October 29, 2006

Med Page: Alternative Treatments Endemic Among Autistic Kids

AACAP: Alternative Treatments Endemic Among Autistic Kids
By Crystal Phend, Staff Writer, MedPage Today
October 27, 2006

SAN DIEGO, Calif., Oct. 27 -- Among autistic children and adolescents, special diets, vitamin supplements and a variety of complimentary and alternative medicine strategies are nearly universal approaches, reported researchers here.

Almost every autistic patient (93.8%) surveyed received some form of nutritional or dietary intervention, said W. Ben Gibbard, M.D., M.C.S., of the University of Calgary in Alberta, in a presentation at the American Academy of Child and Adolescent Psychiatry meeting.

Most had tried many different treatments-the average number used was 9.6-across a wide range of products and strategies encompassing 173 separate types.

The most helpful appeared to be an additive- and preservative-free diet (more than 80% of those who tried it called it helpful), a chocolate-free diet (70%), and herbal remedies (71.4%).

Among the most commonly used treatments were multivitamins and gluten- or casein-free diets.

"Clinicians should inquire about use of complimentary and alternative therapies in their patients," Dr. Gibbard said in an oral session. He suggested referencing specific groups of treatments ("Do you use any special supplements or diet?") while questioning families in a nonjudgmental and sensitive manner.

The investigators surveyed 176 families of children with an autism spectrum disorder who were living in southern Alberta. The 22-page survey was mailed to the families and the parents checked off therapies they had ever tried, past or present, and rated how helpful each had been.

The mean age of the autistic children was 8.9 years and 83.5% were male. Classic autism was the most common diagnosis for the patients (52.8%) while 6.3% also had epilepsy and 2.8% had a genetic condition.

Diet or nutritional supplementation was tried by 45.5% of the families with an average of 5.2 different types of these used by each family (range 1 to 28).

The researchers reported:

* 17.1% tried some kind of omega fatty acid, with 64.3% rating it helpful,
* 10.2% tried an omega-6 fatty acid, with 61.1% rating it helpful,
* 10.2% used an omega-9 fatty acid, with 66.7% rating it helpful,
* 12.5% tried dimethylglycine, with 54.5% rating it helpful, and
* 6.3% tried Eflax oil, with 36.4% rating it helpful.

Dietary therapies were tried by 37.6% of the families. The findings were (percentage tried, percentage rated helpful):

* Gluten-free diet (23.3%, 61.0%),
* Casein-free diet (21.6%, 60.5%), and
* Lactose-free diet (17.6%, 45.2%).

Vitamins and minerals were tried by 63.1% of respondents, making it the most popular category. Nearly 40% had tried a vitamin or mineral supplement besides a multivitamin. The mean number tried was 3.2 (range 1 to 20). The researchers reported:

* 49.4% had tried a multivitamin with 35.6% reporting it helpful,
* 16.5% used an oral calcium supplement with 51.7% reporting it helpful,
* 14.8% tried oral vitamin C with 53.8% reporting it helpful,
* 16.5% had tried any magnesium supplement, and
* 14.2% used any vitamin B6 supplement.

Natural therapies had been used for 40.3% of the children (mean 2.0 different therapies). The most common were:

* Herbal remedies (11.9%, 71.4% rated as helpful),
* Evening primrose (9.1%, 31.3% rated as helpful), and
* Naturopathy (7.4%, 69.2% rated as helpful).

Dr. Gibbard said the findings may have affected by selection biased as with any postal survey. However, he said the study highlights the need for safety and efficacy data on these treatments that patients are clearly using.

While some may dismiss the helpful ratings as placebo effect, these rating may be better treated as open-label or case reports that can point research in the right direction, said session discussant Margaret D. Weiss, M.D., Ph.D., of the University of British Columbia in Vancouver.

"If we've got placebo effects like that in our stimulant trials, stimulants would be off the market," she said.

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