164 Jul 2011 Vol 4 No.

3 North American Journal of Medicine and Science

Review

Autism Treatment from Acupuncture Perspective

Jing Liu, MD, PhD, Zeng Xiaoqing, MD, Ping Yao, MD

Although no clinical trials worldwide have presented

ABSTRACT conclusive results on the effectiveness of acupuncture in the
Although acupuncture has been used in the treatment of treatment of autism, some clues can be obtained from the
autism for many years, almost no formal clinical trials clinical studies in the past decade. Reviewing the reports
have been devoted to confirm the effectiveness of the from about 20 clinical trials published in the last 15 years,
acupuncture for the disease in the western countries, with at least 30 cases in each study, the effective rates of
where a big population of children and family have been autism treatment with acupuncture were around 80%.
suffering from the shortage of effective therapy. This However, only a few of them were randomized controlled
review is to summarize the reports from about 20 clinical studies. No obvious side effects or safety concerns have been
trials of acupuncture for autism in the last decade in stated in these studies.1,2,3 Here are a few examples. A 202
China. The results of these reports suggested that case controlled study with autism showed that the effective
acupuncture may be a potentially valuable approach in rate of the symptom improvement by acupuncture was
treating autism. Around 80% symptom improvements 92.3%. Of the 78 and 58 severe patients, there were 92.3%
were stated in most of the studies. The reports also and 40.5% improvements in the acupuncture treatment and
demonstrated that acupuncture may enhance the control group respectively.4 Reported from a 50 case of
efficacies of conventional therapies for autism, such as randomized controlled clinical trials, significant
behavior rehabilitation therapy. It was suggested that the improvements were observed in language comprehension,
effects of acupuncture for autism may be partially related self-care caregiver assistance, social initiation, receptive
with its effects on anti-inflammation and on the language, motor skills, coordination, and attention span,
modulation of the brain signal conductivity, supported by evaluated by the tests of Functional Independence Measure
the research including fMRI. A concept of transcranial for Children (WeeFIM), Pediatric Evaluation of Disability
electrical acupuncture stimulation (TEAS) is proposed. Inventory (PEDI, Clinical Global Impression-Improvement
Compared with the conventional acupuncture technique, (CGI-I) scale, Aberrant Behavior Checklist (ABC), and
TEAS is hypothesized to target directly on the brain Reynell Developmental Language Scale (RDLS). In this
lesions of autism through modulating hyperpolarized or study, acupuncture induced. significant improvements in the
depolarized neurons of the brain, in order to improve the language comprehension domain of WeeFIM (p=0.02), self-
pathological status of autism. Clinical trials are needed to care caregiver assistant domain of PEDI (p=0.028), and CGI-
approve the proposal in the future. I (p=0.003) in the electrical acupuncture group compared to
[N A J Med Sci. 2011;4(3):164-166.] the sham control group.5 In a case of controlled study, 30
sessions of treatments were applied on 32 autism children to
KEY WORDS: Autistic spectrum disorder, acupuncture test the effects of a acupuncture technique of Seven-star
Needle Stimulation for over 6 weeks. The results showed that
The Centers for Disease Control and Prevention have called the acupuncture treatment induced significant improvement
autism a national public health crisis. Due to shortage of in language and social interaction, but not in stereotyped
effective therapeutic options in conventional medicine, many behavior or motor function, monitored by EEG (qEEG) with
interests have shifted to the alternative remedies. Growing the quantitative behavior measurement.6
evidences support that acupuncture may be a potential
effective approach in treating autism. This commentary will The effectiveness of acupuncture was also evaluated in
briefly review the update information of acupuncture on comparison with other conventional medical approach. In a
autism and open the discussions on the clinical study of clinical study of 40 cases, including those with severe autism,
acupuncture for the disease in the future. acupuncture group using JIN's 3-needling technique
presented significant better results than that of the behavior
Received 7/5/2011; Revised 7/25/2011; Accepted 7/25/2011 intervention.7 A report from a four month clinical trial
revealed that acupuncture, compared to piracetam treatment,
Jing Liu, MD, PhD,1 Zeng Xiaoqing, MD,2 Ping Yao, MD1 showed a more significant improvement on the language
1. The Marino Center for Integrative Health, Cambridge, MA comprehension.8 Acupuncture may be also potentially a
2. Cheng Du University of Traditional Chinese Medicine, valuable adjuvant therapy to certain conventional treatments.
Cheng Du, China It was documented that forty autistic children received
rehabilitation training programs of ABA, Conductive
(Corresponding Author) Education Approach and the sensory integration. Twenty of
Jing Liu, MD, PhD those also received acupuncture treatment by end of the
Email: [email protected] rehabilitation training. There was a 55.0% markedly effective
North American Journal of Medicine and Science Jul 2011 Vol 4 No.3 165

