Treating Autism Spectrum Disorders & Asperger Syndrome

The Babble Staff

Nobody knows for certain what causes autism; likewise, nobody knows how to cure it. There are a number of proposed treatments out there, though most are considered controversial in the medical community. These include the Feingold Diet, Secretin, a gluten and casein free diet, and administering Vitamin B6 with magnesium. While some doctors and parents of children with autism swear such therapies have helped in some cases, nothing has been conclusively proven effective in scientific studies. Asperger's Syndrome is an autism spectrum disorder. Those who have it tend to be higher functioning socially and verbally than people with more severe forms of autism. As with autism, there are many treatments for Asperger's — though no cure. Behavioral therapies and specialized school environments can be successful in lessening symptoms and people with Asperger's often learn to manage their symptoms as they get older. Not all those with Asperger's need to, or should, take drugs, but some of the same drugs used to treat ADHD and similar disorders may be effective on certain people with Asperger's. Some experts also feel certain homeopathic or herbal remedies may help with symptoms.

After the endoscopy, it was as if Parker had awakened from a spell. Within days a completely non-verbal child was smiling, recognizing Mommy and Daddy, and reciting flashcards. It was a miracle!

Victoria and Gary investigated every detail of what had happened to Parker during the test. They discovered that he had been given a small amount of a medicine called secretin. It was Parker's parents who proposed that this might be a treatment for autism. Parker received another dose of secretin followed by further intellectual and social growth.

For a seemingly interminable year, doctors refused to give Parker any more of the medicine. He didn't lose his gains, but further growth stalled. Doctors refused, since secretin hadn't been approved by the FDA for anything more than use in diagnostic tests.

These regulations are designed to protect consumers from unsafe or unproven medications, and they are often very valuable in that function — but they can also sometimes block good medicine. Robert Sinaiko, M.D. is a prominent San Francisco physician who researches the metabolic basis of autism. His interests include an important detoxifying enzyme — phenolsulfyltransferase — that is deficient in autistic kids. He recommends the controversial Feingold diet since it includes fewer phenolic compounds that need to be detoxified.

For this and for similar off-label prescribing for autism, Sinaiko recently had his medical license stripped.

By 1996, about 200 kids had been treated with secretin. About half of them reportedly had significant, objective improvement. Different researchers propose different mechanisms for why it might work. Some point to the role of secretin in the intestines to promote proper digestion. Others suggest that the secretin works directly on the brain (there are secretin receptors in the hypothalamus of the brain). I suspect that the latter mechanism is more important.

Many other questions also remain to be answered. Large, long-term, controlled studies on secretin are much needed to confirm its efficacy, determine what subset of children with autism may respond, and decide what doses are safe and effective. Recent studies involving a small number of children have had variable results.

When your child has been evaluated and diagnosed with an autism spectrum disorder, you may feel inadequate to help your child develop to the fullest extent of his or her ability. As you begin to look at treatment options and at the types of aid available for a child with a disability, you will find out that there is help for you.

There is no single best treatment package for all children with ASD. One point that most professionals agree on is that early intervention is important; another is that most individuals with ASD respond well to highly structured, specialized programs.

Among the many methods available for treatment and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment. Mental Health: A Report of the Surgeon General states, "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior." [...] The goal of behavioral management is to reinforce desirable behaviors and reduce undesirable ones.

An effective treatment program will build on the child's interests, offer a predictable schedule, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior. Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home.

Dietary interventions are based on the idea that 1) food allergies cause symptoms of autism, and 2) an insufficiency of a specific vitamin or mineral may cause some autistic symptoms. If parents decide to try for a given period of time a special diet, they should be sure that the child's nutritional status is measured carefully. A diet that some parents have found was helpful to their autistic child is a gluten-free, casein-free diet. Gluten is a casein-like substance that is found in the seeds of various cereal plants-wheat, oat, rye, and barley. Casein is the principal protein in milk. Since gluten and milk are found in many of the foods we eat, following a gluten-free, casein-free diet is difficult.

A supplement that some parents feel is beneficial for an autistic child is Vitamin B6, taken with magnesium (which makes the vitamin effective). The result of research studies is mixed; some children respond positively, some negatively, some not at all or very little.

