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- Evid Based Complement Alternat Med
- v.2017; 2017
Herbal Medicine Treatment for Children with Autism Spectrum Disorder: A Systematic Review
1 Department of Pediatrics of Korean Medicine, Graduate School of Dongguk University, Pildong-ro 1-Gil 30, Jung-gu, Seoul 04620, Republic of Korea
Sun Haeng Lee
2 Department of Pediatrics of Korean Medicine, Kyung Hee University Korean Medical Hospital, Kyung Hee University Medical Center, Kyung Hee Dae-ro 23, Dongdaemun-gu, Seoul 02447, Republic of Korea
3 Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 02447, Republic of Korea
4 Department of Pediatrics of Korean Medicine, College of Korean Medicine, Dongeui University, Yangjeong-ro 52-57, Busanjin-gu, Busan 47227, Republic of Korea
5 Department of Pediatrics, Korean Medicine Hospital, Pusan National University, Geumo-ro 20, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 50612, Republic of Korea
Hsu Yuan Lu
6 Chan-Nuri Hospital of Korean Medicine, Wonjeok-ro 469, Bupyeong-gu, Incheon 21365, Republic of Korea
Gyu Tae Chang
7 Department of Pediatrics of Korean Medicine, Kyung Hee University Hospital at Gangdong, Dongnam-ro 892, Gangdong-gu, Seoul 05278, Republic of Korea
Sang Yeon Min
8 Department of Pediatrics of Korean Medicine, Korean Medicine Hospital, Dongguk University Medical Center, Dongguk-ro 27, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326, Republic of Korea
To summarize and evaluate the efficacy and safety of herbal medicines used for the treatment of autism spectrum disorder (ASD) in children.
Thirteen electronic databases were searched from their inception to November 2016. Randomized controlled trials (RCTs) that assessed the efficacy of herbal medicines alone or in combination with other Traditional Chinese Medicine treatments for ASD in children were included. The Cochrane Risk of Bias Tool was used and other data analyses were performed using RevMan (Version 5.3).
Ten RCTs involving 567 patients with ASD were included for qualitative synthesis. In conjunction with conventional therapy, herbal medicines significantly improved the Childhood Autism Rating Scale (CARS) score, but the results of effects on total effective rate (TER) were different between the included studies. The use of herbal medicines with integrative therapy improved the CARS score and TER. In the studies that documented adverse events, no serious events were associated with herbal medicines.
The efficacy of herbal medicines for the treatment of ASD appears to be encouraging but was inconclusive owing to low methodological quality, herbal medicine diversity, and small sample size of the examined studies.
The core features of autism spectrum disorder (ASD) are persistent deficits in social communication and interaction and restricted, repetitive patterns of behavior, interests, or activities [ 1 ]. According to estimates from Center for Disease Control and Prevention (CDC) data, approximately 1 in 68 children has been identified with ASD. Studies in North America, Asia, and Europe have reported the average prevalence of individuals with autism as between 1% and 2% [ 2 ]. ASD is a lifelong condition of rising prevalence and community concern. The etiology of ASD is still controversial; various hypotheses concerning genetics, environmental factors, neurobiological factors, and neuropathology have been proffered [ 3 ].
There are many different types of treatment for ASD, such as medication management, education, rehabilitation training, sensory integration, and dietary approaches. Although there are no treatments for the core features of ASD, certain medications and behavioral therapies have been identified for the management of hyperactivity, depression, inattention, or seizures [ 4 , 5 ]. Among the pharmacologic interventions, risperidone is the most commonly used treatment for serious behavioral symptoms in children with autism [ 6 ]. Despite its beneficial effects on behavioral problems, the results of risperidone treatment are inconclusive and have been associated with adverse events, such as increased appetite, rhinorrhea, somnolence, and excessive weight gain [ 7 ]. The parents of children with ASD are therefore concerned about potential adverse drug effects and are seeking treatments that are more secure. The volume of research into herbal medicines, a form of Complementary and Alternative Medicine (CAM), with fewer adverse effects, has increased for the treatment of children with ASD.
Herbal medicines and acupuncture are commonly used in the treatment of children with ASD [ 8 ]. There have been some systematic reviews of acupuncture [ 9 – 11 ], CAM [ 12 , 13 ], and one review article of herbal medicines [ 8 ]. A systematic review on CAM for the treatment of ASD reported promising results for acupuncture, massage, music therapy, and sensory integration therapy [ 13 ]. All three systematic reviews of acupuncture concluded that further high quality trials were needed to evaluate the efficacy of acupuncture for autistic children [ 9 – 11 ] and one of these reviews suggested that acupuncture treatment showed behavioral and developmental improvements in children with ASD [ 11 ].
A review of herbal medicines reported that 32 kinds of Chinese herbal medicine have pharmacological effects, which mainly resulted in immune system improvement, memory enhancement, gastrointestinal tract improvement, and calming of the nerves [ 8 ]. However, that study did not provide evidence on the efficacy of the treatment of children with ASD. There is a lack of evidence on the efficacy of herbal medicines in the treatment of autistic children. The systematic review described here aimed to evaluate the clinical efficacy of herbal medicines as a treatment for ASD in children.
