April 04, 2011, USA TODAY
A new set of analyses offers sobering news in the long search for effective treatments for autism.
Researchers concluded that medications are of little help to most autistic children. Although intensive behavioral therapies can be effective, they don't work for everyone, and doctors don't have a way to predict which children will benefit, according to three reviews in today's Pediatrics.
About one in 110 children have autism, according to the Centers for Disease Control and Prevention.
To help make sense of available research, the federal Agency for Healthcare Research and Quality commissioned scientists to examine three types of treatment: behavioral therapy, antipsychotic and antidepressant drugs, and an enzyme called secretin. They found
*The strongest evidence involves secretin and clearly shows that the enzyme doesn't work in autism, says Zachary Warren of Vanderbilt University School of Medicine in Nashville, lead author of one of the studies.
*Doctors have "strikingly little" evidence about the effectiveness of other medications, the analysis shows. Newer antipsychotic medications -- once called "major tranquilizers" -- can help children with some of the most disruptive symptoms, such as hitting, but cause too many serious side effects, such as weight gain, to be used on most kids, says co-author Jeremy Veenstra-VanderWeele, also of Vanderbilt.
In the most extreme cases, antipsychotics can calm children enough to allow them to attend school. They don't affect the basic problems of autism, which involve difficulty communicating and relating to others.
*Behavioral therapy, which can last more than 30 hours a week, helps some children to talk more, improve their behavior and boost their scores on intelligence tests, the analyses show.
That's an important finding, given that doctors once thought autistic children had no hope of improvement, says Leonard Rappaport of Children's Hospital Boston, who wasn't involved in the new articles.
Behavioral therapy isn't available everywhere, however, and insurance doesn't always cover it, says Geraldine Dawson, chief science officer for Autism Speaks, an advocacy group. About half of states require insurers to pay for autism therapy, she says.
Doctors are trying to do a better job of diagnosing babies and toddlers who are at high risk of autism, such as younger siblings of autistic children. About one in five of these younger siblings will also have autism, Rappaport says.
In the future, doctors may be able to develop more effective therapies based on discoveries about the genetics of autism, which may allow them to prescribe therapy targeted to a child's specific problem, Rappaport says.