Different Options of Treatment. Which of Them Do Not Work?
by Dr. Kenneth Alibek
Due to the fact that constantly communicating with the parents of children with autism we get a lot of questions about the effectiveness of certain methods, today's post I would like to devote to different approaches to the treatment of this disorder. We understand how difficult it is for parents of children with autism to search among hundreds of different approaches to treatment.
Therefore, in today's post I will talk about several types of treatment-effective, ineffective, and those that are likely to do more harm than good.
Unfortunately, there is no official treatment for autism yet. There are drugs that can help alleviate symptoms to some extent, such as aggressiveness, hyperactivity, etc.in the US, only two such drugs are approved - Risperidone and Aripiprazole. However, these drugs do not affect the main problems of autism – social skills, repetitive behavior, and verbal problems. What's more, both drugs can have significant side effects including weight gain and can sometimes backfire. (Bent S, Hendren RL. Improving the prediction of response to therapy in autism. Neurotherapeutics. 2010;7 (3):232-240.)
Various correctional therapies can help to cope with behavioral problems. But it takes at least 20 hours a week of these classes. Even so, not all children will experience improvements (Howlin P, Magiati I, Charman T. Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev . 2009;114(1):23-41)
In a large number of children, the so-called comorbidities, including disorders of the gastrointestinal tract, weakened immune system, sleep problems, irritability and others are observed.
It is also well known that autism is accompanied by 4 types of physiological disorders: oxidative stress, accompanied by increased production of free radicals in cells, tissues and systems, inflammation, disorders of the immune system and mitochondral function (Rossignol da, fry). Review of trends in the study of physiological disorders in autism spectrum disorders: immune dysregulation, inflammation, oxidative stress, mitochondrial dysfunction and exposure to environmental toxicants. Like Psychiatry. 2012;17(4):389-401)
Therefore, parents are constantly in search of various treatments that could help their children. According to some studies, 95 95% of parents use ancillary drugs and supplements (Hanson e, kalish La, Bunce e, et al. The use of complementary and alternative medicine among children diagnosed with autism spectrum disorders.)
For example, one such drug is Secretin, a very expensive intravenous drug. However, 7 scientific studies have shown that this drug is ineffective in the case of autism (krishnaswami s, mcpheeters ML, veenstra-vanderweele J. systematic review of secretin for children with autism spectrum disorders. Pediatrics.)
Chelate therapy (using chelates) is used by some parents. It is believed that chelates can remove heavy metals from the body. The use of this method is based on the fact that there is an unconfirmed opinion that some heavy metals such as mercury are the cause of autism, this therapy has a demand. However, such therapy is not only ineffective, but even dangerous. In 2005, a fatal case was recorded due to the fact that blood calcium was bound in chelates, which led to cardiac arrest. (Sinha G, Silove N, K. Williams Chelate therapy and autism. BMJ. 2006;333 (7571):756.; Kane K. the death of a 5-year-old boy is linked to controversial chelation therapy. Pittsburgh Post-Gazette. January 6, 2006. accessed 9 July 2014.)
Lupron therapy is also offered in a misguided attempt to cure something that doesn't actually cause autism. Lupron is a testosterone-inhibiting drug that is used to treat prostate cancer and premature puberty. The use of lupron in children with autism is based on the idea that testosterone enhances the action of mercury and that lowering testosterone levels will reduce the effect of mercury. There is no research showing mercury causes autism or mercury links to testosterone. Lupron also has many harmful side effects, including reduced sensory sensitivity, General weakness, difficulty breathing, trouble swallowing, hives, blood in the urine, bone pain, testicular pain, and osteoporosis (Cunha JP. Leuprolide-injection, Lupron (continued.). MedicineNet.com Hm. accessed 14 February 2015.)
