发现了一篇内容很全的，介绍相关治疗的文章。对不起，实在有困难翻译。
Alternative and Innovative Therapies for Development Disorders
by Lewis Mehl-Madrona, MD, PhD
Autism was first described in 1943. The 11 children presented what are
now known as autism's characteristic features -- inability to develop
relationships with people, extreme aloofness, delay in speech
development, non-communicative use of speech, repeated simple patterns
of play activities, and islets of unusual ability. The two most
prominent features were recognized as aloneness and an obsessive
insistence on sameness. Today's definition of autism includes the above
along with restricted, repetitive, and stereotypical patterns of
behavior, interests, and activities; a recognition that non-verbal
communication may be as impaired as verbal communication; and an
awareness that some children suffer from involuntary, violent outbursts.
Abnormal movements, problems with coordination and fine motor movements
and sensory impairments are also understood to be part of the disorder.
Research in the past five decades has changed this original concept of a
single disorder (called infantile autism in 1943) to the current concept
of a spectrum of disorders with multiple subtypes. Though this spectrum
contains a variety of named conditions, all are descriptive, with none
representing an actual biochemical or metabolic understanding. These
names are readily recognizable by parents and include autism itself,
Rett's disorder, childhood disintegrative disorder, Asperger's syndrome,
pervasive developmental disorder, and atypical autism. What many parents
do not understand is that these names represent different, apparent
clustering of symptoms, and not a true understanding of the causes of
these conditions. Since what can be said about autism is relevant to all
of the other named disorders, I will use the term autism to refer to all
related developmental disorders, only for the sake of brevity.
In addition to the core symptoms described above, symptoms potentially
related to other conditions are frequently found among children with
developmental disorders. For children with autism, about 60% have poor
attention and concentration; 40% are hyperactive; 43% to 88% exhibit
morbid or unusual preoccupations; 37% have obsessive phenomena; 16% to
86% show compulsions or rituals; 50% to 89% demonstrate stereotypical
speech; 70% exhibit stereotypical behaviors; 17% to 74% have anxiety or
fears; 9% to 44% show depressive mood, irritability, agitation, and
inappropriate affect; 11% have sleep problems; 24% to 43% have a history
of self-injury; and 8% have tics. The current trend has been to diagnose
these behaviors and symptoms as other coexisting conditions (rather than
attributing them to the developmental disorder itself). The resulting
additional diagnoses include attention deficit hyperactivity disorder
(ADHD), affective disorders (depression, bipolar disorder), anxiety
disorder, obsessive-compulsive disorder, and Tourette's disorder (a
disorder in which children have unusual tics and mannerisms and
sometimes involuntary and repetitive cursing).
Genetic analysis has yielded a few potentially interesting genes that
may contribute to autism, but no clear linkage has been established. For
this reason, it has been suggested that the autism may involve multiple
causes.
While autism was once thought to affect only 1 in 500 children, recent
trends indicate that its incidence is increasing, and that it may affect
as many as 1 in 150 U.S. children. Studies in both California and New
Jersey have shown dramatic increases in the numbers of children
diagnosed with developmental disorders in the past 10 years, an increase
which has not been explained. Nevertheless, this dramatic increase has
been used to argue against a genetic basis, but more in favor of
environmental factors (increasing pollution, increasing vaccination,
increasing toxic metal exposure during development) playing a role in
the increase.
People with autism appear differently at various ages. Their symptoms
and behaviors change with aging. In early childhood, hyperactivity,
stereotypical behaviors, irritability, and temper tantrums are be
prominent. Tics, aggressiveness, and self-injurious behaviors appear in
older children. In adolescence and adulthood, particularly in
higher-functioning individuals, depression or obsessive-compulsive
phenomena may develop and interfere with the person's ability to
function and with his quality of life.
Modern medicine strives to understand the biochemical and metabolic
basis for diseases. From this understanding, pharmacology aims to
develop drugs that act at the level of the underlying impairments. The
classic example comes from the discovery that insulin deficiency formed
the basis of childhood diabetes and that insulin replacement was
life-saving. Despite tremendous efforts, we are far from a biochemical
or metabolic understanding of the causes of autism. No treatments have
been developed that address the underlying problem causing autism, since
it is not known and since autism may have many different causes, all
culminating in the cluster of symptoms that present as developmental
disorders. The treatments of conventional medicine for autism are as
speculative and trial-and-error based as the alternative therapies.
