What is acupuncture?

Acupuncture has been around for a long time; certain books describing technical aspects of the practice date back as far as 259 AD. A medical description of the practice, as witnessed in Japan by a European physician, occurred around 1680 (White & Ernst, 2004). It is a practice derived from traditional Chinese medicine using fine needles to stimulate specific points in the body.

How does acupuncture work?

During acupuncture treatment, thin steel needles are inserted into the body, stimulating sensory nerves under the skin. The strategic places where needles are inserted, or acupuncture points, are important as they serve to stimulate nerves, muscles, and connective tissue.

Complicated biochemical changes result which are responsible for stimulating the body to heal itself. This and other health benefits, like the restoration of balance in the body, are some of the reasons why practitioners feel the treatment should be used before considering conventional medicine. Balancing the body’s energy flow, according to the wisdom of traditional Chinese medicine, is something the western world regards with a dash of scepticism.

Releasing the flow of “qi”

Qi (pronounced “chee”) is difficult to define, its meaning probably lies somewhere between energy flow, life force, and energy current. Classical Chinese medicine makes much of the harmonious flow of qi. For optimum health, traditional Chinese medicine tells us qi should flow freely and smoothly through the meridians. Meridians or pathways connect the more than 2,000 acupuncture points in the human body. When one’s qi gets stuck acupuncture may remedy the disruption in flow. Many feel the somewhat reluctant acceptance of acupuncture may be due to the abstract nature of such claims.

In fact, some Western therapists administering acupuncture prefer to ignore the treatment’s history and cultural context completely. Such practitioners think of the practice in more practical terms as needles used to stimulate acupuncture points, stimulating nerves to enhance the body’s natural painkillers. For true sceptics, the practice does little more than stimulate the neurobiological mechanism of the placebo effect.

This may be to their own detriment, as understanding qi may facilitate a deeper knowledge of the healing powers of acupuncture. According to the ancient Oriental view, pain is the manifestation of qi not flowing, because when qi flows effectively there should be no pain. While this background may be of interest to those pursuing the treatment for alleviation of pain, parents seeking help for challenging symptoms of autism spectrum disorders (ASD) may rightfully wonder if the practice is safe and effective for their children.

Beyond pain

In Western countries acupuncture is still primarily associated with pain relief. Various studies, however, have proven the treatment may alleviate symptoms of many conditions and ailments. A study (al-Sadi et al.,1997) found utilizing acupuncture reduced postoperative nausea or vomiting in hospital from 65% to 35% and after discharge from 69% to 31% when compared to placebo controls. Other studies show efficacy of acupuncture for substance use disorder, but some of these studies are detrimentally affected by low quality of evidence.

To definitively prove the efficacy of acupuncture we will need more quality studies, research, and evidence; especially when the treatment is reviewed for a complicated condition like autism spectrum disorder.

Acupuncture and children with ASD

Complementary and alternative medicine are becoming increasingly popular in treating symptoms associated with autism. Even though many of these treatments are only backed up by anecdotal evidence, parents feel the side effects of conventional medicines necessitate looking for gentler alternatives.

Acupuncture is often lauded for its many positive benefits for mental health. Studies have shown positive effects when conditions like depression, anxiety, and schizophrenia were treated with acupuncture. Unfortunately many of these studies lack methodological details; drawing definite conclusions from such studies is problematic as sufficient research evidence is mostly lacking.

Despite research challenges, it does seem as though acupuncture is a beneficial treatment for many mental conditions; autism, however, is a complicated neurodevelopmental condition which even scientists struggle to understand. Furthermore, autistic children often have various sensory difficulties, which brings up questions of the practicality of a treatment involving needles.

It seems, however, that children on the spectrum and their parents can, and do, tolerate acupuncture treatment. A pilot observational study (Warren et al., 2016) found the children in the study tolerated acupuncture and, additionally, their parents fared well in adhering to the eight-week intervention protocol. The authors felt such results suggest acupuncture may be a feasible intervention for autistic children—an option meriting rigorous evaluation by means of randomized controlled trials.

Another review and meta-analysis (Lui et al., 2019) mentions that scalp acupuncture treatment may be more tolerable for kids (under three) in comparison to acupuncture on body points. Scalp acupuncture, according to the authors, is easier to conduct because it does not restrict limb activity.

