Can acupuncture treat autism?

Tiejun Tang

This week is the World Autism Awareness Week. It's estimated about 1 in every 100 people in the UK is autistic. More boys and men are diagnosed with autism than girls and women.

There is currently no effective medication to treat autism. Applied Behaviour Analysis (ABA) is often used in schools and clinics to help autistic children. In recent years stem cell therapy is applied to autism treatment, but its effect is still uncertain according to the latest report. ^[1]

Can acupuncture help autism patients? How can it help? What is the best treatment approach for autism? The following evidence based research reports will answer these questions.

Does it work?
Chen WX^[2] reported 2 cases of child autism spectrum disorder (ASD) treated with electro acupuncture. After 24 sessions over 8 weeks treatment positive changes in "irritability" and "stereotypy" were noted in case 1, and positive changes were found for both cases in "sensory motor," "sensory response".The positive changes in case 1 included much improved "social relatedness, communication, and stereotypy behaviour"; Allam H^[3] used scalp acupuncture to treat 20 ASD children.The results showed a significant improvement in cognitive and expressive language skills after treatment; Chan AS^[4] reported a randomized clinical trial (RCT). They applied seven-star needletotreat 32 children with ASD and the results showed that the treatment group demonstrated significant improvement in language and social interaction, but not in stereotyped behaviour or motor function, compared to the control group.

Wong VC^[5] reported a randomized, double-blind, sham-controlled, clinical trial. Children with ASD were randomly assigned to an electro-acupuncture (EA) group or a sham electro-acupuncture (SEA). After a four-week (12 sessions) course of electro-acupuncture the results showed there were significant improvements in the language comprehension domain, self-care caregiver assistant domain in the EA group compared to the SEA group. As for the parental report, the EA group also showed significantly better social initiation, receptive language, motor skills, coordination, and attention span.

Lee MS. ^[6] aimed to assess the effectiveness of acupuncture as a treatment for ASD.They searched 15 databases,11 RCTs. Two RCTs found that acupuncture plus conventional language therapy was superior to sham acupuncture plus conventional therapy. Two other RCTs found that acupuncture produced significant effects compared with conventional language therapy or complex interventions. Three RCTs suggested that acupuncture plus conventional therapies had beneficial effects compared with conventional therapy alone. Four more RCTs reported that subjects who received acupuncture experienced significant effects compared with subjects who were waitlisted or received no treatment. The results of these studies provide mixed evidence of acupuncture's effectiveness as a treatment for ASD symptoms.

Lee B^[7] searched 13 databases published up to December 2016. Twenty seven RCTs were included and 1736 participants were investigated. The outcome measures were the overall scores on scales evaluating the core symptoms of ASD and the scores for each symptom, such as social communication ability and skills, stereotypies, language ability, and cognitive function. The results showed that acupuncture complementary to behavioural and educational intervention significantly decreased the overall scores on the Childhood Autism Rating Scale (CARS) and the Autism Behaviour Checklist. Acupuncture as a monotherapy also reduced the overall CARS score.

How it works?

Zhao ZQ^[8] used electro-acupuncture to treat 55 childhood with autism (4.52±2.73 years). All patients were examined by single photon emission computed tomography (SPECT) before and after treatment to evaluate its effectiveness. The results showed that intracerebral multiple focal radioactivity distribution defect areas of autism patients were observed to be partially filled. Significant differences in the ratios of regional cerebral blood flow and global cerebral blood flow before and after treatment were observed. The symptoms of patients also improved.Khongrum J^[9] applied laser acupuncture at HT7 to treat the Valproic Acid-Rat Model of Autism. The results showed that laser acupuncture HT7 decreased oxidative stress, interleukin 6 (LI-6) gene expressions, and gamma-aminobutyric acid transaminase T (GABA-T) activity but increased the expressions of glutamic acid decarboxylase (GAD) proteins together with the density of Purkinje cells in the cerebellum. Therefore, laser acupuncture at HT7 is the potential strategy to improve the cerebellar disorders in VPA-rat model of autism.

