Essential Oil Inhalation for Preprocedural Anxiety in Children with an Autism Spectrum Disorder: A Randomized, Controlled, Clinical Trial
While essential oils have been found in the scientific literature to reduce preprocedural anxiety in patients when administered prior to a scheduled medical procedure, no study has evaluated essential oils for autism at the time of this writing. The potential for these effects on preprocedural anxiety among pediatric autistic patients is uncertain due to the way in which autistic children experience sensory stimuli.
Because children with autism spectrum disorders tend to be hypersensitive to sensory experiences, essential oils which have been found in the scientific literature to reduce anxiety may not be suitable. To evaluate the potential for suitability and efficacy of essential oils on preprocedural anxiety among children with an autism spectrum disorder, the Franklin Health Research Foundation conducted a clinical trial in 2017-2018.
"Essential Oil Inhalation on Preprocedural Anxiety in Children with an Autism Spectrum Disorder: A Randomized, Controlled Clinical Trial."
Our research team and pediatric medical partners conducted a randomized, controlled clinical trial on the use of essential oil inhalation for preprocedural anxiety at the beginning of a medical appointment. In this study, children aged 6-11 who visited a participating primary care provider during the intervention phase of the study were randomized using adaptive randomization to either an intervention group or a control group.
The primary purpose of the study was to evaluate whether or not exposure to bergamot essential oil at the start of a medical appointment will have an impact on anxiety among children with an autism spectrum disorder. Among adults, bergamot essential oil has been found to significantly reduce preprocedural anxiety, but it is not known if these results can be replicated in a pediatric population with autism spectrum disorder.
Our research team collaborated with medical offices across the country. Each office specializes in pediatrics with an emphasis on working with patients who have autism spectrum disorders. Each office received a custom adaptive randomization schedule which dictated which patients received aromatherapy and which patients were assigned to the control group. These physicians and nurses administered the aromatherapy to the patients and returned gathered data to the FSIHS Research Department for analysis.
The research team gathered both subjective and objective measurements. Objective measures of anxiety were collected through the patient's heart rate and blood pressure at the start of the exposure and again after 15 minutes of inhalation. Subjective measurements of anxiety were gathered using the Spence Children's Anxiety Scale (SCAS). The short version of the scale, child edition, was used to gather subjective experiences of anxiety both before and after the aromatherapy treatment. All measurement instruments were validated and have a Cronbach's alpha above 0.8.
Patients qualified for the study if they attended the practice of a partner pediatric office, were aged 6-11 on the day of the visit, and had a diagnosis of an autism spectrum disorder using the DSM-IV or the DSM-V criteria. All ASD diagnoses were included in inclusion criteria, but participants in the study did not have a diagnosis of ASD level 1 (DSM-V) or Asperger's Disorder (DSM-IV). Most patients were diagnosed with level 2 (DSM-V).
Findings: Essential Oils for Anxiety
Children with an autism spectrum disorder who inhaled bergamot essential oil for 15 minutes at the start of their medical visit did not have changes on blood pressure or heart rate as compared to a control group. Data were evaluated using ANCOVA, with baseline measurements as the covariate.
However, when the subjective experience of anxiety was evaluated using a modified SCAS, the children with bergamot exposure had increased anxiety scores when compared to the control group.
Previous research has shown that children with autism spectrum disorders are more likely to be relaxed during medical visits that have sensory adapted environments. Offices that emphasize a reduction in sensory exposures, such as light, sound, and scent, create a reduction in anxiety among children with ASD as compared to offices which have the usual sights, sounds, and aromas. These findings are consistent with previous work on the impact of new or unusual aromas during a medical visit.
This study provides evidence that children with autism spectrum disorders have different sensory requirements that children and adults who do not have the potential for increased hypersensitivity to sensory experiences. Aromatic solutions which are effective in a general pediatric population are not generalizable to a population with an ASD. This is the first study to evaluate the effects of aromatherapy on preprocedural anxiety.
This study also underscores the need for additional research on aromatherapy among individuals with ASD. The impact of scent memory on efficacy and anxiety scores should be assessed as it appears to be a necessary component of using essential oils on children who have an autism spectrum disorder.
For More Information
The study was published in the journal Holistic Nursing Practice (September/October 2019 - Volume 33 - Issue 5 - p 285-294) doi: 10.1097/HNP.0000000000000341
Disclosures: This study was funded by the Franklin Health Research Foundation and was conducted by the FSIHS Research Department. Essential oils were purchased from Florihana Distilleries in France and there are no financial ties between the distillery and the FHRF. The researchers who conducted this study are fully trained and certified in human participant research and do not have any conflicts of interest to declare. This study was approved by Middle Tennessee State University's Institutional Review Board for ethical compliance prior to patient recruitment.