Acupuncture is effective for the treatment of autism spectrum disorder (ASD). In a double-blind randomized controlled trial, University of Hong Kong researchers reveal that electroacupuncture improves core functions in children with ASD, especially language comprehension and self-care ability. True acupuncture was compared with sham acupuncture and only true acupuncture provided significant clinical outcomes. Based on the evidence, University of Hong Kong researchers conclude that “acupuncture might be a useful adjunctive therapy in early interventional programs for children with ASD.” [1]
The research is among the first double-blind randomized clinical trials investigating the efficacy and safety of electroacupuncture for the treatment of ASD. Earlier trials primarily focused on tongue or manual scalp acupuncture. In this investigation, the University of Hong Kong researchers implemented acupuncture with electric stimulation. The research team chose electroacupuncture baed on the findings of Chen et al., whose research indicates that a short, intensive course of electroacupuncture potentially improves some specific features in children with ASD. [2]
Design
University of Hong Kong researchers (Wong et al.) used the following study design. A total of 55 patients participated in the study and underwent post-treatment assessment. They were diagnosed and treated for ASD at the Duchess of Kent Children’s Hospital.
Subjects were divided into two arms. The treatment group received true electroacupuncture (EA), which was administered at acupoints based on a previous pilot study. The second arm was given sham electroacupuncture (SEA). Both groups received electric stimulation. Inclusion criteria were based on the following:
- Diagnostic and Statistical Manual (DSM-IV)
- Autism Diagnostic Interview-Revised (ADI-R)
- Autism Diagnostic Observation Scale (ADOS)
- Ages 3–18 years
Exclusion criteria were applied. Patients having taken anti-epileptic drugs or having received acupuncture in the preceding six months did not participate in the study.
Acupuncture Points
EA and SEA patients received three sessions of electroacupuncture treatments weekly on alternate days, for a total of 4 weeks. Each acupuncture treatment lasted 30 minutes and a total of 12 acupuncture sessions were provided. Participants received no sedation. Children were allowed to stay with their parents or caretakers throughout the acupuncture course of care. Patients receiving true acupuncture were needled at the following acupuncture points:
- EX-HN1 (Sishencong)
- M-HN-3 (Yintang)
- PC6 (Neiguan)
- HT7 (Shenmen)
- LV3 (Taichong)
- SP6 (Sanyinjiao)
- AT3 (Ear Naodian)
- TF4 (Ear Shenmen)
Treatment commenced with patients in either a supine or sitting position. After disinfection of the acupoint sites, a 0.30 mm × 40 mm disposable filiform needle was inserted into each acupoint to a standard depth. Once a deqi sensation was obtained, the needles were connected to an electroacupuncture device (model Hwato SDZ-II, Suzhou Medical Appliance Factory, China) with a disperse-dense wave. Once the electric stimulation began, the needles were retained for 30 minutes.
For the sham acupuncture group, the total number of needles, electroacupuncture settings, and duration of treatment time were identical to those of the true acupuncture group; however, sham acupuncture patients received needling at non-meridian sites that were 3–5 cm lateral to the selected acupoints for the true acupuncture group. Both groups received conventional intervention or educational programs for ASD. Two patients from the EA group also received neuroleptic drugs during the study.
Basis
The researchers provided the Traditional Chinese Medicine (TCM) basis for understanding ASD. ASD is categorized as “childhood disturbance.” The main treatment principle is to “awake, assist, and calm the mind, as well as enlighten the mentality and improve the developmental profile.” Primary acupoints were selected from scalp acupoints: Sishencong (EX-HN1), Yintang (EX-NH3). Auricular acupoints were added: Ear Naodian (AT3), Ear Shenmen (TF4).
The researchers selected secondary acupoints to complement the primary points. These points were located on the heart (Shenmen, HT7), pericardium (Neiguan, PC6), liver (Taichong, LV3), and spleen (Sanyinjiao, SP6) channels. The researchers note that “needling these acupoints can make the heart unobstructed, regulate the liver, correct derangements or imbalances, reinforce emotions, dredge stasis, invigorate the spleen and kidneys, and facilitate the source of vital function.”
Evaluations
Multiple instruments were used to measure patient outcomes. The researchers provided the reasons for adopting a comprehensive panel of assessment tools. They note, “Since ASD is a heterogeneous disorder with comorbidities, and there is a lack of a single assessment tool, it is difficult to test the efficacy of a particular therapy.” The researchers add that the measurement tools were chosen based on the researchers’ 25 years of experience with ASD interventions. In addition, assessment tools were applied by parents and professional assessors that were blind to the allocation of groupings. Parents were instructed on how to properly use the assessment tools.
The following outcome measures were provided by parents: Aberrant Behavioral Checklist (ABC), Ritvo-Freeman Real Life Scale (RFRLS), Pediatric Evaluation Disability Inventory (PEDI), Clinical Global Impression-Improvement (CGI-I), parental report. The following outcome measures were performed by assessors: Leiter International Performance Scale-Revised (Leiter-R), Functional Independence Measure for Children (WeeFIM), Reynell Developmental Language Scale (RDLS). The researchers note, “ABC and RFRLS were used to assess core autistic features, PEDI and WeeFIM examined functional abilities, RDLS assessed language, Leiter-R was used to study cognition, and CGI-I assessed global impression.”
Significant improvements were seen in the language comprehension domain of WeeFIM (p=0.02), self-care caregiver assistant domain of PEDI (p=0.028), and CGI-I (p=0.003) in the true EA group compared with the sham group. Based on the parental report, there were significant improvements in social initiation (p=0.01), receptive language (p=0.006), motor skills (p=0.034), coordination (p=0.07), and attention span (p=0.003) in the true EA group compared with the sham group.
Acupuncture compliance and side effects were recorded after treatment completion. In this study, acupuncture compliance was defined as “subjects were able to sit or lie on a couch to accept acupuncture, even if they cried or needed a gentle hand or head holding.” Good compliance meant that subjects were “able to accomplish this within the first three sessions, while poor compliance was defined as subjects “being unable to sit or lie on the couch for treatment for nine or more sessions.” The researchers note, “More than 70 percent of children with ASD adapted to acupuncture with good compliance, while only eight percent demonstrated poor acupuncture compliance.” As for side effects, “Only mild side effects of minor superficial bleeding or irritability during acupuncture were observed.” The researchers conclude, “A short, four-week (12 sessions) course of electroacupuncture is useful to improve core functions in children with ASD, especially for language comprehension and self-care ability.”
Results
The researchers reference a report noting that “About 40% of ASD children have used complementary and alternative medicine, with acupuncture being the most common modality." [3] The results of the current investigation showed significant changes in favor of true acupuncture treatment, including improvements in language comprehension, self-care assistance, social initiation, receptive language, motor skills, coordination, and attention span. They add that most patients demonstrated good compliance with very limited side effects.
Notes
[1] Wong V, Chen W X, Liu W L. Randomized Controlled Trial of Electro-Acupuncture for Autism Spectrum Disorder [J]. Alternative Medicine Review, 2010, 15( 2) :136－146.
[2] Chen W X, Liu W L, Wong V. Electroacupuncture for children with autism spectrum disorder: pilot study of 2 cases [J]. The Journal of Alternative and Complementary Medicine， 2008, 14(8) :1057－1065.
[3] Wong VC. Use of complementary and alternative medicine (CAM) in autism spectrum disorder (ASD): comparison of Chinese and Western culture (Part A). J Autism Dev Disord 2009;39:454-463.
