Although the diagnostic criteria and the dependence on behavior modification strategies might lead one to believe that autism, PDD, and Aspberger’s have psychological origins, there is overwhelming evidence for physiologic causes.  One study showed stunted branches in the nerve cells of an area of the brain called the hippocampus.  Many of the children have enlarged craniums (skulls) and there may be a correlation to a certain gene mutations (Apo E4, Glutathione, etc).  It is unlikely there is a single causative abnormality.  Rather there are multiple factors that all ultimately cause neurotoxicity with a common clinical outcome:

 

1. Oxidative Stress
2. Methylation and/or Sulfuration Dysfunction
3. Toxic Metal poisoning
4. Immune System Dysregulation
5. Gastrointestinal Inflammation and/or infection
6. Mitochondrial Dysfunction

 

For now my suggestions are 1) optimize physiologic processes; 2) promote detoxification; 3) modify and strengthen appropriate behaviors; and 4) be diligent in searching for possible underlying causes.  www.thriiive.com is an excellent resource.

 

                                            Causative and/or Exacerbating factors that lead to ASD through the above mechanisms

 

q    DIETARY FACTORS: Food additives, impaired simple carbohydrate (glucose) metabolism, and food allergies/sensitivities.  The most common intolerances are gluten-containing grains (Wheat (durum, semolina, kamut, spelt), rye, barley, triticale, etc) and casein (a milk protein).  Healing the intestines is a by-product of proper diet.  Many parents are finding the Specific Carbohydrate Diet an excellent guideline to heal the intestines, improve behavior, and provide balanced nutrition.

 

q    SENSORY INPUT IMPAIRMENT:  Chronic fluid retention in the middle ear - children with moderate to severe hearing loss tend to have impaired speech and language development, lowered general intelligence scores and learning difficulties.  Visual abilities such as integration, tracking, etc. play a significant role.

 

q    NUTRIENT DEFICIENCIES: Almost any nutrient deficiency can impair brain function.  Iron deficiency is the most common nutrient deficiency in American children and is associated with marked reduction in attentiveness, less complex or purposeful, narrower attention span, decreased persistence and decreased voluntary activity.  Correction of even subtle nutritional variables exerts a substantial influence on learning and behavior.   Zinc and sulfur are also commonly insufficient.

 

q    TOXIC ELEMENT & CHEMICAL EXPOSURE: There is a strong relationship between childhood learning disabilities and body stores of heavy metals, particularly lead.  Copper toxicity with elevated ceruloplasmin levels has been considered of possible significance since catecholamine-synthesizing enzymes are activated by copper.  Aluminum interferes with the citric acid cycle (alpha-ketoglutarate) and thereby reduces energy production from foods.  This has been shown to influence mood, energy levels.  Antimony interferes with monoamine oxidase and cholinesterase.   Mercury is not uncommonly involved.  Chemical

 

q    CANDIDAL OVERGROWTH:  there is a substantial amount of clinical observations that support the effect that byproducts of bowel candida and/or other fungi overgrowth have on the nervous system and behavior.  Gastrointestinal health plays a key role in many chronic illnesses. 

 

q    DISORDERED AMINO ACID METABOLISM:  serotonin metabolism may be an avenue of exploration based on the occasional response to SSRI's like Prozac.  Experts estimate that 25-30% of children with PDD have elevated serotonin blood levels and low brain levels.  The source is thought to be from an inflamed GI tract, food reactivities, and/or malabsorption.  The effects could be manifested as light, sound, and external stimuli hypersensitivity.  The metabolism of sulfur amino acids are often abnormal with low levels of cystine and cystathione which in turn could reduce the body's ability to perform Phase II detoxication and allow toxic by-products to accumulate in the brain.  Methylation plays an important role in brain function and is an area that shows promise in developmental and behavioral dysfunction.

 

q    IMMUNE DYSREGULATION: It is not uncommon for the onset of autism to occur after a viral episode or an immunization.  There is ongoing work that suggests the abnormal response to measles and rubella vaccination (part of MMR) plays a role.  Synergistic toxicity of the mercury preservative may occur in certain children, which explains why the reaction does not occur in all children. 

 

q      DISORDERED FATTY ACID METABOLISM: Data suggests very long chain fatty acids (VLCFA) are disproportionately elevated in many children with autism and indicate a deficiency in peroxisomal b-oxidation. This in turn leads causes an accumulation of VLCFA, which is toxic to the nervous system.  In my experience, supplying the essential fatty acids (omega-3 and omega-6) in the right proportions provides some of the most satisfying responses.

