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Published in: Trials 1/2019

Open Access 01-12-2019 | Acupuncture | Study protocol

Safety, effectiveness, and economic evaluation of an herbal medicine, Ukgansangajinpibanha granule, in children with autism spectrum disorder: a study protocol for a prospective, multicenter, randomized, double-blinded, placebo-controlled, parallel-group clinical trial

Authors: Sun Haeng Lee, Seungwon Shin, Tae-hun Kim, Sang Min Kim, Tae Yoon Do, Sulgi Park, Boram Lee, Hye Jin Shin, Jihong Lee, Jin Yong Lee, Gyu Tae Chang

Published in: Trials | Issue 1/2019

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Abstract

Background

Autism spectrum disorder (ASD) is characterized by continuous impairment in communication and social interaction and by limited and repetitive behaviors, interests, or activities. Behavioral, educational, and pharmaceutical interventions have been shown to reduce behavioral disabilities, improve verbal/non-verbal communication, and help patients acquire self-reliance skills. However, there has been a lack of systematic verification and consensus regarding the treatment of the core symptoms of ASD because of its unclear etiology. Ukgansangajinpibanha (UGSJB), a legitimately prescribed herbal medicine for nervousness, insomnia, night crying, and malnutrition in South Korea and Japan, has been used for angry, sensitive, nervous, and unsettled children with ASD.

Methods/design

This trial is a prospective, multicenter, randomized, double-blinded, placebo-controlled, parallel-group, clinical trial. The 4- to 6-year-old children with ASD will be randomly assigned to following groups:
1.
A UGSJB granule with acupuncture, twice daily (n = 120)
 
2.
A placebo group with acupuncture, twice daily (n = 120).
 
The following outcome measures will be used: behavior by the Childhood Autism Rating Scale, Autism Behavior Checklist, and Aberrant Behavior Checklist; social maturity by the Social Maturity Scale; quality of life by the Child Health Questionnaire and EuroQoL Five-dimension Five-level Youth; and parental stress by the Parenting Stress Index at baseline and at 6, 12, and 24 weeks after the beginning of treatment.
In addition, to evaluate safety, we will investigate the adverse reactions that may be caused by UGSJB granule. Finally, we will make an economic evaluation of UGSJB for the treatment of ASD.

Discussion

We prepared a well-designed clinical trial to investigate the safety and effectiveness of UGSJB on ASD symptoms compared with placebo treatment. The results from this study will provide clinical evidence on the safety, effectiveness, and economic value of UGSJB combined with acupuncture in children with ASD.

