As parents and clinicians seek to find symptom relief for children with autism spectrum disorder (ASD), complementary therapies are increasingly being used to enhance outcomes. Today, it is estimated that up to 95% of caregivers have used some form of complementary treatments and prevalence of these therapies is rising.
Despite widespread use, the lack of empirical support for certain complementary therapies. such as hyperbaric therapy, has historically led to skepticism of all complementary therapies within the medical community. Now, this is starting to change. As the American Medical Association’s Journal of Ethics stated in 2015, “The tide is beginning to shift as evidence accumulates that some [complementary] therapies are addressing abnormal physiology of autism.” Indeed, a growing body of evidence suggests that the advantages of complementary therapies are numerous and can have a significant impact on both ASD symptoms and overall quality of life. In particular, nutritional supplements are offering innovative and well-tolerated ways of addressing symptoms to enhance treatment outcomes.
Shortcomings Of Conventional Therapies
The popularity of complementary therapies in the treatment of ASD can be attributed to two primary factors: they typically have fewer side effects that psychopharmacological therapies and they may address symptoms that have not been successfully resolved using conventional treatments.
45.7% of patients with autism use psychotropic medications, primarily antipsychotics or selective serotonin reuptake inhibitors (SSRIs). These medications can have significant clinical benefits for some symptoms, but may also present tolerability and safety challenges. Though effective at reducing ASD symptoms like irritability, antipsychotics can produce side effects that interfere with functionality and quality of life, such as weight gain, fatigue, and tremors. SSRIs may also have bothersome side effect profiles, Understandably, tolerability issues and potential safety concerns worry some parents, leading them to seek out alternatives.
Of course, psychotropic medication is not the mainstay of ASD treatment for most patients. Rather, the treatment of autism typically involves a range of therapies designed to address the multiple, complex needs of people with ASD. One study describes an optimal lifetime treatment strategy for ASD as “Early Intensive Behavioral Intervention (EIBI), special education, psychopharmacology, medical interventions, physical therapy, occupational therapy, speech therapy, vocational therapy, social skills training, and instruction in adaptive living skills.” And, indeed, many of these therapies are remarkably effective in addressing specific symptoms as well as improving overall function. However, even with thoughtfully layered conventional treatments, certain symptoms may remain unresolved. As such, many parents look beyond conventional therapies in order to find safe and effective symptom relief for their children.
The Potential of Nutritional Supplements as Complementary Therapies
Today there is a broad range of complementary therapies that address the symptoms of autism with varying degrees of efficacy. Yoga, for example, has been found to enhance sensory awareness and integration while research suggests that equine-assisted therapy reduces maladaptive behaviors. But while there are many complementary therapies that improve ASD symptoms, nutritional supplements are among the most commonly used due to their efficacy, tolerability, and safety. Significantly, a number of these supplements have been shown to successfully target some of the same symptoms addressed by psychopharmacological interventions.
Omega-3 Fatty Acids
Omega-3 fatty acid supplementation has been found to improve social regulation, irritability, and self-injurious behaviors in ASD patients. In one study, omega-3 fatty acid supplementation with additional micronutrient supplementation was more effective than antipsychotic pharmacological therapy for addressing aberrant and self-injurious behaviors while reducing overall scores on the Childhood Autism Rating Scale and the Childhood Psychiatric Rating Scale. The study also found that Omega-3 fatty acid supplementation helped with social initiation. Significantly, supplementation was found to produce significantly fewer side effects than antipsychotic treatment.
A different study indicated that Omega-3 fatty acid supplementation increased the social responsiveness of adolescents with ASD without causing any serious side effects. Much like with omega-3 fatty acids, vitamin D supplementation is popular and effective.
Vitamin D supplementation may result in broad core symptom improvement of ASD symptoms, with one study proposing that the broad beneficial effects of supplementation can improve symptoms for 75% of patients. Specifically, vitamin D supplementation is particularly effective in improving social cognition, social awareness, and social motivation while reducing hyperactivity and social withdrawal. Vitamin D supplementation causes few side effects, and 57% of children with ASD may have a vitamin D deficiency, leading some researchers to suspect that ASD patients have impaired vitamin D metabolism.
Roughly 7% of children with ASD take melatonin supplements for help with insomnia, a condition commonly experienced by people with autism. According to one study, 68.7% of children with ASD responded to delayed release melatonin supplementation. Melatonin is effective at helping with initiating sleep, maintaining sleep, improving the quality of sleep, and maintaining a consistent waking time. It is also considered safe for long-term use, and may also reduce hyperactivity.
While there are few reported side effects, melatonin should be used with caution in patients with seizure disorders or brain injuries.
Butyric acid is a relative newcomer to the supplement scene with regard to treating ASD. While naturally produced by bacteria in the gut, patients with ASD typically have disrupted gut flora, meaning that their ability to self-regulate their butyric acid concentrations is compromised. As a result, people with ASD may require supplementation to experience the beneficial effects of butyric acid and restore a healthy gut flora which will produce fewer gastrointestinal disturbances associated with ASD.
Many of the effects of butyric acid are a result of its rare ability to inhibit histone deacetylase (HDAC), an enzyme that is critical to many biological processes. HDAC inhibitors like butyric acid have been used successfully in several disease contexts to reverse neurodegeneration and improve cognition. While it remains to be seen whether HDAC inhibitors are beneficial in humans, in mouse models of ASD other HDAC inhibitors have successfully and drastically reduced the symptoms of social withdrawal and improved social cognition.
Bioavailability is the Future of Nutritional Supplementation
The growing recognition of advantages of complementary therapies in general—the efficacy of nutritional supplements specifically—in the treatment of ASD symptoms is opening up innovative ways for people with autism to find relief from a broad spectrum of symptoms. Already we are seeing parents, clinicians, and patients themselves increasingly incorporate these therapies within treatment plans to complement conventional treatments.
However, optimizing the benefits of nutritional supplements will require the production of highly bioavailable supplement forms. Unfortunately, differences in the GI tracts and drug metabolisms between people with ASD and the general population can make bioavailability a complex issue. More specifically, people with autism are prone to absorbing nutrients with diminished or excessive efficiency, preventing predictable therapeutic effect. In order to correct for this, some researchers are now developing advanced delivery systems that enhance bioavailability while helping patients achieve better and more stable outcomes. As such delivery systems come into mainstream use, the ability of patients to benefit from nutrition-based complementary therapies will greatly expand, opening up new possibilities for symptom relief.
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