# Effect of Hiwa syrup, a Persian Medicine Product, on Autism Symptoms and in Children with Autism Spectrum Disorders: A Randomized Double-Blinded Clinical Trial

## TL;DR

A Persian herbal syrup called Hiwa was tested in children with autism and showed improvements in symptoms and eye contact.

## Contribution

This study evaluates the efficacy of Hiwa syrup, a Persian Medicine product, in treating autism symptoms in children.

## Key findings

- Hiwa syrup significantly reduced autism symptoms compared to a placebo.
- The syrup increased eye contact duration in children with autism.
- Improvements were measured using the GARS-2 questionnaire and eye contact tests.

## Abstract

Background: Autism spectrum disorder (ASD) is a pervasive neurodevelopmental
condition characterized by challenges in communication, social interaction,
sensory processing, emotional regulation, and repetitive behaviors. Eye contact,
a crucial diagnostic and evaluative marker for autism, plays a significant role
in enhancing social communication and educational abilities. Given the
complexity of ASD and the absence of a definitive cure, attention has turned to
traditional and complementary medicine for potential therapeutic options. Assess
the efficacy of the Persian Medicine, Hiwa syrup, which consists of consisted of
apple (Malus domestica Borkh.) fruit, quince (Cydonia Oblonga Mill.) fruit,
basil (Ocimum basilicum L.), green cardamom (Elettaria cardamomum), and
sandalwood (Santalum album Linn), in ameliorating autism symptoms and extending
eye contact duration in children diagnosed with ASD.Materials and Methods: A
double-blind randomized clinical trial involved 60 children (3-5 years) with
level 1 autism, randomly assigned to intervention and control (placebo) groups.
The intervention group received Hiwa syrup for eight weeks alongside routine
therapy. Autism status was assessed using Persian version of Gilliam Autism
Rating 2nd edition (GARS-2) questionnaire, and eye contact duration in response
to auditory stimuli was measured pre and post-intervention. SPSS software
version 25 (SPSS Inc., Chicago, IL, USA) was used for data analysis.Results: The
Hiwa syrup group exhibited a significant decrease in the mean GARS-2 score from
75.03 ± 7.83 to 69.47 ± 5.87 (P=0.01) with a mean difference of 5.56 ± 3.12.
This decrease surpassed that of the placebo group. Furthermore, the intervention
group showed a significant increase in eye contact duration, from (7.90 ± 3.81
seconds to 9.26 ± 3.21 seconds (P=0.05), with a mean difference of 1.36±1.88
seconds. In contrast, the placebo group exhibited a smaller increase, from (7.50
± 2.21seconds to 7.83 ± 2.91 seconds (P=0.64), with a mean difference of 0.33 ±
0.48 seconds.Conclusion: The polyherbal product from Persian Medicine appears to
be effective in ameliorating autism symptoms and extending the duration of eye
contact in children diagnosed with ASD. Further clinical trials are essential to
validate the efficacy of this product in treating autism spectrum disorders.