The use or misuse of biomedical treatment approaches to autism

Introduction: The need for evidence based recommendations regarding biomedical approaches to autism was felt in view of the significant number of autistic children presenting within the Child Development Assessment Unit, Malta and the interest shown in these approaches by their families and local nongovernmental organisations. Aim: To establish the medical basis of biomedical approaches to treating autism, by establishing which of these approaches are of reported proven efficacy, effectiveness and safety and hence offer recommendations for their use. Methods: An electronic literature search was carried out for supporting evidence-based biomedical approaches in autism, particularly mainstream authoritative national guidelines. Results: No strong recommendation was found to support any of the biomedical approaches to autism addressed in 10 authoritative national guidelines from 1999 to 2011. The evidence and recommendations were against using chelation, immunoglobulin therapy, secretin, amantadine, antifungal/yeast therapies, naltrexone, dimethylglycine, vancomycin, digestive enzyme supplements and donepezil. Melatonin for sleep disturbances and to a lesser degree, Omega-3 fatty acids for hyperactivity had enough support to consider their use in autism. The recommendations for gluten/casein diets, and Vitamin B6/magnesium were mostly either indeterminate or negative. Iron, vitamin C, piracetam, pentoxifylline, ketogenic diets, L-carnosine and hyperbaric oxygen therapy could not be safely recommended. Conclusion: The evidence-based literature does not support most biomedical approaches to autism. There is limited support for melatonin and Omega-3 use.peer-reviewe