2.1. Data Source and Search Strategy
Databases and search terms were determined through discussion between all authors before the literature searches were executed; Sun Haeng Lee performed the electronic literature searches. The following electronic databases were searched for studies uploaded by November 2016 that investigated the treatment of ASD: MEDLINE, EMBASE, AMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycARTICLES, three Korean databases (KoreaMed, Oriental Medicine Advanced Searching Integrated System (OASIS), and Korean Traditional Knowledge Portal (KTCKP)), two Chinese database (China National Knowledge Infrastructure (CNKI) and WanFang Data), and two Japanese databases (CiNii and Japanese Institutional Repositories Online (JAIRO)). The following search strategy was used in MEDLINE: (autis ∗ OR pervasive developmental disorder ∗ OR childhood disintegrative disorder OR Asperger ∗ OR Autism Spectrum Disorder OR Child Development Disorders, Pervasive) AND (herb ∗ OR decoction ∗ OR remed ∗ OR Chinese medic ∗ OR Korean medi ∗ OR kampo OR formul ∗ OR herbal drug ∗ OR Chinese drug ∗ OR plant ∗ OR Chinese prescrip ∗ OR Chinese materica ∗ medica ∗ OR traditional medic ∗ OR Medicine, East Asian Traditional OR Herbal Medicine). To search the Korean, Chinese, and Japanese databases, slight modifications were applied to the above strategy. The details of search strategies used in English databases are presented in the Supplementary Material (Supplement 1, in Supplementary Material available online at https://doi.org/10.1155/2017/8614680 ). We contacted the original authors of the included studies via e-mail if additional information was needed. The protocol of this review was registered in PROSPERO (an international prospective register of systematic reviews) with the registration number CRD42016053391 . The protocol of this review is available from https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016053391 .
2.2. Inclusion Criteria
We only included randomized controlled trials (RCTs) that aimed to assess the efficacy of herbal medicines or herbal medicines in combination with other Traditional Chinese Medicine (TCM) treatments for ASD in children. The other TCM treatments included, but were not limited to, acupuncture, acupoint injection, Chuna therapy, and acupoint massage. RCTs were not limited to placebo-controlled, parallel-group, or cross-over studies. Other designs such as in vivo, in vitro, case reports, and retrospective studies were excluded. The herbal medicine forms (e.g., formula, decoction, and pills) were not restricted. Studies using herbal medicines in combination with conventional therapies, such as behavioral therapy, rehabilitation, education, and Western medicine, were included. All participants were aged less than 18 years and were diagnosed with ASD. The outcome measures of the trials were also restricted. The primary outcome measures included one or more of the following: Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC), and Aberrant Behavior Checklist-Community (ABC-C). The secondary outcome measures included total effective rate (TER) determined based on the improvement of clinical symptoms and the reduction of ABC or CARS score.
2.3. Study Selection and Data Extraction
2.3.1. selection of literature articles.
After the exclusion of duplicate studies, two authors (Miran Bang and Sun-Ae Yu) independently reviewed titles and abstracts for the first exclusion. The full texts of the selected literature articles that potentially met the eligibility criteria were subjected to another review prior to the final selection of literature articles. Differences were resolved via discussion with the corresponding authors of this review (Gyu Tae Chang and Sang Yeon Min) in order to reach consensus.
2.3.2. Data Extraction
One author (Miran Bang) conducted data extraction and another author (Sun Haeng Lee) reviewed the data. Items extracted from each study included author, publication year, sample size, patient age, diagnostic criteria, period of treatment, experimental and control intervention, outcomes, and ingredients of the herbal medicine.
2.4. Assessment of Risk of Bias
Two independent reviewers (Miran Bang and Kibong Kim) assessed methodological quality using the risk of bias (RoB) tool developed by Cochrane. Each study was assessed for selection bias (random sequence generation and allocation concealment), performance bias (blinding of participants and personnel), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data reporting), and reporting bias (selective outcome reporting). Each item of every included RCT was rated as “high risk,” “unclear,” or “low risk”; disagreements were resolved via discussion with other reviewers.
2.5. Data Analysis
Statistical analysis was performed using RevMan 5.3 analysis software (Cochrane Collaboration Review Manager Software). The impact of herbal medicines or herbal medicines in combination with other TCM treatment on dichotomous outcomes was expressed as a risk ratio (RR) with 95% confidence interval (CI). For continuous outcomes, mean difference (MD) with 95% CI was used.
3.1. Study Selection and Description
A total of 5516 studies were initially retrieved: 588 studies in MEDLINE, 36 studies in AMED, 448 studies in EMBASE, 1559 studies in PsycARTICLES, 126 studies in the Cochrane Library, 196 studies in CINAHL, 899 studies in CNKI, 1455 studies in WANGFANG, 200 studies in CiNii, two studies in JAIRO, no studies in KoreaMed, 6 studies in OASIS, and 1 study in KTCKP. After removing 713 identical articles, 4803 studies were screened for eligibility. Among these, 4790 studies were excluded based on the title and abstract. Most of the studies were not related to herbal medicines intervention and were in vivo, in vitro, case reports, and retrospective studies; therefore, we could determine if the studies met inclusion criteria by inspecting only the title and abstract. After reviewing the full text of each article, 10 studies [ 14 – 23 ] involving 567 participants were included in this systematic review. The entire process was displayed by generating a flow diagram in Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) ( Figure 1 ).
The PRISMA flow diagram of study selection.
