A landmark review of autism therapies has uncovered that there is no strong evidence that alternative treatments work, and they have not been evaluated for safety.
The most comprehensive analysis of its kind identified several treatments for autism spectrum disorder that showed promise, though their evidence is still considered weak, according to researchers at Paris Nanterre University, Paris Cité University and the University of Southampton.
Oxytocin therapy, an experimental treatment that involves administering the ‘love hormone’ oxytocin, typically via a nasal spray, to improve social and behavioral challenges, emerged with the strongest supporting data.
It was found to produce a small but measurable reduction in repetitive behaviors for autistic adults, though it proved largely ineffective for other characteristic autism symptoms, such as social communication impairments and overall symptom severity, and across different age groups.
Several other therapies, including music therapy and animal-assisted interventions for children, magnetic stimulation for adolescents, physical activity for adults, and melatonin for improving sleep in children, showed significant effects but were backed only by very low-quality evidence, raising uncertainty about their true efficacy.
Professor Richard Delorme, a co-author of the analysis, said: ‘Many parents of autistic children, as well as autistic adults, turn to complementary and alternative medicines hoping they may help without unwanted side effects.
‘However, it is necessary to carefully consider evidence from rigorous randomized trials before concluding that these treatments should be tried.’
Behavioral approaches are the most extensively studied interventions for autism in children, involving reinforcement strategies to increase beneficial behaviors like communication and social skills, and reduce those that may be harmful or interfere with learning.
Although the average age of an autism diagnosis is five, most parents observe early signs, particularly in social skills, by the time their child is two years old (stock)
The umbrella review encompassed 248 individual meta-analyses, which synthesized data from over 200 controlled clinical trials involving more than 10,000 autistic people.
The review evaluated the evidence for 19 complementary, alternative, and integrative medicine (CAIM) interventions, including oxytocin therapy, melatonin, music therapy, animal-assisted therapy and physical activity.
They also considered polyunsaturated fatty acids, dietary supplements theorized to support brain health, transcranial direct current stimulation (tDCS), a non-invasive technique that uses a mild electrical current to modulate brain activity, and repetitive transcranial magnetic stimulation (rTMS), another non-invasive method that uses magnetic pulses to stimulate or inhibit specific brain regions.
Brain stimulation techniques may help autism by modulating abnormal neural activity, either stimulating underactive areas or inhibiting overactive ones, and improving communication and synchronization between brain regions involved in social, communication, and cognitive functions.
The analysis also included a wide range of other therapies, such as secretin, a hormone traditionally produced in the small intestine that plays a role in regulating the digestive system. It was used in the 1990s as an experimental treatment for autism, based on the idea that it might improve gastrointestinal issues and, consequently, behavioral symptoms.
Researchers also investigated acupuncture, Chinese medicine, including herbal mixtures and therapeutic massage, various diets, and hyperbaric oxygen therapy.
The research found that, on average, 54 percent of autistic people use some form of CAIM. In some studies, this figure was as high as 92 percent over a person’s lifetime.
The researchers added: ‘However, many studies and international clinical guidelines indicate a lack of efficacy—and, in some cases, adverse events—for this type of intervention in autism.’
The analysis evaluated alternative treatments based on their impact on both core symptoms of autism and a wide range of associated behaviors.
For core symptoms, the review included social communication impairments, restricted and repetitive behaviors, sensory challenges, and overall symptom severity.
Oxytocin therapy had the strongest evidence but was largely ineffective, showing only a small reduction in repetitive behaviors for autistic adults (stock image)
Several other therapies, like music and animal-assisted interventions for children, magnetic stimulation for teens and physical activity for adults, showed promising results, but findings were supported by very low-quality evidence, making their true effectiveness uncertain (stock)
The review also measured effects on key associated outcomes such as disruptive behaviors, co-occurring conditions, such as anxiety, depression, and ADHD symptoms, adaptive functioning, cognitive abilities, quality of life, and language skills.
The study specifically analyzed improvements in sleep quality and quantity as a secondary outcome of crucial importance, ‘given the significance of sleep for autistic individuals and their families that emerged from the screened papers,’ researchers said.
Professor Samuele Cortese, NIHR Research Professor at the University of Southampton and co-senior author, said: ‘This study shows that when people want to know whether a treatment is effective, they shouldn’t just look at one single study.
‘It’s essential to consider all the available evidence and how good that evidence is. Drawing conclusions from one low-quality study can be misleading.’
The team also created an online platform to make it easier for people to see the evidence they generated on different CAIMS.
Their review WAS published in the journal Nature Human Behavior.
Dr Corentin Gosling, associate professor at the Paris Nanterre University and first author of the study, said: ‘Ultimately, we hope this tool will support autistic people and practitioners in choosing together the best treatment.’
The umbrella review did not explicitly recommend any specific therapies over alternative ones. Still, the researchers suggested that the standard of care should be behavioral, educational, and developmental therapies that have a strong evidence base.
In 2000, about 1 in 150 children received an ASD diagnosis; by 2020, that figure had climbed to 1 in 31, a near-quadrupling that reflects both greater awareness and evolving diagnostic criteria.
The average age for an autism diagnosis is five, though the vast majority of parents notice developmental delays or atypical behavior in their children, particularly around social skills, as early as two years old. And rates at which children are being diagnosed have spiked in recent years.
According to a 2024 analysis of millions of health records, diagnosis rates climbed 175 percent from 2011 to 2022, increasing from 2.3 to 6.3 per 1,000 people across all age groups.
The most significant rise was observed in young adults aged 26 to 34, whose rates jumped 450 percent.
However, children between the ages of five and eight continue to have the highest diagnosis rate, at 30 per 1,000.
A jump in diagnoses has largely been attributed to improvements in screening children, reduced stigma around the diagnosis and greater society-wide awareness.
The precise cause of the condition remains unknown, recent studies indicate that environmental influences, such as exposure to pollution, maternal infections during pregnancy, and advanced parental age, may play a role.
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