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Meta-Analysis
. 2011 Sep 7;2011(9):CD007849.
doi: 10.1002/14651858.CD007849.pub2.

Acupuncture for autism spectrum disorders (ASD)

Daniel Kl Cheuk  1 , Virginia Wong, Wen Xiong Chen
Affiliations
Meta-Analysis

Acupuncture for autism spectrum disorders (ASD)

Daniel Kl Cheuk et al. Cochrane Database Syst Rev. .

Abstract

Background: Autism spectrum disorders (ASD) are characterized by impairment in social interaction, impairment in communication and lack of flexibility of thought and behavior. Acupuncture, which involves the use of needles or pressure to specific points on the body, is used widely in Traditional Chinese Medicine and increasingly within a western medical paradigm. It has sometimes been used as a treatment aimed at improving ASD symptoms and outcomes, but its clinical effectiveness and safety has not been rigorously reviewed.

Objectives: To determine the effectiveness of acupuncture for people with ASD in improving core autistic features, as well as communication, cognition, overall functioning and quality of life, and to establish if it has any adverse effects.

Search strategy: We searched the following databases on 30 September 2010: CENTRAL (The Cochrane Library, 2010, Issue 3), MEDLINE (1950 to September 2010 Week 2), EMBASE (1980 to 2010 Week 38), PsycINFO, CINAHL, China Journal Full-text Database, China Master Theses Full-text Database, China Doctor Dissertation Full-text Database, China Proceedings of Conference Database, Index to Taiwan Periodical Literature System, metaRegister of Controlled Trials and the Chinese Clinical Trials Registry. We also searched AMED (26 February 2009) and Dissertation Abstracts International (3 March 2009), but these were no longer available to the authors or editorial base at the date of the most recent search. TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System) was last searched on 3 March 2009.

Selection criteria: We included randomized and quasi-randomized controlled trials. We included studies comparing an acupuncture group with at least one control group that used no treatment, placebo or sham acupuncture treatment in people with ASD. We excluded trials that compared different forms of acupuncture or compared acupuncture with another treatment.

Data collection and analysis: Two review authors independently extracted trial data and assessed the risk of bias in the trials. We used relative risk (RR) for dichotomous data and mean difference (MD) for continuous data.

Main results: We included 10 trials that involved 390 children with ASD. The age range was three to 18 years and the treatment duration ranged from four weeks to nine months. The studies were carried out in Hong Kong, mainland China and Egypt.Two trials compared needle acupuncture with sham acupuncture and found no difference in the primary outcome of core autistic features (RFRLRS total score: MD 0.09; 95% CI -0.03 to 0.21, P = 0.16), although results suggested needle acupuncture might be associated with improvement in some aspects of the secondary outcomes of communication and linguistic ability, cognitive function and global functioning.Six trials compared needle acupuncture plus conventional treatment with conventional treatment alone. The trials used different primary outcome measures and most could not demonstrate effectiveness of acupuncture in improving core autistic features in general, though one trial reported patients in the acupuncture group were more likely to have improvement on the Autism Behavior Checklist (RR 1.53; 95% CI 1.09 to 2.16, P = 0.02) and had slightly better post-treatment total scores (MD -5.53; 95% CI -10.76 to -0.31, P = 0.04). There was no evidence that acupuncture was effective for the secondary outcome of communication and linguistic ability, though there seemed to be some benefit for the secondary outcomes of cognitive function and global functioning.Two trials compared acupressure plus conventional treatment with conventional treatment alone and did not report on the primary outcome. Individual study results suggested there may be some benefit from acupressure for certain aspects of the secondary outcomes of communication and linguistic ability, cognitive function and global functioning.Four trials reported some adverse effects, though there was little quantitative information, and at times both intervention and control groups experienced them. Adverse effects noted included bleeding, crying due to fear or pain, irritability, sleep disturbance and increased hyperactivity. None of the trials reported on quality of life.There are a number of problems with the evidence base: the trials were few in number and included only children; six of the trials were at high risk of bias; they were heterogeneous in terms of participants and intervention; they were of short duration and follow-up; they reported inconsistent and imprecise results, and, due to carrying out large numbers of analyses, they were at risk of false positivity.

Authors' conclusions: Current evidence does not support the use of acupuncture for treatment of ASD. There is no conclusive evidence that acupuncture is effective for treatment of ASD in children and no RCTs have been carried out with adults. Further high quality trials of larger size and longer follow-up are needed.

