自閉症児の親は代替療法に頼る傾向に（米国）

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自閉症児の親は代替療法に頼る傾向に

自閉症児5人のうち約1人が、神経発達障害に対して代替療法を用いており、特別食の利用が最も多いことが、カナダ、バンクーバーで開催された米国小児科学会（PAS）年次集会で報告された。

自閉症スペクトラム障害児1,212人を対象とした研究の結果、約17％が特別食を用いており、半数以上が小麦や乳製品を除いた無グルテン、無カゼイン食を摂取していた。他に多くみられた食事法の変更としては、加工糖を避けることや、腸内細菌叢（そう）の維持に有用と思われるヨーグルトなどの微生物のプロバイオティクスやサプリメントの摂取があった。

研究支援団体である米オーティズム・スピークスAutism Speaks（ニューヨーク）自閉症治療ネットワーク（ATN）医長で、米オハイオ州立大学小児精神医学科教授のDaniel Coury博士は「従来の治療が有効でなかったり、高価すぎる場合に、補完代替療法のほうが自然であると思えば、人はそれに頼るようになる」と述べている。

親たちが自閉症児に試みさせている他の代替療法は、高圧酸素療法や体内から重金属を除去するキレート療法など多岐に及んでいたが、1％未満の保護者しか試していなかった。Coury氏は「これらが有効であるエビデンス（科学的根拠）はなく、危険性を示すエビデンスもあるため、これは良いことである」と述べている。

同集会で発表された別の研究では、ATNに登録した小児1,185人の家族が消化管（GI）症状、行動、睡眠、QOL（生活の質）に関する質問票に記入。その結果、約45％の小児に腹痛や便秘、下痢などのGI症状がみられ、年齢が上がるほど多く、5歳未満で約9％、7歳以上で51％に認められた。また、GI症状のある小児の約70％に睡眠障害を認めたが、問題のない小児では30％であった。さらに別の研究では、GI障害児には睡眠不足が原因と思われる行動問題も多いことが示唆された。

米ケネディ・クリーガー研究所（ボルチモア）のPaul Law博士は「ある治療法が有効であるという医学的証拠はほとんどなく、プラセボ効果が強い可能性がある。有効性が示されているものには、行動的介入と、攻撃性や他の行動の問題の予防に有用な薬物療法がある」という。自閉症スペクトラム障害児の約27％が1種類以上の薬剤を服用しているとの研究も報告された。
（软件译：服用药物儿童中，有将近一半服用两种或两种以上的药物。
药物的使用变得更为常见，因为孩子上了年纪，研究发现。吃药，大约60％的11岁及以上的儿童相比，44％的6至10岁的儿童，3至5岁儿童11％的，孩子年龄小于3岁为4％。
最常见的药物是兴奋剂治疗注意力障碍（ADHD）和利培酮（维思通），批准由美国食品和药物管理局，治疗烦躁，侵略，发脾气和自伤行为。）（HealthDay News 2010-5月2日）

（英文原文：Parents of Autistic Children Turning to Alternative Treatments
Little research supports most options, but families driven by need to help, experts say
Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. Questions about personal health should always be referred to a physician or other health care professional.

