Many believe in the power of "stacking the deck" in favor of those with autism by combining Applied Behavior Analysis (ABA) with complementary and alternative medicinal (CAM) therapy. In recent months, hyperbaric oxygen therapy (HBOT) has become a focal point for people in this group. However, little evidence suggests it has any true benefit, reasserting ABA's position as the preferred treatment for autism.
Rather than blindly consenting to the use of HBOT to treat individuals with autism, you need to understand what the research actually reveals, what risks may be associated with HBOT and why some may still vouch for its use.
What Do the Studies Say?
In 2008, researchers completed the first controlled study on the effectivity of HBOT for autism, asserts the U.S. National Library of Medicine. Obviously, changing variables between the study participants made controlling results in the study difficult. As a result, researchers opted to use ABA to review the effectivity of HBOT.
Two out of three of the study's participants did not exhibit any fundamental changes in "spontaneous communication," and while the third participant did increase communication with researchers, ongoing ABA outside of the research setting cannot be excluded as a possible source for treatment improvement. Consequently, researchers recommended further studies were necessary to determine if HBOT would be a viable alternative to ABA in the future.
Since then, two other studies have been conducted on HBOT for people with autism. A randomized controlled trial of 62 young participants with an autism spectrum disorder (ASD) was conducted in 2009. Participants received HBOT twice per day, five days per week and for four weeks.
Participants who received HBOT showed significant improvements in behaviors, but a number of "methodological flaws" in the study rendered the results useless, reports the National Center for Complementary and Integrative Health (NCCIH). A subsequent study found no significant differences between HBOT and placebo groups for any outcomes.
In 2015, the Undersea and Hyperbaric Medical Society thoroughly reviewed all existing evidence, claims and methodological issues associated with these studies. Out of all reviewed studies, including those that were not necessarily published by major entities, only one methodologically flawed study showed any evidence to support the use of HBOT for autism.
There may be another reason for this continuing trend of minimal, if any, evidence to support the use of HBOT. When a person is diagnosed with autism, ABA often begins immediately and continues indefinitely. As a result, ongoing improvements to behaviors and higher-functioning skills are typically expected.
So, the effectivity of HBOT must go beyond the typical results achieved from ABA exclusively. In other words, researchers cannot justify the use of HBOT as a boosting treatment to ABA, even when ABA was used in determining the effectivity of HBOT.
If HBOT Is a Form of CAM Therapy, Would It Be Risk-Free?
Using CAM therapies to treat different diseases or disorders is often seen as risk-free alternatives to medications or more invasive medicinal treatments. In reality, HBOT is not considered an invasive therapy. But, that does not eliminate risk from the equation. Some of the risks associated with HBOT, reports John Hopkins Medicine, include the following:
- Lightheadedness. While lightheadedness may not be a major risk, it does increase the risk of injury from falls after HBOT treatment.
- Buildup of fluid in the middle ear. This may cause the middle ear to become injured, furthering hindering the ability of a person with autism to communicate.
- Damage to the sinuses. Depending on the severity of the damage, damaged sinuses may result in profuse bleeding or problems breathing.
- Vision problems. The high-pressure environment of HBOT chamber can affect the pressure within the eyes. As a result, people with high pressure in the eyes should avoid HBOT.
- Oxygen poisoning. Too much oxygen in the blood can be fatal as oxygen molecules can harm living tissue when a 100-percent concentration of them come into contact with healthy tissue. In other words, hemoglobin cannot bind all of the molecules, resulting in changes to pressures within the body.
HBOT is also an expensive type of treatment. While statistics for its cost are not known, a study of CAM therapies for children with ASDs, explains the U.S. National Library of Medicine, cites costs, the aforementioned risks and a lack of evidence as primary reasons to avoid HBOT in treating individuals with an ASD.
Why Do Some Continue to Argue For HBOT to Treat Autism?
There will always be proponents of using as many CAM therapies as possible to provide the best treatment outcomes for people with autism. If HBOT is pursued as a treatment option by the parents or caregivers of people being currently treated with ABA, it is imperative that ABA continues regardless of the treatment outcomes for HBOT. Ultimately, the risks of stopping ABA to pursue HBOT can result in setbacks, if not permanent, negative changes to behaviors.
Moreover, the current lack of evidence implies an inherent need for future studies of HBOT for treating ASDs. Consequently, some people, provided they do not have any pre-existing conditions that are associated with the risks of HBOT, may participate in future studies of HBOT, especially with more people opting out of traditional autism treatment approaches.
The Big Picture
As a behavioral therapist or behavioral technician, you need to fully explain to the family members and friends of those you serve why HBOT for autism is not currently recommended. Among adults, you may be asked about the effectivity of HBOT for autism treatment in the future, or you may be questioned about clinical trials involving this form of HBOT.
Ultimately, you may or may not recommend against the practice. But, you can make a difference by explaining what current research has shown in relation to the effectivity of HBOT versus ABA for treating autism.