Conventional medicine approaches autism with a variety of treatments,
including parental counseling, behavior modification, special education
in a highly structured environment, sensory integration training, speech
therapy, social skill training, and medication. The results of these
comprehensive suites of therapies have not been sufficiently satisfying
to prevent parents from seeking alternative therapies for the benefit of
their children. If conventional medicine were completely successful in
treatment autism, no need would exist for alternative or innovative
therapies.
Exciting research efforts are underway to improve our basic
understanding of autism. These efforts will help both conventional and
alternative medicine practitioners. These researchers are developing
ways to identify on biological grounds different subtypes of autism.
Using electrophysiology (recordings of EEG, heart rate, blood pressure,
breathing rates, and skin conductance) two subtypes were identified
among 145 developmentally disordered children. These different profiles
were thought to reflect different types of brain dysfunction. One type
was associated with intellectual impairment and excess reactivity of the
central, parietal part of the brain, while the other subtype linked
typical autistic behavior with excess reactivity of the temporal part of
the brain (the part of the brain that is also involved with language
processing). In an earlier study of 222 children, these same researchers
had identified four subtypes of developmentally disabled children based
upon information from clinical assessments. They used the type of
communication disorder, type of abnormal findings on the neurological
examination, type of impairment of intelligence, and types of autistic
behaviors to separate out four different groups of developmentally
disabled children. These subtypes correlated with different findings on
dopamine and homovanillic acid, brain neurotransmitter metabolites.
From a different direction, single-photon emission computed tomography
(SPECT) of the brain was used to define functional abnormalities in two
groups of childhood behavior disorders: (1) a "primary" category in
which there is exclusive or predominant presentation with cognitive
and/or behavioral dysfunction and (2) encephalopathies, often defined
etiologically at the biochemical or molecular level, in which clinical
expression includes, but is not confined to, neural dysfunction. Among
other behavioral disorders, SPECT scan studies have suggested a pattern
of hypoperfusion of two particular brain areas (the striatal and
periventricular areas) along with excess blood flow to the part of the
brain that handles sensation and movement (the sensorimotor cortex) in
attention deficit hyperactivity disorder. Specific abnormalities have
also been found in cerebral palsy and other brain conditions manifesting
as problems with behavior (phenylketonuria, MELAS (mitochondrial
encephalomyopathy with lactic acidosis and stroke-like episodes)
syndrome, Wilson's disease, etc).
During my medical training, autism and its related disorders were
considered essentially incurable. Little has changed in the intervening
years. The autism clinic from my psychiatry residency was largely an
exercise in diagnosis without treatment; what little we did for the
children we saw was largely ineffective. While we had come a long way
from Bettelheim's refrigerator mother theory of autism (in which a cold,
unresponsive mother was the cause of the condition), we were stuck in a
genetic-biochemical hypothesis that allowed no possibility for cure or
improvement. We were confident that the unknown genetic defect was
buried deep in the biochemistry of the brain. We were excused from
searching for treatments, thereby leaving this crucial journey to the
parents.
The parents of autistic children convinced me that everything I had
learned was wrong. Freed from the fetters of training and pessimistic
professors, they taught me that children with developmental disorders
are interesting, and have rich social and communicative lives, though
different from their so-called normal counterparts. Attentive parents
naturally learn the secret language of their autistic children without
even realizing this amazing feat. Autistic children do communicate and
do respond, but as if they live in a parallel universe, which can
nevertheless be accessed by those who want to reach them. They respond
to many treatments, including just receiving attention and being cared
for. They respond to nutritional therapies, body therapies, reiki, and
craniosacral therapy. They respond to acupuncture. They respond to
biofeedback and to behavioral educational therapies. What don't they
respond to?
Can autistic children become indistinguishable from so-called "normal"
children? I have seen it happen sufficiently often to believe; though,
in every case, the parents invested significant time and money to their
child's treatment, far above what school systems and insurance carriers
would have paid. To what can we attribute these successes, for no one
treatment seems to out perform the others, and no clear signposts exist
to tell parents what to do. Despite this, there are therapies with which
I begin.