The characteristics of the 10 studies are summarized in Table 1 . The results of the included studies are summarized in Table 2 . In eight studies [ 15 – 19 , 21 – 23 ], participants were diagnosed using DSM-IV or the International Classification of Diseases version 10 (ICD-10). One study [ 14 ] did not report specific diagnostic criteria, and another study [ 20 ] used the ABC behavior scale, Klinefelter behavior scale, CARS scale, and clinical manifestations to diagnose ASD. All studies recruited only children. The treatment periods of the included studies were 1–6 months. Four studies [ 14 , 16 , 20 , 23 ] evaluated herbal medicines as an adjuvant to conventional therapies, such as behavioral therapy, rehabilitation, and education, whereas one study [ 15 ] assessed herbal medicines combined with risperidone, a conventional medication. Various types of integrative therapy combined with conventional therapy were used in five studies [ 17 – 19 , 21 , 22 ]. In two studies [ 17 , 21 ], herbal medicines plus acupuncture were used, Qiao et al. [ 18 ] assessed herbal medicines plus acupuncture and acupoint injection, Sun et al. [ 19 ] investigated herbal medicines plus acupuncture, acupoint injection, auricular acupoint massage, and acupoint catgut-embedding, and Zhao et al. [ 22 ] investigated herbal medicines plus acupuncture and Chuna therapy. The ingredients of herbal medicines used in the included RCTs are summarized in Table 3 . The CARS score was reported in three studies [ 16 , 19 , 23 ], the ABC score was reported in one study [ 19 ], and the ABC-C score was reported in one study [ 15 ]. TER was reported in nine studies [ 14 , 16 – 23 ].
Characteristics of the included studies.
Note. E: experimental group; C: control group; b.i.d.: twice a day; ABA: Applied Behavior Analysis; HMs: herbal medicines; TER: total effective rate; ABC-C: Aberrant Behavior Checklist-Community; CARS: Childhood Autism Rating Scale; ICD-10: International Classification of Diseases version 10; TCM: Traditional Chinese Medicine; t.i.d.: three times a day; ABC: Autism Behavior Checklist.
Results of the included studies.
Note.∗ is showed as TER: RR [95% CI], P value; CARS, ABC-C, or ABC score: MD [95% CI], P value; TER: total effective rate; ABC-C: Aberrant Behavior Checklist-Community; RR: risk ratio; MD: mean difference; 95% CI: 95% confidence interval; CARS: Childhood Autism Rating Scale; ABC: Autism Behavior Checklist.
Composition of herbal medicines in the included RCTs.
3.2. Assessment of Risk of Bias
Among 10 studies, three studies [ 15 , 17 , 18 ] reported the method of randomization and were rated with a low risk of bias, but the remaining studies [ 14 , 16 , 19 – 23 ] did not include the method of random sequence generation and were rated as unclear. One study [ 15 ], which used sealed, opaque envelopes, had a low risk of bias for allocation concealment, but the remaining studies were rated as unclear. Nine studies [ 14 , 16 – 23 ] showed a high risk for blinding of participants and personnel and were also rated as unclear for blinding of outcome assessment. One study [ 15 ] showed a low risk of bias for blinding of participants, personnel, and outcome assessment. Two studies [ 17 , 19 ] showed a high risk of bias for incomplete outcome data, because the studies did not include details of how the problem of dropout was resolved in statistical analysis. The remaining eight studies [ 14 – 16 , 18 , 20 – 23 ] showed a low risk of bias for incomplete outcome data. Four studies [ 17 , 18 , 21 , 22 ] were rated as an unclear risk for selective reporting because the change in the CARS score was used in the criteria of TER, but the mean CARS score was not provided in the studies. Although we contacted a total of four corresponding authors of these studies via e-mail to obtain raw data, we received no replies. The remaining six studies [ 14 – 16 , 19 , 20 , 23 ] that reported their outcomes using a previously described method or protocol had a low risk for selective reporting. The details of the risk of bias are provided in Figures 2(a) and 2(b) .
(a) Risk of bias graph: review of authors' judgements about each risk of bias item presented as percentages across all included studies. (b) Risk of bias summary: review of authors' judgements about each risk of bias item for each included study. “+”: low risk, “?”: unclear risk, and “−”: high risk.
3.3. Outcomes of the Included Studies
3.3.1. cars score.
Three RCTs [ 16 , 19 , 23 ] provided CARS scores. Of these three studies, two RCTs [ 16 , 23 ] examined whether herbal medicines improved the CARS score when combined with conventional therapy. In the study of Jiang et al. [ 16 ], the administration of herbal medicines for 3 months showed significant effects on the CARS score when combined with conventional therapy ( n = 60 participants, MD = −3.60, 95% CI: −7.00 to −0.20, P = 0.04). In the study of Zhou et al. [ 23 ], administration of herbal medicines for 3 months showed significant effects on CARS score when combined with conventional therapy ( n = 60 participants, MD = −2.76, 95% CI: −5.20 to −0.32, P = 0.03) and for 6 months showed significant effects on CARS score ( n = 60 participants, MD = −5.90, 95% CI: −8.50 to −3.30, P < 0.00001). The remaining study [ 19 ] examined whether the administration of herbal medicines for 3 months plus integrative therapy, including acupuncture, acupoint injection, auricular acupoint massage, and acupoint catgut-embedding, improved the CARS score when combined with conventional therapy. When herbal medicines plus integrative therapy were combined with conventional therapy, significant improvements were reported in the CARS score ( n = 59 participants, MD = −3.59, 95% CI: −6.04 to −1.14, P = 0.004).
