HBOT Therapy and Autism: The Good, The Bad & The Ugly

Annie Tanasugarn, PhDc, BCBA CEO/AUTHOR, The Autism Analyst
"Autism Awareness simply means to acknowledge that Autism exists; Acceptance is to acknowledge its value."
My first introduction to hyperbaric chambers came years ago when working with a client. She was an 8-year old girl with mild/moderate Autism and was moderately verbal. She could form her own 4-word sentences independently (“I want apple, please”) and could initiate simple conversation with only minor gestural or material prompts. She was a great client to work with, and I am very lucky to have gotten to sit in the chamber with her and experience the early days of HBOT therapy for children with ASD.
What is a Hyperbaric Chamber?
Hyperbaric chambers are pressurized small compartments for individual use, or pressurized large rooms which can accommodate several people at once. These chambers have oxygen-rich air and include up to 100% concentrated oxygen, depending on the type of chamber. Chambers include both small, take-home variety which includes a hood for the head and a small generator attachment to produce the concentrated air. The in-clinic chambers are either steel or an acrylic material and include small portal windows to see out, along with options such as available DVD player attachment within the chamber.
HBOT Therapy
Existing research supports the use hyperbaric chambers for the treatment of acute medical symptoms. Hyperbaric Oxygen Therapy (HBOT) has been used for years to help eliminate critical medical conditions such as decompression sickness (“the bends” associated with deep sea diving), embolisms, severe anemia, gangrene, tissue infections and carbon monoxide poisoning. More recently, studies have included the use of hyperbaric chambers in helping reduce some symptoms associated with Autism with a mixed bag of results on its efficacy and validity.
The Good
As I stated in the introduction to this blog, my first experiences to HBOT therapy came as a result of a client I had. I got to tag along and collect data on her behaviors during the 60 minute therapy sessions. Below is a list of the good experiences I was able to collect data on and analyze from the therapy:
Increase in initiating conversation: My client often needed a small material prompt for independently asking questions or initiating conversations (a piece of paper prompting her for social cues to ask a question/make statement). After 8 weeks of treatment, going three times a week for 60 minutes per session, her ability to independently speak without prompting increased significantly. She began asking questions and engaging in conversation more consistently without requiring the use of gestural or material prompting.
Less aggression: Prior to HBOT therapy, my client would often aggress at her ABA therapists and parents when denied access to her toys or activities she wanted. On a good day, aggression would be at about 3 aggressions per hour. On a bad day, aggressions could increase to 8 per hour. After the HBOT therapy, data suggested a decrease in her aggression to approximately 1 per hour on a good day, and 4 per hour on a bad day.
Longer Duration of Task Engagement: Most 8-year olds don’t have a terribly long attention span in general, but my client had a very short one, even for an 8-year old. A goal was created to get her to sit for 5-minutes and complete some independent work (puzzles, drawing, matching, etc). At baseline, she could only sit between 35 seconds and 1 minute before attempting to elope. After HBOT treatment, she mastered her 5-minute goal within a week. She then moved on to a 10-minute independent goal. Great progress!
Eye Contact: All I can say about this one is, “Wow!” Anyone who’s familiar with Autism knows that hallmark of ASD is limited, or no eye contact, especially during communication. My client’s eye contact was minimal prior to HBOT therapy where she would scan human faces while speaking, but would not retain eye contact for more than a couple seconds. After HBOT therapy she was able to retain eye contact for most 1-minute conversations, with only minimal gazes away from the conversation.
The Bad
Expensive: HBOT therapy is often not covered by insurance companies as a form of treating Autism and its related behaviors. Thus, parents and caregivers can spend upwards of $300 per HBOT session. Yikes. Most families cannot afford the 40 “recommended sessions” to receive ‘full’ benefits of the therapy, which can total a whopping $12,000+ bill.
No Scientific Validation for Use with Autism: Currently, while there is a great amount of research that supports its usefulness for children with ASD, HBOT therapy has no scientific validation for treatment. Its efficacy is debated, and currently, the only scientifically validated treatment for Autism is Applied Behavior Analysis (ABA) therapy.
Results Are Not Permanent: As with most treatments, when the treatment itself stops, the behavior can return to pretreatment levels. This is often reported with HBOT therapy in which regression has been reported on communication, aggression, self-injury and attention span. Some research suggests that children’s language skills remained even after HBOT therapy was discontinued, but again, it’s a mixed review on its effects.
The Ugly
Controversial: HBOT therapy often falls under “dangerous” or “controversial” treatments for Autism. Granted, HBOT therapy is just concentrated oxygen – of up to 100% pure – being pumped into a small, contained hood and chamber. This can’t be bad for you, right? WRONG. Complications from this type of treatment can include middle ear bruising, eardrum rupture, dizziness, seizures or temporary vision disturbances. Since the chambers themselves are very small, they can only comfortably accommodate a small child and an average size adult. Individuals entering the chamber must be able to comfortably fit through the small opening. Communication with staff and personnel is only through a small portal window on the side of the chamber, or through a 2-way communication device in the chamber. Staff must secure individuals within the chamber and the only way out of the chamber is with assistance from staff opening the door after shutting off the oxygen. Individuals with claustrophobia may find these chambers uncomfortable. Children with ASD or other special needs may also have a difficult time entering and exiting them which can lead to physical injury.
The Verdict
Parents and caregivers should weigh the pros and cons of HBOT therapy to see if it is a good match for your child and your pocket book. Speak with a Board Certified Behavior Analyst who is familiar with this treatment or your child’s pediatrician who can help you make an informed decision that is both safe and appropriate for you and your family.
References
Ghanizadeh, A. (2012). Hyperbaric oxygen therapy for treatment of children with autism: A systematic review of randomized trials. Medical Gas Research, 2, 2-6.
Mayo Clinic. (2014). Tests and procedures: Hyperbaric oxygen therapy.
Satulkchit, T., Ladish, C., & Goldman, R. D. (2017). Hyperbaric oxygen therapy for children with autism spectrum disorder. Canadian Family Physicians, 63(6), 446-448.

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