I have not seen any differences in the application of these alternative
therapies to children that depending upon whether the child is diagnosed
with autism, pervasive developmental disorder, Asperger's syndrome, or
another related disorder. I am not sure that these distinctions are
relevant. When we do eventually understand the neurobiology of
developmental disorders, we may have very different classifications.
Science and Alternative Therapies for Developmental Disorders.
Little scientific research has been conducted on the many alternative
therapies being discussed by parents. Science is expensive, and best
funded by drug companies. Most of these therapies cannot be patented.
They are not amenable to mass production, but require one-on-one human
interaction, a mode of treatment which is definitely not profitable.
Beyond that, research on developmental disorders may require a different
protocol than drug research. Typical drug research compares a treated
group with a group treated with a placebo or to a standard of care drug
considered the "gold standard" in the field. Longitudinal, observational
research has fallen out of favor. This type of research is suited for
the situations in which we are less than certain of what we are
treating. Developmental disorders fall in this category. We cannot
explain the various developmental disorders. We do not know how many
different entities are contained within the one label of autism or
pervasive developmental disorder. We do not know how many different
pathways results in the collection of symptoms that get labeled as
developmental disorders. How can we properly pick children to treat in
randomized, controlled trials, if we don't even know what's wrong with
them.
Parents need to remember that autism is not a diagnosis like diabetes.
We know that type 1 diabetes results from a deficiency of insulin,
probably from auto-immune causes, though there may be more than one
pathway even there, to insulin deficiency. We know that type 2 diabetes
results from insulin insensitivity - the receptors no longer respond to
what insulin is circulating. With autism, we do not even come close to
such a definitive explanation. We have many competing explanations, any
or all of which may be correct.
Consider recent randomized, controlled trials of secretin (a peptide
hormone secreted by both the brain and the pancreas that was initially
reported as showing promising results for autistic children) that show
no effect. Have these studies been properly conducted? Do we know which
subtypes of autism to select for such a trial? Can we say that we
understand autism sufficiently to select those children who would
respond to secretin? I think not. What if only particular subtypes of
autism respond to secretin. A trial that included multiple types of
autism would not necessarily show positive results. A more appropriate
study might be to observe children receiving secretin over time,
comparing responders to non-responders. Then we might learn something
about who responds. From this knowledge, we could select potential
responders for a randomized, placebo-controlled trial that would be more
successful.
So much of alternative therapies are based upon anecdotal reports,
because the funds are lacking for rigorous studies. Yet, so much of
clinical medicine is based upon anecdote and is not evidence-based
either. Most of the drug therapies used for autism have not been
subjected to rigorous clinical trials. They have not been shown to be
better than placebo.
Pygmalion Effect. A major problem in autism treatment is separating what
could be called the Pygmalion Effect from true biological efficacy. The
problem is complicated by the possibility that true biological activity
without an emotional and environmental context for a treatment doesn't
really exist. The Pygmalion Effect is named after George Bernard Shaw's
play in which a lower class, "uncultured" woman from the slums of London
is trained to be a "lady," and becomes every bit as sophisticated as one
born to this position. The effect has been demonstrated in elementary
school classrooms. In the classic experiment, children's IQ's were
measured and the children were ranked as higher or lower IQ. Teachers
were told the opposite from what was found. High IQ children were
presented to teachers as lower IQ. Low IQ children were presented to
teachers as high IQ. One year later, the teachers' expectations were
much more important in determining children's performance than their
actual IQ. Knowing this, we could never ethically repeat this
experiment, for we are so much more aware of how people's expectations
for others, determines performance. A confounding problem in evaluating
any therapy for autism, including vitamins, is this Pygmalion Effect.
Because of this, many conventional physicians dismiss the potential
value of alternative therapies in favor of pharmaceuticals. Drugs are
always better studied than alternatives, because 1) they are easier to
study, 2) more money exists to study drugs because of the potential
profitability, and 3) it is more respectable as a researcher and a
physician to study drugs.
