Recent Advances in the treatment of Autistic Spectrum Disorders

By the end of 7 monthsSmile back at another personRespond to sound with soundsEnjoy social play

Red Flags• No big smiles or other warm, joyful

expressions by six months or thereafter

• No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter

By the end of 12 monthsUse simple gestures Imitate actions in their play Respond when told “no”

Red Flags• No back-and-forth gestures, such as

pointing, showing, reaching, or waving bye

• Not answering to one’s name when called

• No babbling – mama, dada, baba

By the end of 18 monthsDo simple pretend play Point to interesting objectsUse several single words

unpromptedRed Flags• No single words by 18 months• No simple pretend play

By the end of 2 years (24 months)

Use 2- to 4-word phrasesFollow simple instructionsBecome more interested in other childrenPoint to object or picture when named

Red Flags• No two-word meaningful phrases

(without imitating or repeating)• Lack of interest in other children

Red Flag: Any loss of speech or babbling or social skills

Regression at any age is cause for immediate referral

The emergence of anew autism model

Older model• Genetically determined• Brain based• Hard-wired• Treatable but not

curable

Is autism a BRAINDISORDER?

Newer model• Environmentally triggered• Genetically influenced• Both brain and body• Metabolic abnormalities

play big role• Treatable and recovery

possible

OR is itA DISORDER THATAFFECTS THE BRAIN?

Topics

AUTISM is A Medical condition .It is not a mental DisorderAs such it is preventableTreatable .

8

TreatmentGoals

Minimize core features and associated deficits Maximize functional independence and QOLAlleviate family stress

Educational interventionDevelopmental Therapies

CommunicationSensory, fine motor, gross motor

Behaviorally Based treatmentsCore and associated symptomsSocial skills

Medical or biologic treatmentsSupport family in home and community

ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behaviorAll of our parents used it!

Involves the A, B, C’sNot airway, breathing circulation

Antecedent Behavior Consequence

Speech/Language TherapyBehaviorally based/ intensive structured

teaching E.g., Verbal Behavior

Augmentative strategiesSign languagePECSAided augmentative/ alternative system(s)

Decrease non-communicative languageDevelopmental-pragmatic approaches

appropriate use of language in social situationse.g., SCERTSSocial skills training

Adjunct to educational, developmental & behavioral treatmentsSo far no evidence of impact on core symptomsEvidence supporting is variable

Toolkit – handouts for MD & families

Treat target symptomsStereotypiesWithdrawalObsessionsIrritabilityHyperactivityattention spanself-injurious behavior Aggressionsleep

Mind-body Medicine

YogaMusic Therapy

Manipulative and Body-based

ChiropracticMassage/Therapeutic

TouchAuditory IntegrationEnergy Medicine

Transcranial & magnetic stimulation

Biologically Based

Most commonly used~ 50% - biologically based30% - mind body25% - manipulation/ body based

** Most use > 1 modality

SupplementsB6/Magnesium, B12DMG/ TMG Vitamin A, Vitamin CFolateOmega 3 Fatty Acids

Elimination DietsCasein/ gluten free

Off-label medications

Secretin

ImmuneAntifungal therapy Immunotherapy, steroidsAntibiotics/AntiviralsStem cell

transplantation

Immunization-relatedWith-hold immunizationChelation

Hyperbaric oxygen therapy (HBOT)

Always others coming along…

One of most commonly used CAM treatments

Hypothesis : Exogenous opiate-like peptides = false

neurotransmittersEvidence – most non-blinded; few RCT emerging, no

differences

Requires elimination of ALL dairy products (not “GFCF except for ice cream…”) & elimination of barley, rye, oats &

wheat products

Potential deficienciesInherently deficient in calcium, vitamin D

B vits, Iodine, others may be lower in substitute products

Weight typically adequate, monitor Fe status

Another approach to therapy

Dealing with the yeast overgrowth.Dealing with the leaky gut.Heavy metals and their effects.Chelation.Methylcobalamin.

