Table 1.
Summary of the studies included.
| Study (reference) | Country | Sample size (A)/(B) | Mean age | Gender (M : F) | Diagnostic criteria | (A) Experimental intervention | (B) Control intervention | Acupuncture points | Outcomes |
|---|---|---|---|---|---|---|---|---|---|
| Allam [25] | Egypt | 10/10 | 5.5 ± 1.22 y | (A) 7 : 3 (B) 5 : 5 |
DSM-IV ADI-R CARS ≥30 | MA + (B) | Language therapy | GV20, GV26, GV17, 3 temple needles, YNSA cerebrum, and aphasia points | Arabic language test |
| Chen [26] | China | 30/30 | 5.06 ± 1.32 y | 36 : 24 | CCMD-3 | MA + (B) | Cognitive behavior rehabilitation training | GV20, GV24, EX-HN3, HT7, SP6, HI3, head Anmian point | CSHQ, TER (CSHQ), PTQ |
| Fan [27] | China | 38/38 | (A) 5.21 ± 1.56 y (B) 4.98 ± 2.05 y |
(A) 22 : 16 (B) 20 : 18 |
NR | MA | Language therapy, guided education, cooperative exchanges, music therapy | Jin's three needles (Sishenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Shouzhizhen, Zuzhizhen, Shesanzhen, Xingshenzhen) | CARS, TER (language ability) |
| Gao [28] | China | 50/50 | (A) 5.7 ± 0.8 y (B) 5.4 ± 0.7 y |
(A) 29 : 21 (B) 31 : 19 |
WHO | MA | Physical therapy, cognitive education, language education, behavior modification | Jin's three needles (Sishenzhen, Naosanzhen, Niesanzhen, Zuonieshangsanzhen, Dingshenzhen, Xingshenzhen, Shouzhizhen, Zuzhizhen, Shesanzhen) | PEP |
| He [29] | China | 30/30 | (A) 7.16 ± 4.26 y (B) 6.94 ± 3.86 y |
(A) 24 : 6 (B) 25 : 5 |
DSM-IV ICD-10 CCMD-2R | EA + MA + (B) | Verbal communication training, social communication training, self-care training, cognitive training, motion training | EA (EX-HN1, EX-HN3, PC6, HT7, SP6, KI3), MA (LR3, AT3, TF4) | ABC2, CARS, ATEC |
| Li [30] | China | 30/40 | NR | (A) 27 : 3 (B) 33 : 7 |
DSM-IV CCMD | EA + (B) | Music therapy and structured teaching | Scalp points (Zhijiuzhen, emotional zone, heart, and liver zone) | Clancy autism behavior scale, CARS, ABC1, GDS |
| Li [31] | China | 19/19 | 42.75 ± 2.5 m | 36 : 2 | DSM-IV | MA + (B) | Behavioral educational intervention | Tongue points (Naozhongxue, Naoshuxue, Naoyuanxue, Bizhongxue) | PEP-revised |
| Li [32] | China | 53/53 | 5.1 ± 3.9 y | 82 : 24 | NR | MA + (B) | Intensive therapy, game therapy, sensory integration training | Jin's three needle (Shesanzhen, Zuzhizhen, Shouzhizhen, Xingshenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Dingshenzhen, Sishenzhen) | CARS, ABC1 |
| Liao [33] | China | 30/30 | (A) 9.24 ± 1.64 y (B) 9.51 ± 1.50 y |
(A) 19 : 11 (B) 18 : 12 |
NR | MA + (B) | ABA, language cognitive therapy, sensory integration training | Scalp temporal, frontal, suboccipital, occipital region | CARS, TER (CARS) |
| Liu [34] | China | 33/34 | 5.41 y | 60 : 7 | DSM-IV | MA | Sensory integration training | Jin's three needles (Sishenzhen, Niesanzhen, Zhisanzhen, Naosanzhen, Shesanzhen, Shouzhizhen, Zuzhizhen, Siguanxue), Siguan | ABC1, CARS |
| Sun [35] | China | 42/42 | (A) 70 m (B) 65 m |
(A) 30 : 12 (B) 29 : 13 |
DSM-IV | EA + (B) | Behavior therapy, sensory integration training | Tongue points (Naozhongxue, Naoshuxue, Naoyuanxue, Bizhongxue) | CARS, TER (CARS) |