Other treatments for autism include dietary supplements, vitamins, hyperbaric oxygen, hormone injections, swimming with dolphins, horse riding, yoga and massage. These remedies may seem tempting and low-risk, there is not enough evidence that they effectively reduce autism symptoms. Complementary, some of these unwarranted treatments can be downright dangerous (complementary and alternative treatments for autism part 2: Identifying and avoiding non-evidence-based treatments. (2015). AMA journal of ethics, 17 (4), 375-380. doi: 10.1001 / journalofethics.2015.17.4.sect2-1504).
Many practices are based on erroneous theories about the causes of autism. The rationale for gluten-free diets (a protein found in wheat, rye, and barley) and casein (a protein found in dairy products), for example, is that children with autism have a weak gut that allows opioids from these proteins to enter the bloodstream, travel to the brain, and induce autistic behavior.
However, studies have consistently shown no differences between blood opioid levels in people with autism and those with neurotypical manifestations (Hunter LC, o'hare a, Herron WJ, Fisher La, Jones GE. Opioid peptides and dipeptidyl peptidase in autism. Dev Med Child Neurol. 2003;45 (2): 121-128.; Cass H, Gringras P, March J et al.Absence of opioid peptides in urine in children with autism. Arch Dis Baby. 2008;93 (9):745-750.)
Other studies have shown that a gluten-and casein-free diet can lead to lower bone density, which in turn can lead to osteoporosis (Levy SE, Hyman SL. Additional and alternative treatment of children with autism spectrum disorders. Children's Adolf Klin N Am. 2008;17 (4): 807.)
Studies testing the effectiveness of gluten-free and casein diets in the treatment of autism have not yielded statistically significant results, although several parents reported improvements in their children. (Elder JH, Shankar M, Shuster J, Theriaque D, Burns S, Sherrill L. gluten-free, casein diet in autism: results of a preliminary double-blind clinical trial. J Autism And Disord. 2006;36 (3): 413-420.)
Next, we will touch on those publications that provide an opportunity to improve the quality of life of children with autism (however, it would be a big mistake to "appoint" such treatment on their own, without consulting with knowledgeable experts in the field of these pathologies). In addition, such specialists should be able to verify the effectiveness of certain compounds based on the results of scientific publications, which are mainly published in English-language scientific journals.
Starting this part, we want to say that there are publications on the effectiveness of certain drugs and supplements affecting 4 categories of physiological disorders associated with autism: oxidative stress, inflammation, immune system disorders and mitochondrial dysfunction, which also positively affect the symptoms of autism (Lofthouse N Hendren R E hurt, Arnold Le, oil E. review complementary and alternative treatments for autism spectrum disorder. 2012;2012(870391)
Oxidative stress refers to an imbalance in the formation and detoxification of reactive oxygen and nitrogen species, which are known to cause damage to cells and tissues. These reactive oxygen species are a normal part of human physiological processes, but if they are not "removed" properly, they accumulate and cause damage to proteins, DNA, cells and even tissues. Several studies have found evidence of overly elevated oxidative stress in children with autism, which also included decreased antioxidant enzymes (e.g., superoxide dismutase, transferrin, and ceruloplasmin) and increased biological indicators of oxidative stress (including increased lipid peroxidation and impaired plasma methylation of methionine). (Chauhan A, Chauhan V, Brown WT, Cohen I. oxidative stress in autism: increased lipid peroxidation and decreased serum levels of ceruloplasmin and transferrin, antioxidant proteins. Life of TSM. 2004; 75 (21): 2539-2549; James SJ, Cutler P, Melnyk S et al.Metabolic biomarkers of increased oxidative stress and methylation impairment in children with autism. Am J Clin Nutr.)
In children with autism who had a higher degree of oxidative stress, autism symptoms were more severe (Frye re, Melnyk s, Fuchs G, et al. The effectiveness of methylcobalamin and folic acid treatment in adaptive behavior in children with autism disorder is associated with glutathione-redox status. Autism Is Not Treated. 2013;2013(609705).
