A "Best Practices" Model for Treating Autism: Biomedical & ABA Therapies Put into Practice Together Improve Optimal Outcomes
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A "Best Practices" Model for Treating Autism: Biomedical & ABA Therapies Put into Practice Together Improve Optimal Outcomes
Autism One 2009 Chicago The Hopes of a Mother, the Dreams of a Father are Real. Our Children get Better Chicago, IL May 20th - May 24th Lauren W. Underwood, PhD
What is autistic spectrum disorder?
A developmental
disability resulting from a neurological disorder
That affects normal functioning of the brain . . .
Autistic Spectrum Disorder
Abnormal development of Communication skills Social skills Reasoning
… affecting children in a spectrum of ways . . .
. . . . and children affected behave in a spectrum of ways . .
The tough part about autism is that there is no definitive “cure” or treatment
No one will tell you that this is something that will definitely work
Today’s presentation
Treatments grounded in Applied Behavior
Analysis as well as biomedical treatments have individually helped provide effective treatment models for autism In recent years, evidence for successful outcomes with biomedical treatments has also been observed Ultimately, in developing a “Best Practices” Model, these interventions must work together to provide the best possibilities for optimal outcomes
An overview of support for the behavioral-biomedical treatment model will be presented
Why behavioral AND biomedical?
Many children with autism also suffer
from co-morbid medical conditions Treat the underlying medical disorders Increase reception to behavioral interventions Then, the synergistic effects of behavioral and biomedical interventions result in an increase in successful outcomes
Synergy of biomedical and behavioral interventions
Therapies or interventions are designed to
remedy specific symptoms in each individual The best-studied therapies include a combination of educational/behavioral, sensory and biomedical interventions They may not cure autism, but they often result in substantial improvement
My goal as an educator . . .
1st . . . The Science . . . . Biology Anatomy and cell biology Immunology Biochemistry
Then,
the reasoning behind what can go wrong with these systems . . . explain how issues with these systems can affect Behavior Behavioral intervention Sensory intervention
. . . to enable you to understand some of the biological approaches currently available for the treatment of the medical condition described as autism, . . . .so if you choose you can consider applying them responsibly
Why consider biomedical approaches for treating of autism?
There is literature in peer review journals and other related sources that suggests that there are several biomedical interventions that . . . can be helpful for the treatment of the symptoms in many autistic spectrum disorder children
What does biomedical approach mean?
The application of the natural, biological and physiological sciences to clinical medicine
http://talkaboutcuringautism.org/medical/supplement_help.htm
http://www.pediatrics.org/cgi/content/full/120/5/1162
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/5/1221.pdf
The Science
The body is made up of specific
systems, including skeletal, circulatory, immune, cardiovascular, nervous, digestive Digestive system Anatomy and function Food allergies/food intolerances Leaky gut/intestinal dysbiosis Immune system function Basic biochemistry
Digestive System
Mouth Stomach Small intestine-absorption
Duodenum Jejunum Ileum Large intestine/Colon Rectum Liver Pancreas-secretes enzymes and hormones
Digestion-digestive tract function
Digests food Absorbs nutrients Carries vitamins and nutrients
into bloodstream Chemical detoxification Excretion
How do you get nutrients from foods? Protein
Foods are made up of proteins When foods are eaten and properly
digested, proteins are broken down by enzymes into peptides Peptides are then further broken down into amino acids Amino acids are the building blocks of life
What can go wrong with the GI?
1. Leaky gut 2. Intestinal dysbiosis
Constipation b. Diarrhea c. Enterocolitis
a.