Trial registration

Clinical Research Information Service: KCT0003007 (registered on April 5, 2018)
Appendix
Available only for authorised users
Literature
1.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Seoul: Hakjisa; 2015. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Seoul: Hakjisa; 2015.
2.
go back to reference Fombonne E. Epidemiology of pervasive developmental disorders. Pediatr Res. 2009;65:591–8.CrossRef Fombonne E. Epidemiology of pervasive developmental disorders. Pediatr Res. 2009;65:591–8.CrossRef
3.
go back to reference Christensen DL, Bilder DA, Zahorodny W, Pettygrove S, Durkin MS, Fitzgerald RT, et al. Prevalence and characteristics of autism spectrum disorder among 4-year-old children in the autism and developmental disabilities monitoring network. J Dev Behav Pediatrics. 2016;37:1–8.CrossRef Christensen DL, Bilder DA, Zahorodny W, Pettygrove S, Durkin MS, Fitzgerald RT, et al. Prevalence and characteristics of autism spectrum disorder among 4-year-old children in the autism and developmental disabilities monitoring network. J Dev Behav Pediatrics. 2016;37:1–8.CrossRef
4.
go back to reference Scottish Intercollegiate Guidelines Network (SIGN). Assessment, diagnosis and interventions for autism spectrum disorders. Edinburgh: SIGN; 2016. Scottish Intercollegiate Guidelines Network (SIGN). Assessment, diagnosis and interventions for autism spectrum disorders. Edinburgh: SIGN; 2016.
5.
go back to reference Textbook Compiliation Committee. Pediatrics of Korean Medicine. revised edn. Seoul: Euisungdang; 2015. Textbook Compiliation Committee. Pediatrics of Korean Medicine. revised edn. Seoul: Euisungdang; 2015.
6.
go back to reference Cho KH, Kim TH, Jin C, Lee JE, Kwon S. The literary trends of herbal prescription Ukgan-san and its application in modern traditional Korean medicine. J Korean Med. 2018;39:17–27.CrossRef Cho KH, Kim TH, Jin C, Lee JE, Kwon S. The literary trends of herbal prescription Ukgan-san and its application in modern traditional Korean medicine. J Korean Med. 2018;39:17–27.CrossRef
7.
go back to reference Wake R, Miyaoka T, Furuya M, Hashioka S, Horiguchi J. Effects of Yokukansan, a Japanese Kampo Medicine for Symptoms Associated Autism Spectrum Disorder. CNS Neurol Disord Drug Targets. 2016;15:551–63.CrossRef Wake R, Miyaoka T, Furuya M, Hashioka S, Horiguchi J. Effects of Yokukansan, a Japanese Kampo Medicine for Symptoms Associated Autism Spectrum Disorder. CNS Neurol Disord Drug Targets. 2016;15:551–63.CrossRef
8.
go back to reference Muneoka K, Kuwagata M, Ogawa T, Shioda S. Mother/offspring co-administration of the traditional herbal remedy yokukansan during the nursing period influences grooming and cerebellar serotonin levels in a rat model of neurodevelopmental disorders. Cerebellum. 2015;14:86–96.CrossRef Muneoka K, Kuwagata M, Ogawa T, Shioda S. Mother/offspring co-administration of the traditional herbal remedy yokukansan during the nursing period influences grooming and cerebellar serotonin levels in a rat model of neurodevelopmental disorders. Cerebellum. 2015;14:86–96.CrossRef
9.
go back to reference Fujiwara H, Han Y, Ebihara K, Awale S, Araki R, Yabe T, et al. Daily administration of yokukansan and keishito prevents social isolation-induced behavioral abnormalities and down-regulation of phosphorylation of neuroplasticity-related signaling molecules in mice. BMC Complement Altern Med. 2017;17:195.CrossRef Fujiwara H, Han Y, Ebihara K, Awale S, Araki R, Yabe T, et al. Daily administration of yokukansan and keishito prevents social isolation-induced behavioral abnormalities and down-regulation of phosphorylation of neuroplasticity-related signaling molecules in mice. BMC Complement Altern Med. 2017;17:195.CrossRef
10.
go back to reference Sato R, Kato K, Yamada K, Akama F, Kimoto K, Kimoto K, et al. A case of irritability with autistic disorder in children and adolescents improved by Yokukansan. Psychiatr. 2002;20:693–8. Sato R, Kato K, Yamada K, Akama F, Kimoto K, Kimoto K, et al. A case of irritability with autistic disorder in children and adolescents improved by Yokukansan. Psychiatr. 2002;20:693–8.
