  15. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. 1996. Clin Orthop Relat Res 2007; 455:3.
  16. Golnik AE, Ireland M. Complementary alternative medicine for children with autism: a physician survey. J Autism Dev Disord 2009; 39:996.
  17. Committee on Children with Disabilities. American Academy of Pediatrics: Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Committee on Children With Disabilities. Pediatrics 2001; 107:598.
  18. Myers SM, Johnson CP, American Academy of Pediatrics Council on Children With Disabilities. Management of children with autism spectrum disorders. Pediatrics 2007; 120:1162.
  19. Barbaresi WJ, Katusic SK, Voigt RG. Autism: a review of the state of the science for pediatric primary health care clinicians. Arch Pediatr Adolesc Med 2006; 160:1167.
  20. Sandler A. Placebo effects in developmental disabilities: implications for research and practice. Ment Retard Dev Disabil Res Rev 2005; 11:164.
  21. Kaptchuk TJ, Eisenberg DM. The persuasive appeal of alternative medicine. Ann Intern Med 1998; 129:1061.
  22. Nickel R. Controversial therapies for young children with developmental disabilities. Infants Young Child 1996; 8:29.
  23. Johnson KP, Giannotti F, Cortesi F. Sleep patterns in autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2009; 18:917.
  24. Horvath K, Stefanatos G, Sokolski KN, et al. Improved social and language skills after secretin administration in patients with autistic spectrum disorders. J Assoc Acad Minor Phys 1998; 9:9.
  25. Scottish Intercollegiate Guidelines Network. Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders. A national clinical guideline. Scottish Intercollegiate Guidelines Network, Edinburgh 2007. www.sign.ac.uk/guidelines/fulltext/98/index.html (Accessed on November 10, 2011).
  26. National Institute for Health and Care Excellence. Autism - management of autism in children and young people (CG170) http://guidance.nice.org.uk/CG170 (Accessed on September 05, 2013).
  27. Krishnaswami S, McPheeters ML, Veenstra-Vanderweele J. A systematic review of secretin for children with autism spectrum disorders. Pediatrics 2011; 127:e1322.
  28. Williams K, Wray JA, Wheeler DM. Intravenous secretin for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2012; :CD003495.
  29. Sliwinski S, Croonenberghs J, Christophe A, et al. Polyunsaturated fatty acids: do they have a role in the pathophysiology of autism? Neuro Endocrinol Lett 2006; 27:465.
  30. Vancassel S, Durand G, Barthélémy C, et al. Plasma fatty acid levels in autistic children. Prostaglandins Leukot Essent Fatty Acids 2001; 65:1.
  31. Bent S, Bertoglio K, Hendren RL. Omega-3 fatty acids for autistic spectrum disorder: a systematic review. J Autism Dev Disord 2009; 39:1145.
  32. James S, Montgomery P, Williams K. Omega-3 fatty acids supplementation for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2011; :CD007992.
  33. Amminger GP, Berger GE, Schäfer MR, et al. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study. Biol Psychiatry 2007; 61:551.
  34. Bent S, Bertoglio K, Ashwood P, et al. A pilot randomized controlled trial of omega-3 fatty acids for autism spectrum disorder. J Autism Dev Disord 2011; 41:545.
  35. Pavone L, Fiumara A, Bottaro G, et al. Autism and celiac disease: failure to validate the hypothesis that a link might exist. Biol Psychiatry 1997; 42:72.
  36. Black C, Kaye JA, Jick H. Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database. BMJ 2002; 325:419.
  37. Hunter LC, O'Hare A, Herron WJ, et al. Opioid peptides and dipeptidyl peptidase in autism. Dev Med Child Neurol 2003; 45:121.
  38. Le Couteur A, Trygstad O, Evered C, et al. Infantile autism and urinary excretion of peptides and protein-associated peptide complexes. J Autism Dev Disord 1988; 18:181.
  39. Parr J. Autism. In: Clinical Evidence Handbook, BMJ Publishing Group, London 2008. p.69.
  40. Marí-Bauset S, Zazpe I, Mari-Sanchis A, et al. Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review. J Child Neurol 2014; 29:1718.
  41. Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev 2008; :CD003498.
  42. Mulloy A, Lang R, O'Reilly M, et al. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: a systematic review. Res Autism Spectr Disord 2010; 4:328.
  43. Mulloy A, Lang R, O'Reilly M, et al. Addendum to "gluten-free and casein-free diets in the treatment of autism spectrum disorders: a systematic review". Res Autism Spectr Disord 2011; 5:86.
