Massive Review Of 19 Autism Therapies Finds No Strong Evidence And Lack Of Safety Data

A large-scale review of studies into 19 different “treatments” for autism has concluded that, for every single one, there is no strong evidence to support their use. Worryingly, the research team also found that many of these studies lack any assessment of patient safety. They’ve compiled their findings into an online database that’s easy to navigate, so autistic people, parents, caregivers, and medical professionals can take a look for themselves.

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The team of scientists from Paris Nanterre University, Paris Cité University, and the University of Southampton trawled through 248 meta-analyses comprising data from over 10,000 individuals. A whole range of complementary, alternative, and integrative medicines (CAIMs) were represented, from dietary supplements to music therapy, behavioral interventions, and even non-invasive brain stimulation. 

“Many parents of autistic children, as well as autistic adults, turn to complementary and alternative medicines hoping they may help without unwanted side effects,” said co-senior author Professor Richard Delorme in a statement. “However, it is necessary to carefully consider evidence from rigorous randomised trials before concluding that these treatments should be tried.”

No two autistic people are identical; people with a diagnosis can experience a range of different challenges and may benefit from lots of different support strategies. However, the very idea of a “treatment” for autism is considered by many within the community to be offensive and outdated. As the UK’s National Autistic Society puts it, “autism is not an illness or a disease and it cannot be ‘treated’ or ‘cured’.”

That’s not to say, however, that some of the characteristics that may be present in autistic people don’t negatively impact quality of life. For instance, repetitive behaviors are common in autistic people, but in some cases, those behaviors may cause self-injury. As another example, sensory processing difficulties may limit access to public spaces if the environment is too overwhelming. 

According to the study authors, up to 90 percent of autistic people report having used a CAIM at least once in their lives – but as this study reveals, the evidence base for many of these interventions is patchy to say the least. 

The team undertook what is called an umbrella review of the available data. “Rather than looking at individual trials, we reviewed all the available meta-analyses, which are a compilation of many trials. This allowed us to evaluate the full body of evidence across different treatments,” explained first author Dr Corentin Gosling. 

The evidence for any positive effect from each of the 19 treatments was judged to be weak and/or poor quality. Fewer than half of the interventions had any safety data to support them, meaning we can’t be sure how well-tolerated they will be or whether they could cause adverse effects.

The team grouped the interventions into two categories: psychosocial and complementary. Psychosocial therapies include cognitive behavioral therapy (CBT), social skills group therapy, and behavioral interventions based on the Applied Behavior Analysis (ABA) model. 

This is a controversial framework that can be applied in ways that some have criticized for focusing too heavily on suppressing “stimming” behaviors. These can include things like hand-flapping, repeating sounds, hair twirling, and chewing objects, and may be a way for autistic people to feel calm, express strong emotions, or experience comforting sensory input. 

“It can be actively harmful when we teach people from a very early age that the way they act, the way they move is fundamentally wrong,” autistic self-advocate Ari Ne’eman told the Child Mind Institute.

The second category of interventions, complementary therapies, included a whole range of things like special diets, supplements, and even transcranial magnetic or direct current stimulation. You can explore each intervention, the claims that have been made about them, and the quality of the evidence via the study team’s interactive online platform.

Autism today

More people than ever before are receiving an autism diagnosis; but experts are divided on whether there are truly more autistic people being born today, whether this reflects a correction of historic underdiagnosis of autism, or whether we’re creeping into overdiagnosis territory.

Fearmongering rhetoric about an autism “epidemic” has been loudly promoted at the highest levels of government in the US, with Health and Human Services Secretary Robert F. Kennedy Jr declaring earlier this year that we will definitively know the causes of autism by September. His department also announced funding for a new study to explore the completely baseless idea of a link between vaccines and autism, a concept that has been thoroughly debunked over and over again.

Kennedy’s self-imposed target is fast-approaching; unfortunately for him and his supporters, centuries of experience have demonstrated that attaching a hard deadline to a properly conducted scientific investigation is a bit of a fool’s game.

Rather than getting wrapped up in these questions, autistic people and their advocates have argued that the more pressing priority should be acceptance, awareness, and the provision of support, as well as “upholding scientific integrity.” This study highlights the paucity of good quality scientific evidence for CAIMs targeted at autistic people.

“It’s essential to consider all the available evidence and how good that evidence is. Drawing conclusions from one low-quality study can be misleading,” said co-senior author Professor Samuele Cortese.  

The study is published in Nature Human Behaviour.