Autistic children may tolerate acupuncture if practitioners are sensitive to their needs. Practitioners need appropriate qualifications, experience, and patience to work with children with sensory processing differences. Such knowledgeable practitioners will be aware of all necessary precautions and contraindications. For example, scalp acupuncture may be dangerous for a baby whose fontanels have not closed.

Scalp acupuncture treatment (SAT) is increasingly employed for autism spectrum disorder, to help with symptoms like speech and language difficulties, behavioral challenges, anxiety, and sleep issues. Reported results are encouraging and benefits seem to be obtainable within the first three sessions.

Scalp acupuncture treatment (SAT)

Researching SAT, it becomes apparent that this specific treatment is quite different to traditional acupuncture. In fact, a review (Hao & Hao, 2012) describes SAT as a “contemporary acupuncture technique” which uses a combination of traditional Chinese needling methods with Western medical knowledge, specifically that pertaining to representative areas of the cerebral cortex.

SAT is sometimes referred to as neuro acupuncture (the mix of traditional acupuncture and neurology). Hair-thin, sterile, single-use acupuncture needles are inserted into a specific layer of the scalp thereby influencing the functioning of corresponding areas of the cerebral cortex.

The therapy which stimulates reflex areas in the scalp may prevent disease, promote healing, and relieve symptoms. Sessions usually last between 30 and 45 minutes and when administered by a qualified practitioner, the treatment should be painless.

The review (Hao & Hao, 2012) mentions a neurosurgeon from Shan Xi province, Dr. Jiao Shun-fa, as the founder of Chinese scalp acupuncture. The authors of the review give some history and background and emphasize three important principles of scalp acupuncture, which they underline as departing from traditional Chinese medicine:

• The location of scalp acupuncture areas, which do not relate to the theory of channels in Chinese medicine
• As the practice is new, the authors state positive benefits can only reasonably be expected from practitioners who have studied it
• Lastly, scalp acupuncture involves needling areas rather than points on the skull; traditional acupuncture may use a single needle into a single point whereas scalp acupuncture utilizes needles inserted into whole sections (Hao & Hao, 2012)

Such research makes it abundantly clear that scalp acupuncture is a specialized practice that should be administered by an expert—a broad knowledge of traditional acupuncture will not suffice. If the treatment is tolerated and administered by a knowledgeable practitioner, the results may be remarkable.

Research and results obtained

Most researchers seem to share optimism about scalp acupuncture for autism, but the general consensus does highlight the need for randomized control trials before widespread application of the practice is recommended. For many parents the current positive results are enough to give the treatment serious consideration, especially as certain studies suggest earlier intervention is preferable.

A study (Yau et al., 2018) found the therapeutic effectiveness of scalp acupuncture decreased with increasing age. The retrospective study aimed to establish the change in ASD symptoms when introducing scalp acupuncture. Additionally, the effect of age and onset type was also explored in the study titled The Therapeutic Effect of Scalp Acupuncture on Natal Autism and Regressive Autism.

Some of the interesting conclusions from this study include:

• The significant effective rate of scalp acupuncture on ASD was very high at 97%
• Verbal communication problems seemed to improve most while noise sensitivity increased least
• Children with natal autism benefited more than those with regressive or acquired autism

These and other conclusions from the study led the authors to recommend early intervention of scalp acupuncture. This recommendation is aligned with the advice of doctors for early diagnosis and subsequent early intervention for children on the spectrum.

Even more potential benefits (Yau et al., 2019) of SAT for children with autism include:

• Improvement in emotion-related behavior
• Progress in cognitive, social, and behavior performance as noted by parents
• Decreased resistance and less anxiety towards sleep

Some of these positive findings speak to the heart of core challenging autism symptoms: communication deficits, behavioral problems, and sleep issues. While more controlled studies are needed before the treatment can be recommended, it is encouraging to imagine a gentler treatment for autism symptoms interfering with quality of life.

Is acupuncture safe?

Asking about safety seems pretty important when parents are considering a treatment involving needles inserted in their child’s scalp. When the safety of acupuncture for children was reviewed (Jindal et al., 2008) data seemed to suggest acupuncture is a safe complementary or alternative medicine for pediatric patients.

