To assess the efficacy and safety of scalp acupuncture in the treatment of autism spectrum disorder (ASD).

A comprehensive search was conducted using PubMed, EMbase, The Cochrane Library, Web of Science, SinoMed, China National Knowledge Internet, China Science and Technology Journal Database, and Wanfang Data databases. The Cochrane Handbook of Systematic Reviews 5.1.0 was used to evaluate the risk of bias in the included randomized control trials (RCTs). A Meta-analysis was performed using RevMan 5.4.1 statistical software.

A total of 33 RCTs were included, including 2701 patients with ASD. Meta-analysis results showed that compared with the rehabilitation training group, the scalp acupuncture combined with rehabilitation training could significantly reduce the autism behavior rating scale score [MD= -5.70, 95% CI (-6.51, -4.89), P<0.01], and childhood autism rating scale score [MD= -4.02, 95% CI (-4.38, -3.66), P<0.01], and improve the Gesell developmental diagnostic scale-social adaptative developmental quotient [MD=5.90, 95% CI (4.29, 7.51), P<0.01], Gesell-language development quotient [MD=4.39, 95% CI (3.03, 5.75), P<0.01], Gesell-personal social competence [MD=4.32, 95% CI (2.48, 6.15), P<0.01], psychoeducational assessment for children 3^rd edition (PEP-3)-communication skills score [MD=3.76, 95% CI (3.25, 4.27), P<0.01], PEP-3-physical agility score [MD=1.99, 95% CI (1.40, 2.59), P<0.01], and PEP-3-behavior score [MD=2.18, 95% CI (1.77, 2.59), P<0.01].

Scalp acupuncture is effective in improving the language problems, behavior problems, social adaptation and other symptoms of autism children, and has high safety. However, due to the insufficient quality of the research methods included in the literature, the integration of subjects with different severity and age, and the wide variation in the duration of the intervention, the conclusion of this study still needs to be validated by more rigorous and high-quality randomized controlled trials, with long-term follow up.