Synopsis

Source of validity: Scientific
Rating (out of 5): 2

N-acetylcysteine (NAC), sometimes marketed as L-acetyl n-cysteine, has been investigated as a potential adjunctive treatment for autism spectrum disorder (ASD), particularly for the management of irritability and behavioral symptoms. The rationale is based on NAC’s role as a precursor to glutathione, a major antioxidant in the body. Some studies suggest that individuals with ASD may have increased oxidative stress and glutathione deficiency, and NAC may help to mitigate these biochemical abnormalities.

A handful of small, randomized controlled trials (RCTs) have examined NAC in children and adolescents with ASD. Some studies, such as Hardan et al. (2012, Biological Psychiatry), found modest improvements in irritability (as measured by the Aberrant Behavior Checklist), but effects on core ASD symptoms are less clear. Other studies have produced mixed or non-significant results, and sample sizes have been small. Meta-analyses and reviews generally conclude that while there is some signal for benefit regarding irritability and stereotypic behaviors, the overall quality and quantity of evidence is low, and further larger, high-quality studies are needed.

NAC is not a standard or FDA-approved treatment for ASD and should not be considered a primary therapy. Its use is supported by preliminary, not definitive, evidence. Side effects such as gastrointestinal upset and rare allergic reactions have been reported. Overall, the scientific evidence is limited and warrants a rating of 2 out of 5.

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