The Office of Complementary and Alternative Medicine  and the Fay J. Lindner Center for Autism have designed a Questionnaire   to facilitate better understanding and treatment.

What CAM modalities are my families hearing about? – a compendium

Introduction
Controversial, nontraditional therapies will continue to gain local and national attention, and questions about their efficacy and use will be brought to the attention of their primary healthcare provider. Because parents of children with ASD look to their provider for advice about their children's health, behaviors, education, and treatment, practitioners should approach alternative therapies openly and compassionately. They can greatly assist families by:

• Ensuring they have access to standard services and are actively involved in all treatment decisions
  
• Discussing controversial therapies initially and whenever asked
  
• Becoming knowledgeable about traditional and controversial treatments or referring families for appropriate consultation
  
• Allowing adequate time for discussion and ensuring that comments are not unintentionally viewed as an endorsement of a treatment
  
• Discussing the placebo effect and the importance of controlled research studies
  
• Being willing to support a trial of therapy in select situations, and in such situations, requiring clear treatment objectives and pretesting and posttesting
  
• Remaining actively involved, even if in disagreement with the family's decision.
  

Nutritional Supplements
Although nutritional supplementation with high-dose pyridoxine and magnesium have has been recommended by proponents, all reports have been criticized for their methodologic shortcomings and failure to address the issue of safety of use. Although the only blinded and controlled study showed no adverse effects of high-dose pyridoxine and magnesium, it also demonstrated no differences in behaviors of controls or patients who received placebo versus high-dose pyridoxine and magnesium for a 10-week period.

Elimination Diets
The presence of allergies or food intolerance in children often stimulates families to explore unconventional diets. However, theories relating such proposed food intolerance to the etiology and/or pathogenesis of autism are not based on scientific principles and the benefits of such diets (which can result in nutritional deficiencies and distress secondary to the elimination of highly preferred foods) have not been demonstrated.

Immune Globulin Therapy
Throughout the past 20 years, investigators have presented evidence for immunologic abnormalities in small groups of children with ASD, including abnormalities of T cells, B cells, natural killer cells, and the complement system. However, most studies have lacked necessary scientific control and have not demonstrated an etiological link between these immunologic findings and the clinical features of autism.   Two recent reports failed to demonstrate significant changes in behaviors associated with ASD in 17 children who received regular infusions of immune globulin for a six-month period. Larger controlled investigations would be needed to assess this kind of treatment, but there is no scientific evidence to justify the use of infusions of immune globulin to treat children with ASD.

Secretin
Several well-controlled studies have failed to demonstrate any scientific evidence to justify the use of secretin infusion to treat children with ASD.

Chelation Therapy
Most recently, some concerns have been raised that ASD might be caused by early childhood exposure to environmental toxicants, particularly metals and minerals. Among the incriminated metals, mercury has been most consistently believed to be associated with the development of ASD.  Developmentally delayed children, including those with ASD, may have pica or unusual diets that increase their risk of exposure to environmental neurotoxicants.  Additionally, recent media coverage regarding mercury exposure from dietary sources (e.g., methylmercury in some fish) and from thimerosal (ethylmercury) in vaccines has heightened parental concerns regarding the possible link between ASD and mercury exposure.

To date, there are no published studies linking mercury exposure to the development of ASD or demonstrating that children with ASD have had greater exposure to mercury than have unaffected children.  Several well-conducted studies have found no relationship between thimerosal-containing vaccines and ASD. Hair analysis is not recommended for biomonitoring, because false elevations may occur if the specimen is not carefully collected. Provocative chelation tests for mercury have not been scientifically validated and are also not recommended.  Several chelating agents, including succimer, dimercaprol, d-penicillamine, and N-acetylcysteine, have been shown to accelerate mercury elimination from the body.  However, there is no evidence that chelation therapy will improve developmental function when given to treat mercury toxicosis. Moreover, chelating agents can have significant toxicity (e.g., hepatotoxicity) and precipitate allergic reaction.  Chelation therapy is therefore not recommended for the purpose of improving neurodevelopmental function in children with ASD.

Auditory Integration Training (AIT)
AIT has been proposed as a beneficial treatment for autism since the 1960s, despite the lack of a scientifically valid rationale or convincing scientific evidence indicating improvement in symptoms related to autism (including hyperacusis).   In addition, the Audiokinetron procedure may potentially be unsafe, delivering levels of sound to the eardrum that may be harmful to hearing.  A recent study that incorporated a blinded crossover experimental design using the following measures: parent and teacher behavioral questionnaires, direct observation recordings, IQ, language, and social and adaptive testing, found no clinical differences, with the exception of poorer scores on social and adaptive and expressive language scores after AIT. On the basis of the lack of clearly demonstrated efficacy, the American Academy of Pediatrics has recommended against the use of AIT.

Facilitated Communication (FC)
FC is a technique whereby a trained facilitator provides physical support to a nonverbal person's arm and hand while that person uses a typewriter, computer keyboard, or communication device.  A large number of carefully conducted studies convincingly demonstrated that the communication produced by this procedure (unknowingly) came from the facilitators and not the persons with autism.