| Tang [36] | China | 20/18/18 | (A1) 4.526 ± 1.623 y (A2) 4.436 ± 1.520 y (B) 3.954 ± 1.572 y |
(A1) 14 : 6 (A2) 13 : 5 (B) 14 : 4 |
DSM-IV CCMD-2R CARS 36-41 | (A1) doing (B) during retention of MA (A2) MA after (B) | Educational training, behavior modification, sensory integration training, language therapy | Scalp areas according to symptoms | CARS, TER (CARS) |
| Wang [37] | China | 30/30 | NR | (A) 24 : 6 (B) 23 : 7 |
ICD-10 CCMD-3 | EA + (B) | Behavior therapy | GV20, EX-HN1, GV24, GB13, EX-HN3, GV17, GB19, PC6, scalp speech area 1, 2, 3 | Social adaptive quotient, TER (social adaptive quotient) |
| Wang [38] | China | 30/30 | (A) 5.14 ± 1.53 y (B) 5.46 ± 1.68 y |
(A) 24 : 6 (B) 23 : 7 |
ICD-10 CCMD-3 | EA + (B) | Sensory integration training, auditory integration training, language therapy | GV20, EX-HN1, GV24, GB13, EX-HN3, GV17, GB19, PC6, scalp speech area 1, 2, 3 | ABC1, TER (ABC1), PPVT |
| Wang [39] | China | 32/30 | (A) 5.12 ± 1.42 y (B) 5.10 ± 3.4 y |
(A) 18 : 14 (B) 15 : 15 |
NR | MA | Language therapy, guided education, ABA, music therapy | Jin's three needles (Sishenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Shouzhizhen, Zuzhizhen, Shesanzhen, Xingshenzhen) | CARS, TER (language ability) |
| Wong [40] | China | 18/18 | (A) 7.40 ± 2.215 y (B) 7.62 ± 2.367 y |
(A) 17 : 1 (B) 17 : 1 |
DSM-IV ADI-R ADOS | EA + MA + (B) | Conventional educational program | EA (GV20, EX-HN3, HT7, SP6), MA (AT3) | ADOS, ABC2, ATEC, RFRLRS, WeeFIM, CGI, SPT |
| Wong [41] | China | 30/25 | (A) 9.17 ± 4.12 y (B) 9.56 ± 4.22 y |
(A) 25 : 5 (B) 22 : 3 |
DSM-IV ADI-R ADOS | EA, conventional educational program | Sham EA, conventional educational program | EX-HN1, EX-HN3, PC6, HT7, LR3, SP6, AT3, TF4 | WeeFIM, PEDI, Leiter-R, CGI, ABC2, RFRLRS, RDLS, A standardized parental report |
| Wong [42] | China | 25/25 | (A) 6.23 ± 1.8 y (B) 6 ± 1.99 y |
(A) 21 : 4 (B) 23 : 2 |
DSM-IV ADI-R CARS ≥30 | MA, conventional educational and behavior model | Sham MA, conventional educational and behavior model | Tongue points (Runze, Guangzhou, Tianmen, Diyou) | GMDS, RFRLRS, RDLS, SPT, WeeFIM |
| Wong [43] | China | 16/11 (12/9) | (A) 10.167 ± 3.930 y (B) 8.750 ± 4.617 y |
(A) 16 : 0 (B) 11 : 0 |
DSM-IV ADI-R CARS ≥30 | MA + (B) | Conventional educational and behavior model | Tongue points (Runze, Guangzhou, Tianmen, Diyou) | ATEC, RDLS, SPT, WeeFIM, CGI, Cerebral FDG metabolism by PET |
| Wu [44] | China | 40/40 | (A) 6.5 ± 2.3 y (B) 6.2 ± 2.1 y |
(A) 28 : 12 (B) 30 : 10 |
DSM-5 | MA | Conventional intervention | Jin's three needles (NR) | Functional development scale |
| Xiong [45] | China | 32/32 | (A) 7.48 ± 3.26 y (B) 7.56 ± 3.12 y |
(A) 18 : 14 (B) 17 : 15 |
CCMD-3 | MA + (B) | Educational training, sensory training, behavior modification, language therapy | Scalp frontal, temporal, occipital, suboccipital, and parietal regions | CARS |
| Yang [46] | China | 20/20 | (A) 5.6053 ± 2.2582 y (B) 4.2778 ± 1.8249 y |
(A) 16 : 4 (B) 14 : 6 |