In the search for treatment for autism, there has been discussion in the last few years about the use of secretin, a substance approved by the Food and Drug Administration (FDA) for a single dose normally given to aid in diagnosis of a gastrointestinal problem. Anecdotal reports have shown improvement in autism symptoms, including sleep patterns, eye contact, language skills, and alertness. Several clinical trials conducted in the last few years have found no significant improvements in symptoms between patients who received secretin and those who received a placebo.

The latest in a series of studies on secretin has failed to show that giving the digestive hormone to children with autism alleviates symptoms of the disorder, according to a study funded by the National Institute of Child Health and Human Development.

The study, which appeared in the November 2001 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, found that patients with autism who received a form of the hormone derived from swine showed no statistically significant improvements in the core symptoms of the disorder when compared to when the same patients received a placebo. (The core symptoms of autism involve social and communications skills.) In certain secondary measures of autism, patients receiving secretin also showed no improvement when compared to when they received a placebo.

Interest in secretin as a possible treatment for autism, a neurodevelopmental disorder characterized by social and communication problems and repetitive behaviors and interests, arose from reports of children with autism whose symptoms improved after receiving a single dose of the hormone.

"Our study reiterates the need to perform careful studies of any new treatment — even one that appears promising — before routinely prescribing it to patients," said the study's first author, Thomas Owley, M.D., Assistant Professor of Child and Adolescent Psychiatry at the University of Chicago.

Children were randomized to receive either an intravenous dose of secretin, followed by a dose of harmless saline (salt) solution four weeks later, or an intravenous dose of saline, followed by a dose of secretin four weeks later.

None of the five controlled clinical trials published on secretin, either in the porcine form or in the synthetic form, given at varying doses, have shown any improvement over the placebo in symptoms of autism.

Open label studies — those in which researchers know what they are giving to the patients — comparing secretin with the saline solution, have suggested that some improvements might result when secretin is used in patients with autism. The current study was "double-blinded," meaning that neither the patients nor the researchers who treated and evaluated the patients knew when the patients received the secretin or the placebo.

A great number of medications, special diets, megavitamin regimens, and other therapies have been promoted as miracle cures for autism. To date, none has fulfilled its promise.

Often no real harm has been done, except that the considerable time and money devoted to the new form of therapy has diverted a child from less exciting treatments that might, in the long run, be more helpful

This is not to say that all new therapies are bad, or that autism will never be cured — only that parents must thoroughly examine a new treatment's claims before committing their child to it.

This is well illustrated by the secretin story.

In 1998 doctors in Maryland reported that three children who had been given secretin injections showed remarkable improvement in their intestinal functioning and, most amazingly, in their communication and social skills. Soon after, secretin success stories began to circulate on the Internet, and demand for the costly treatments skyrocketed.

Sadly, what happened next is typical of so-called miracle cures: Two studies found that secretin had no significant effect on the symptoms of autism. These studies differed from earlier reports in that they involved a greater number of subjects (20 in one study, 60 in another), and the children were randomly assigned to receive either secretin or a nonactive injection (a placebo).

There is no cure [for Asperger Syndrome]. However, a combination of support, regular routine, training and medication may assist the parents and child.

Asperger syndrome is one of the 'autism spectrum disorders'. People with Asperger syndrome can show a wide range of behaviours and social skills. Some people's skills are clearly 'normal' most of the time, some may seem 'odd' at times, while some are quite different from other people.

Asperger syndrome is not a disease or illness. A person does not catch it or recover from it, however, the effects often lessen as people get older and learn coping skills. It is present from birth but it usually takes a long time for people to be convinced that the unusual behaviour and difficulties of a child fit the pattern of Asperger syndrome.

There is no cure or specific treatment for Asperger syndrome. However, social skills training can be helpful. Obtaining a diagnosis of the condition may mean that children and their families can access special services, such as teacher support time. Diagnosis can also allow the family and others to understand the behaviours and feelings of the child. This can assist in developing more realistic expectations of the child, taking a planned approach to routines and incremental changes, and managing stress.