  44. Hyman, S, Stewart, PA, Smith, T, et al. The gluten free and casein free (GFCF) diet: A double-blind, placebo-controlled challenge study. International Meeting for Autism Research (IMFAR) 2010. imfar.confex.com/imfar/2010/webprogram/Paper6183.html (Accessed on November 10, 2011).
  45. ClinicalTrials.gov. A Study to Assess the Role of a Gluten Free-dairy Free (GFCF) Diet in the Dietary Management of Autism Associated Gastrointestinal Disorders. NCT)1116388 https://clinicaltrials.gov/ct2/show/NCT01116388 (Accessed on September 03, 2016).
  46. Whiteley P, Haracopos D, Knivsberg AM, et al. The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci 2010; 13:87.
  47. Nye C, Brice A. Combined vitamin B6-magnesium treatment in autism spectrum disorder. Cochrane Database Syst Rev 2005; :CD003497.
  48. Kern JK, Miller VS, Cauller PL, et al. Effectiveness of N,N-dimethylglycine in autism and pervasive developmental disorder. J Child Neurol 2001; 16:169.
  49. Bolman WM, Richmond JA. A double-blind, placebo-controlled, crossover pilot trial of low dose dimethylglycine in patients with autistic disorder. J Autism Dev Disord 1999; 29:191.
  50. Zhang Y, Kensler TW, Cho CG, et al. Anticarcinogenic activities of sulforaphane and structurally related synthetic norbornyl isothiocyanates. Proc Natl Acad Sci U S A 1994; 91:3147.
  51. Zhang Y, Talalay P, Cho CG, Posner GH. A major inducer of anticarcinogenic protective enzymes from broccoli: isolation and elucidation of structure. Proc Natl Acad Sci U S A 1992; 89:2399.
  52. Singh K, Connors SL, Macklin EA, et al. Sulforaphane treatment of autism spectrum disorder (ASD). Proc Natl Acad Sci U S A 2014; 111:15550.
  53. Autism Speaks. Broccoli sprouts for autism? What you need to know. http://www.autismspeaks.org/blog/2014/10/14/broccoli-sprouts-autism-what-you-need-know (Accessed on February 05, 2015).
  54. Srinivasjois R, Rao S, Patole S. Probiotic supplementation in children with autism spectrum disorder. Arch Dis Child 2015; 100:505.
  55. Levy SE, Hyman SL. Novel treatments for autistic spectrum disorders. Ment Retard Dev Disabil Res Rev 2005; 11:131.
  56. Shaw W, Kassen E, Chaves E. Increased urinary excretion of analogs of Krebs cycle metabolites and arabinose in two brothers with autistic features. Clin Chem 1995; 41:1094.
  57. Gupta S. Immunological treatments for autism. J Autism Dev Disord 2000; 30:475.
  58. Feasby T, Banwell B, Benstead T, et al. Guidelines on the use of intravenous immune globulin for neurologic conditions. Transfus Med Rev 2007; 21:S57.
  59. Krause I, He XS, Gershwin ME, Shoenfeld Y. Brief report: immune factors in autism: a critical review. J Autism Dev Disord 2002; 32:337.
  60. Gupta S, Aggarwal S, Heads C. Dysregulated immune system in children with autism: beneficial effects of intravenous immune globulin on autistic characteristics. J Autism Dev Disord 1996; 26:439.
  61. DelGiudice-Asch G, Simon L, Schmeidler J, et al. Brief report: a pilot open clinical trial of intravenous immunoglobulin in childhood autism. J Autism Dev Disord 1999; 29:157.
  62. Plioplys AV. Intravenous immunoglobulin treatment of children with autism. J Child Neurol 1998; 13:79.
  63. Voelker R. FDA warning targets OTC chelation products. JAMA 2010; 304:2112.
  64. US Food and Drug Administration. Chelation products: Unapproved over-the-counter drugs -- consumer warning. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm229454.htm.
  65. Adams JB, Baral M, Geis E, et al. Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: part B - behavioral results. BMC Clin Pharmacol 2009; 9:17.
  66. Adams JB, Baral M, Geis E, et al. Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A--medical results. BMC Clin Pharmacol 2009; 9:16.
  67. James S, Stevenson SW, Silove N, Williams K. Chelation for autism spectrum disorder (ASD). Cochrane Database Syst Rev 2015; :CD010766.