DSM-IV | MA | Behavior therapy, sensory integration training | Jin's three needles (Sishenzhen, Dingshenzhen, Zhisanzhen, Yansanzhen, Naosanzhen, Shesanzhen, Shousanzhen, Shouzhizhen, Zusanzhen, Zuzhizhen), CV12, CV4, CV6, GV14, BL20, GV4 | CARS, TER (CARS), EEG, attention value |
| Zeng [47] | China | 30/25 | (A) 3.51 ± 1.48 y (B) 3.49 ± 1.47 y |
(A) 18 : 12 (B) 14 : 11 |
ICD-10 | MA + (B) | ABA, TEACCH, PCI, sensory integration training, auditory integration training, language cognitive therapy | Jin's three needles (Sishenzhen, Naosanzhen, Niesanzhen, Zhisanzhen, Shesanzhen, Dingshenzhen, Shouzhizhen, Zuzhizhen) | TER (CARS), TER (PEP) |
| Zeng [48] | China | 60/25 | (A) 3.62 ± 1.36 y (B) 3.60 ± 1.52 y |
(A) 36 : 24 (B) 16 : 9 |
ICD-10 | MA + (B) | ABA, TEACCH, PCI, sensory integration training, language cognitive therapy, music therapy | Jin's three needles (Naosanzhen, Niesanzhen, Zhisanzhen, Shesanzhen, Dingshenzhen, Shouzhizhen, Zuzhizhen) | TER (CARS), TER (PEP3) |
| Zhao [49] | China | 30/30 | NR | NR | ICD-10 | EA + (B) | Special education | Group 1: GV20, Sishenzhen, GV24, GB13 Group 2: ST8, GV23, Dingshenzhen, GV17, GB19; use group 1 or 2 alternately every other week |
ABC1, TER (ABC1) |
| Zhao [50] | China | 35/30 | (A) 3.5 y (B) 3.2 y |
(A) 28 : 7 (B) 25 : 5 |
DSM-IV ICD-10 | MA + (B) | Risperidone 0.5–2 mg/d | Jin's three needles (Dingshenzhen, Zhisanzhen, Sishenzhen, Niesanzhen), GV17, transport point mainly pericardium, heart, or liver meridian | TER (Improvement of abnormal behavior) |
| Zhen [51] | China | 68/68 (63/65) |
(A) 4.2 y (B) 4.5 y |
(A) 56 : 12 (B) 53 : 15 |
DSM-IV | MA + (B) | Speech training and structured teaching | Jin's three needles (Esanzhen, Niesanzhen, Zhensanzhen), EX-HN1 | PEP-3 |
ABA, applied behavior analysis; ABC1, autism behavior checklist; ABC2, aberrant behavior checklist; ADI-R, autism diagnostic interview-revised; ADOS, autism diagnostic observation scale; ATEC, autism treatment evaluation checklist; CARS, childhood autism rating scale; CCMD, Chinese classification of mental disorder; CGI, clinical global impression; CSHQ, children's sleep habits questionnaire; DSM, diagnostic and statistical manual of mental disorders; EA, electroacupuncture; EEG, electroencephalography; FDG, fluorodeoxyglucose; GDS, gesell developmental schedules; GMDS, griffiths mental developmental scale; ICD, international classification of diseases; MA, manual acupuncture; NR, not recorded; PCI, play and cultural intervention; PEDI, pediatric evaluation of disability inventory; PEP, psychoeducational profile; PET, positron emission tomography; PPVT, peabody picture and vocabulary test; PTQ, parent temperament questionnaire; RDLS, reynell developmental language scales; RFRLRS, ritvo-freeman real life rating scale; SPT, symbolic play test; TEACCH, treatment and education of autistic and related communication handicapped children; TER, total effective rate; WeeFIM, functional independence measure for children; WHO, World Health Organization; YNSA, Yamamoto new scalp acupuncture. aCrossover trial. The rest are parallel studies.