Autism spectrum disorders (ASD) are lifelong disorders of development. People with ASD have particular difficulties with social interaction and communication and they lack flexibility in their thinking and behavior. No cure is currently available but interventions may improve symptoms. Acupuncture involves using needles or pressure on specific areas of the body and is an important therapeutic method in Traditional Chinese Medicine. It is also being used more and more in countries in the west for a range of ailments. Acupuncture has been considered as a possible intervention to improve ASD symptoms, but it has not been thoroughly evaluated to see if it works and is safe.
We wanted to evaluate the effectiveness and safety of acupuncture for ASD by systematically reviewing all studies of acupuncture for ASD where people were randomly allocated to a treatment or control group (placebo, sham or no treatment), i.e. randomized controlled trials (RCTs). We searched through 15 databases, most recently in September 2010, and read over the titles and abstracts to make sure we identified everything relevant. We found10 RCTs to include in this review. These studies, which were carried out in Hong Kong, mainland China and Egypt, involved 390 children aged between three and 18 years.
Two studies compared needle acupuncture with sham acupuncture and found no difference in core autistic features. Results did suggest that needle acupuncture might be associated with improvement in other areas of communication and linguistic ability, cognitive function and global functioning.
Six studies compared needle acupuncture plus conventional treatment with conventional treatment alone. They used a range of tools to measure core autistic features and most could not show that acupuncture led to improvement in these. One trial did report, though, that needle acupuncture led to an improvement in scores on Autism Behavior Checklist. There was no evidence for improvement due to acupuncture on communication and linguistic ability but it might be beneficial for cognitive function and global functioning.
Two studies compared acupressure plus conventional treatment with conventional treatment alone and found no difference in core autistic features, although acupressure seemed to improve some aspects of the secondary outcomes.
Problems that were noted by parents of study participants included crying due to fear or pain, bleeding, sleep disturbance and increased hyperactivity. It is unclear if these were due to the acupuncture treatment. Half of the trials reported some negative effects but did not report how often or how severe these were and sometimes the problems occurred in both the treatment and control groups. None of the studies used measures of quality of life.
Overall, acupuncture did not seem to be effective in improving core features of ASD but it might have improved certain developmental and functioning outcomes, at least in the short term.
There are problems with assessing acupuncture due to the quality of the evidence. There were a small number of studies and they were all conducted with children. Moreover, there is a high likelihood that they may have been biased due to the methods used not being rigorous enough, the wide variety in the people and interventions in the studies, the inconsistent and imprecise reporting of results and the large number of analyses carried out, which make it more likely a significant result will be found just by chance.
In conclusion, current evidence does not support the use of acupuncture for the treatment of ASD. We need high quality trials of larger size and longer follow-up as the evidence base at present has many limitations.