3. Allergy
1. What is “leaky-gut”?
Definition: an abnormal or unfavorable increase in intestinal permeability Epithelia are either 'tight' or 'leaky' depending on the ability of the tight junctions to prevent water and solute movement The intestinal lining is supposed to be the protective barrier between the gut and the bloodstream If the intestinal lining becomes damaged-it is possible for incompletely digested proteins and/or other by-products to “leak” through the intestinal lining They can be recognized as foreign by the immune system, and/or “leak” into bloodstream
2. Dysbiosis
Intestinal flora (yeast and bacteria) are
a normal part of digestive track Intestinal dysbiosis occurs when there is an overgrowth/imbalance of intestinal flora(s) Dysbiosis results from
Increased use of antibiotics, steroids, etc. Poor diet Diets high in sugar Stress Immune system dysregulation
a. Constipation/ b. Diarrhea
Constipation-having a bowel movement fewer than three times per week
Stools are usually hard, dry, small
in size, and difficult to eliminate. Can be painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel
Diarrhea-frequent loose or liquid bowel movements (often associated with infection, allergy and food
c. Enterocolitis
Inflammation [itis](due to infection or
irritation) that affects part or all of the intestines (the small [entero]and/or large [col] intestines)
Hyperplasia-general term for an increase in
the number of the cells of an organ or tissue causing it to increase in size Endoscopy-looking inside, the human body for medical reasons, by inserting a small scope in the body
Ileonodular Hyperplasia
Normal Terminal Ileum
Consequences of intestinal dysbiosis or “leaky gut”-if left untreated
Nutrients and vitamins aren’t absorbed
properly---vitamin deficiencies Intestinal distress Food allergies are created Detoxification is compromised Bacteria and yeast can be mobilized Formation of antibodies you might not want--because of immune dysregulation
3. Allergy
The most obvious place for an allergic
reaction to food to take place is in the GI track Reactions can range from acute to chronic A large part of the immune system is located in or near the intestinal tract-to helps prevent microorganisms in the intestine from entering into the rest of the body
1st line of defense against pathogens Defects in the immune system can lead to
gastrointestinal problems
Food allergies vs. food sensitivies
Food allergies
An immune system response . . . to foods Body mistakes a protein in food as
harmful, and creates a defense against it (antibody) Allergy symptoms appear within minutes to an hour or so after eating the suspected food-body is battling invading food
Symptoms include eczema, an itchy red rash
most common in the elbow creases or behind the knees hives, nausea, swelling, difficulty breathing and/or anaphylactic shock
Food sensitivities/food intolerances
Digestive system response to foods Not an immune system response Something in food irritates digestive
system or person is unable to breakdown/digest food Can include metabolic food disorders such as lactose intolerance (missing enzyme) Symptoms include crapping, gas, nausea, and stomach pain
Overview of the immune system
White blood cells associated with acquired immune system are called lymphocytes T Cells B Cells
Normally, there is a balance between infection and immunity
infection
immunity
Immune system function
The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful to the body Normal immune system function, depends upon proper immune system responses 3.Protects and defends against foreign cells 4.Memory-gets smarter 5.Responds appropriately 6.Do no harm
Things can go wrong with the immune system . . .
Hypersensitivity Autoimmunity Inflammation Immune system dysregulation
Immune system dysregulation
Immune system dysregulation causes
an abnormal immune response there is a “ shift or skewing” – lack of balance The immune system looses the ability to respond appropriately. . . and when this happens, it is possible that the body develops abnormal responses to things it might not normally react to . . . like foods
What happens if the immune system is compromised
Immune dysregulation Abnormal balance and communication between immune cells Chronic Inflammation An abnormal, persistent activation of immune cells in the tissues Autoimmune reactions Antibodies targeting and causing injury to normal body tissues The immune system is closely connected to virtually every other system of the body Disorders in the immune system can cause disease
The liver & detoxification
Designed to remove toxic matter from the
bloodstream Produces bile Metabolizes proteins and fats
What happens if liver function is compromised?
