What is complementary and alternative medicine (CAM)?
Many families of children with autism spectrum disorders (ASDs) have questions about other types of interventions for symptoms of ASDs. They may read about these on the Internet or hear about them from other parents.
Complementary medicine refers to practices that are used in addition to the educational, behavioral, and medical interventions recommended by your child's pediatrician and schools.
Alternative medicine refers to practices that are used in place of the recommendations of your child's pediatrician.
When traditional and complementary practices are used together, it is sometimes called integrative medicine.
Pediatricians are trained to recommend evidence-based interventions for which scientific studies have been done to see if they are effective and safe. Studies are being done to examine CAM therapies that can help determine which interventions are safe and effective.
Complementary and alternative medicine is often separated into the following categories:
Biological. Examples include supplements, diets, and medicines. They are often directed at beliefs about immunologic problems, intestinal problems, metabolic imbalances, and regulation of brain chemicals. These theories differ from conventional understanding of metabolic disease in scientific literature and are based on observation or alternative interpretations of medical literature.
Mind-body medicine. Examples include biofeedback, auditory integration training, and optometric exercises.
Manipulation. Massage and craniosacral manipulation are 2 examples.
Energy medicine. One example is qigong.
How do we learn about CAM and alternatives to traditional medicine and educational practices?
Most families learn about nontraditional approaches on the Internet, in books and other media, and from other families. There are still few studies in peer-reviewed scientific journals. Peer-reviewed means that other scientists have examined the studies and felt that they supported the claims of the authors.
You will want to understand the evidence supporting any therapy you are interested in for your child. Questions you might ask include
Has it been published in a medical or psychological journal?
How good was the study? Did it have enough children in it to make the claims it made? Was the intervention the same for all children? Was there a placebo (substitute with no expected effect, like a sugar pill) so that the results could be compared with results of children not receiving the intervention but receiving similar attention? Did the children receive other interventions that would affect the result?
Will my insurance cover it? How much will it cost? Most health care insurers will not cover interventions that are not evidence based.
Will my child miss therapy or have to stop other effective interventions to use it?
What are the side effects? (Every intervention has some potential side effects.)
How do we decide to use a CAM therapy?
Many adults in the United States use CAM themselves. Parents who use CAM are more likely to use it with their children.
You need to examine evidence for the therapy that you are interested in and decide if you think that the chance for benefit is great enough to accept the cost and risks.
Because there is little science to guide parents in CAM use, it is important to introduce any intervention that you choose to use in a stepwise fashion. It is also important to let your pediatrician know of any CAM therapies you are considering.
Children with ASDs learn skills and mature, so over time many children may appear to improve whether or not CAM is used. Stopping interventions should also occur in a stepwise fashion to see if the changes were due to the CAM intervention.
Are CAM therapies harmful?
No one knows the long-term effects of high-dose vitamins or supplements in young children. Some vitamins may be given at doses high enough to cause side effects. Dietary restriction might also decrease needed nutrients by mistake.
Some CAM therapies, like chelation and intravenous immunoglobulin, have known side effects and may place a child at risk. Their use should be limited to medical indications. Others, like stem cell therapy and hyperbaric oxygen, have no clinical indication for ASD at this time and carry risk.
There are many CAM therapies that are expensive, and each family must decide the potential effect of cost.
Should we tell our child's pediatrician if we are planning to or using CAM with our child?
Many families do not think that their pediatrician needs to know about CAM because it is usually obtained without a prescription or from a complementary provider. Families may be concerned that their pediatrician may be unaware or disapproving of the intervention.
It is important to tell your pediatrician about all the interventions you are using for your child so you can jointly monitor for side effects and potential interactions with other medications or therapies your child receives. If your child is on the gluten-free and casein-free diet, for example, your pediatrician can help you determine if your child is getting enough calcium and vitamin D and refer you to a registered dietitian if there are any concerns.
In a medical home, families and doctors partner to plan health care. As such, it is important for families and pediatricians to have an open dialogue about complementary interventions. While your doctor may not agree that the intervention you wish to try has the necessary scientific evidence to support its use, you need to discuss it so your doctor can help you monitor your child for side effects or response. You and your child's pediatrician are partners in your child's health care. As such, it is important to have an open dialogue so you can provide a positive and safe outcome for your child.
American Academy of Pediatrics HealthyChildren.org: www.HealthyChildren.org
Freeman SK. The Complete Guide to Autism Treatments: A Parent's Handbook Make Sure Your Child Gets What Works! Bellingham, WA: SKF Books; 2011
Interactive Autism Network Vitamins and Other Nutritional Supplements: www.iancommunity.org/cs/what do we know/vitamins_and_supplements
Kaiser Permanente Complementary and Alternative Medicine (CAM) for Autism Spectrum Disorders (ASDs): www.permanente.net/homepage/kaiser/pdf/6l682.pdf
Family handout from Autism: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians, 2nd Edition, developed by the American Academy of Pediatrics (AAP) Council on Children With Disabilities Autism Subcommittee (ASC).