Trying to find the appropriate treatment to help our patients with autism spectrum disorder (ASD) is a quest we find ourselves on in partnership with parents. Our journal welcomes studies that investigate a variety of therapeutic approaches with the hope that we can do as much as possible to help children with ASD and their families thrive. It is for that reason that we are publishing two systematic reviews this week that look at two areas of intervention for children with ASD—the role of nutrition and diet and the role of interventions that help children with ASD manage their sensory challenges.
The first of these systematic reviews by Sathe et al. (10.1542/peds.2017-0346) looks at the safety and effectiveness of a variety of dietary interventions as well as use of nutritional supplements through randomized controlled trials that met the investigators search criteria. The review article looks at studies on the gluten-free diet, omega-3 fatty acids, digestive enzymes, and other supplements. Unfortunately the sample sizes in these studies are small, the studies are short-term and the evidence for any of these interventions while showing no real harm to their use (except perhaps their cost) is underwhelming but certainly calls for additional rigorous studies to better understand the potential benefits of these interventions
The second review by Weitlauf et al. (10.1542/peds.2017-0347) from the same team of investigators as the nutrition review takes a systematic look at trials of interventions to help improve sensory challenges faced by children with ASD. 24 studies are identified including 20 randomized controlled trials with some positive effects noted of sensory-integration based approaches to improve sensory and motor skills, and some environmental enrichment studies to improve nonverbal cognitive skills. Some approaches such as auditory integration did not work as well to improve language and there was some evidence of the benefits of massage therapy with music therapy being more inconclusive. Again these studies are small and short-term suggesting that there may be modest benefit to using some of these modalities, but additional long-term studies are needed.
So what can we learn from these two reviews that will help our patients and move future intervention trials forward. Fortunately Dr. Geraldine Dawson from the Department of Psychiatry and Behavioral Sciences at Duke helps us interpret the review findings in an important accompanying commentary (10.1542/peds.2017-0730) that together with the two reviews makes for must reading if you are following children with ASD in your practice. Link to these three articles and see what we mean.