3.3.2. ABC Score
Among the 10 studies, only one study [ 19 ] reported the ABC score. This study examined whether the administration of herbal medicines for 3 months plus integrative therapy, including acupuncture, acupoint injection, auricular acupoint massage, and acupoint catgut-embedding, improved the ABC score when combined with conventional therapy. When herbal medicines plus integrative therapy were combined with conventional therapy, significant improvements were reported in the ABC score ( n = 59 participants, MD = −7.57, 95% CI: −12.12 to −3.02, P = 0.001).
3.3.3. ABC-C Score
Among the 10 studies, one study [ 15 ] reported the ABC-C score. This study used five subscales of the ABC-C score to examine whether herbal medicines used as an adjuvant to conventional medication conferred additional benefits. In the present study, the experimental group was given Ginkgo biloba and risperidone for 10 weeks, while the control group received placebo and risperidone. The differences between the two groups were not significant, as indicated by the effect of groups-by-time interaction in all of the five subscales of the ABC-C score (Irritability Subscale: F = 1.72, df = 2.16, P = 0.18; Lethargy/Social Withdrawal Subscale: F = 0.24, df = 1.67, P = 0.74; Stereotypic Behavior Subscale: F = 0.95, df = 2.42, P = 0.40; Hyperactivity/Noncompliance Subscale: F = 0.26, df = 1.74, P = 0.73; Inappropriate Speech Subscale: F = 0.94, df = 1.84, P = 0.38).
Nine RCTs [ 14 , 16 – 23 ] provided TER. Of these studies, four [ 14 , 16 , 20 , 23 ] examined whether herbal medicines showed a significant increase in TER when combined with conventional therapy. In the study of Ainuer et al. [ 14 ], the administration of herbal medicines for 1 month showed no significant difference in TER when combined with conventional therapy ( n = 21 participants, RR 1.24, 95% CI: 0.88 to 1.75, P = 0.22). In the study of Jiang et al. [ 16 ], the administration of herbal medicines for 3 months showed a significant increase in TER when combined with conventional therapy ( n = 60 participants, RR 1.37, 95% CI: 1.01 to 1.86, P = 0.04). In the study of Yan and Lei [ 20 ], the administration of herbal medicines for 1 month showed a significant increase in TER when combined with conventional therapy ( n = 37 participants, RR = 2.02, 95% CI: 1.01 to 4.02, P < 0.05). In the study of Zhou et al. [ 23 ], the administration of herbal medicines for 3 months showed a significant increase in TER when combined with conventional therapy ( n = 60 participants, RR = 1.47, 95% CI: 1.03 to 2.09, P = 0.03), but the administration of herbal medicines for 6 months showed no significant difference in TER ( n = 60 participants, RR = 1.07, 95% CI: 0.94 to 1.23, P = 0.31). The remaining five studies [ 17 – 19 , 21 , 22 ] examined whether administration of herbal medicines for 3 months plus integrative therapy improved TER when combined with conventional therapy. Of the five studies [ 17 – 19 , 21 , 22 ], two studies [ 17 , 21 ] used herbal medicines plus acupuncture combined with conventional therapy in experimental group. In the study of Liang et al. [ 17 ], a significant increase in TER was reported ( n = 67 participants, RR = 2.06, 95% CI: 1.30 to 3.27, P = 0.002). In the study of Zhao and Wang [ 21 ], a significant increase in TER was also reported ( n = 60 participants, RR = 1.53, 95% CI: 1.09 to 2.16, P = 0.02). When herbal medicines plus integrative therapy, including acupuncture and acupoint injection, were combined with conventional therapy, significant differences were observed in TER ( n = 84 participants, RR = 1.38, 95% CI: 1.11 to 1.71, P = 0.003) [ 18 ]. When herbal medicines plus integrative therapy, including acupuncture and Chuna therapy, were combined with conventional therapy, a significant increase was reported in TER ( n = 72 participants, RR = 1.41, 95% CI: 1.05 to 1.89, P = 0.02) [ 22 ]. When herbal medicines plus integrative therapy, including acupuncture, acupoint injection, auricular acupoint massage, and acupoint catgut-embedding, were combined with conventional therapy, no significant differences were observed in TER ( n = 59 participants, RR = 1.29, 95% CI: 0.97 to 1.73, P = 0.08) [ 19 ].
3.4. Adverse Events
Among the 10 RCTs, eight studies [ 14 , 16 – 18 , 20 – 23 ] did not record information on the occurrence of adverse events. Of the remaining two studies, one study [ 19 ] reported that none of the participants had experienced adverse events, and another study [ 15 ] reported that there was no significant difference in the incidents of side effects such as daytime drowsiness, increased appetite, and nervousness between the experimental group receiving G. biloba plus risperidone and the control group receiving risperidone alone. These adverse events were thought to be associated with the administration of risperidone in both the experimental and control groups, because the authors of the study mentioned that G. biloba was relatively safe.
4.1. summary of evidence.