Until sophisticated clinical trials are completed, any of the
alternative therapies I will discuss could be explained partially or
completely by the Pygmalion Effect. What is exciting about this is the
realization that expectations can alter behavior. If parents expect
strongly that their autistic child will improve, the child does. I am
not afraid to try safe therapies that may only work because they
activate this Pygmalion Effect. This type of healing is just as real as
that produced by drugs, and probably much safer! While we struggle to
find biologically active treatments for autism, we cannot err too
greatly by supporting parents' enthusiasm for safe, new treatments. We
know from research on the placebo effect that an enthusiastic doctor
whose patients believe in him or her has a 70% success rate regardless
of the effectiveness of the treatment. An unenthusiastic doctor has only
a 30% success rate with an ineffective treatment. Therefore, we should
never discount enthusiasm. I continue to believe that alternative
therapies are an important part of treating autism, the above
considerations aside.
Drug Therapy. Findings from preliminary studies of major
neurotransmitters and other neurochemical agents strongly suggest that
neurochemical factors play a major role in autism. The findings also
provide the rationale for drug treatment in individuals with autism.
Nevertheless, as scientific as drug treatments sound, and as helpful as
these medications can be, they have not cured the problem of autism.
Nutritional Therapy. Nutritional therapies are the least expensive of
all complementary and alternative therapies, therefore providing a
logical place to begin. By far, the most common approach is to eliminate
gluten, casein, and soy from the child's diet. This can be difficult
since gluten can be found even the coatings of pills used for medicine.
The simplest course is to eliminate all grains, soy, and dairy for one
month, to determine if improvement occurs. Then various grains can be
gradually re-introduced to determine if improvements are reduced.
The basis for the gluten/casein free diet is the opioid theory of
autism. In the early 1980's similarities were noted between the
behavioral effects of animals on opioids, such as morphine, and the
symptoms of autism. People with autism were thought to have elevated
opioids in their nervous system, the best known being beta-endorphin.
The known effects of this compound were seen as similar to the symptoms
of autism.
To support this hypothesis, elevated levels of "endorphin like
substances" were found in the cerebrospinal fluid of some people with
autism, especially among those children who appeared to feel less pain
than the normal population, also exhibiting self-injurious behavior. At
about the same time, abnormal peptides were found in the urine of people
with autism. In the urine of about 50% of people with autism there
appeared to be elevated levels of substances with properties similar to
those expected from opioid peptides. Against the opioid hypothesis is
the finding by Dr. Magda Campbell of the University of Pittsburgh School
of Medicine that naltrexone, an opioid receptor blocker did not help
autistic children (though some argue that her doses were too low).
The quantities of these opioid compounds in the urine were too large to
come from the nervous system and could only have come from the
incomplete breakdown of food. Normal proteins are digested by enzymes in
the intestines and are broken down into these units. Incomplete
digestion of proteins results in short chains of amino acids (known as
peptides). Some of these peptides are biologically active, thought to
potentially contribute to the symptoms of autism. While most are found
in urine, a small proportion will cross the blood-brain barrier and
interfere with nervous signal transmission in such a way that normal
activity is altered or disrupted.
Defective intestinal enzymes (especially dipeptidyl-dipeptidase IV)
allow incompletely digested gluten and casein (with opioid properties)
to "leak" across the gut and into the blood stream. In larger doses,
these molecules cause hallucinations. Those who cannot metabolize
gluten, produce a-gliadin and gliadinomorphins, compounds which bind to
the opioid receptors (C and D) that are associated with mood and
behavior disturbances.
Glutens are proteins found in the Plant Kingdom Subclass of
Monocotyledonae (monocots.) These plants are members of the grass family
of wheat, oats, barley, rye and triticale, and their derivatives,
including malt, grain starches, hydrolyzed vegetable/plant proteins,
textured vegetable protein, grain vinegar, soy sauce, grain alcohol,
flavorings and the binders and fillers found in vitamins and
medications.
Casein is a milk protein, with a molecular structure similar to
gluten's. Casein (from human or cow milk) breaks down in the stomach
into a peptide known as casomorphine, which has opioid activities.
Gluten and casein could also be problematic for reasons unrelated to
their effects upon opioid receptors. One potential effect is an allergic
reaction (delayed hypersensitivity type) similar to what is found in
celiac disease and its variants.
In fact, autism has some surprising similarities to celiac disease.