  68. Baxter AJ, Krenzelok EP. Pediatric fatality secondary to EDTA chelation. Clin Toxicol (Phila) 2008; 46:1083.
  69. Centers for Disease Control and Prevention (CDC). Deaths associated with hypocalcemia from chelation therapy--Texas, Pennsylvania, and Oregon, 2003-2005. MMWR Morb Mortal Wkly Rep 2006; 55:204.
  70. Rossignol DA. Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism. Med Hypotheses 2007; 68:1208.
  71. Rossignol DA, Rossignol LW, James SJ, et al. The effects of hyperbaric oxygen therapy on oxidative stress, inflammation, and symptoms in children with autism: an open-label pilot study. BMC Pediatr 2007; 7:36.
  72. Chungpaibulpatana J, Sumpatanarax T, Thadakul N, et al. Hyperbaric oxygen therapy in Thai autistic children. J Med Assoc Thai 2008; 91:1232.
  73. Rossignol DA, Rossignol LW, Smith S, et al. Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial. BMC Pediatr 2009; 9:21.
  74. Collet JP, Vanasse M, Marois P, et al. Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group. Lancet 2001; 357:582.
  75. Dolske MC, Spollen J, McKay S, et al. A preliminary trial of ascorbic acid as supplemental therapy for autism. Prog Neuropsychopharmacol Biol Psychiatry 1993; 17:765.
  76. Main PA, Angley MT, Thomas P, et al. Folate and methionine metabolism in autism: a systematic review. Am J Clin Nutr 2010; 91:1598.
  77. Geretsegger M, Elefant C, Mössler KA, Gold C. Music therapy for people with autism spectrum disorder. Cochrane Database Syst Rev 2014; :CD004381.
  78. Bass MM, Duchowny CA, Llabre MM. The effect of therapeutic horseback riding on social functioning in children with autism. J Autism Dev Disord 2009; 39:1261.
  79. Gabriels RL, Pan Z, Dechant B, et al. Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2015; 54:541.
  80. Sokhadze EM, El-Baz A, Baruth J, et al. Effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on gamma frequency oscillations and event-related potentials during processing of illusory figures in autism. J Autism Dev Disord 2009; 39:619.
  81. Mostert MP. Facilitated communication since 1995: a review of published studies. J Autism Dev Disord 2001; 31:287.
  82. Smith MD, Haas PJ, Belcher RG. Facilitated communication: the effects of facilitator knowledge and level of assistance on output. J Autism Dev Disord 1994; 24:357.
  83. Jacobson JW, Mulick JA, Schwartz AA. A history of facilitated communication: Science, pseudoscience, and anti-science: Science working group on facilitated communication. Am Psychol 1995; 50:750.
  84. Auditory integration training and facilitated communication for autism. American Academy of Pediatrics. Committee on Children with Disabilities. Pediatrics 1998; 102:431.
  85. Section On Complementary And Integrative Medicine, Council on Children with Disabilities, American Academy of Pediatrics, et al. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics 2012; 129:1186.
  86. Maglione MA, Gans D, Das L, et al. Nonmedical interventions for children with ASD: recommended guidelines and further research needs. Pediatrics 2012; 130 Suppl 2:S169.
  87. Sinha Y, Silove N, Hayen A, Williams K. Auditory integration training and other sound therapies for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2011; :CD003681.
  88. Silva LM, Schalock M, Ayres R, et al. Qigong massage treatment for sensory and self-regulation problems in young children with autism: a randomized controlled trial. Am J Occup Ther 2009; 63:423.
  89. Silva LM, Cignolini A, Warren R, et al. Improvement in sensory impairment and social interaction in young children with autism following treatment with an original Qigong massage methodology. Am J Chin Med 2007; 35:393.
  90. Lee MS, Kim JI, Ernst E. Massage therapy for children with autism spectrum disorders: a systematic review. J Clin Psychiatry 2011; 72:406.
  91. Holtmann M, Steiner S, Hohmann S, et al. Neurofeedback in autism spectrum disorders. Dev Med Child Neurol 2011; 53:986.
  92. Cheuk DK, Wong V, Chen WX. Acupuncture for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2011; :CD007849.
  93. Lee MS, Choi TY, Shin BC, Ernst E. Acupuncture for children with autism spectrum disorders: a systematic review of randomized clinical trials. J Autism Dev Disord 2012; 42:1671.
  94. Ming X, Chen X, Wang XT, et al. Acupuncture for treatment of autism spectrum disorders. Evid Based Complement Alternat Med 2012; 2012:679845.
  95. Carbone PS, Farley M, Davis T. Primary care for children with autism. Am Fam Physician 2010; 81:453.