In the present study, we analyzed 10 RCTs involving 567 individuals to assess the efficacy of herbal medicines for the treatment of ASD. Because of the high risk of bias for blinding of participants observed in the included studies, diversity of herbal medicines, and an insufficient number of the studies included, meta-analysis was not performed in this review. Based on the findings in this systematic review, herbal medicines and herbal medicines plus integrative therapy can significantly improve the CARS score, which measures the core autistic features in children with ASD, when combined with conventional therapy. In one study, herbal medicines plus integrative therapy significantly improved ABC score when combined with conventional treatment. Herbal medicines had no beneficial effects on the ABC-C scale score when combined with risperidone in one study. When herbal medicines were combined with conventional therapy, two [ 16 , 20 ] of the four studies [ 14 , 16 , 20 , 23 ] showed a significant increase in TER and one study [ 14 ] showed no significant difference in TER. In the remaining study [ 23 ], the administration of herbal medicines for 3 months showed a significant increase in TER, but a 6-month administration showed no significant difference in TER. This was thought to be because there was significant difference between experimental and control group by 3 months, but after that time, the TER of the control group also increased; finally, no significant difference was observed between the two groups by 6 months. Herbal medicines plus integrative therapy in four of the five studies showed a significant increase in TER. Within the studies documenting the adverse events, no serious adverse events associated with herbal medicines were observed. Conclusions regarding the safety of herbal medicines and herbal medicines plus integrative therapy could not be drawn owing to the paucity of evidence reported by the included studies.
4.2. Pharmacological and Clinical Effects of Herbal Medicines Used in the Included Studies
Among the 10 studies, the commonly used herbal medicines included Poria cocos, Panax ginseng, Acorus gramineus, Schisandra chinensis, and Glycyrrhiza uralensis. One study reported that P. ginseng improved abnormal behaviors in animal models of autism [ 24 ]. A. gramineus , which has various pharmacological effects such as sedative, antispasmodic, and anticonvulsant activities, is used for the treatment of various pediatric aliments such as cough, epilepsy, abdominal pain, and mental diseases, including psychoneurosis, schizophrenia, insomnia, and loss of memory [ 25 ]. S. chinensis was reported to have sedative and hypnotic activities, which might be mediated via the control of the serotonergic system [ 26 ]. P. cocos is a well-known herbal medicine used for its sedative and tonic effects [ 27 ]. These herbal medicines may contribute to the improvement of abnormal behaviors, inattention, or seizures in autistic children. However, further research should be conducted to demonstrate the specific pharmacological mechanisms of treating autism and to examine whether herbal medicines exhibit pharmacological activities as polyherbal formulations.
4.3. Comparison with Other Systematic Reviews
In 2015, a systematic review revealed effective Chinese herbal medicines and provided evidence for autism treatment by analyzing modern literature, ancient books, and monographs [ 8 ]. The study concluded that TCM used a holistic treatment strategy with comprehensive care and the pharmacological activities of 32 types of Chinese herbal medicines in the treatment of ASD. However, this study did not evaluate the clinical efficacy of herbal medicines in the treatment of children with ASD. In our systematic review, we managed to summarize all published RCTs to assess the clinical efficacy of herbal medicines for the treatment of ASD in children. The findings of our systematic review suggested that herbal medicines and herbal medicines plus integrative therapy improved the CARS score, and herbal medicines plus integrative therapy showed further significant effects on TER when combined with conventional treatment.
The present systematic review has several limitations. First, most of the included studies had a relatively low methodological quality. Of the 10 RCTs, only 3 described a randomization method, 1 included the allocation method, and only 1 had a double-blind design. Thus, there might have been a possibility that the clinical effects of herbal medicines for the treatment of ASD have been overestimated. Second, in nine studies [ 14 , 16 – 23 ], with the exclusion of one study [ 15 ], a placebo identical to herbal medicines was not used and conventional therapy was concurrently used in both the experimental and control groups. Therefore, the positive effects cannot be solely attributed to the efficacy of herbal medicines. Third, the tested herbal medicines varied in terms of the composition and duration of treatment. Because of this diversity of herbal medicines, a meta-analysis for the evaluation of the effects of herbal medicines could not be performed. Additionally, sensitivity analysis and tests for publication bias could not be conducted because there were an insufficient number of studies with a high methodological quality among the included trials. Finally, this review may have potential publication or location biases; of the 10 RCTs, 1 was conducted in Iran and the remaining 9 were performed in China.
4.5. Suggestions for Future Research
The RCTs included in the present systematic review comprised low methodological qualities and it was confirmed that the conclusions drawn from this review are somewhat limited owing to methodological deficiencies. Future trials should use rigorous randomization and blinding methods and provide details of the methods. In addition, future studies should report the incidence of adverse events associated with herbal medicines. Given the difficulty to diagnose ASD especially at younger age, future studies should use international criteria and adopt standardized assessment tools, such as Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS), for the diagnosis and assessment of autism [ 28 , 29 ]. Considering the diversity of herbal medicines and varieties of integrative therapy combined with herbal medicines in this review, future research should standardize the optimal composition of herbal medicines and types of integrative therapy. This standardization will improve the applicability and generalization of herbal medicine treatment for children with ASD.
The results of this systematic review indicated that herbal medicines combined with conventional treatment seem to have a positive effect on the treatment of ASD in children. Herbal medicines plus integrative therapy as an adjuvant to conventional therapy also have an encouraging effect in the treatment of autistic children. However, owing to the low methodological quality of the included studies, small sample size, and diversity of herbal medicines, firm conclusions could not be drawn. Further well-designed, large-scale RCTs, which have a low risk of bias, are needed to confirm these results.
Search Strategy Used in English Databases.
This study was supported by the Traditional Korean Medicine R&D Program, which was funded by the Ministry of Health and Welfare through the Korea Health Industry Development Institute (KHIDI) (no. HB16C0075).
Conflicts of Interest
The authors declare that there are no conflicts of interest regarding the publication of this paper.