Compounds such as N-acetylcysteine (NAC) and methylcobalamin (B12) can help with oxidative stress. NAC is available over the counter and, when used systematically, can act as a direct antioxidant and an effective agent in the formation of the amino acid cysteine. A relatively recent 12-week randomized placebo-controlled study showed that NAC is able to reduce irritability in children with autism, as well as the two above antipsychotic approved drugs, but without significant side effects (Hardan AI, Fung LC Libove RA et al. Randomized controlled pilot study of oral N-acetylcysteine in children with autism. Biol Psychiatry. 2012;71 (11):956-961.)
Vitamin B12 is a vital cofactor in the antioxidant system that stimulates methionine synthesis from homocysteine. In a pilot randomized controlled trial of 30 children with ASD, a subgroup of children with B12 supplementation showed improvement in both oxidative stress and clinical symptoms (bertoglio K, James JS, deprey L, Brule N, hendren RL. Pilot study of the effect of methyl B12 treatment on behavioral and biomarker indicators in children with autism. J. Altern Complement Med. 2010; 16 (5): 555-560.)
Reduced levels of systemic inflammation and neuroinflammation have also been shown to reduce autism symptoms. In a relatively recent animal study, the effect of probiotic treatment has been shown (hsiao EY, McBride SW, hsien S, et al. Microbiota modulates behavioral and physiological disorders associated with disorders of neuropsychiatric development. Cell. 2013;155(7):1451-1463).
In this experiment, it was shown that when administered a chemical (polyinosine-polycytidylic acid) that simulates (simulates) a reaction similar to a viral infection, a result was obtained showing that newborn laboratory animals had symptoms similar to those of autism in humans. These included impaired ability to socialize and repetitive behavior. It was also found that these animals had increased intestinal permeability, called "leaky gut" (one of the manifestations of autism), which is a consequence of systemic inflammation.
In the same study, treatment with certain probiotics was shown to restore the "leaky gut" to normal intestinal flora, reduce anxiety behavior, and improve communication and reduce stereotypical behavior.
Analyzing the publications, we drew attention to those that talk about "amazing drugs" for the treatment of autism.
Unfortunately, there are unscrupulous people who want to take advantage of the vulnerability of parents desperate to find anything that can help their child with autism. In the US, there is some group sending out emails that offer a" cure "for autism (often at a" low-low price " of $ 299). These emails "push" guilt (which parents shouldn't have, since it's not their fault). These "miracle" sellers suggest families try untested treatments, saying that "if you really love your child, would you like to leave things as they are?»
The same and other articles describe how people practicing selling these supposed drugs can say things like "I know it works," "I've seen it work," or "I don't want to waste time and money on testing when it can help kids right away." In addition, there are alleged to have given birth to children with autism, who can on the Internet or on forums to report the healing of their children with the use of a "miracle drug". It is very important that the decision-making parents carefully studied whether there were positive results, and whether the mechanisms of action are described, published in scientific journals.
As an example, we want to give the situation with vitamin B6 in combination with magnesium. This combination has been a popular treatment for autism for the past 20 years. Three controlled studies published between 1993 and 2002 claimed that B6 and magnesium were effective treatments for autism.
However, a recent review noted that all three studies incorrectly described the criteria for autism and failed to establish proper "selection criteria and outcome indicators." Therefore, today it is not possible to say with certainty whether this combination is highly effective. (Levy SE, Hyman SL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am. 2008;17 (4):807.)
Another example is the situation with yoga. Studies show that yoga reduces anxiety. However, there is no evidence or reason to believe that yoga affects people with autism who are not diagnosed with anxiety. However, some "practitioners" advertise yoga as a treatment for autism (Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with attention-deficit/ hyperactivity disorder (ADHD). J Atten Disord. 2004;7 (4):205-216.)
Analyzing a fairly large number of publications, we see that (as we said above), the main "root" factors of etiopathogenesis are disorders in genes caused by oxidative stress, systemic and neuro - inflammation and dysfunction of the immune-endocrine system. Therefore, possible success will lie in the areas associated with these impairments. This, fortunately, is confirmed by the fact that among the hundred-plus children who were offered the correction of these indicators, in more than 95% of cases there is a significant positive trend and many parents have hope for a significant improvement in the quality of life of these children.