rate in the group using additional acupuncture, compared the signal conductivities, particularly, the exaggeration of the
with a rate 15.0% in the group with rehabilitation alone.9 The excitatory signals and deficit of the inhibitory signals during
studies above all selected some of internationally recognized information processing. Such abnormal balance mostly exist
questionnaires to evaluate the changes of psycho-behavior- in the prefrontal and temporal cortex as well as deep nucleis
neural symptoms and the effectiveness rate of acupuncture such corpus callosum.14 In fact, the anti-inflammatory
treatment. Those questionnaires include Aberrant Behavior effects of acupuncture were explored in many studies.15,16
Checklist(ABC), Autism treatment evaluation checklist Acupuncture may down-regulate exaggerated neural activity
(ATEC), Functional Independence Measure for Children and generate a tranquilizing effect by enhancing GABAergic
(WeeFIM), Pediatric Evaluation of Disability Inventory enhancing efficacy.17 The results from Dr. Kathleen Hui’s
(PEDI, Clinical Global Impression-Improvement (CGI-I) fMRI studies further suggested that acupuncture may
scale, , and Reynell Developmental Language Scale (RDLS). modulate the conductivity of cortico – limbic-subcortical
Overall, there is shortage of well designed randomized network.18
controlled clinical trails to evaluate the true values of
acupuncture treatment for the autism. However, the Another new technique used in the autism study was based
information obtained should be enough to encourage further on the discovery that the activity of the sympathetic
investigations. autonomic nervous system is significantly altered in children
with autism. The authors measured 48 acupuncture points on
The selections of acupuncture points have been various in the fingertips by using a biometric device capable of gas
above clinical studies. In general, the acupuncture points discharge visualization (GDV). They found that the psycho-
were selected mostly based on the meridian theory in Chinese emotional and physiological functional states of autism were
medicine. Some of those points are thought act by “waking correlated with the enhanced activities of the autonomic
up the brain and opening the orifice” in the theory. On the nervous system.19
other hand, the relatively newly developed scalp acupuncture
based on the brain anatomy has been commonly used in So far, it seems that acupuncture is a potential approach to
almost every group of clinical studies of autism. The most benefit the children with autism. However, it is clear that the
frequently used points of scalp acupuncture include: (1) ongoing knowledge and techniques of acupuncture need to be
Three Acupoints of the Temple: GB 8, l cun anterior and further studied and improved. For instance, no autism
posterior to GB 8; (2) Three Wisdom Acupoints: GV l 2, research of acupuncture has focused on the digestive system,
bilateral GB 1 3，GV 20; (3) Three Acupoints of Brain: GV although the inflammation in gut system may play an
17, 1．3 cun left and right to GV 1 7; (4) Four Acupoints of important role in the development of autism.20,21,22
the Mind: Ex-HN 1(Si Shen Cong); (5) three points on the Furthermore, acupuncture alone is not a complete solution for
occipital area: GVl5，GB20，GBl2.10 A few years ago, a autism, although many clinical studies suggested potent
randomized controlled 50 case clinical trial of tongue benefits. We hypothesize that acupuncture may mostly affect
acupuncture was first reported being effective for autism. A on the aspect of functional activities, probably including
significant improvement in the treatment as compared to the neural conductivity ignition and signal transduction, which
control group was seen in self-care and cognition domains of may be similar to the concept of “Qi” effect of acupuncture
the Functional Independence Measure for children. The in the view of traditional Chinese medicine. Considering that
authors applied acupuncture on the tongue including points autism children have not only functional psycho-behavior
symptoms but also significant abnormalities in nutritional
of Ex•HN 1 2，Ex-HN l , and CV23.11
abnormalities, such as essential fatty acid and phospholipids
metabolism, which may accompany with the inflammation
Quite a few new technologies have been developed in
process and even the genetic disturbances.23,24 So, it is
evaluating the effectiveness of acupuncture in treating
reasonable to suggest that integration of acupuncture with
autism, in addition to the subjective psycho-behavior tests.
proper nutritional therapy based on the individual needs is
One of the impressive works was from Dr. Jia Shaowei. His
necessary.
group reported at 2008 that electrical acupuncture
significantly improved SPECT brain image of 78.95% in a 34
The acupuncture technique itself needs to be upgraded based
case clinical study, a result corresponding the clinical
on scientific evidences. fMRI found that the superior
behavior improvement. They suspected that the increased
temporal sulcus (STS) region is an important component of
blood flow and enhanced function in the prefrontal cortex,
the network of brain regions that support various aspects of
broca and wernicke region could partially contribute such
social cognition and social perception.25 Excessive signaling
changes.12 fMRI has been one of the most promising tool in
may lead to hyperexcitable behavior as a result of shortage of
assessing the functional and structural changes of autism. For
GABAergic functions in the area. The superior temporal
example, growing evidences support that autism is an
sulcus function may underlie many of the social and language
inflammatory disorder of brain, evidenced by the fMRI
abnormalities seen in autism.26 Therefore, one of the major
finding that the total volume of brain, cerebella and caudate
targets of autism treatment should be on the prefrontal and
nucleus enlarged. The area of corpus callosum is reduced. 13
temporal-limbic region functions. From this point of view,
The inflammation may involve in the changes of the
conventional acupuncture may not provide enough impact in
neurophysiology of autism, characterized by a disturbance of
166 Jul 2011 Vol 4 No.3 North American Journal of Medicine and Science