Genes influencing both autism and celiac disease are close together. I
have seen children improve on a gluten/casein free diet despite negative
antibody testing for celiac disease. Perhaps these children will have
celiac disease when they are adults. HLA testing for the celiac genes
can better define this, but is not usually covered by insurance. For
more information on celiac disease, see
http://www.healing-arts.org/celiac.
The opioid theory predicts more of a toxicological reaction than an
allergic one. The results are more like poisoning than the kind of
extreme sensitivity that occurs in celiac disease or sensitivity to
certain food colorings.
A strict gluten and casein-free diet appears to reduce the level of
opioid peptides and improve autism for some people. The younger the
child is when the diet is implemented, the better are the results. The
initial response to the diet may be negative, consisting of an upset
stomach, anxiety, clinginess and slight ill-temper. Experience suggests
that these are good signs and are signs that a positive response will
follow. While the diet is difficult to follow, one month is usually
sufficient to determine if following the diet will help. After one
month, if any question exists, challenging the child with a grilled
cheese sandwich on whole wheat bread helps to determine if symptoms will
worsen after exposure to gluten or casein. Sensitive children become
clearly worse after this meal. Outcome is best tracked by counting
self-stimulation behaviors in the same 30 to 60 minute time slot every
day, by counting gastrointestinal complaints made per day, by counting
the number of times the child initiates eye contact in a half-hour time
frame, to name a few. Objective scales like the Autism Child Behavior
Checklist, the Achenbach Child Behavior Checklist are helpful, too.
At least half of my patients improve significantly after starting the
gluten/casein free diet. Excellent cookbooks exist and are found on our
web site (http://www.healing-arts.org/children). Second on my list of
interventions, after "GF/CF diet" or variants of it, is vitamin
supplementation.
Vitamin therapy.
The role of metabolic abnormalities in autism and other developmental
disorders is relatively unknown, though many case reports and anecdotes
have been written about autistic children recovering with nutritional
therapies. Because of the several known metabolic (genetic) defects that
are associated with autistic-like symptoms, it stands to reason that
milder versions of these more severe disorders exist and that metabolic
problems span a range from minimal to severe. The metabolic problems
that are known to be associated with autism include those related to
phenylalanine and histidine metabolism. Various enzyme deficiencies and
abnormalities are linked to autistic symptoms. When the metabolic
consequences of an enzyme defect are well defined, treatment with diet,
drugs, or nutritional supplements may bring about a dramatic reduction
in autistic symptoms.
A number of vitamins have research to support their use among children
with developmental disorders. Others are used based upon theory or case
reports of benefit.
Magnesium. Magnesium deficiency has long been speculated to be a central
precipitating event and common pathway for a number of children's
developmental disorders, as well as other conditions found among
developmentally disabled children (Tourette's syndrome, allergy, asthma,
attention deficit-hyperactivity disorder, obsessive compulsive disorder,
coprolalia, copropraxia, anxiety, depression, restless leg syndrome,
migraine, self-injurious behavior, autoimmunity, rage, bruxism,
seizures, heart arrhythmia, heightened sensitivity to sensory stimuli,
and an exaggerated startle response). A number of theorists link
magnesium deficiency to biochemical effects on substance P, kynurenine,
NMDA receptors, and vitamin B6, substances implicated in autism. A
number of studies have reported improvement with magnesium
supplementation, though usually in conjunction with vitamin B6.
Magnesium is high on my list of supplements, though its usefulness may
only come from its calming effects and its effects on relaxing smooth
muscles.
Trace and Other Minerals. Hair analysis for mineral content has been
used to determine differences in samples from control, autistic and
autistic-like children. Significant differences were noted between
children with autism and normal males and females for calcium, magnesium
and mercury. The autistic population had significantly lower levels of
calcium, magnesium, copper, manganese and chromium and higher levels of
lithium and mercury as compared to sex- and age-matched controls.