If detoxification systems are overloaded,
destruction of nutrients necessary for proper detoxification occurs If detoxification pathways are overloaded, build up of toxins can occur If transsulfuration is disrupted, there is less antioxidant production, and oxidative stress can occur
The Vicious Circle Of Chronic Toxic Overload
Detoxification Problems
Liver Overload
Candida Dysbiosis
•heavy metal exposure •environmental toxins •foreign proteinsincompletely brokendown food Intestinal permeability
Oxidative Stress
May treat with Rx/drugs Health Problems •gastrointestinal distress
•allergy •autoimmune problems •infections •antibiotics •antifungals •steroids
Free Radical Production
Detoxification biochemistry
Methylation and sulfation
A healthy body’s way to rid itself of toxic
substances Methylation-transferring a methyl group Transsulfation-responsible for production of glutathione-the body’s number one antioxidant
Children with autistic spectrum disorders
often need supplements to provide them with the raw materials their bodies need to efficiently carry out methylation and sulfation
49
Lauren W. Underwood, PhD
Methionine/Glutathione Transsulfuration Pathway
THFolate Remethylation pathway
Transsulfuration pathway Methionine TMG DMG Homocysteine B6 Cysteine SAM
Methylene THFolate Methyl THF
Methionine Synthase
Methyl B12 B12
SAH
MTHFR
Glutathione (GSH)
Critical to the body’s ability to remove toxins!
Methionine/glutathione transsulfuration pathway in autistic children
How do you treats biomedically?
Look for a physician or other healthcare
practitioner who considers an integrative approach to treatment
combining mainstream medical therapies
and CAM (Complementary and Alternative Medicine) therapies
No single treatment works for every child. What works for one child may not work for
another, and a successful course of treatment often includes a combination of approaches
Expected key benefits of biomedical treatment for autism
Improvements in immune function,
resulting in healthier children who seem to be very resistant to coughs, colds, runny noses, ear infections and who seem to get over viral infections quicker than the rest of the family. Improvements in digestive function, resulting in more normal stool frequency and consistency; reduction or elimination of lower abdominal pain or discomfort; reduction or elimination of Children seem to loose stools or diarrhea. thrive
Expected key benefits of biomedical treatment for autism
Improved appetite and a wider variety
of foods tried and consumed, increased nutrition THEN . . . Better socialization and initiation of communication with family and peers; Increase in more normal social interactions and social play Improved vocabulary and sentence structure; Improved cognitive function Improved higher order functions
Some basic biomedical interventions
Diet Healthier diet Specialized diet Gluten-Free Casein-Free Diet (GFCF) Rotation Diets, others Nutritional Supplementation Detoxification
Some complementary/alternative biomedical interventions
HBOT Chelation
Healthier Diet
Read labels . . . .
Are special diets so “special” and which one do I choose?
Many autistic children suffer from
inflammatory response/immune system dysregulation Many autistic children don’t/can’t digest their foods efficiently diet options: GF/CF, SCD, BED, LOD,
Pick one that works best for you and your
family
regardless of diet choice, it is important
to ensure proper nutrition
Diet: Gluten-free Casein-free Diet
A restrictive diet that removes all food
items that contain both gluten and casein The are two main theories currently present in scientific literature that explain why some people with autism and PDD respond positively to a GFCF diet
improperly broken down dietary
peptides immune system dysregulation
Improperly broken down dietary peptides
Some people with ASD cannot properly digest
gluten and casein, which break down into substances that act like opiates in their bodies According to this theory, these "drug-like" substance alters the person's behavior, perceptions, and responses to his environment
Casein/casomorphin and gluten/gliadorphin
Casein is a protein found in milk and products
containing milk Casomorphin (or caseomorhin) is a peptide derived from the milk protein casein
Gluten and gluten-like proteins are found in
wheat and other grains Gliadorphin (or gluteomorphin) is a peptide derived from the wheat protein gluten
Immune system dysregulation
Immune system loses it’s ability to
respond properly Body develops abnormal responses to things it might not normally react to An abnormal immune response can result in Autoimmunity Inflammation Hypersensitivity Allergy
Other dieting options
SCD diet Rotation diet Soy and corn-free diet White diet Sarah’s diet
“But bread and cheese are all my child eats!” If I take away those foods, . . . they’ll starve!”