these areas, because the acupuncture stimuli are usually 8. Zhong QR, Yu RI, Pong J, Zhou YF, Zhou YJ. Efect of acupuncture
in improving intelligence and language disorder of autistic children.
distant from the pathological lesions of the brain. Here,
Chinese Journal of Clinical Rehabilitation. 2005; 9(28): 11-14
transcranial electrical acupuncture stimulation (TEAS) is 9. Yan YF, Wei YY, Chen YH, Chen MM. Effect of acupuncture on
proposed by Dr. Jing Liu based on the information review autism children with rehabilitation training. Chinese Acupuncture &
and the preliminary clinical experiences. Moxibustion. 2007; 27(7):503-505.
10. Xi Y, Liu Y, Zhou AI, Zhang Q. Interference effect of acupuncture on
language function of children with Autism. J Acupunct Tuina Sci.
The idea of TEAS is supported by the evidence of 2010.8(4):226-229.
transcranial direct current stimulation (tDCS). tDCS 11. Wong YM. Tongue acupuncture and autism spectrum disorder. J Altern
involves placing metal electrodes on the scalp and applying a Complement Med. 2010;16(12):1247-8.
12. Jia SW, Sun TT, Fan Ri. Visualized study on acupuncture treatment of
small and harmless electrical current across the cranium. The
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14. Casanova MF, van Kooten IA, Switala AE, et al. Minicolumnar
tDCS can induce a slight change in the resting potential of
abnormalities in autism. Acta Neuropathol. 2006; 112(3):287-303.
the brain cells, resulting improvement of the information 15. Zijistra FJ, Lange IB, Huygen F, Klein J. Anti-inflammatory actions of
process through modulating the depolarization thresholds of acupuncture. Mediators of Inflammation. 2003; 12(2):59-69.
neurons.29 Hence, we predict that TEAS may bring the 16. Chung WY, Zhang HQ, Zhang SP. Peripheral muscarinic receptors
mediate the anti-inflammatory effects of auricular acupuncture. Chin
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Med. 2011; 6(1):3-5.
do, instead of the surface to surface stimulation of the scalp 17. Lee BH, Zhao RJ, Moon JY, et al. Differential involvement of GABA
acupuncture. Both traditional acupoints and the neural system in mediating behavioral and neurochemical effect of
anatomy should be considered when the acupoints of TEAS acupuncture in ethanol-withdrawn rats. Neurosci Lett. 2008;
443(3):213-217.
are selected. Another advantage of TEAS found from the
18. Hui KK, Liu J, Marina O, et al. The integrated response of the human
previous clinical practice may be that the application is cerebro-cerebellar and limbic systems to acupuncture stimulation at ST
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Public Health. 2010; 7(5):1984-1995.
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those with autism. However, we predict that the targeted intestinal barrier in patients with autism spectrum disorders and in their
treatment of the TEAS can be well measured and evaluated first-degree relatives. J Pediatr Gastroenterol Nutr. 2010; 51(4):418-
by using modern techniques such as fMRI or EEG, 424.
21. Jyonouchi H, Geng L, Ruby A, Zimmerman-Bier. Dysregulated innate
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