New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

Part 4: Treatment and management of ASD
Part 4
Dimethylglycine (DMG)
Dimethylglycine is closely related to the
inhibitory neurotransmitter, glycine. It is
readily available from health-food shops in
New Zealand. Rimland (of the Autism Research
Institute in San Diego) has advocated its use and
there are a large number of anecdotal reports
that DMG is useful. Only one small randomised
controlled trial was found 335 . This did not
demonstrate significant differences between the
groups (Recommendation 4.5.1).
Gluten-casein free diet
In a Cochrane systematic review (updated
2004) of gluten and casein free diets in ASD,
only one small trial (n=20) met the criteria
for inclusion 336 . Three of the four outcomes
studied were not significant between groups
but a benefit was found for one outcome,
reduction in autistic traits, on parental report
for participants randomised to the gluten-casein
free diet compared to placebo. The reviewers
concluded that these results added weight to the
existing anecdotal evidence but that there was
insufficient evidence for clinicians to advise the
use of gluten-casein free diets for individuals
with ASD and more adequately powered
research was needed (Recommendation 4.5.1).
Omega-3/long chain polyunsaturated
fatty acids
There is current interest in the role of
polyunsaturated fatty acids (PUFA), especially
omega-3 and omega-6 long-chain PUFA (LC-
PUFA), in brain development and function.
A Medline search in July 2005 did not yield
any studies meeting our criteria for review.
The use of these agents cannot currently be
recommended (Recommendation 4.5.1).
Other biomedical treatments have been
tried but there is either insufficient or no
evidence to recommend them. These include
electroconvulsive therapy and cranial
osteopathy. None of these approaches can
currently be recommended.
Other alternative approaches
Facilitated Communication
Facilitated Communication was developed by
Rosemary Crossley in Melbourne. The technique
involves supporting the hand, wrist or arm of
the communicator, pulling back the hand and,
where necessary, helping to isolate the index
finger while the person accesses a word, picture
board or keyboard to communicate. Emotional
support in the form of encouragement is also
supplied by the facilitator. It is intended that the
supports be faded over time. Some qualitative
reports show people have become independent
typists after training with Facilitated
Communication.
There has been considerable controversy about
whether the facilitated output is from the
person with ASD or is under the influence of
the facilitator. A large number of quantitative
studies show facilitator influence 96 . There
is no scientific validation of Facilitated
Communication and it is not recommended
(Recommendation 4.5.2).
Auditory integration training (AIT)
This is a procedure to retrain the auditory
system in an attempt to address hearing
abnormalities and to effect positive behaviour
changes for people with ASD. Anecdotal
reports of negative side effects, such as hearing
loss, have raised a number of ethical questions
regarding its use and it has been suggested that
the nonstandardised and unregulated use of
AIT may place individuals using this treatment
at risk 337 . A Cochrane systematic review of
AIT studies with a number of methodological
flaws concluded that there is no clear evidence
for auditory integration therapy nor does
the procedure provide beneficial changes to
behaviours of people with ASD 338 . The review
concluded that further research is required to
determine the effectiveness of sound therapies
and that, in the absence of evidence, the
treatment must be considered experimental
and parents should be made aware of the
cost of treatment. The American Academy of
Pediatrics also suggests that the use of AIT
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New Zealand Autism Spectrum Disorder Guideline