16

GUT Issues must be dealt with before dealing with the heavy metal issue

There are 3 main issues common to all autistic Children

1. Yeast Overgrowth

2. Leaky gut

3. Heavy Metal Accumulation

17

Yeast Overgrowth

Yeast overgrowth leads to poor absorption of necessary vitamins, minerals & esssential nutrients.

It is normal to have a small amount of yeast in the GI tract. Autistic children however have abnormal amounts, usually leading to poor absorption of essential nutrients and the leakage of toxic substances into the bloodstream which should not be absorbed.

18

How do we treat the Yeast overgrowth & Leaky gut syndrome

Nutrition/Antioxidants in food and metabolised in the body Vitamins A, B Complex, C, E, B12 , B6, Folic Acid,

Niacin Essential Fatty Acids These are extremely important.

They are a most powerful anti-inflammatory agent. Co-Enzyme Q10,DMG Trace elements – Magnesium, Selenium, Chromium,

Zinc Probiotics Reduced L glutathione,N Acetyl cysteine, Alpha-

Lipoic Acid Anti-fungals medications. Herbal Products,

19

Heavy Metals – what are they and where do they come from

Lead – petrol, paint, batteries, certain water mainsMercury – fillings in teeth, fish, paint, numerous

appliances such as mercury thermometers, nasal sprays and eye drops, certain vaccines.

Cadmium – Cigarettes, tyres, metal platingsArsenic – Pesticides, chicken feeds, rice, treated

wood

20

Heavy Metals – what are they and where do they come from

Aluminum – Cooking wares, aluminum foil, antacids, certain vaccines, canned drinks/foods

Antimony – Carpets, flame retardant clothes

IronCopper

21

Heavy Metals – how are we protected against these free radicals

Diet /nutrition– “let food be your medicine and let medicine be your food”- Hippocrates

Supplementation Skin release Good kidney eliminations Good bowel eliminations Exercise Healthy lifestyle

22

What are the effects of these toxic metals overloadThey are oxidised to form free radicals

resulting in the destruction of cells, They affect organs ,interfere with enzyme

systems, inhibit prostaglandin formation. Weaken the immune system, inhibit the proper functioning of cells, contribute to gastrointestinal problems, and are carcinogenic.

23

What Chelation agents are there1. EDTA-Ethylene diamine tetra acetic acid

2. DMSA(dimercocaptosuccinic acid)

3. DMPS(dimercaptopropanesulfonic acid)

4. TTFD Transdermal Allithiamine

24

How are they used EDTA is effective only intravenously.It is used

in adults in the form of MG EDTA for Heart Disease,Circulatory disorders,neurological disorders, and the chronic degenerative diseases.

DMSA (dimercocaptosuccinic acid)DMPS(Dimercaptopropanesulfonic acid)TTFD/allathiamine (active form of B1)

25

EDTA and its safetyGiven according to ACAM protocol millions of

chelations in past 30 years no recorded death.Doctors licensed in western Canada since

1997 No serious ADRS NIH conducting $30 million clinical trial on

2,300 patients no serious adrsNIH 800,000 I.V EDTA chelations in U.S.

alone no serious ADRSNot suitable for ASD children 3 hour i.v.

inneffective in chelating mercuryPowerful chelator of all other toxic heavy

metals

26

Metal Dertoxification in Auistic childrenDMSA is the most widely used , convenient,

safe , and given orally. It is a good chelator of Mercury, Lead and Cadmium.

Dmps May be given intravenously. A good chelator of mercury,often used as a provovative agent, usually given in oral form

27

Chelating With the oral chelators DMSA is given orally according to the Dan protocol 10mg/kg

body weight/3times daily for three days on and 11 days off.

Repeat Full Blood Count and Blood chemistry tests at 3 to 4 month intervals.

Mobilization and excretion of the heavy metals produces a shift in the equilibrium between the various compartments of the body. This exerts an almost magnetic effect on metals in depots which are not directly accessible to the chelating agent. The body attempts to restore an equilibrium between the depots again. The heavy metals will then migrate partially into compartmenst where it is accessible to the chelating agent.

28

Advantages of DMSA over DMPSDMSA more widley used therefore greater experience with

its use and well established safety profile.