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Conflict of interest statement

  1. Daniel KL Cheuk ‐ none known.

  2. Virginia Wong and Wen Xiong Chen were involved in a funded project on 'Integration of Traditional Chinese Medicine (Acupuncture) in Interventional Program of Children with Autistic Spectrum Disorder (or Autism)' with Tung Wah Group of Hospitals locally in Hong Kong that was performed from 2004‐2007. Paper published: WX Chen, WL Liu, V Wong. Electroacupuncture for Children with Autism Spectrum Disorder. Pilot study of 2 cases. The Journal of Alternative and Complementary Medicine 14(8); 1057‐1‐65, 2008.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison 1: Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment; analysis 1.1 ‐ Improvement in Ritvo‐Freeman Real Life Rating Scale (RFRLRS).
4
4
Forest plot of comparison 2: Needle acupuncture plus conventional treatment versus conventional treatment alone; analysis 2.1 ‐ Improvement in Ritvo‐Reeman Real Life Rating Scale (RFRLRS).
5
5
Forest plot of comparison 2: Needle acupuncture plus conventional treatment versus conventional treatment alone; analysis 2.2 ‐ Improvement in Autism Treatment Evaluation Checklist (ATEC).
1.1
1.1. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 1 Improvement in Ritvo‐Freeman Real Life Rating Scale (RFRLRS).
1.2
1.2. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 2 Improvement in Aberrant Behavior Checklist (ABC).
1.3
1.3. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 3 Improvement in Reynell Language Developmental Scale (RDLS).
1.4
1.4. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 4 Improvement in Symbolic Play Test (SPT).
1.5
1.5. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 5 Improvement in Griffiths Mental Developmental Scale (GMDS).
1.6
1.6. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 6 Improvement in Leiter International Performance Scale‐Revised (Leiter‐R).
1.7
1.7. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 7 Improvement in Functional Independent Measure of children (WeeFIM).
1.8
1.8. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 8 Improvement in Pediatric Evaluation of Disability Inventory (PEDI).
1.9
1.9. Analysis
Comparison 1 Needle acupuncture plus conventional treatment versus sham acupuncture plus conventional treatment, Outcome 9 Frequency of improvement in Clinical Global Impression Scale (CGIS).
2.1
2.1. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 1 Improvement in Ritvo‐Reeman Real Life Rating Scale (RFRLRS).
2.2
2.2. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 2 Improvement in Autism Treatment Evaluation Checklist (ATEC).
2.3
2.3. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 3 Improvement in Aberrant Behavior Cheklist (ABC).
2.4
2.4. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 4 Improvement in Autism Diagnostic Observation Scale (ADOS).
2.5
2.5. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 5 Frequency of improvement in Autism Behavior Checklist.
2.6
2.6. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 6 Post‐treatment Autism Behavior Checklist score.
2.7
2.7. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 7 Frequency of improvement in Social Adaptive Behavior Scale (SABS).
2.8
2.8. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 8 Improvement in Social Adaptive Behavior Scale (SABS).
2.9
2.9. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 9 Improvement in Symbolic Play Test (SPT).
2.10
2.10. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 10 Improvement in Reynell Language Developmental Scale (RLDS).
2.11
2.11. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 11 Post‐treatment Arabic Language Test (ALT) score.
2.12
2.12. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 12 Post‐treatment Peabody Picture Vocabulary Test (PPVT) score.
2.13
2.13. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 13 Frequency of improvement in Chinese version of Psychoeducational Profile (CPEP).
2.14
2.14. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 14 Improvement in Chinese version of Psychodeducational Profile (CPEP) score.
2.15
2.15. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 15 Improvement in Functional Independence Measure of Children (WeeFim).
2.16
2.16. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 16 Improvement in Functional Independence Measure of children (WeeFim): sensitivity analysis excluding trials with inadequate allocation concealment or blinding.
2.17
2.17. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 17 Clinical Global Impression Scale (CGIS) score.
2.18
2.18. Analysis
Comparison 2 Needle acupuncture plus conventional treatment versus conventional treatment alone, Outcome 18 Frequency of improvement in Clinical Global Impression Scale (CGIS).
3.1
3.1. Analysis
Comparison 3 Acupressure plus conventional treatment versus conventional treatment alone, Outcome 1 Frequency of improvement in China Rehabilitation Research Council (CRRC) sign‐significance relations scale.
3.2
3.2. Analysis
Comparison 3 Acupressure plus conventional treatment versus conventional treatment alone, Outcome 2 Frequency of improvement in basic developmental assessment.
3.3
3.3. Analysis
Comparison 3 Acupressure plus conventional treatment versus conventional treatment alone, Outcome 3 Improvement in Parents' Rating Questionnaire.
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Update of

  • doi: 10.1002/14651858.CD007849

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