The authors did mention the difficulty of determining the risk for individual children because of factors like differing acupuncture practices around the world, in addition to variations in qualifications of practitioners. Immunocompromised patients and those with underlying (and comorbid) conditions may also respond uniquely to alternative treatments.

A more recent review (Lee et al., 2018) analyzing the safety and efficacy acupuncture for the treatment of ASD in children came to similar conclusions: the practice may be effective and safe but the proof is not conclusive due to the heterogeneity of the acupuncture treatment methods reviewed.

Reading through such research it seems acupuncture is most probably safe for children, but to know for sure we’d need better, more specific studies. For parents, a randomized controlled trial, testing the safety and efficacy of scalp acupuncture in children on the spectrum, is needed.

Is acupuncture an effective treatment for children with ASD?

While parents may need more research to prove the safety of scalp acupuncture, the effectiveness of the treatment seems more certain. Various studies have noted benefits and even dramatic improvement of challenging symptoms when children on the spectrum were treated with SAT.

Language development

Finding a speech-language pathologist should be a priority for children diagnosed with autism. These language practitioners address symptoms associated with one of the core characteristics of autism: social-communication impairments. A study (Allam et al., 2008) found scalp acupuncture is a safe complementary modality when combined with language therapy. The authors concluded a combination of these practices has a significantly positive effect on the language development of autistic children.

Behavior

Reviews and analysis of relevant research and studies point to behavioral benefits of acupuncture for autism spectrum disorders. A study (Ming et al., 2012) mentions behavioral and/or developmental improvements reported in all acupuncture treatment studies in the literature reviewed.

Challenging behavior may be addressed even more effectively when complementary medicine like acupuncture therapy is used alongside pharmacotherapy. A study (Zhao et al., 2015) compared the benefits of acupuncture in addition to pharmacotherapy (prescription medication like risperidone) in contrast to using pharmacotherapy in isolation. Results suggested greater improvement in behavior, including restrictive/repeated behavior, when acupuncture was used together with the prescription medicine.

Feasibility of using acupuncture for children with
ASD

Research does make a convincing case for acupuncture. But is it a feasible option for a child who struggles to adapt to every new therapy? For parents who need more information, this study (Pledger, 2014) details various cases of autistic children and their experience with acupuncture. Contained in the appendix is a description of each patient’s outcomes—after treatment and after a further six months lapsed.

Reported improvements range from feeling more relaxed to improved social behavior. Another important aspect described in the study is the extensive preparation needed to ensure children with ASD will be comfortable when acupuncture is administered. The importance of discussions and demonstrations before any treatment commences cannot be overemphasized when dealing with a child who may be very sensitive to change.

Sham acupuncture

When doing research about acupuncture, parents may come across the term sham acupuncture. The term sounds slightly ominous, which is why some practitioners prefer using “placebo acupuncture”. Whatever term is preferred, this practice is used as a control in scientific studies to determine the efficacy of acupuncture treatment.

Interestingly, some studies suggest sham acupuncture may be as efficacious as true acupuncture (Moffet, 2009). Such research does add weight to the argument that acupuncture is little more than a powerful placebo. Other researchers feel that, while acupuncture therapy does utilize the placebo effect, this is not the only mechanism at play.

Indeed, research has found acupuncture to be superior to non-acupuncture controls and sham acupuncture for treatment of chronic pain (MacPherson et al., 2017). It will be interesting to observe future findings about the efficacy of scalp acupuncture when compared to sham acupuncture.

The debate about acupuncture and the placebo effect is interesting but, for parents with autistic children, the proof will be in the symptomatology pudding. Parents want a treatment that is safe and free from serious side effects.

A treatment, not aimed at fixing their child, but rather one that addresses the symptoms interfering with quality of life. If acupuncture, specifically scalp acupuncture therapy, provides language, behavioral, and sleep benefits it may be close to an ideal intervention.

Unfortunately, we are still some way from official acceptance due to a lack of controlled trials. While we wait for better research parents should act with caution and consult a medical professional before embarking on any new treatment for autism spectrum disorder.