Well established in the DAN protocol.

No well established oral DMPS protocol.

DMPS used more in acute poisoning with Lead, Mercury, Arsenic etc.

DMSA is more effective in removing Mercury from the brain, particularly when combined with Alpha Lipoic Acid.

29

Disadvantages of DMSA oral therpayDMSA may feed into the yeast/leaky gut/Gastrointestinal

problems.

DMPS is not as severe on the gastrointestinal problems

DMPS used by some physiciansina once weekly dosage of 100 mg per week

Is over 50 % absorbed

30

Methylcobalamin and pharmacology Metylathion is the process by which a single

Carbon atom is transferred from a Methyl donor to another molecule.This process is essential to life itself.

Dr. Richard Deth of Boston believes that Thiomersail interferes with the Metylathion process in converting Vitamin B12 to Metylcobalamin.

In many cases Autsim can be treated effectively by the Administration of Metyl B12 to augment the Metylathion capacity.

31

Biosynthesis of Active Methylcobalamin

The low levels of Glutathione in autistic children will adversely affect their ability to detoxify and protect against heavy metals such as Thiomersal.

32

Impaired MethylationAs impaired Methylation is important in

Autism, the administration of Methylcobalamin should bring about an improvement.

Dr. James Neubrander has found significant improvement with injections of Methylcobalamin by giving the Methylcobalamin every 3 days.

Improvements were noted in Attention, language ability and social skills.

33

How is Methylcobalamin given?Dosage recommendation is 65 micrograms

per Kilogram Bodyweight every 3 days.This means that as much as 1250 micrograms

is present in 0.05mlThe needle 30 gauge 3/10 Ultrafine BD

insulin. It may be given by the parent while the child is sleeping.

It is inserted into the buttock at a 30 – 45 degree angle just under the skin.

34

Adverse effects1. Stimming

2. Hyperactivity

Should these effects occur one does not necessarily stop the treatment.

If Adverse effects are tolerable the treatment should continue

35

Concentrated Metylcobalamin by InjectionMetylcobalamin is the active Co-enzyme

element of B12

B12 is present in the brain and central nervous system as Metylcobalamin & is Non toxic.

It is known that Metylcobalamin metabolism is impaired in the Autistic child.

Much information on this is available for Dr. Neubrander.

36

Typical NaturopathicTreatment Plan

Heavy Metal ToxicityAsses presence of heavy metalsInvestigate heavy metal exposureUndergo chelation therapy for removal of heavy metals

Brain ChemistyEvaluate levels of Glutamate/GABA, serotonin and dopamine

Gastrointestinal HealthWheat (gluten) and milk (casein) free dietCandida diet (sugar, arabinose, tartaric acid)Hypoallergic diet to prevent autoimmunityAnti-inflammatory diet to control inflammationSupplements including EFA, probiotics, glutamine, MCT

NutritionWhy does food matter?

Opium, gluten and milk in AutismBreakdown of gluten and casein by secretions of the pancreas

and the intestines create peptides (small proteins) that are similar in structure to endorphins (the body’s natural pain killer). These peptides have opiate-like qualities.

Normally, these peptides are degraded and excreted with little effect.

In autistic patients, these peptides can lead to reduced brain electrical activity and thus altered behavioural changes.

This activity is improved by naltrexone administration (an opioid antagonist) therefore proving opioid action.

Much anecdotal evidence exists of significant improvement in autistic symptoms when milk and wheat are eliminated from the diet.

A study using 15 autistic children correlated significantly increased urine exorphin level with autistic spectrum patients. Elimination of milk and gluten from the diet resulted in improvement of social, cognitive and communications sills, commensurate with reduction of urinary exorphin level. Knivsberg et al, 1990

Treatment Atypical antipsychotic,

Abilify (Aripiprazole) oral formulation was approved November 24, 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years.

Data based on two 8 week, randomized, placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I).

Multi dimensional approachIt should be remembered that improving

Methylation capacity is only one component of the multi dimensional approach in the treatment of Autism.

Gluten Casein free dietNutritional supplementationChelatingBehavioural therapiesPharmacotherapy

41