January 2004

Many autistic children receive CAM

A significant percentage of children recently diagnosed with autism receive complementary or alternative medicine treatments. Researchers at the Children’s Hospital of Philadelphia reviewed charts for 284 patients evaluated at the hospital's Regional Autism Center for autistic spectrum disorder. They found that 90 children, or 32 percent of the total, were using complementary and alternative medicine.

The research also showed that 9 percent of the total reviewed were using a potentially harmful approach to CAM.

CAM should not be dismissed out of hand, said the study’s lead author, Susan E. Levy, MD in an article in the December issue of the Journal of Developmental and Behavioral Pediatrics.

She said that the American Academy of Pediatrics strongly encourages clinicians to discuss CAM practices in a non-accusatory, nonjudgmental manner with patients.

"If parents believe that clinicians do not respect their beliefs and decisions or are unwilling to negotiate around the use of additional treatment strategies," Dr. Levy concludes, "these strategies may become alternative rather than complementary."

In the article, Levy suggests ways that physicians can creatively engage parents regarding their beliefs about autism and how to treat it. For example, if a complementary treatment is not toxic, the clinician might not discourage that treatment, but could suggest that it will be more effective to add or continue to use the standard treatments the clinician has prescribed. If the parent is using a potentially harmful treatment, the clinician may negotiate a safer replacement practice — such as lowering the dose of a vitamin that may have been taken at excessive concentrations.

"Some of these CAM treatments may alleviate problems associated with autism, such as sleep disorders and gastrointestinal problems, but the treatments are unlikely to resolve core symptoms of the disorder," said Levy, who is the director of the hospital’s Regional Autism Center.

Use of potentially harmful CAM was found at significant levels among those who had seen a healthcare provider about the diagnosis before coming to the autism center. There was some evidence that patients who had to wait longer for an appointment at the center also were more likely to use riskier alternatives.

The researchers caution that the data they found at one clinical location may not reflect figures for the entire population of children with autism.

Dr. Levy's co-authors were David S. Mandell, ScD, and Stephanie Merhar, both of the University of Pennsylvania School of Medicine; Richard F. Ittenbach, PhD, of the Children's Hospital Division of Biostatistics; and Jennifer A. Pinto-Martin, PhD, of the University of Pennsylvania School of Nursing.

Source: The Children's Hospital of Philadelphia, www.chop.edu

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