Clinical effects of spinal manipulation in the management of children and young adults diagnosed with autism spectrum disorder – a systematic review of the literature

Introduction Autism spectrum disorders (ASD) are defined as a range of conditions classified as neurodevelopmental disorders, including autistic disorder (autism), Asperger syndrome, and pervasive developmental disorder (PDD). 1 Symptoms are quality-related disorders in the areas of social interaction, verbal and non-verbal communication, and a variety of behaviours and learning disorders.1 Abnormalities in development are apparent already in early childhood and have a high variability.1,2 ASD is reported to occur in all racial, ethnic and socioeconomic groups, with about 1 in 68 children Background: Autism spectrum disorders (ASD) are classified as pervasive developmental disorders that permanently affect essential mental functions. Symptoms include quality-related disorders in areas of social interaction, verbal and non-verbal communication, the variability of behaviours and specific learning disabilities. Abnormalities in development are already apparent in early childhood. Aim: To identify evidence for the clinical benefits of manual therapy of the musculoskeletal system in children diagnosed with ASD. Methods: The following databases and search interfaces were searched from Database start up until October 2015: Bio Med Central, Chiropractic Library Collaboration, Clinical Trials, Cochrane library, Dimdi, EBSCO host, Pubmed, Pubmed central, Medline Plus, Osteopathic research Digital repository, Osteopathic Research Web, and Physiotherapy Evidence Database. Further searches included journals provided by the University of Wales and the University of Duisburg-Essen. Studies were included if participants were children and young adults aged 0-21 years; studies published in English, German, or French; a diagnosis of autism or ASD, and study designs of randomized clinical trial, case-control studies, case series, case reports, and single subject studies (N of 1), which include manual therapeutic interventions of the musculoskeletal system. Two authors independently screened the studies for inclusion criteria, extracted the data and assessed for risk of bias. Methodological quality of randomized clinical trials was assessed by the Downs and Black tool. Quality of reporting for case series and case reports was assessed with the appropriate checklists provided by the QUAlity and Transparency Of health Research (EQUATOR) network. Results: Included in the review were one randomized clinical trial (uncontrolled), one case series, and 11 case reports. The methodological quality of the included randomised clinical trial was rated as being poor. Quality of reporting for the included case series and case reports was also insufficient. All included studies used spinal manipulation, and indicated an improvement in autistic symptoms after the manual therapeutic intervention. Conclusion: The results of this systematic review confirm a general lack of good quality, high level of evidence studies on the topic, as well as no existing experimental studies that have been published in the last 10 years. This review indicates that the literature on the effects of chiropractic interventions to the musculoskeletal system of autistic children and young adults appears to be favourable with respect to the severity of their symptoms. However, the results of this review have to be interpreted with great caution, as the majority of identified studies were case reports. Further feasibility and pilot research is needed to lay the foundation for good quality clinical trials of spinal manipulation in the autistic child population. being identified with ASD in 2012 in the US.3 Boys seem to be 4.5 times more often affected than girls.3 With respect to the causation of autism, no universally accepted explanations are currently present. The possibility of a genetic component, environmental triggers and imbalances in the neurophysiological state are all discussed.4-6 No specific medication is available to address autism Medication is generally used to treat accompanying symptoms and modify behaviors of the condition.7 Current clinical guidelines recommend a combination of behavioral, devel-