Zhang R^[10] applied transcutaneous electrical acupoint stimulation (TEAS) to treat 76 autistic children, the plasma level of arginine-vasopressin (AVP) and oxytocin (OXT) were detected before and after treatment. The result found the AVP and OXT level was significantly higher in the TEAS group than in the control group. Li LY^[11]analyzed the molecular mechanism of acupuncture treated ASD, because acupuncture can induce activation gene expression of brain-derived neurotrophic factor (BDNF) in many neurological disorders. In view of these findings, they hypothesise the potential therapeutic effect of acupuncture-induced activation of BDNF in the treatment of ASD.

What is the best protocol ?

Abo Almaali ^[12] analyzed acupuncture point's combination and protocols of thirteen articles. The most frequently used acupuncture points are EX-HN1 (5), GV-17 (4), PC-6 (4), LR-3 (3), KI-3 (3), HT-7 (3), Lu-9 (3), GV-20 (2), GV-24 (2), GV-24.5 (2), GB-13(2), GB-19 (2), KI-4 (2), LR-4 (2), ST-36 (2), SP-3 (2), SP-6. The most frequently used meridians are Du meridian (12), Gallbladder meridian (9), Kidney meridian (8), Pericardium meridian (7), Extra points (7), Liver meridian (7), Heart meridian (6), Ren meridian (6), and Bladder meridian (6).

Why it can help?

The clinical manifestation of autism was described in traditional Chinese medicine classics of thousand years ago. It was called Wu Chi (five retardations). TCM theory believes the five retardations were due to kidney essence deficiency. Kidney essence can nourish the brain. Du meridian is an important connection between kidney and brain. Brain development also relies on the normal function of each organ. Acupuncture can balance yin-yang and regulate the function of zang fu organs by stimulating certain points on certain meridians. That is why it can give a lot of help in autism treatment. 

Reference: 

1. Dario Siniscalco. Stem cell therapy in autism: recent insights. Stem Cells Cloning. 2018; 11: 55–67.
2. Chen WX. Electroacupuncture for children with autism spectrum disorder: pilot study of 2 cases. J Altern Complement Med. 2008; 14(8):1057-65.
3. Allam H. Scalp acupuncture effect on language development in children with autism: a pilot study. J Altern Complement Med. 2008; 14(2):109-14.
4. Chan AS. Seven-star needle stimulation improves language and social interaction of children with autistic spectrum disorders. Am J Chin Med. 2009; 37(3):495-504.
5. Wong VC. Randomized controlled trial of electro-acupuncture for autism spectrum disorder. Altern Med Rev. 2010; 15(2):136-46.
6. Lee MS. Acupuncture for children with autism spectrum disorders: a systematic review of randomized clinical trials. J Autism Dev Disord. 2012 Aug; 42(8):1671-83. doi: 10.1007/s10803-011-1409-4.
7. Lee B The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2018 Jan 11; 2018:1057539.
8. Zhao ZQ. Evaluating the effectiveness of electro-acupuncture as a treatment for childhood autism using single photon emission computed tomography. Chin J Integr Med. 2014; 20(1):19-23.
9. Khongrum J. Laser Acupuncture at HT7 Improves the Cerebellar Disorders in Valproic Acid-Rat Model of Autism. J Acupunct  Meridian Stud. 2017;10 (4):231-239.
10.  Zhang R. Transcutaneous electrical acupoint stimulation in children with autism and its impact on plasma levels of arginine-vasopressin and oxytocin: a prospective single-blinded controlled study. Res Dev Disabil. 2012; 33(4):1136-46.
11.  Li LY. Could acupuncture have a role in the treatment of autism spectrum disorder via modulation of BDNF expression and activation? Acupunct  Med. 2014; 32(6):503-5.
12. Abo Almaali. Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. J Acupunct Meridian Stud. 2017; 10(6):375-384.