Consider this . . . .
Although at the beginning the diet may seem difficult, it maybe infinitely easier to try the diet, and end up having a happier healthier higher functioning autistic child, than living with a bad/poorly functioning one!!!
Nutritional supplementation
Why nutritional supplementation?
1. Nutritional deficiency involves a lack of one or more nutrients obtained from food essential for normal cell and body function occur due to
Mal-absorption/poor absorption in the small intestine Unhealthy eating, or Self-imposed/imposed dietary restrictions Poor utilization of nutrients because of genetic or
environmental factors
2. Oxidative Stress
There are nutritional deficiencies associated with disease
Rickets-vitamin D
deficiency Scurvy-vitamin C deficiency Beriberi-thiamine deficiency Pellagra-niacin deficiency Goiter-iodine deficiency
Signs and symptoms associated with nutritional deficiency
Neurological symptoms Memory loss Psychosis Bruising Confusion Impaired learning Growth retardation
How can a child attend, focus, and learn?
Loss of appetite Poor immune function
Commonly deficient nutrients
Vitamin B12 Vitamin B6 Folate or folic acid Vitamin A Vitamin C Vitamin D Zinc Magnesium Omega 3 fatty acids
Nutritional Supplementation
Supplementation Enzymes Methyl b12 Antioxidants TMG/DMG Essential fatty
acids Glutathione Folic acid Melatonin
Nutritional supplementation to combat oxidative stress
Vitamin E Vitamin C Zinc Vitamin B6 or
Calcium Selenium
its activated form, pyridoxal-5-phosphate (P5P) with Magnesium
Why detoxification?
To prevent injury to the cells
and ultimately cell death Cell injury and cell death is bad In autism, toxins may be a cause of the neurological and immune dysfunction Detoxification may help the cells to recover which will enable for healing If toxins accumulate too rapidly, without being safely eliminated, they can cause damaging effects upon cells and
How does your body detoxify?
Designed to remove/eliminate toxic
substances from the body Primary function of liver and kidney Glutathione Once toxins are bound they are eliminated via bile and urine Can also be achieved via artificial (chelation) or supplementary (sauna) means or through hyperbaric oxygen therapy (HBOT) . . .
Complementary interventions:
HBOT
Effective way to get more oxygen into the body at the cellular level by using pressurized air chambers
healing the gut and brain inflammation (two that
may be separate issues or experienced simultaneously) blood flow to key areas of the brain dealing with gut parasites, yeast or bacteria or if it helps all four areas
Chelation
Chemical process in which a substance is used to bind molecules, such as heavy metals metals (arsenic, lead, mercury) and hold them tightly so that they can be removed from the body
How do you implement a detoxification program?
Should be done under the direction of an
experience physician or other practitioner Support the body’s own detoxification system—nutrients,
Methyl B12 Glutathione DMG/TMG Folic acid
Remove accessible toxins—chelation Monitor closely
Maximize metabolism; normalize biochemical pathways
Understanding the “overlay” of biomedical and behavioral interventions . . .
Why consider behavioral therapy programs?
An autism diagnosis is based upon
behaviors---NOT medically based Generally a psychiatric/psychological diagnosis is made at 18-24 months Most neurological development occurs during this time Experienced 18 months of abnormal deviant developmental behaviors . . . HUGE developmental gap You can not go back in time to go through this developmental period
18 month old
Warning signs that might reflect biomedical issues
Any shift in behavior Looks for patterns of behavior change Look for signs and sources, red flags: Changes in sleep Increased irritability Rashes Red ears All discipline strategies can be affected
by biomedical issues/conditions
Why is there an overlap between behavioral and biomedical interventions . . .
