According to the Centers for Disease Control and Prevention, one in 68 children has autism spectrum disorder, or ASD. Autism typically affects individuals in five areas: communication, social skills, learning, behaviors and medical. Dr. Bernard Rimland challenged the notion that autism has a psychological origin rather than a physical one in his 1964 book, Infantile Autism: The Syndrome and Its Implication for a Neural Theory of Behavior. Scientific studies continue to challenge the traditional view that autism is genetically hardwired and not treatable. Treating the medical issues can positively impact the other four areas. Autism is complex. We cannot heal a child overnight. Some treatments may create rapid improvements while others happen more slowly. But the collective effect of several treatments can be considerable.

Behavior is one way a child with autism communicates. When a child is not feeling well, behaviors can worsen. Too often, practitioners don’t look at the underlying medical problems; parents are told behaviors and health problems are “just part of the autism” so they are not given tools to help their child. The key is to work with an integrative doctor who will treat autism as a whole-body disorder that affects the brain.

Healing the body not only helps the child feel better, but also improves their brain function. A combination of traditional and medical therapies helps a child reach their full potential. Children can become happier, healthier and able to function at a higher level; some even lose their autism diagnosis.

COMMON MEDICAL CONDITIONS IN AUTISM

There are many medical conditions that occur at the same time as autism. Co-morbid conditions can affect the digestive, immune and nervous systems as well as the brain and the body’s biochemical processes.

What do those conditions look like? Children can have bloated bellies, frequent illnesses or they haven’t been sick in years, dry skin, rashes, smelly bowel movements, insomnia, diarrhea or constipation, head banging, biting, obsessive-compulsive (OCD) behaviors, anxiety, sensory issues, hyperactivity, inattentiveness, seizures and more.

Potential co-morbid conditions

• Immunologic
• Autoimmune
• Chronic bacterial/viral infection
• Environmental/food allergies
• Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

Neurologic

• Seizures
• Sensory issues

Gastrointestinal

• Leaky gut syndrome, or intestinal hyperpermeability
• Dysregulated microbiome
• Malabsorption
• Reflux esophagitis
• Inflammatory bowel disease

Metabolic

• Vitamin and mineral deficiency
• Methylation disorder
• Elevated ammonia
• Serotonin/melatonin deficiency
• Folate autoimmunity
• Mitochondrial dysfunction

Each child has a unique biochemical, genetic and medical profile. Not every child has difficulties in all areas but they may have several. We may need to address multiple deficiencies, environmental insults and toxins in a child whose genetics make them vulnerable to begin with. Issues can be reduced, managed or even resolved.

There is no fixed protocol and treatment plans must be tailored to each child. They are based on appropriate medical testing, combined with an examination of family history and the current medical profile, including what autistic behaviors/symptoms are prominent. An integrative physician will examine the patient’s metabolic foundation and then treat the underlying cause of the condition. First, they will look at what the child is getting too much of and what he is not getting enough of. This often includes environmental changes, such as reducing toxic exposure, limiting electromagnetic fields and dietary changes. Then the practitioner reinforces the adjustments with vitamins, minerals and good fats. The next focus is on the gut, mitochondria, methylation, immune system and other areas of need.

It is key to remember these co-morbid conditions are interrelated. When one system is not functioning, the others are either over-compensating or not functioning fully. For example, if a child is born with a defect in their methylation pathway—such as the MTHFR gene mutation—then they are predisposed to detoxification issues, which may result in a toxic overload. Once the body has too many toxins, it is susceptible to increased allergies or intolerances. This can lead to inflammation, pathogen overload—such as yeast, bacteria or viruses—and gut problems like diarrhea, bloating, pain and constipation. This burden precipitates immune dysfunction and oxidative stress, making the vicious cycle get worse.

Dr. Nancy O’Hara, of Center for Integrative Care in Wilton, begins treatment by determining, “what this child needs to get that he or she is not getting enough of. The first thing is diet. Go gluten- and casein-free 100 percent for three months. If it is not a ‘Wow’, then continue with a good anti-inflammatory diet, less carbs, less sugars. Essential fatty acids are essential for a reason. Then add in a good probiotic. I then look at the individual child and what they need. Look at their history; it is not all about expensive tests.”

Gastrointestinal Issues (GI) and Gut Bacteria

Children with autism are more likely than typically developing peers to have a GI disorder. One study indicates that up to 91 percent of children with autism have a wide range of GI issues. These children have gut dysbiosis, or an imbalance of good to bad microbes in the gut. Yeast levels can be high; signs of yeast overgrowth are diaper rash, headaches, inappropriate laughter, sleep disturbances, gut pain and constipation.