By Jenifer Goodwin
HealthDay Reporter
SUNDAY, May 2 (HealthDay News) -- About one in five children with autism uses alternative treatments to help with the neurodevelopmental disorder, most often a special diet, a new study finds.
Of 1,212 children with an autism spectrum disorder included in the study, about 17 percent were on special diets. More than half of those were on a gluten-free, casein-free diet, which eliminates wheat and dairy products. Other common dietary changes included avoiding processed sugars and taking probiotics, microorganisms found in foods such as yogurt and supplements that may help maintain gut bacterial flora.
" People turn to complementary and alternative treatments anytime they perceive conventional medical treatments as either not doing the job or being too expensive, or that the complementary and alternative treatments are more natural," said Dr. Daniel Coury, medical director of the Autism Treatment Network and a professor of pediatrics and psychiatry at Ohio State University. "We see the same sorts of reasons among children on the spectrum."
The study was to be presented Sunday at the Pediatric Academic Societies' annual meeting in Vancouver, British Columbia, Canada.
Other alternative treatments parents reported trying for their kids ran the gamut from hyperbaric oxygen, which involves pressurized chambers with oxygen-rich air that usually are used to treat divers with the bends, to chelation therapy, a treatment that removes heavy metals from the body. That treatment stemmed from fears that mercury causes autism, Coury said.
Despite significant publicity about the methods, less than 1 percent of parents had tried them, the study found. And that's a good thing, Coury said, because there's no evidence that either works and some evidence that they might be dangerous.
Parents might be turning to special diets because of reports that autistic children are more prone to gastrointestinal (GI) problems. Though earlier studies have had mixed results about the prevalence of GI issues, a second study also slated for presentation at the meeting found that parents reported GI symptoms in nearly half of the children.
For that study, families of 1,185 children enrolled in the Autism Treatment Network filled out questionnaires about GI symptoms, behavior, sleep and quality of life.
About 45 percent reported their children had GI symptoms, such as abdominal pain, constipation and diarrhea. The problems were more common as children got older, affecting about 9 percent of children younger than 5 and 51 percent of children 7 and older.
Their symptoms were bad enough to affect the quality of their lives, with about 70 percent of children with GI symptoms having sleep problems, compared with 30 percent who didn't have GI issues, the study found.
Kids with GI issues also have more behavioral issues, possibly because of their lack of sleep, suggests a third study from the meeting, which included 1,056 children in the Autism Treatment Network. It found an association between sleep problems and behavioral issues that included emotional problems and anxiety.
Autism is a complex disorder, and parents are driven by the desire to help their children, said Dr. Paul Law, director of the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore. He said he's seen hundreds of alternative treatments tried by parents: supplements and vitamins, acupuncture, acupressure, bathing in distilled water and various types of animal therapy, among them. One mother, Law said, had tried 68 different methods.
Though it's not hard to find testimonials about the effectiveness of one treatment or another, medical evidence that they work is scanty, and the placebo effect can be powerful, Law said.
"There is an adage in medicine that the more you don't know about how to treat something, the more treatments there are," Law said, noting that medications can treat some of the symptoms of autism, but no medication treats the autism itself.
Coury agreed. "For the majority of these treatments, there is no good research to support their effectiveness," he said.
Treatments that have been shown to work include behavioral interventions and medications that can help curb aggressive and other behavioral issues, Law said.
About 27 percent of children with an autism spectrum disorder are taking at least one medication to manage their behavior, according to a fourth study from the meeting. It found that the most common reasons for medication use were hyperactivity, repetitive behaviors, irritability and problems with attention.
Of the children taking medications, nearly half were taking two or more medications.
Medication use became more common as children got older, the study found. About 60 percent of children aged 11 and older took medication, compared with 44 percent of children aged 6 to 10, 11 percent of children aged 3 to 5 and 4 percent of kids younger than 3.
The most common medications were stimulants to treat attention-deficit/hyperactivity disorder (ADHD) and risperidone (Risperdal), approved by the U.S. Food and Drug Administration to treat irritability, aggression, temper tantrums and self-injurious behavior.
About one in 110 U.S. children has autism, which is characterized by difficulties with social, language and communications skills and restricted or repetitive behaviors or interests.
The Autism Treatment Network, run by Autism Speaks, a New York-based research and advocacy organization, includes 14 treatment and research centers in the United States and Canada for children with autism who are 2 to 18 years old.
More information
Autism Speaks has more on autism.
SOURCES: Daniel Coury, M.D., medical director, Autism Treatment Network, and professor, pediatrics and psychiatry, Ohio State University College of Medicine, Columbus, Ohio; Paul Law, M.D., director, Interactive Autism Network, Kennedy Krieger Institute, Baltimore; May 2, 2010, presentations, Pediatric Academic Societies annual meeting, Vancouver, British Columbia, Canada
Last Updated: May 03, 2010 ）