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
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
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
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
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
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
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
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:
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
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!