Both constipation and diarrhea make gut dysbiosis worse, which contributes to immune and metabolism problems. The bad microbes produce toxins that can compound a leaky gut (permeable intestinal walls), which impairs absorption, digestion, immune function and detoxification. A leaky gut allows toxins to pass into the blood stream and some can cross the brain blood barrier. Bacteria also trigger inflammation and negatively affect the immune system. Gut bacteria produce neurotransmitters that inhibit or activate brain function. With treatment, common improvements can be better focus; improved sleep; and less hyperactivity, GI pain, constipation or diarrhea, self-injury or anxiety.

Treating GI Issues with Diet

In order for the body to function correctly, it needs nutrient-dense foods that are not laden with chemicals, allergens and excito-toxins. Artificial and high inflammatory foods contribute to a leaky gut and food colorings and preservatives can increase hyperactivity. The most common diet utilized is gluten-free/casein-free, or GF/CF, but many need to tailor the diet to address specific needs. Certain foods may need to be removed due to allergies and intolerances. Even without a positive allergy (IgE) or intolerance (IgG), some children see positive changes with the removal of common food allergens. Further dietary changes can be helpful, such as lowering histamines, limiting carbohydrates, following a ketogenic diet and reducing oxalate. There is no one-size-fits-all diet; most need to be modified.

“I have seen children improve dramatically when a therapeutic diet tailored to their individual history and symptoms is utilized properly. For many of my clients, their biggest fear is that if they take away the few foods their picky child relies on, they won’t have anything to feed them. In most cases, when we remove the problem foods, we actually see kids broaden their food choices as their gut heals and their ‘drug of choice’ is no longer available,” says Vicki Kobliner, MS, RDN, of Holcare Nutrition in Wilton.

Treating Dysbiosis

There are various treatment protocols to treat dysbiosis, which is a microbial imbalance or maladaptation. Children with autism sometimes have low levels of certain enzymes and need to take digestive enzymes. Probiotics help populate the gut with good bacteria. Antifungal medications are often added to treat dysbiosis. Parasite treatments may also be added especially if behaviors increase at the full or new moon.

Immune Disorders

A healthy immune system should recognize foreign organisms, eradicate pathogens, prevent a subsequent infection from the same organism and not cause injury to self. Many autistic children have a dysfunctional immune system due to immune dysfunction, hypersensitivity, autoimmunity and/or inflammation. Any autistic child with recurrent infections or atypical reactions should have an immune evaluation. Some may have a primary immune deficiency, or PI, making them susceptible to chronic infections. An autistic child with chronic sinus symptoms, asthma, respiratory infections, GI issues or eczema should also be evaluated for IgE and IgG food and environmental allergies or intolerances as these can cause behaviors.

“Eighty percent of the immune system comes from the gut,” says Darin Ingels, ND, BCIP, of Ingels Family Health in Fairfield. “Many immune and autoimmune problems stem from bacteria that are a normal part of the microbiome. The infection may be the initial problem, but it’s what the infection does to one’s immunity and how it turns on itself, creating autoimmunity, that matters. Kids keep going on antibiotics for months or years and relapse when they stop. It is not just about treating the infection; one must modulate the immune system without suppressing it and must not kill the normal flora in the process.”

PANS/PANDAS

A subset of autistic children has Pediatric Acute-onset Neuropsychiatric Disorders, or PANS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal
infection (PANDAS). The hallmark symptoms are sudden onset OCD, food restriction, anxiety, emotional lability, depression, aggression, behavioral regression, decline in learning abilities, sensory and motoric changes, sleep disturbances and enuresis. It is a clinical diagnosis and not based on one test. Treatment typically starts with antibiotics, often for an extended period of time. Subsequent treatments, depending on clinical assessment and lab tests, include immune modulation with corticosteroids, intravenous immunoglobulin (IVIG) and plasmapheresis. Natural anti-inflammatory, natural immune-supporting therapies, and natural anti-microbials are often utilized to promote further healing.

Metabolic Disorders

Individuals with ASD may have several metabolic disorders.

Mitochondrial (mito) metabolism

A 2010 study indicated that 80 percent of those enrolled had mito dysfunction (not mito disease). Mitochondria are in almost every cell; they are responsible for creating energy for the body’s functions. When mitochondria are dysfunctional, many symptoms occur, including developmental delay or regression, seizures, headaches, low muscle tone, intellectual disability, GI issues and fatigue. Neuropsychiatric symptoms can include attention-deficit/hyperactivity disorder (ADHD), anxiety, OCD and depression. Some triggers of mito dysfunction are overload of toxins and metals, certain pathogens, stress, gene mutations, and mineral and vitamin deficiency.