11.
go back to reference Wake R, Miyaoka T, Inagaki T, Furuya M, Ieda M, Liaury K, et al. Yokukansan (TJ-54) for irritability associated with pervasive developmental disorder in children and adolescents: a 12-week prospective, open-label study. J Child Adolesc Psychopharmacol. 2013;23:329–36.CrossRef Wake R, Miyaoka T, Inagaki T, Furuya M, Ieda M, Liaury K, et al. Yokukansan (TJ-54) for irritability associated with pervasive developmental disorder in children and adolescents: a 12-week prospective, open-label study. J Child Adolesc Psychopharmacol. 2013;23:329–36.CrossRef
12.
go back to reference Miyaoka T, Wake R, Furuya M, Liaury K, Ieda M, Kawakami K, et al. Yokukansan (TJ-54) for treatment of pervasive developmental disorder not otherwise specified and Asperger’s disorder: a 12-week prospective, open-label study. BMC Psychiatry. 2012;12:215.CrossRef Miyaoka T, Wake R, Furuya M, Liaury K, Ieda M, Kawakami K, et al. Yokukansan (TJ-54) for treatment of pervasive developmental disorder not otherwise specified and Asperger’s disorder: a 12-week prospective, open-label study. BMC Psychiatry. 2012;12:215.CrossRef
13.
go back to reference Japanese Pediatric Oriental Medicine Association. Handbook of Kampo treatment for children. Tokyo: Japan Pediatric Medical Publishers; 2015. Japanese Pediatric Oriental Medicine Association. Handbook of Kampo treatment for children. Tokyo: Japan Pediatric Medical Publishers; 2015.
15.
go back to reference McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014;133:872–83.CrossRef McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014;133:872–83.CrossRef
16.
go back to reference Lyra L, Rizzo LE, Sunahara CS, Pachito DV, Latorraca COC, et al. What do Cochrane systematic reviews say about interventions for autism spectrum disorders? Sao Paulo Med J. 2017;135:192–201.CrossRef Lyra L, Rizzo LE, Sunahara CS, Pachito DV, Latorraca COC, et al. What do Cochrane systematic reviews say about interventions for autism spectrum disorders? Sao Paulo Med J. 2017;135:192–201.CrossRef
17.
go back to reference Abo Almaali HMM, Gelewkhan A, Mahdi ZAA. Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. J Acupunct Meridian Stud. 2017;10:375–84.CrossRef Abo Almaali HMM, Gelewkhan A, Mahdi ZAA. Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. J Acupunct Meridian Stud. 2017;10:375–84.CrossRef
18.
go back to reference Lee B, Lee J, Cheon JH, Sung HK, Cho SH, Chang GT. The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2018;2018:1057539.PubMedPubMedCentral Lee B, Lee J, Cheon JH, Sung HK, Cho SH, Chang GT. The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2018;2018:1057539.PubMedPubMedCentral
19.
go back to reference Liu C, Li T, Wang Z, Zhou R, Zhuang L. Scalp acupuncture treatment for children's autism spectrum disorders: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e14880.CrossRef Liu C, Li T, Wang Z, Zhou R, Zhuang L. Scalp acupuncture treatment for children's autism spectrum disorders: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e14880.CrossRef
20.
go back to reference Shin MS, Kim YH. Standardization study for the Korean version of Childhood Autism Rating Scale: reliability, validity and cut-off score. Korean J Clin Psychol. 1998;17:1–15. Shin MS, Kim YH. Standardization study for the Korean version of Childhood Autism Rating Scale: reliability, validity and cut-off score. Korean J Clin Psychol. 1998;17:1–15.
21.
go back to reference Krug DA, Arick J, Almond P. Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior. J Child Psychol Psychiatry. 1980;21:221–9.CrossRef Krug DA, Arick J, Almond P. Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior. J Child Psychol Psychiatry. 1980;21:221–9.CrossRef
22.
go back to reference Eaves RC, Williams TO. The reliability and construct validity of ratings for the autism behavior checklist. Psychol Sch. 2006;43:129–42.CrossRef Eaves RC, Williams TO. The reliability and construct validity of ratings for the autism behavior checklist. Psychol Sch. 2006;43:129–42.CrossRef