Children with autistic spectrum disorders (pervasive development
disorder, for example) had lower levels of magnesium, cadmium, cobalt
and manganese as compared to controls. Discriminant function analysis
using the 14 trace elements correctly classified 90.5% of the normal and
100% of the autistic population. Using a stepwise procedure, the five
elements with the greatest discriminatory power were calcium, copper,
zinc, chromium and lithium. Analysis based on these five trace elements
led to the correct classification of 85.7% of the normal and 91.7% of
the autistic group. The concentrations of trace elements in hair from
normal children differed from patterns observed in both autistic and
autistic-like children. Affected children may need supplementation with
calcium, magnesium, copper, manganese, zinc, and chromium, cobalt, and
other trace minerals. They may need reductions in mercury and lithium
levels (see the mercury section later in this paper). Mineral and trace
mineral supplements are frequently prescribed to autistic children with
anecdotal reports of good results. I also recommend these supplements.
Pyridoxine (Vitamin B6). Vitamin B6, or pyridoxine, has been thought to
be a factor in autism, as well as Alzheimer's disease, hyperactivity,
learning disability, anxiety disorder, and depression. It plays an
intrinsic role in the synthesis of certain neurotransmitters. Autistic
children have been reported to respond to high dose vitamin B6 and
magnesium with decreased physical aggression and improved social
responsiveness. Doses of pyridoxine used in reports with positive
outcomes have ranged from 15 to 30 mg/kg per day or 700 to 1000 mg/d.
Doses of magnesium have ranged from 10 to 15 mg/kg per day or 380 to 500
mg/d. The majority of studies do report a favorable response, though the
studies have methodological shortcomings. A 10-week double-blind,
placebo-controlled trial was conducted at Case Western Reserve
University with 10 patients (mean age 6 years, 3 months) with an average
dose of 638.9 mg of pyridoxine and 216.3 mg of magnesium oxide per day.
However, the treatment periods were rather short (2 weeks to 30 days).
Measures of change included the Children's Psychiatric Rating Scale
(CPRS), the Clinical Global Impression Scale, and the NIMH Global
Obsessive Compulsive Scale. No side effects were noted.
Vitamin B12 and Folic Acid. No significant change was found when folic
acid and vitamin B12 was given to an unselected group of children with
autism. On the other hand, behavioral improvement was noted among
prepubertal boys with fragile X syndrome treated with folate 10 mg/d.
Another study found no significant behavioral change among 4 autistic
boys with fragile X syndrome who were given folic acid. This finding
calls for a trial of folate in autistic children because about 8% of
autistic people also have fragile X syndrome. Despite this limited data,
a trial of folic acid for autistic children seems justified.
Zinc has some crucial functions in brain development and function.
During development, zinc binds to p53, preventing it from binding to
supercoiled DNA and ensuring that p53 cause the expression of several
paramount genes, such as the one that encodes for the type I receptors
to pituitary adenine cylase-activator peptide (PACAP), which directs
embryonic development of the brain cortex and adrenal glands. Zinc is
required for the production of CuZnSOD and Zn-thionein, which are
essential to prevent oxidative damage. Zinc is required for the function
of essential enzymes for growth and homeostasis. For example, the
synthesis of serotonin involves Zn enzymes and since serotonin is
necessary for melatonin synthesis. A Zn deficiency may result in low
levels of both hormones. Unfortunately, Zn levels tend to be low when
there is excess Cu and Cd. High estrogen levels lead to increased
absorption of Cu and Cd, as does smoking and eating food contaminated
with Cd. Ethanol ingestion increases the elimination of Zn and Mg (which
acts as a cofactor for CuZnSOD). Increased Cu levels may also be found
in people with Wilson's disease, which is a rather rare disease.
However, the heterozygote form (only one faulty copy of the chromosome)
is not so rare. Therefore, the developing fetus of a pregnant women who
is low in Zn and high in Cu may experience major difficulties in the
early development of the brain, which may later manifest themselves as
autism. Similarly, a person who gradually accumulates Cu, will tend to
experience a gradual depletion of Zn, with a corresponding increase in
oxidative damage, worsening autistic symptoms.
A currently popular nutritional theory of autism links its symptoms to
the separation of the G-alpha protein from retinoid receptors by the
pertussis toxin found in the DPT vaccine among already genetically
susceptible children. Children at highest risk have a family history of
at least one parent with a pre-existing G-alpha protein defect,
including night blindness, pseudohypoparathyroidism or adenoma of the
thyroid or pituitary gland. Natural vitamin A may reconnect the retinoid
receptors critical for vision, sensory perception, language processing
and attention.
