Scalp acupuncture treatment for children's autism spectrum disorders: A systematic review and meta-analysis

Abstract

Background: Autism spectrum disorder (ASD) is a neurodevelopment disorder without definitive cure. Previous studies have provided evidences for efficacy and safety of scalp acupuncture in children with ASD. However, the efficacy of scalp acupuncture treatment (SAT) in children with ASD has not been evaluated systematically. The objective of this study is to evaluate the efficacy of SAT in children with ASD.

Methods: Information from 6 databases, including MEDLINE, EMBASE, Cochrane database, AMED, China National Knowledge Infrastructure, and Wanfang Data, were retrieved from the inception of each database from 1980 through September 2018. Randomized controlled trials evaluating the efficacy of SAT for patients with ASD were included. The primary outcome measures were the Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). The secondary outcome measures were Psychoeducational Profile (Third Edition) (PEP-3) scores. Risk of bias assessment and data synthesis were conducted with Review Manager 5.3 software. Methodological quality was assessed with the Cochrane risk of bias tool.

Results: Fourteen trials with 968 participants were conducted and 11 of the trials were suitable for meta-analysis. Compared with behavioral and educational interventions, SAT significantly decreased the overall CARS scores for children under 3 years old (mean difference (MD) = 3.08, 95% confidence interval (CI) [-3.96, -2.19], P < .001) and above 3 years old (MD = 5.29, 95% CI [-8.53, -2.06], P < .001), ABC scores (MD = 4.70, 95% CI [-6.94, -2.79], P < .001). Furthermore, SAT significantly improved PEP-3 scores in communication (MD = 3.61, 95% CI [2.85, 4.37], P < .001), physical ability (MD = 2.00, 95% CI [1.16, 2.84], P < .001), and behavior (MD = 2.76, 95% CI [1.80, 2.71], P < .001).

Conclusion: SAT may be an effective treatment for children with ASD. Given the heterogeneity and number of participants, randomized controlled trials of high quality and design are required before widespread application of this therapy.

Figure 1

PRISMA flow chart of the literature screening and selection process.

Figure 2

Methodological quality graph.

Figure 3

Methodological quality summary.

Figure 4

Forest plot for the CARS score. CARS = Childhood Autism Rating Scale.

Figure 5

Forest plot for the ABC score. ABC = Autism Behavior Checklist.

Figure 6

Forest plot for the PEP-3 score in communication. PEP-3 = Psychoeducational Profile (Third Edition).

Figure 7

Forest plot for the PEP-3 score in physical ability.

Figure 8

Forest plot for the PEP-3 score in physical behavior.