Secretin and autism: the role of cysteine

Practical Paediatric Psychopharmacological Prescribing in Autism

Claims of ‘miracle cures’ for autism in the press and on the Internet bring new pressures to bear on parents of children with autism, and the professionals who care for them. Between a third and a half of people with autism in America are receiving some psychotropic medication. Despite recent advances in paediatric psychopharmacology, there is no proof that any medication can target the primary social impairments that characterize autism. The article discusses the evidence behind two approaches to psychopharmacological management in children with autism. The first approach selects certain target symptoms such as resistance to change, ritualistic/compulsive behaviours, hyperactivity, aggressive behaviours and sleep problems. The evidence for the effectiveness of agents including stimulants, anti- depressants, and melatonin when used to treat these symptoms is appraised. The second approach attempts to treat or cure the primary social impairment underlying autism. The evidence for the effectiveness of agents including naltrexone, fenfluramine and secretin is appraised. Early reports in this field have generated false hope, and the need for well-designed larger multicentre trials is emphasized.

Secretin as a Treatment for Autism: A Review of the Evidence

Secretin is used in the United States for diagnosis of pancreatic gastrointestinal (GI) dysfunction and disease. Repeated therapeutic use has not been approved. Widespread interest in secretin as a treatment for autism followed media reports of behavioral improvements in an autistic child who received the hormone during a GI diagnostic procedure. International demand for secretin soared in the absence of experimental evidence of its efficacy for autism. This review presents a brief history of secretin's rise to popularity and summarizes research on secretin as a treatment for autism. Seventeen studies are reviewed comparing the effects of secretin forms, dosage levels, and dosing intervals on outcome measures with approximately 600 children. Twelve of 13 placebo-controlled studies failed to demonstrate the differential efficacy of secretin. Implications for advocating treatment in the absence of empirical evidence are discussed.