The number of U.S. children diagnosed with autism has dramatically increased to one child out of every 36, according to a Centers for Disease Control study published last year. That’s nearly double the amount of diagnoses a decade prior.
Meanwhile, most commercial insurance and Medicaid health plans must cover at least some autism treatments, and venture capital investors have poured significant, if ever fluctuating, money into autism care providers.
Each of these factors contributes to a few potentially landmark new treatments for autism. This exceptionally complex condition that cannot currently be diagnosed by a blood test and for which no federally approved treatment exists for its main effects.
Still, these novel treatments do not replace applied behavioral analysis (ABA), a time-and-labor-intensive treatment in which a caregiver monitors a child’s behavior and incentivizes the acquisition of social skills.
However, providers and advocates for people with autism agree questions remain before new behavioral therapies, and especially new medications, are ready for widespread use.
Said Neil Hattangadi, CEO of growing autism care provider Cortica, “Our overall conclusion remains: These new treatments are very much in the realm of research.”
Virtual reality
One treatment that industry insiders say is ready for patient use, at least in limited circumstances, is virtual reality (VR) headsets.
“We’re incredibly optimistic about it because getting a VR simulation enables children to be in environments that otherwise could not be replicated,” Hattangadi said.
San Diego-based Cortica partners with Floreo, a company whose business model is selling VR lesson plans to autism treatment providers. These lesson plans include a child immersed in how to cross the street or navigate a school cafeteria.
Advocates, including Zoe Gross, who is the director of the Washington, D.C.-based Autism Self Advocacy Network, support the use of VR to rehearse specific social situations. Her examples included a grocery checkout counter and a Transportation Security Administration checkpoint.
But some insiders question if VR can be more than a dress rehearsal for very specific scenarios. Also, both provider and advocate currently do not see the technology being used at a home by a parent or guardian and replacing the clinical environment.
Gross also cited a practical problem: Some children might not have developed the attention span to keep the headset on.
Oxytocin
Oxytocin is a hormone released from the brain’s hypothalamus and into the bloodstream to help pregnant women with labor contractions and lactation after childbirth. However, the hormone is also linked to more qualitative kinds of human attachment, including what makes people love and trust one another.
On a podcast that aired in December, Karen Parker, who is the director of the Stanford University Social Neuroscience Lab, cited a “handful of small studies,” including one she co-led at Stanford, that demonstrate that autism patients who test for low oxytocin levels may benefit from a nasal spray injection of the hormone.
Conversely, Parker explained, patients with autism who do not have an oxytocin deficit did not seem to benefit from an injection.
These revelations could deliver not just a medication to help treat some patients with autism but also point to a direct biological cause for the disorder.
Still, clinicians (including Parker) are not ready to make any conclusions.
“The research on oxytocin is still somewhat mixed,” said Suzanne Goh, the chief medical officer at Cortica.
Goh said that the best medications currently are for co-occurring conditions of autism including epilepsy and sleep disorders.
Indeed, advocates expressed concerns oxytocin induces a false trust between children with autism and adult figures possibly not deserving of such trust. And Parker herself has suggested that a different hormone, vasopressin—most associated with helping a person’s blood pressure, might be more effective in helping certain patients with autism.
Psychedelics
After decades of being marginalized as criminal, psychedelic substances including ketamine and even lysergic acid diethylamide, or LSD, are today used to help behavioral health patients with addiction or mental health conditions. But some researchers are looking to use the substances to help patients with autism.
A series of studies, including one published in June by the World Journal of Psychiatry, have labeled the administration of psychotropic medications as “promising.”
At the same time, fears of a psychotic episode in patients with autism are acute enough that the only two Food and Drug Administration-approved drugs to handle autism are the antipsychotics aripiprazole and risperidone.
Gross, at the Autism Self-Advocacy Network, is open to the idea of psychedelics. But she stresses “informed consent,” fearing a minor being told to take a drug with a hallucinatory effect and then having a psychotic episode.
Providers are also taking a wait-and-see approach.
“More tightly controlled studies are needed concerning complementary and alternative medicine,” said Adam Hahs, chief science officer at autism treatment provider Hopebridge. “We do not administer psilocybin but remain open to the possibilities, should the data support safety and success for our patients.”
Biomarkers
What makes treating autism so difficult is that no one knows the possible biological markers for the disorder. Each study on the biological or genetic causes of autism seems to produce a drip-drop of inconclusive new evidence. As Gross put it, “A lot of factors have been identified that have been kind of loosely correlated with autism.”
Hattangadi at Cortica says that his company has looked at possible biomarkers that could be found through hair samples or saliva, but says the disorder has “multiple contributing pathways” that not a single clinical test is going to capture. In other words, while autism care is changing, the fundamentals of the condition remain the same: An involved clinical evaluation for diagnosis, and an individualized plan for treatment.