Something old, something neuroscience needs

Scalp acupuncture treatment—where ancient medicinal wisdom is enhanced with modern medical knowledge—may be the missing ingredient in safely treating the symptomatology of ASD. A Chinese needling practice based on achieving balance and healing, combined with Western medical knowledge, may help many kids on the spectrum thrive. Or according to Hao & Hao (2012) when writing about the benefits of scalp acupuncture therapy for treating acute and chronic central nervous system disorder: “Scalp acupuncture often produces remarkable results with just a few needles and usually brings about immediate improvement, sometimes taking only several seconds to a minute.”

References:

Allam, H., ElDine, N. G., & Helmy, G. (2008). Scalp acupuncture effect on language development in children with autism: a pilot study. Journal of alternative and complementary medicine (New York, N.Y.), 14(2), 109–114. https://doi.org/10.1089/acm.2007.0508.

al-Sadi, M., Newman, B., & Julious, S. A. (1997). Acupuncture in the prevention of postoperative nausea and vomiting. Anaesthesia, 52(7), 658–661. https://doi.org/10.1111/j.1365-2044.1997.143-az0147.x

Hao, J. J., & Hao, L. L. (2012). Review of clinical applications of scalp acupuncture for paralysis: an excerpt from chinese scalp acupuncture. Global advances in health and medicine, 1(1), 102–121. https://doi.org/10.7453/gahmj.2012.1.1.017.

Jindal, V., Ge, A., & Mansky, P. J. (2008). Safety and efficacy of acupuncture in children: a review of the evidence. Journal of pediatric hematology/oncology, 30(6), 431–442. https://doi.org/10.1097/MPH.0b013e318165b2cc.

Lee, B., Lee, J., Cheon, J. H., Sung, H. K., Cho, S. H., & Chang, G. T. (2018). The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM, 2018, 1057539. https://doi.org/10.1155/2018/1057539.

Liu, C., Li, T., Wang, Z., Zhou, R., & Zhuang, L. (2019). Scalp acupuncture treatment for children’s autism spectrum disorders: A systematic review and meta-analysis. Medicine, 98(13), e14880. https://doi.org/10.1097/MD.0000000000014880.

MacPherson H, Vickers A, Bland M, et al. Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library; 2017 Jan. (Programme Grants for Applied Research, No. 5.3.) Chapter 2, Acupuncture for chronic pain: an individual patient data meta-analysis.Available from: https://www.ncbi.nlm.nih.gov/books/NBK409498/

Ming, Xue & Chen, Xiang & Wang, Xiao & Zhang, Zhen & Kang, Victor & Zimmerman-Bier, Barbie. (2012). Acupuncture for Treatment of Autism Spectrum Disorders. Evidence-based complementary and alternative medicine : eCAM. 2012. 679845. 10.1155/2012/679845.

Moffet H. H. (2009). Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. Journal of alternative and complementary medicine (New York, N.Y.), 15(3), 213–216. https://doi.org/10.1089/acm.2008.0356.

Warren, L. R., Rao, P. A., & Paton, D. C. (2017). A Pilot Observational Study of an Acupressure/Acupuncture Intervention in Children with Autism Spectrum Disorder. Journal of alternative and complementary medicine (New York, N.Y.), 23(11), 844–851. https://doi.org/10.1089/acm.2016.0257.

White, A., & Ernst, E. (2004). A brief history of acupuncture. Rheumatology (Oxford, England), 43(5), 662–663. https://doi.org/10.1093/rheumatology/keg005.

Yau, C. H., Ip, C. L., & Chau, Y. Y. (2018). The therapeutic effect of scalp acupuncture on natal autism and regressive autism. Chinese medicine, 13, 30. https://doi.org/10.1186/s13020-018-0189-6.

Yau, Chuen & Ip, Cheuk & Chau, Yuk & Lai, Ho. (2019). The Effect of Scalp Acupuncture on Autism: Could This Be a Possible Treatment of Autism?. 10.5772/intechopen.84547.

Zhao, N. Zhang, N. Jiao, W and Gao F. (2015). “Observations on the efficacy of acupuncture plus Risperidone in improving the abnormal behavior of autistic children,” Shaanxi Journal of Traditional Chinese Medicine, vol. 36, no. 8, pp. 1070-1071.