AHRQ Reports: Massage, Other Sensory Interventions Improve Autism Behaviors; Evidence Lacking on Nutritional Supplements or Special Diets

Sensory-focused interventions – such as massage, swinging and trampoline exercises and exposure to different textures – reduced sensory and motor impairments in children with autism spectrum disorder (ASD), according to an AHRQ-funded article in the May 26 issue of Pediatrics. A companion article, meanwhile, concluded that little evidence exists to support the use of nutritional supplements or gluten-free/casein-free diets to improve autistic behaviors in children. The articles highlighted findings in a pair of new AHRQ research reviews, Interventions Targeting Sensory Challenges in Children With Autism Spectrum Disorder and Medical Therapies for Children With Autism Spectrum Disorder. The reports are research updates developed to provide clinicians and patients with information to make the best possible decisions about managing ASD behaviors. Both analyses noted that more research is needed over longer periods to establish additional evidence on the benefits and harms of ASD interventions. Access an AHRQ press release on the findings as well as an AHRQ Views blog post by Chief Medical Officer David Meyers, M.D.

Pediatrics

May 2017

Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review

Nila Sathe, Jeffrey C. Andrews, Melissa L. McPheeters, Zachary E. Warren

Abstract

CONTEXT: Children with autism spectrum disorder (ASD) frequently use special diets or receive nutritional supplements to treat ASD symptoms.

OBJECTIVES: Our objective was to evaluate the effectiveness and safety of dietary interventions or nutritional supplements in ASD.

DATA SOURCES: Databases, including Medline and PsycINFO.

STUDY SELECTION: Two investigators independently screened studies against predetermined criteria.

DATA EXTRACTION: One investigator extracted data with review by a second investigator. Investigators independently assessed the risk of bias and strength of evidence (SOE) (ie, confidence in the estimate of effects).

RESULTS: Nineteen randomized controlled trials (RCTs), 4 with a low risk of bias, evaluated supplements or variations of the gluten/casein-free diet and other dietary approaches. Populations, interventions, and outcomes varied. Ω-3 supplementation did not affect challenging behaviors and was associated with minimal harms (low SOE). Two RCTs of different digestive enzymes reported mixed effects on symptom severity (insufficient SOE). Studies of other supplements (methyl B12, levocarnitine) reported some improvements in symptom severity (insufficient SOE). Studies evaluating gluten/casein-free diets reported some parent-rated improvements in communication and challenging behaviors; however, data were inadequate to make conclusions about the body of evidence (insufficient SOE). Studies of gluten- or casein-containing challenge foods reported no effects on behavior or gastrointestinal symptoms with challenge foods (insufficient SOE); 1 RCT reported no effects of camel’s milk on ASD severity (insufficient SOE). Harms were disparate.

LIMITATIONS: Studies were small and short-term, and there were few fully categorized populations or concomitant interventions.

CONCLUSIONS: There is little evidence to support the use of nutritional supplements or dietary therapies for children with ASD.