So-called alternative medicine (SCAM) for autism spectrum disorder: A systematic review

Many families explore so-called alternative medicine (SCAM) to manage autism spectrum disorder (ASD) and many SCAM practitioners claim to be able to treat ASD effectively. This review evaluated the efficacy and safety of SCAM therapies, including acupuncture, cupping, massage, dietary changes, herbal medicine, apitherapy, and Ayurveda medicine.

Systematic searches were carried out in PubMed, Scopus, and Web of Science to identify studies of SCAM interventions for ASD. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including various study types. Data extraction focused on design, population, intervention, outcomes, and bias risk.

The inclusion criteria were met by 45 studies, which encompassed six SCAM modalities. Acupuncture and massage consistently exhibited enhancements in sensory processing, communication, and social interaction levels. Dietary interventions, particularly probiotic supplementation and gluten-/casein-free regimens, had beneficial effects on behavioral and GI domains. While Ayurveda therapies such as Medhya Rasayanas (Bacopa monnieri), Swarnaprashana, and Panchakarma techniques improved cognition and reduced social deficits in small clinical series, herbal and apitherapy treatments primarily demonstrated neuroprotective and anti-inflammatory effects in preclinical studies. Control groups received no treatment, sham interventions, or standard care. The methodological limitations and heterogeneity of the study design limited the ability to draw definitive conclusions.

The authors conclused that the evidence indicates that SCAM approaches, including acupuncture, massage, and Ayurveda therapies, may be effective adjuncts in the management of ASD. The current body of research is constrained by the moderate-to-high risk of bias, variable protocols, and small sample sizes. Standardized, large-scale randomized trials are required to establish efficacy and safety. Clinicians should balance patient safety with innovation by adopting an integrative, evidence-informed approach.

This is almost complete nonsense:

• The authors claim to have followed the PRISMA guidelines. As one of the co-authors of these guidelines, I can affirm that this is untrue.
• The authors included 10 animal studies that provided mechanistic support for clinical findings, 18 RCTs, 12 pre-post controlled studies, and 5 case series or pilot studies comprised the designs. Several of these study types are unable to “evaluate the efficacy and safety of SCAM therapies” which is the stated aim of the review.
• Most of the included studies fail to control for placebo effects. Therefore, they cannot provide evidence regarding the “efficacy” of the treatments in question.

In view of these – and many other – flaws of the review, I fear that I might have to re-write the conclusions:

Many SCAMs have been studied as treatments for ASD. The results of these investigations fail to show that any of them is effective in alleviating the symptoms of ASD. Unless sound evidence emerges, SCAM cannot be recommended for ASD.