Evidence lacking for most autism treatments

NEW YORK (Reuters Health) - When it comes to treating autism, there are still more questions than answers.

That's the message from a series of reviews published today in the journal Pediatrics, in which researchers analyzed past studies on the effectiveness of medication or behavioral and developmental therapies in kids with autism spectrum disorders.

Parents, doctors, and even entire school systems are "routinely put in the position of having to make decisions about what the most appropriate services will be" for kids with autism, said Zachary Warren, one of the researchers, in an interview with Reuters Health.

"What we would really hope for is an evidence base where you could make those decisions based on what we know about how particular children respond to particular interventions," said Warren, who runs an autism clinic at Vanderbilt University in Nashville, Tenn.

But for most treatment options, there is not convincing evidence that they actually help kids get better, Warren said.

Close to 1 percent of children in the United States have an autism spectrum disorder, which includes both autism and Asperger's syndrome. People with these conditions have difficulty interacting with and understanding the emotions of others, and they often engage in repetitive behaviors.

Most children with autism are treated with behavioral therapy starting at a young age, and many will try multiple kinds of therapy or medications as they get older.

For their reviews, Warren and his colleagues collected data from all studies done in the last decade on the effectiveness of a range of medications and therapies in reducing symptoms of autism.

In their most convincing finding, the authors determined that secretin - a hormone otherwise used to treat stomach ulcers -- is not an effective treatment for kids with autism. Excitement about the drug started in the late 1990's, when very limited evidence suggested it might promote social skills in kids with autism - but after more thorough research, it's clear that's not the case, Warren said.

That conclusion was based on 7 past studies that found the drug did not improve language or reasoning skills or any other autism symptoms.

The researchers found there was not enough evidence to determine whether anti-depressants such as Prozac and Celexa or the stimulant drug Ritalin might help kids with autism.

There is some evidence showing that both Risperdal and Abilify might help cut down on kids' repetitive behaviors. But because both drugs may cause side effects such as uncontrolled muscle tremors and drowsiness, the authors said they should only be used in kids who are very impaired because of their autism.

Dr. Bryan King, the director of Seattle Children's Autism Center, said that as many as 70 percent of kids with autism are treated with some kind of medication.

"The real take-home message for me.... is the striking disparity between the treatments that we use and the number of children that are receiving them, and the strength of the evidence that we have in support of these practices," said King, who was not involved in the current study.

It is "hard to reconcile" the popularity of these drugs with the lack of information about their effectiveness, he told Reuters Health, but not having enough evidence isn't the same thing as saying the drugs don't work.

Warren and his colleagues concluded that intensive behavioral therapy or behavioral treatment started in very young kids has helped some of them improve reasoning and language skills, as well as their ability to interact with others. It's hard to know which kids will benefit from those therapies, however.

"Some (behavioral) interventions can show some pretty dramatic changes," Warren said. "At the same time, understanding which specific treatments are going to be best for specific (kids) - we're not quite there."

King said it was time to "redouble our efforts" to gain more conclusive evidence on possible treatment options.

The research "just really highlights that we urgently need new treatments and better treatments, in addition to refining our understanding of how available treatments work for specific individuals and specific families," Warren concluded.

SOURCE: http://bit.ly/5N5tuZ Pediatrics, online April 4, 2011.