Online Exclusives

Autism and CAM

By Joanna Cosgrove | October 1, 2009

New study polls physician attitudes regarding alternative treatment options for autistic patients.

Autism is a complex developmental disability that typically affects a person's ability to communicate and interact with others. While research into the causes of and treatments for autism have abounded, there is no known single cause for autism and it currently ranks as one of the fastest-growing developmental disabilities.

About 1.5 million Americans currently live with the effects of autism spectrum disorder. When the Centers for Disease Control and Prevention (CDC) issued their ADDM autism prevalence report in February 2007, it revealed that the diagnoses of autism had increased, affecting one in every 150 American children with almost one in every 94 of those children being male.

According to the Autism Society, the estimated lifetime cost of caring for a child with autism ranges from $3.5 million to $5 million-the U.S. is facing almost $90 billion annually in costs for autism (this figure includes research, insurance costs and non-covered expenses, Medicaid waivers for autism, educational spending, housing, transportation, employment, in addition to related therapeutic services and caregiver costs).

In addition to conventional therapies, many families explore the realm of alternative therapies to treat autism spectrum disorders because they are perceived to be more natural and less invasive than their conventional counterparts.

While some of the wider known alternative treatments include gluten-free and casein-free diets, vitamin B6 and magnesium supplementation, omega 3 fatty acid supplementation, dimethylglycine and trimethylglyceine supplementation, and other supplementation like CoQ1O, zinc, and vitamins A, C and E, there is a strong desire for more evidence-based treatment options.

Inspired by the statistic indicating that more than 50% of autistic children are currently utilizing complementary alternative medicine (CAM) therapies, researchers at the University of Minnesota conducted a national survey of 539 physiciansregarding their attitudes and practices when it comes to caring for children with autism using CAM treatments. The results were published in the Journal of Autism and Developmental Disorders.

Physicians in the survey said they were more likely to ask patients with autism about CAM use compared with children who have other chronic conditions. "In light of the high prevalence of CAM used to treat children with autism, it is important that physicians ask about CAM use in the context of routine primary care," said Allison Golnik, MD, MPH, the study's author and an assistant professor in the University of Minnesota Medical School Department of Pediatrics.

While past surveys indicate that physicians desire more CAM education, this survey indicates they desire CAM education specifically for children with autism. "Physicians need access to balanced education that will inform their own recommendations for specific CAM therapies and adequate information to care for families who elect their use," Dr. Golnik said.

The subset of physicians responding to the survey reported integrating some CAM modalities that may be supported by emerging evidence but need further research. Physician respondents also reported actively discouraging some forms of CAM that have been refuted by evidence or carry significant risks. Physicians encouraged the use of multivitamins (49%), essential fatty acids (25%), melatonin (25%) and probiotics (19%). They discouraged withholding immunizations (76%), chelation (61%), anti-infectives (57%), delaying immunizations (55%) and secretin (43%).

Although there are many CAM treatments for autism, most have not yet been tested in clinical trials and need further research.

Physicians encouraging CAM were more likely to desire CAM training, inquire about CAM use, be female, younger and report greater autism visits, autism education and CAM knowledge.

For children with autism, the intersection of standard medical therapies, CAM and the complex healthcare system requires a significant level of engagement by the primary care physician. "With the high prevalence of CAM use by children with autism, asking all patients about CAM, establishing an infrastructure to monitor CAM use and developing CAM education are important goals," said Dr. Golnik. "It is important that families be involved in this process."

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