High-pressure oxygen therapy for children and adults with autism spectrum disorder (ASD)

Background

Autism spectrum disorder (ASD) is associated with problems in social communication and restricted behaviors. High-pressure (hyperbaric) oxygen therapy has been proposed as treatment for these ASD symptoms. We reviewed the evidence on effects of high-pressure (hyperbaric) oxygen therapy among children and adults with ASD. We also assessed the evidence on the safety of high-pressure oxygen therapy.

Review question

Does high-pressure oxygen therapy improve social communication or other aspects of function in children and adults with ASD, and how safe is this therapy?

Study characteristics

We searched electronic databases and identified randomized controlled trials (in which participants are randomly allocated to one of two or more treatment groups) consisting of participants who received high-pressure oxygen therapy or room air or no treatment as a control.

The evidence is current up to December 2015.

Key results

We found a single, small study of 60 children that evaluated high-pressure oxygen therapy for ASD.

There was no evidence that high-pressure oxygen therapy improved social interaction, behavioral problems, speech or language communication, or mental function in children with ASD. However, children who received high-pressure (hyperbaric) oxygen therapy showed an increased occurrence of ear barotrauma events when compared with those in the control group.

Quality of the evidence

The quality of the evidence is low. Evidence is insufficient to confirm that high-pressure oxygen is an effective treatment for individuals with ASD.

Authors' conclusions: 

To date, there is no evidence that hyperbaric oxygen therapy improves core symptoms and associated symptoms of ASD. It is important to note that adverse effects (minor-grade ear barotrauma events) can occur. Given the absence of evidence of effectiveness and the limited biological plausibility and possible adverse effects, the need for future RCTs of hyperbaric oxygen therapy must be carefully considered.

Read the full abstract...
Background: 

The rising prevalence of autism spectrum disorder (ASD) has increased the need for evidence-based treatments to lessen the impact of symptoms. Presently, no therapies are available to effectively treat individuals with all of the symptoms of this disorder. It has been suggested that hyperbaric oxygen therapy may alleviate the biochemical dysfunction and clinical symptoms of ASD.

Objectives: 

To determine whether treatment with hyperbaric oxygen:

1. improves core symptoms of ASD, including social communication problems and stereotypical and repetitive behaviors;

2. improves noncore symptoms of ASD, such as challenging behaviors;

3. improves comorbid states, such as depression and anxiety; and

4. causes adverse effects.

Search strategy: 

On 10 December 2015, we searched CENTRAL, Ovid MEDLINE, Embase, and 15 other databases, four of which were Chinese language databases. We also searched multiple trial and research registers.

Selection criteria: 

We selected randomized controlled trials (RCTs) and quasi-RCTs of any dose, duration, and frequency for hyperbaric oxygen therapy compared with no treatment or sham treatment for children and adults with ASD.

Data collection and analysis: 

We used standard methodological procedures expected by The Cochrane Collaboration, in that three review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence by using the GRADE approach.

Main results: 

We included one trial with a total of 60 children with a diagnosis of ASD who randomly received hyperbaric oxygen therapy or a sham treatment. Using GRADE criteria, we rated the quality of the evidence as low because of the small sample size and wide confidence intervals (CIs). Other problems included selection bias and short duration or follow-up.

Overall, study authors reported no improvement in social interaction and communication, behavioral problems, communication and linguistic abilities, or cognitive function. With regard to the safety of hyperbaric oxygen therapy (adverse events), they reported minor-grade ear barotrauma events. Investigators found significant differences between groups in total number of side effect events (Peto odds ratio (OR) 3.87, 95% CI 1.53 to 9.82) and in the number of children who experienced side effects (Peto OR 4.40, 95% CI 1.33 to 14.48).

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