Melatonin. An abnormal circadian pattern of melatonin was found in a
group of young adults with autism. Melatonin, at a dose ranging from 1
to 10 mg, has been effective in some autistic children with sleep
problems. Serious side effects were not observed.
A group of Vancouver, British Columbia, health professionals studied the
use of oral melatonin in the treatment of chronic sleep disorders in
children with disabilities since the Fall of 1991. They reported their
first 100 patients, half of whom were visually impaired or blind.
Children with neurological, neuropsychiatric, and developmental
disabilities are predisposed to chronic sleep-wake cycle disturbances.
Disorders such as blindness, deaf-blindness, mental retardation, autism,
and central nervous system diseases, among others, diminish the ability
of these individuals to perceive and interpret the multitude of cues for
synchronizing their sleep with the environment. Melatonin, which
benefitted slightly over 80% of our patients, appeared to be a safe,
inexpensive, and effective treatment of sleep-wake cycle disorders. The
oral dose of fast release melatonin taken at bed-time ranged from 2.5 mg
to 10 mg. Side effects or the development of tolerance was not observed.
Symptomatic vitamin A and D deficiencies in an eight-year-old with
autism.
Full Author Name: Clark, J H; Rhoden, D K; Turner, D S.
Clark JH, Rhoden DK, Turner DS.
JPEN J Parenter Enteral Nutr. 1993 May-Jun;17(3):284-6.
[Article in English]
Department of Pediatrics, Medical College of Georgia, Augusta 30912.
An 8-year-old boy with autism developed a limp and periorbital swelling.
He was found to have hypocalcemia and radiographic evidence of rickets.
Ophthalmologic examination revealed xerophthalmia and corneal erosions.
Serum vitamin A was undetectable and serum 25-hydroxyvitamin D was
decreased. Dietary history revealed a markedly altered intake consisting
of only french fried potatoes and water for several years. All
biochemical and physical abnormalities reversed with appropriate
supplementation. The nutritional content of french fries is reviewed.
Feeding dysfunction is an integral part of autism and closer attention
should be paid to potential nutritional deficiencies.
vitamin E,
peroxynitrate,
A case has been described of an autistic 15 year old boy with seizures,
mental retardation, aerophagia, breath holding, and self-injury.
Pyridoxine administration dramatically reduced seizure activity and
improved other symptoms as well. An autosomal-recessive genetic disorder
exists in which the binding of pyridoxine to the enzyme glutamic acid
decarboxylase-1 is impaired, leading to reduced synthesis of
gamma-aminobutyric acid (GABA). The clinical result is seizures
appearing even before birth. The gene affected is at 2q31. Knowing this,
I have treated autistic children, especially those with seizures, with
high dose pyridoxine, often with good results.
A number of disorders of neurodevelopment, including attention deficit
hyperactivity disorder, dyspraxia, dyslexia, and autism,have been
reported to be associated with fatty acid abnormalities ranging from
genetic abnormalities in the enzymes involved in phospholipid metabolism
to symptoms reportedly improved following dietary supplementation with
long chain fatty acids. Dr. Patricia Kane has promoted awareness of
fatty acid metabolism among autistic spectrum children. Through BodyBio,
she offers analysis of fatty acids on the red blood cell membrane to
determine their relative levels. Fatty acid metabolism can be directed
toward a pro-inflammatory state or an anti-inflammatory state, the
former being worse for autistic children. Supplementation with specific
fatty acids (especially omega-3 and omega-6) can alter pro-inflammatory
tendencies toward anti-inflammatory. While the details of fatty acid
therapy can become quite intricate, three oils provide almost all of the
compounds needed: evening primrose oil, borage seed oil, and marine
lipids.
Inositol has not emerged as effective for autism in clinical trials,
though it does help patients with depression, panic disorder and
obsessive compulsive disorder (OCD). Inositol is a precursor of the
second messenger for some serotonin receptors. A controlled double-blind
crossover trial of inositol 200 mg/kg per day showed no benefit on 9
children with autism.