Mito dysfunction treatment is multi-factorial.

• Support with supplements, such as L-carnitine, vitamin C and E, CoQ10, B vitamins and others.
• Increase meal frequency and hydration.
• Avoid mito toxins, such as acetaminophen, valproic acid and beta-blockers.
• Exercise moderately.
• Check folate levels as they are integral for mitochondrial function. Some individuals have positive FR auto-antibodies, which, when treated, can show improvements in social interaction, attention and communication.

Some see immediate improvements, while others never see an improvement but treatment can delay the progression of the disease.

Redox metabolism

Treatments for oxidative stress can be beneficial. Glutathione metabolism can be improved with methylcobalamin B-12. NAC, or N-acetyl cysteine, can reduce oxidative stress and irritability. Treatments may improve core symptoms, hyperactivity, language and general functioning.

Neurologic Disorders and Sleep Disorders

Seizures

Seizures disorders are more prevalent in individuals with ASD than typically developing individuals. Some studies show that up to 38 percent of individuals with autism have epilepsy. Seizures are most commonly treated with antiepileptic drugs (AEDs). When AEDs are not effective by themselves, non-AED treatments are typically used. The most favorable treatment is a low-carbohydrate diet (ketogenic, modified Atkins). Other treatments include IVIG, steroids and Vagus Nerve stimulator.

Sleep disorders

Problems sleeping are exceedingly common. Behaviors are usually exacerbated as a result. One study shows a defect in the gene that makes melatonin; however, not all sleep issues are resolved by melatonin. GI issues, specifically GERD/reflux, can disrupt sleep. Foods that trigger GERD, or gastroesophageal reflux disease, should be eliminated; these include tomatoes, garlic, citrus, vinegar, carbonated drinks, high fat foods and others. A comprehensive GI workup by a gastroenterologist, including scopes, should be considered. Seizures should be considered as they can disturb sleep. PANS can trigger sudden onset sleep issues. If a child is unable to fall asleep for hours, rule out yeast, parasites, phenol sensitivity, and vitamin and mineral deficiency like magnesium and iron.

Neurotransmitter Dysfunction

Several neurotransmitter deficiencies are seen in ASD. These include amino acids (GABA, glutamate), cholinergic (acetylcholine), hormone (oxytocin) and amino acids (serotonin, norepinephrine, dopamine). Auto-antibodies can also disrupt neurotransmitter function. Many medications used in ADHD to control dopamine and norepinephrine neurotransmission cause negative side effects in children with ASD. There are some promising possibilities though. Medications targeting GABA (gamma-amino butyric acid) and glutamate may be effective due to abnormal excitatory/inhibitory balance. This intervention may improve language and core deficits. In some, galantamine can be effective in improving language and social functioning as it modulates acetylcholine.

Current research continues to prove that we need to further develop the way we think about and treat autism. It matters that many people still believe autism is lifelong and not treatable, or not something some children can recover from. It means less funding is dedicated to research and treatment. It also means that most traditional therapies are discontinued after the primary years, closing the opportunities for growth and development of skills. It closes the door on hope when the door should always be left open for a child or an adult with autism to reach his/her full potential. Continued growth should be encouraged and celebrated. Treating these co-morbid conditions does not negate the acceptance of a child’s uniqueness and autism. Making someone feel better and healthier should never be considered a problem. Treatment and acceptance can coexist.

Gabriella True is the mother of twin boys, one of whom has autism and PANS. She is the board president of New England PANS PANDAS and
the coordinator for Talk About Curing Autism (TACA)’s Connecticut chapter. She and her family reside in Connecticut. Connect at Gabriella.[email protected]. See ad, page 23.

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Autism Journey: Steps for Success

by Gabriella True

Implementing and continuing medical treatments requires a long-term commitment. The path is not easy but the results can make it all worth it.

1. Find support from other families. Autism can be isolating but there are many families in similar situations. Advice and support from other families can be crucial.
2. Start working with a doctor who understands the complexities of a child with autism and how their symptomology, behaviors and medical profile drive a treatment plan.
3. Triage the issues. What are the top three to five deficits your child has? What strengths do you want to support? What are the medical interventions to improve the deficits or strengths? You don’t want to overload yourself or your child. Choose a select number of interventions to implement within a six-month to one-year span.
4. Understand the process. Educate yourself on the medical basis behind treatment protocols so you can address positive and negative reactions. That way, when reactions occur, there is a plan in place to handle them. At the start of each protocol, it is key to know why you are doing it, what reactions you may see and how you will assess whether to continue.