Miran Bang, Sun Haeng Lee, Seung-Hun Cho, Gyu Tae Chang, and Sang Yeon Min were responsible for the study concept and design; Miran Bang, Sun Haeng Lee, Sun-Ae Yu, and Kibong Kim participated in the literature searching; Miran Bang, Sun Haeng Lee, Seung-Hun Cho, Sun-Ae Yu, and Kibong Kim participated in data analysis and interpretation; Hsu Yuan Lu contacted the corresponding authors of the Chinese studies; Miran Bang drafted the paper; Gyu Tae Chang and Sang Yeon Min supervised the study and critically reviewed the paper; all authors participated in the analysis and interpretation of data and approved the final paper.
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What is Ayurveda?
Ayurveda is a traditional Indian healing system that uses a range of therapies to maintain good health and manage various health conditions. Some Ayurvedic therapies include herbal medicine, changes to diet, yoga, massage, acupuncture and Panchakarma .
Who is Ayurveda for?
Supporters of Ayurveda say that it can be used for people with a wide range of conditions, including autism, digestive problems, asthma, arthritis, heart disease, cancer, diabetes and skin diseases.
What is Ayurveda used for?
Ayurveda is used to prevent and treat many health conditions.
Supporters of Ayurveda as a therapy for autistic people say it can improve the characteristics of autism. They say it can improve behaviour , social skills , communication , anxiety , stomach and digestion problems, sleep , sensory difficulties , eye contact and ability to focus .
There is no scientific evidence that Ayurveda changes the characteristics of autism .
Where does Ayurveda come from?
Ayurveda originated in India thousands of years ago. It’s commonly practised today in some Asian countries, especially in India and Nepal, and has gained popularity around the world.
In Australia, Ayurveda is practised as a form of complementary and alternative medicine for a wide range of conditions, including arthritis, digestive problems, vertigo, skin conditions and autism.
What is the idea behind Ayurvedic therapy for autistic people?
Ayurveda is based on the belief that good health happens when your mind, body and spirit are perfectly balanced. Any imbalances can lead to health problems.
Supporters of using Ayurvedic therapy for autistic people claim that autism is mainly caused by imbalances or problems with metabolism and digestion. These imbalances lead to a build-up of harmful toxins in the body. When Ayurveda is used as a therapy for autism, the idea is to remove these toxins and reduce the characteristics of autism.
These ideas are not supported by research.
What does Ayurvedic therapy for autistic people involve?
Ayurveda involves a combination of therapies. When it’s used as a therapy for autistic people, it can include:
- changes to diet – for example, avoiding processed foods and following a vegetarian or vegan diet
- herbal medicine
- breathing exercises
- sound therapy – for example, listening to music, reciting mantras or using sound bowls
The recommended treatments will vary for each individual. An Ayurvedic practitioner will assess your child’s physical, emotional and spiritual health and design a personalised treatment plan.
Does Ayurvedic therapy help autistic children?
There is currently no good-quality evidence that Ayurveda helps autistic people .
There’s also evidence that certain Ayurvedic medicines and therapies are harmful . For example, some Ayurvedic herbal medicines might contain toxic levels of lead, mercury or arsenic, which can seriously harm children. And some Ayurvedic therapies can be dangerous. These include vomiting, enemas and withdrawing blood.
Ayurvedic therapy for autism that involves a vegetarian or vegan diet will need careful planning to make sure children get all the nutrients they need.
Who practises Ayurveda?
Ayurvedic practitioners offer Ayurveda at private clinics. Some practitioners are certified by Ayurvedic associations. But Ayurveda might also be offered by inexperienced practitioners.
Although you can buy Ayurvedic herbal medicines in health food stores and online, many Ayurvedic therapies have not been proven to be safe and effective.
It’s always best to speak to your GP or paediatrician or a paediatric dietitian before using this therapy.
Where can you find a Ayurvedic practitioner?
If you’re thinking about Ayurvedic therapy for your autistic child, see your GP or one of the other professionals working with your child. They can talk with you about its risks and benefits.
You could talk about Ayurvedic therapy with your NDIA planner , early childhood partner or local area coordinator , if you have one.
Parent education, training, support and involvement
If your autistic child is having Ayurvedic therapy, you need to take your child to a clinic for sessions.
You might also need to choose and buy Ayurvedic herbal medicine, plan and make changes to your child’s diet, and make time for daily routines like yoga, meditation and breathing exercises.
The cost of Ayurvedic therapy for autism depends on which therapies are used.
Therapies and supports for autistic children range from behaviour therapies and developmental approaches to medicines and alternative therapies. When you understand the main types of therapies and supports for autistic children , it’ll be easier to work out the approach that will best suit your child.
Year: 2023 | Month: January-March | Volume: 7 | Issue: 1 | Pages: 33-37
Ayurvedic Intervention for Autism Spectrum Disorder – A Case Study
Dr. sudheer sharma 1 , ayush verma 2 , riya jasrotia 3.
1 Assistant Professor, Department of Kaumarbhritya, GAMC Akhnoor Jammu 2 U.G Scholar, GAMC Akhnoor Jammu 3 U.G Scholar, GAMC Akhnoor Jammu
Corresponding Author: Ayush Verma
Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. It is a lifelong neurodevelopmental condition with its onset before the age of three years. It is characterized by abnormalities in communication, impaired social function, repetitive behaviors and restricted interests. Western medicine and research have seemingly stalled in respect to the management of autism however early intervention and behavioral therapies have shown improvement to some extent. The present study describes the case of childhood autism visited at Government Ayurvedic Medical College and Hospital, Akhnoor, Jammu. Child was diagnosed clinically and has been treated with Ayurvedic interventions, Panchakarma therapies and diet modification. Child has got relief symptomatically within one week of therapy started. Case study briefly explained Ayurvedic concepts regarding childhood autism and Ayurvedic treatment protocols in autistic disorder.