 

q      OTHER:

 

Diagnostic Considerations

 

q  Food Sensitivities - There are many ways to try to assess food hypersensitivity.  Each has limitations.  Allergy skin tests are rapid, inexpensive, accurate, and can be helpful when positive but do not include non-IgE mediated immune reactions to foods or other ingested agents.  Blood tests include RASTs and ELISA methods to detect allergies caused by IgE or IgG antibodies.  Drawing blood is required, they can be expensive, and are considered controversial in terms of their significance but have the advantage of having a wider array of foods available than skin tests.  There is evidence IgG type blood tests only indicate recent or recurrent intake rather than allergic or hypersensitivity reactions.  Other immunologic tests include the ELISA/ACT that reportedly reveals other type of immune reactions including those due to IgA, IgM, Immune Complexes, and/or T cells.  The test is expensive and specific.  None of the above procedures identifies foods/items causing metabolic reactions that have no immune basis.  Muscle tests or other Applied Kinesiology techniques can be of help but are dependent on the skill of the tester and are considered invalid by most medical doctors.  Electromagnetic and resistance type equipment uses a similar basis for finding intolerances and remains dependent on the skill of the tester, the device being used, and is controversial.  A diet diary with food avoidance of “high-risk” foods or by use of defined rotational diets often provides the most convincing information. Even if the lab tests are negative, your child may still have reactions to a particular food - the reactions may not even involve the immune system directly.  For this reason, gluten and casein are always suspect because of their metabolic effects in addition to any immune reactions they may trigger.  100% avoidance and monitoring is the only way to be certain of food's effect on your child.

 

q Sensory Input Impairment - audiometry and tympanometry are simple, inexpensive, and readily available.  More sophisticated testing with neural mapping of hearing and visual input may also be worthwhile.  Functional vision problems should be evaluated by a Developmental Optometrist as vision is more than simply having 20/20 eyesight.  Visual processing is a complex process involving over 20 visual abilities and more than 65% of all the pathways to the brain.  Nearly 80% of what a child perceives, comprehends and remembers depends on the efficiency of the visual system.

 

q Nutrient Deficiency - can be detected by a few symptoms such as peculiar food intake habits and a few physical findings suggestive of mineral imbalances.  Common laboratory tests of the blood, urine, and hair can also give insight into the nutritional needs and metabolic status of the individual. 

 

q Heavy metal evaluation - Hair analyses are a simple and inexpensive screening tool for heavy metals.  When collected properly, hair samples give a reliable indication of heavy metal burdens.  A urinary provocation challenge is a more sensitive test and involves a timed 6 hour urine collection after giving a chelating agent such as DMSA or NDF Plus Drops that chelates heavy metals into the urine.

 

q  Immunologic Assessment - initially includes looking for deficiencies, abnormal responses to immunizations, elevated viral antibodies or replication, and evidence of yeast overgrowth.

 

q  Structural Abnormalities - some children with autism have disorders detectable through imaging studies.  If there is any suggestion of injury, seizure activity, etc. a full diagnostic evaluation should be performed.

 

                                                                                                 Basic Management Approaches

 

q  Dietary Recommendations - for all children limiting simple processed carbohydrates (sugar, candies, sweets, etc.) is required without exception.  Specific foods based on tests or observation at home plays a critical role in nearly every case successfully managed.  Some fats should be avoided by all children canola oil, hydrogenated vegetable oils, and margarine.  Appropriate alternatives include extra virgin olive oil, organic raw butter, and flax oil.  Aspartame (Nutrasweet®, Equal®) may be a neurotoxin and must be avoided.  Gluten and casein avoidance seems critical for the vast majority and therefore is mandatory.

 

q  Nutritional Supplementation - A U.S.D.A.’s report on the vitamin and mineral status of Americans eating a standard Western diet showed marked and widespread nutrient deficits without overt signs of malnourishment or disease. Based on this data and many nutritional evaluations of children with autism and other learning difficulties, specific and individualized supplementation is always required.  Zinc, sulfur, fatty acids, neurotransmitters, and methylation are common areas that warrant specific attention.

 

q  Detoxication - of heavy metals or organic toxins may provide dramatic improvement.  This is my opinion provides the most consistent benefit of any intervention we offer.  Reducing Candida or bowel bacterial overgrowth also helps.  Glutathione, both a nutrient and a detoxification agent, is often associated with remarkable improvements.  Unfortunately, intravenous glutathione is much more effective than any other form (oral, inhaled, and transdermal) we have tried.

 

q  Behavioral Interventions - although autism is not a behavioral problem, programs involving discrete trials and sensory input benefits many autistic children and can be an adjunct to other biological therapies. ABA, MAPPS, etc. are often very helpful.

 

q  Neuronal Pathway Stimulation - stimulation of the nerve cells may be accomplished by fibroblast growth factor (FGF), neural trophic products, certain phosphatides, and perhaps masking (which I do not recommend).

 

q  Oxygen Therapies – hyperbaric, cyclic variation in altitude/pressure, activated oxygen, alkalinization, ionized oxygen.