23.
go back to reference Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders. Am Acad Pediatrics Counc Children Disabil. 2007;120:1183–215. Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders. Am Acad Pediatrics Counc Children Disabil. 2007;120:1183–215.
24.
go back to reference Yousefi N, Dadgar H, Mohammadi MR, Jalilevand N, Keyhani MR, Mehri A. The Validity and Reliability of Autism Behavior Checklist in Iran. Iran J Psychiatry. 2015;10:144–9.PubMedPubMedCentral Yousefi N, Dadgar H, Mohammadi MR, Jalilevand N, Keyhani MR, Mehri A. The Validity and Reliability of Autism Behavior Checklist in Iran. Iran J Psychiatry. 2015;10:144–9.PubMedPubMedCentral
25.
go back to reference Aman MG, Singh NN, Stewart AW, Field CJ. Psychometric characteristics of the aberrant behavior checklist. Am J Ment Defic. 1985;89:492–502.PubMed Aman MG, Singh NN, Stewart AW, Field CJ. Psychometric characteristics of the aberrant behavior checklist. Am J Ment Defic. 1985;89:492–502.PubMed
26.
go back to reference Scahill L, Hallett V, Aman MG, McDougle CJ, Eugene Arnold L, McCracken JT, et al. Brief Report: social disability in autism spectrum disorder: results from Research Units on Pediatric Psychopharmacology (RUPP) Autism Network trials. J Autism Dev Disord. 2013;43:739–46.CrossRef Scahill L, Hallett V, Aman MG, McDougle CJ, Eugene Arnold L, McCracken JT, et al. Brief Report: social disability in autism spectrum disorder: results from Research Units on Pediatric Psychopharmacology (RUPP) Autism Network trials. J Autism Dev Disord. 2013;43:739–46.CrossRef
27.
go back to reference Aman MG, Singh NN, Turbott SH. Reliability of the Aberrant Behavior Checklist and the effect of variations in instructions. Am J Ment Defic. 1987;92:237–40.PubMed Aman MG, Singh NN, Turbott SH. Reliability of the Aberrant Behavior Checklist and the effect of variations in instructions. Am J Ment Defic. 1987;92:237–40.PubMed
28.
go back to reference Kim SG, Kim OG. Social Maturity Scale Protocol. Seoul: Jungang Aptitude Laboratory; 1995. Kim SG, Kim OG. Social Maturity Scale Protocol. Seoul: Jungang Aptitude Laboratory; 1995.
29.
go back to reference Raat H, Bonsel GJ, Essink-Bot ML, Landgraf JM, Gemke RJ. Reliability and validity of comprehensive health status measures in children: The Child Health Questionnaire in relation to the Health Utilities Index. J Clin Epidemiol. 2002;55:67–76.CrossRef Raat H, Bonsel GJ, Essink-Bot ML, Landgraf JM, Gemke RJ. Reliability and validity of comprehensive health status measures in children: The Child Health Questionnaire in relation to the Health Utilities Index. J Clin Epidemiol. 2002;55:67–76.CrossRef
30.
go back to reference Ravens-Sieberer U, Wille N, Badia X, Bonsel G, Burström K, et al. Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Qual Life Res. 2010;19:887–97.CrossRef Ravens-Sieberer U, Wille N, Badia X, Bonsel G, Burström K, et al. Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Qual Life Res. 2010;19:887–97.CrossRef
31.
go back to reference Abidin RR, Jung GM, Lee GS, Park JA. Guide to Korean Parenting Stress Index. Seoul: Insight of Psychology; 2008. Abidin RR, Jung GM, Lee GS, Park JA. Guide to Korean Parenting Stress Index. Seoul: Insight of Psychology; 2008.
32.
go back to reference Zhou NY, Li YC, Jiang XY. Clinical Observation of Supplemented Lizhong Decoction in Treating Children Autism. J New Chinese Med. 2015;47(6):200–2. Zhou NY, Li YC, Jiang XY. Clinical Observation of Supplemented Lizhong Decoction in Treating Children Autism. J New Chinese Med. 2015;47(6):200–2.
33.
go back to reference Sun YB, Song HJ, Feng TZ, Yuan Y, Zhao NX. Comprehensive treatment of 60 cases of childhood autism. Liaoning J Tradit Chin Med. 2016;43:2105–8. Sun YB, Song HJ, Feng TZ, Yuan Y, Zhao NX. Comprehensive treatment of 60 cases of childhood autism. Liaoning J Tradit Chin Med. 2016;43:2105–8.
34.