Keywords: Autism Spectrum Disorder, hyperactivity, Ayurveda, Management, Prevention, Pinda Sweda, Abhyanga, Pichu, Nasya, Uttar Basti.
Autism Spectrum Disorder
Our Ayurveda case studies are the first-line evidence in Ayurveda medical literature as they present the original observations from our Ayurveda practitioners.
Brief Medical History
Patient aged 15 years, came to AyurVAID Hospitals, Ramamurthy Nagar with the following complaints
- Lack of Attention
- Poor Comprehension
- Indigestion and bed wetting.
Dr. Zankhana Buch, the Chief Medical Officer at AyurVAID Hospitals, Ramamurthynagar assessed TB, and he was advised Classical Ayurveda Comprehensive Approach of Diet, lifestyle, Medicine, and Therapies.
TB’s response after completing two phases of his Panchakarma treatments at AyurVAID Hospitals, Ramamurthynagar , came as a welcome relief to his parents. TB showed a satisfactory outcome by a visible correction in his bowel and bladder control, and functions, digestion, quality of sleep. His mother says: “TB is lot more calm and attentive. We would have never expected, TB to stay back in an unknown and strange environment outside. But, he spent a day long at AyurVAID Hospitals, Ramamurthynagar , while he was on intensive cleansing treatment. We feel this indicates a strong positive change.”
AyurVAID firmly believes in its potential to deliver key outcomes, based on Ayurveda Shastras in a complex subject of Autism Spectrum. The current medical science of neurological conditions including Autism spectrum/Multiple Sclerosis /Alzheimer’s disease is moving towards a paradigm shift. Overturning decades old postulations in textbook regarding developmental disorders including Autism, textbooks are being rewritten, including the role of immune system and metabolism, role of gut microbiome.(Reference:University of Virginia,School of Medicine,Jonathan Kipnis)
Ayurveda, the Mother System of medicine, has bolstered this finding several centuries ago and have documented details of Manas, Buddhi and Indriya, its connection with the primary/innate immunity, metabolic fire and a ‘formulation’ for medicines, targeting the pervasive developmental disorders.
A beneficiary of this approach, TB recovers at AyurVAID Hospitals, Ramamurthynagar , under the vigil of Dr. Zankhana Buch , supported by Dr. Laya, and the dedicated and compassionate Paricharaka team of Justin, Sreekanth, Kumar and Manu.
Ayurveda offers effective management for Autism Spectrum Disorder.
View the Video Testimonial (Top – Sidebar) and hear what TB’s parents have to say about their child’s significant recovery through Classical Ayurveda at AyurVAID Hospitals, Ramamurthynagar .
Autism spectrum disorder – ayurvaid delivering key outcomes.
* Outcomes may vary from person to person
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An Overview and Approach towards Autism and its Management in Ayurveda
2018, Pediatrics & Health Research
The disorder that usually becomes evident during the first three years of life. Ayurvedic literatures throws light on etiopathogenesis, presentation along with prophylactic and some specific measures for management of such disorders.
World Journal of Pharmaceutical Research
In today’s world people are very conscious about Mental Health (Manas bhava). The new word added in modern medicine called as Holistic Health. Holistic health comprises two aspect physical as well Mental Health. Acharya Madhav mentioned Amlapitta (Non ulcer dyspepsia) 1 . In this disease patient afflict physically as well as mentally due to pitta dosha. Pitta may get aggravated because of Manasik (Psychological), aharaj (dietary regimen) as well as Viharaj Hetu (lifestyle regimen) which produce symptoms like Chaardi (vomiting), Amlodgara (sour eructation), Kanthdaha (throat burn), Hrudadaha (heart burn), Utklesh (nausea), Avipaka (indigestion) which collectively termed as Amlapitta (Non ulcer dyspepsia). Vamana procedure has got effects on Mana (mind) also. This can be considered as holistic approach of Ayurveda means which covers Sharira, Manas and Indriyas. So, here main aim is to study the Holistic Health effects of vamana karma (Emesis Therapy) in Amlapitta (Non ulcer dyspepsia)...
International Journal of Ayurvedic Medicine
Background: Rett syndrome-RS comes under Autism spectrum disorder-ASD which is a neurodevelopmental syndrome. It is diagnosed by the main differentiating features of lack of interpersonal and communication skills, poor eye contact, delayed speech with pervasive abnormal body movements. Aim and Objectives: This case report is aimed at dissemination of comprehensive role of Ayurveda in management of ASD, Rett syndrome. Material and Methods: RS is the severe form of ASD. This case study of 2.3 year’s girl presented with RS and global delay, being treated with wholistic approach. It comprises Ayurveda chikitsa and other therapies like Yoga, hydrotherapy, occupational, music, physiotherapy and many more. Observation and Result: Patient has shown promising results in all developmental milestones such as gross motor, fine motor and personal social in 6 months duration except language. Different varieties of massage therapy, diet and Basti, Nasya (Panchkarma) procedures, Omkar mantra chanti...