Remember co-morbid biomedical
conditions which can setback or slow down therapies No single treatment works for every child--What works for one child may not work for another, and A successful course of treatment often includes a combination of approaches Be aware of any change in meds or supplements–this can affect behavior-
Why do behavioral and biomedical interventions go hand in hand?
If a child suffers from allergies
Focus and concentration can be affected
If a child suffers from GI distress, like
constipation, diarrhea
Cramping, bloating will distract them Pain may lead to self-injurious behavior
If their are immune system issues
Increased infections, inflammation can affect
attention and concentration
If biochemical pathways compromised
Neurotransmission can be under or over
stimulated
Why do behavioral and biomedical interventions go hand in hand?
If a child suffers from digestive issues
Improperly broken-down foods can have an
affect upon behavior Not receiving essential nutrients for biochemical pathways and maximum metabolism
If a child has detoxification problems
Build-up of toxins, increased oxidative stress,
symptoms—affect attention
Treat underlying medical conditions
Look for signs:
Posturing Bloated belly Eczema Allergy Sound sensitivity
Look for symptoms associated with abdominal pain…
Crying Unexplained tantrums Night time wakening General irritability Vocalizing complaints Posturing Irritability just prior to bowel movement Hyperactivity and distractibility Self injurious behavior
Treat underlying medical conditions
Look for signs:
Sleep issues Toileting issues Tantruming Irritability Hyperactivity Self-injurious behavior
A happier, healthier child is going to be more responsive to behavioral, social and sensory interventions
Paradigm switch
autism is not a psychological condition – it is a neuro-gastro-immunological disorder resulting from an genetic susceptibility and an environmental insult
“The abnormal metabolic profile in
children with autism is consistent with the abnormal genetic profile and strengthens the hypothesis that may predispose these children genetic susceptibility to oxidative stress and reduced methylation capacity to neurological, immunological, and gastrointestinal dysfunction that occurs with autism”—Dr. Jill James
Maybe there is a genetic susceptibility . . .
and environmental factors can affect trigger effects
A new paradigm in autism
Autism is an environmental illness with
a genetic component. It is a complex metabolic disease, not just a developmental disability. Autism is treatable, but . . . We must continue fighting for a cure!
Understanding Autism for Dummies
Provides the simple breakdown of behavioral, medical and other intervention Offers practical advice on how to educate children, as well as insights on helping people with autism maximize their potential
S. Shore, L. Rastelli, T. Grandin
Take home lessons
1. There are many behavioral therapy
options-pick one that works best for you and your family 2. There are biomedical options for treatment 3. Basic immunology and biochemistry can explain how things can go wrong in the body, and
that many autistic children suffer from real clinic symptoms that are treatable, and nutritional supplementation may be necessary to replace necessary building blocks for proper cell function and system functions
Take Home Lessons
1. If detoxification is not functioning
properly, it may be necessary to supplement with co-factors to bypass deficiencies. These include methyl B12, folic acid, B6, DMG and/or TMG 2. Most importantly, understand that biochemical and behavioral interventions need to be implemented together to enable more successful treatment results and outcomes
And this is how you feel now . ..
Don’t try to do everything all at once!!!!
Baby Girl: 12 weeks
Baby girl: 9 months
Baby girl: 12 months
Baby girl: 13 months
Baby girl: 15 months
Baby girl: 20 months
Baby girl: 24 months
Baby girl: 30 months
After interventions: 4 year old girl
Same child: Age 10 and 12
Baby boy: 12 weeks old
Baby boy:13 months old
Baby boy: 22 months old
Baby boy: 24 months old
Boy after interventions 3 years old 5 years old
More and more autistic children are getting better every day,
and although there is no guarantee . .. there are more reasons to be hopeful that your child could be part of the extraordinary journey towards recovery
Remember, . . .
Be patient Be inspired Have strength Never give up hope, and Never give up courage Love your child!