go back to reference Bang M, Lee SH, Cho SH, Yu SA, Kim K, Lu HY, et al. Herbal Medicine Treatment for Children with Autism Spectrum Disorder: A Systematic Review. Evid Based Complement Alternat Med. 2017;2017:8614680.CrossRef Bang M, Lee SH, Cho SH, Yu SA, Kim K, Lu HY, et al. Herbal Medicine Treatment for Children with Autism Spectrum Disorder: A Systematic Review. Evid Based Complement Alternat Med. 2017;2017:8614680.CrossRef
35.
go back to reference Christensen DL, Baio J, Van Naarden Braun K, Bilder D, Charles J, Constantino JN, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years--Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ. 2016;65:1–23.CrossRef Christensen DL, Baio J, Van Naarden Braun K, Bilder D, Charles J, Constantino JN, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years--Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ. 2016;65:1–23.CrossRef
36.
go back to reference Shin SH. Understanding of high-functioning autism spectrum disorder. In: 2019 Spring Conference and Workshop. Seoul: Korean Association for Persons with Autism, Korean Academy for Autism Spectrim Disorder; 2019. Shin SH. Understanding of high-functioning autism spectrum disorder. In: 2019 Spring Conference and Workshop. Seoul: Korean Association for Persons with Autism, Korean Academy for Autism Spectrim Disorder; 2019.
37.
go back to reference Tamano H, Yusuke E, Ide K, Takeda A. Influences of yokukansankachimpihange on aggressive behavior of zinc-deficient mice and actions of the ingredients on excessive neural exocytosis in the hippocampus of zinc-deficient rats. Exp Anim. 2016;65:353–61.CrossRef Tamano H, Yusuke E, Ide K, Takeda A. Influences of yokukansankachimpihange on aggressive behavior of zinc-deficient mice and actions of the ingredients on excessive neural exocytosis in the hippocampus of zinc-deficient rats. Exp Anim. 2016;65:353–61.CrossRef
38.
go back to reference Ito A, Shin N, Tsuchida T, Okubo T, Norimoto H. Antianxiety-like effects of Chimpi (dried citrus peels) in the elevated open-platform test. Molecules. 2013;18:10014–23.CrossRef Ito A, Shin N, Tsuchida T, Okubo T, Norimoto H. Antianxiety-like effects of Chimpi (dried citrus peels) in the elevated open-platform test. Molecules. 2013;18:10014–23.CrossRef
39.
go back to reference Murayama C, Watanabe S, Nakamura M, Norimoto H. Inhibitory Activity of Yokukansankachimpihange against Nerve Growth Factor-Induced Neurite Growth in Cultured Rat Dorsal Root Ganglion Neurons. Molecules. 2015;20:14959–69.CrossRef Murayama C, Watanabe S, Nakamura M, Norimoto H. Inhibitory Activity of Yokukansankachimpihange against Nerve Growth Factor-Induced Neurite Growth in Cultured Rat Dorsal Root Ganglion Neurons. Molecules. 2015;20:14959–69.CrossRef
40.
go back to reference Aizawa R, Kanbayashi T, Saito Y, Ogawa Y, Sugiyama T, Kitajima T, et al. Effects of Yoku-kan-san-ka-chimpi-hange on the sleep of normal healthy adult subjects. Psychiatry Clin Neurosci. 2002;56:303–4.CrossRef Aizawa R, Kanbayashi T, Saito Y, Ogawa Y, Sugiyama T, Kitajima T, et al. Effects of Yoku-kan-san-ka-chimpi-hange on the sleep of normal healthy adult subjects. Psychiatry Clin Neurosci. 2002;56:303–4.CrossRef
41.
go back to reference Shin HJ, Lee B, Lee J, Chang GT. A clinical study of treating autism spectrum disorder in childhood. J Pediatr Korean Med. 2017;31:49–60. Shin HJ, Lee B, Lee J, Chang GT. A clinical study of treating autism spectrum disorder in childhood. J Pediatr Korean Med. 2017;31:49–60.
Metadata
Title
Safety, effectiveness, and economic evaluation of an herbal medicine, Ukgansangajinpibanha granule, in children with autism spectrum disorder: a study protocol for a prospective, multicenter, randomized, double-blinded, placebo-controlled, parallel-group clinical trial
Authors
Sun Haeng Lee
Seungwon Shin
Tae-hun Kim
Sang Min Kim
Tae Yoon Do
Sulgi Park
Boram Lee
Hye Jin Shin
Jihong Lee
Jin Yong Lee
Gyu Tae Chang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3537-7

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