AYU (An International Quarterly Journal of Research in Ayurveda)
Introduction: Behavioral problems are commonly prevalent worldwide. It is important to diagnose and treat timely as if untreated, increase the risk of getting psychiatric illnesses. Present review is aimed at providing Ayurvedic guidelines in the form of Sadvritta (Code of conduct), Achar rasayan-AR (ethical principles) and few Ayurveda interventions corelating with recently developed interventions of Psychology which may prove helpful in prevention and management of behavioral problems in children. Material and Methods: This review is based on data collected from classical Ayurvedic literature, published research works in various journals and counseling experiences. Observations and Results: Behavioral problems are generally multi-factorial in origin and arise as a result of conflict between the children’s personality, attitudes of parents, teacher or peers. Counseling with family and adoption of Ayurveda principles can manage and prevent further progress of behavioral problems in ...
International Journal of Research in Ayurveda and Pharmacy
Janmejaya Samal , Varanasi Prof. Suresh Kumar Editor J Res Educ Indian Med
Abstract: Background: In the present era of geometrical rise of demand for indigenous medicines, maintaining quality standards is the need of hour. Absence of reference standards for compound formulations is a hindrance on the way towards standardisation. Objectives: The present study is aimed at setting a preliminary pharmacognostical and pharmaceutical profile of Kasahara Dashemani Vati (KD tablet). Methods: Study included preparation of KD tablets using pre authenticated raw drugs following all SOPs. Later KD tablet was subjected to pharmacognostical, physicochemical and phytochemical analysis as per standard protocols. The final observations were systematically recorded. Results: Pharmacognostical findings matched with that of individual raw drugs negating any major change in the microscopic structure of the raw drugs during the pharmaceutical processes of preparation of tablet. Tested physicochemical parameters were within the optimum reference range for a tablet. Phytochemical...
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Arun was brought for consultation with Dr. A M Reddy by his parents. He was about 4 years old, the second child to the parents. Even while he was being brought into the room, we could hear his loud wailing. It took some time for the child to calm down and later we could observe that the child was very restless. He was running around the room, pulling down cushions and generally creating chaos in the room and mother was quite harried in trying to control him. He was diagnosed with ASD (Autism Spectrum Disorder).
What is ASD?
Autism or Mutinism as it was earlier known was thought primarily to affect communication skills but with more studies, it was understood that autistic children display a wide range of symptoms, hence the word “spectrum” was added to Autism disorder. Autism is a complex neurodevelopmental disorder which affects a person’s social behavior and communication skills.
Why it occurs?
The exact reason why ASD occurs is not known but many risk factors have been identified like age of the parents, poor ovulation, infections or exposures to harmful chemicals or radiation during pregnancy, thyroid, diabetes type of hormonal disorders, birth injuries, infections in childhood, vaccinations, etc.
What are its symptoms?
As its name suggests, ASD displays a myriad of symptoms but some of the common symptoms of ASD is lack of speech. While some children have no speech, in some children speech that was developed before may regress. Many of them do not prefer to mingle with children of their age group. Repetitive action, physical restlessness, inability to understand emotions, mood swings like sudden bouts of excitement, crying without any reason, are few symptoms displayed by many autistic children.
Aggressive behaviors like self-harming, head-banging, tantrum-throwing, biting/pushing others, destructiveness, can be displayed by few. Response to name call, having sustained eye contact, unable to understand commands, stereotypical actions and stimming are some of the common symptoms exhibited by many.
Coming back to the case of Arun, a detailed case history was noted down by our doctors, a summary of which is given below.
He is the second child and the age difference between both the siblings is seven years. After the first child was born, the mother developed hypothyroidism for which she was on thyroxine 50 mcg daily tablets. No history of abortions or contraceptive use was reported. Father was apparently healthy. The age of the parents was 35 and 38 years respectively during conception. She conceived naturally and pregnancy was apparently uneventful. But on deeper probing few differences were found out between both the pregnancies.
While during the first pregnancy the parents were in India, but during second there were in the United States. She was advised to continue with the same dosage of thyroxine and during 6-7 months of the pregnancy, she was given flu and T Dap vaccine. The child was born of emergency C – section as the water broke early. The birth cry was normal and seemingly the child was progressing well but after his first birthday, the child had a bout of severe gastrointestinal infection when they visited India where he was hospitalized for three days and given medicines.
Parents were worried that he seems to put everything in his mouth and his favorite items were paper, cloth, wall plaster. His demands have to be met, else he used to become very upset. Emotional connectivity towards parents was less. He would not follow simple commands and it was becoming increasingly difficult for the parents to manage him. With therapies, his eye contact improved a little and was able to follow a few simple commands but the progress was slow.
He was a picky eater and liked crunchy foods. His bowels were constipated and he was not yet toilet trained. He was given Cuprum Sulph 10 M and was kept on regular follow up.
On the next visit to Dr. A M Reddy Autism Center , the parents complained that their child developed itching on the skin but his restlessness reduced slightly. The medication was continued for about three months during which the child’s anger reduced by 30%, his eye contact improved and he was no longer constipated. His itching too reduced in the meanwhile. A second dose was repeated and about six to seven months of treatment, he started saying few words, tantrum-throwing reduced and his habit of putting everything in the mouth was gone.
The dose was repeated in 50M potency. After about a year and half of treatment, he started interactive communication, giving relevant answers to questions and was doing much better. On the advice of Dr. A M Reddy, they placed him in normal school and he is doing well.
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