What do Cochrane systematic reviews say about interventions for autism spectrum disorders?

Abstract

CONTEXT AND OBJECTIVE: Autism spectrum disorders (ASDs) include autistic disorder, Asperger's disorder and pervasive developmental disorder. The manifestations of ASDs can have an important impact on learning and social functioning that may persist during adulthood. The aim here was to summarize the evidence from Cochrane systematic reviews on interventions for ASDs. DESIGN AND SETTING: Review of systematic reviews, conducted within the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS:We included and summarized the results from Cochrane systematic reviews on interventions for ASDs. RESULTS: Seventeen reviews were included. These found weak evidence of benefits from acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups, Theory of Mind cognitive model, aripiprazole, risperidone, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI); this last only for adults. No benefits were found for sound therapies, chelating agents, hyperbaric oxygen therapy, omega-3, secretin, vitamin B6/ magnesium and SSRI for children. CONCLUSION: Acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups and the Theory of Mind cognitive model seem to have benefits for patients with autism spectrum disorders (very low to low-quality evidence). Aripiprazole, risperidone, tricyclic antidepressants and SSRI (this last only for adults) also showed some benefits, although associated with higher risk of adverse events. Experimental studies to confirm a link between probable therapies and the disease, and then high-quality long-term clinical trials, are needed. RESUMO MÉTODOS:Nós incluímos e resumimos os resultados de revisões sistemáticas Cochrane sobre intervenções para TEA. RESULTADOS: Foram incluídas 17 revisões que encontraram evidências fracas de benefícios da acupuntura, dietas isentas de glúten e caseína, intervenção comportamental intensiva precoce, musicoterapia, intervenção precoce mediada pelos pais, grupos de habilidades sociais, modelo cognitivo de Teoria da Mente, aripiprazol, risperidona, antidepressivos tricíclicos, inibidores seletivos da recaptação da serotonina (ISRS); o último apenas para adultos. Nenhum benefício foi encontrado com terapias sonoras, agentes quelantes, oxigenoterapia hiperbárica, ômega-3, secretina, vitamina B6/magnésio e ISRS para crianças. CONCLUSÃO: Acupuntura, dietas sem glúten e caseína, intervenção comportamental intensiva precoce, musicoterapia, intervenção precoce mediada pelos pais, grupos de habilidades sociais e modelo cognitivo de Teoria da Mente parecem ter benefícios para pacientes com TEA (evidência de qualidade muito baixa a baixa). Aripiprazol, risperidona, antidepressivos tricíclicos e ISRS (o último apenas para adultos) também apresentam algum benefício, embora estejam associados a maior risco de event...

Identification, Evaluation, and Management of Children With Autism Spectrum Disorder

“…Systematic reviews of the evidence base for treatment have been completed on early intensive intervention, 44,300 medical treatments, 301 behavioral interventions, 294,298 and evidencebased practice guidelines. 292,302 Wong et al 295 295,303 Focused intervention practices are designed to address a single or limited range of skills, such as increasing social communication or learning a specific task, and may be delivered over a short period of time.…”

“…Although these behaviors are not core features of ASD, they commonly interfere with functioning in school, at home, and in the community and contribute substantially to the challenges faced by families. 293,294,381,[452][453][454][455][456][457] Psychiatric conditions (such as ADHD, anxiety, OCD, mood disorders, conduct disorders, or others) are identified in 70% to 90% of children and youth with ASD. 458,459 Behavioral challenges have a significant effect on health and quality of life for children and adolescents with ASD and their families.…”

The Potential Role of Gut Peptide Hormones in Autism Spectrum Disorder

“…In 1998, a case series reported secretin in amelioration of the symptoms in three ASD children (Horvath et al, 1998). However, later double-blind placebo-controlled clinical studies revealed that there was a lack of significant impact of secretin in the treatment of ASD symptoms (Esch and Carr, 2004;Malone et al, 2005;Krishnaswami et al, 2011;Lyra et al, 2017). In spite of the failure in clinical studies, animal obervations support the roles of secretin in some social functions.…”

“…However, failures are frequently reported when directly trying the administration of those peptides to ameliorate autistic behaviors. For example, one clinical trial failed to detect significantly improvement of social phobia by using CCK-tetrapeptide (CCK-4) (Katzman et al, 2004), and many double-blind placebocontrolled studies using secretin to alleviate autism symptoms infusion have also been failed (Esch and Carr, 2004;Malone et al, 2005;Krishnaswami et al, 2011;Lyra et al, 2017) even though the existence of one early study reporting the beneficial effects of secretin (Horvath et al, 1998). Therefore, major challenges are faced by those gut hormones probably due to their rapid turnover in vivo and low efficiency for penetrating the blood brain barrier (BBB).…”

Efficacy of Gluten-Free Diet in Patients With Neurological Diseases and Psychiatric Disorders: Myth or Reality?

“…Аналогичные работы последних лет, целью которых явилась попытка систематизировать данные в отношении эффективности диетотерапии при расстрой-ствах аутистического спектра, также указывают на недоста-точную доказательную базу и необходимость проведения дополнительных, хорошо организованных клинических исследований. При этом авторы вовсе не отрицают возмож-ную эффективность безглютеновой диеты, принимая во внимание субъективное мнение родителей пациентов и положительные результаты отдельных работ [27,28].…”