We can broadly speak of an inflammatory theory of autism, in which nerve
cell membranes are irritated and nerve transmission is affected. The
inflammation can come from a variety of sources, including viral
infections, auto-immune phenomena (in which the body's immune system
attacks its own nervous system), post-vaccine reactions, abnormal
molecules in the nervous system (coming from the leaky gut and deficient
enzyme activity in the gut), and abnormal fatty acid metabolism. The
inflammatory theory can explain the role of some vitamins as
anti-oxidants (preventing and reversing cellular damage from
inflammation) and as direct anti-inflammatory agents (vitamin C, omega
fatty acids).
Vitamin supplementation alters metabolism of the nervous system and
provides an abundance of resources for healing within the brain. Getting
children to take vitamins can be difficult, but can be overcome by
blending vitamins into palatable drinks or by mixing the vitamins into
foods that the children will eat. Stevia is a sweetening herb that makes
these concoctions more palatable without causing the adverse side
effects sometimes associated with simple sugars.
My basic supplement program includes vitamin C, trace minerals
(vanadium, germanium, selenium, tungsten, tin, etc.), common minerals
(zinc, manganese, magnesium, calcium), B vitamins (with extra thiamin,
B6, and B12), vitamin A, evening primrose oil, marine lipids, OPC-3's,
and vitamin E.
Recent enthusiasm has centered around vitamin A followed by doses of
5-10 mg per day of urecholine. I have seen some children appear to
benefit from this approach, and others not benefit at all.
Environmental Toxins, Detoxification Approaches, and Chelation.
The literature that links autism to environmental toxins draws upon more
extensive studies of the possible role of environmental toxins in the
pathogenesis of Parkinson's disease, an adult neurodegenerative
disorder. Considerable evidence supports the role of toxins,
particularly pesticides and herbicides, in contributing to this disease
in at least some affected individuals (presumably, the genetically most
vulnerable). Proponents of the environmental toxin theory argue that
early exposure to synthetic chemicals is one suspect for the dramatic,
recent increase in the incidence of autism. Impaired detoxification of
environmental chemicals is thought to be common to both autism and
neuro-degenerative diseases like Parkinson's disease.
A small pilot study of 20 children (15 males and 5 females) with a
formal diagnosis of autism (mean age, 6.35 yrs, range = 3-12 years)
investigated the possible role of toxins coupled with impaired liver
detoxification. Measures included: (1) Glucaric Acid Analysis, (2) blood
analyses for identification of specific environmental (or xenobiotic)
agents, and (3) Comprehensive Liver Detoxification Evaluation. The
distributions for the autistic children on these measures were
significantly different from what would be expected in a normal
population (p < .01; using Kolmogorov-Smirnov testing for a chi-square
and Normal distribution of the Glucaric Acid). All the 20 children
showed liver detoxication profiles outside the normal range. Blood
analyses conducted for 18 of the children showed evidence of levels of
toxic chemicals exceeding adult maximum tolerance for 16. In the two
cases where toxic chemical levels were not found, there was abnormal
d-glucaric acid findings suggesting excess xenobiotic influences on
liver detoxication processes. The authors proposed that the interaction
of xenobiotic toxins with immune system dysfunction and continuous
and/or progressive endogenous toxicity leads to the development of
behaviors found in the autistic spectrum.
Closely related to theories of excess xenobiotic exposure coupled with
impaired liver detoxification is the impaired sulfate metabolism theory
of autism. Sulfation is an important method of detoxification,
especially for phenolic compounds, and its impairment has been found in
a number of degenerative neurological and immunological conditions,
including Alzheimer's disease, Parkinson's disease, motor neuron
disease, rheumatoid arthritis, delayed food sensitivity, and drug
intolerances. Preliminary data suggests that impaired sulfation may also
be important in multiple chemical sensitivities and diet responsive
autism. One of the important enzymes involved is
S-carboxymethyl-L-cysteine (SCMC). Reduced activity of this enzyme has
been found in the previously mentioned conditions. Impairment is
demonstrated by measuring the speed with which the probe drug
acetaminophen (Tylenol) is metabolized. Delayed processing is presumed
to be due to starvation of the sulfotransferase enzymes (like SCMC) for
sulfate substrate. We know that the general population's ability to
metabolize acetaminophen is bimodal, meaning that the population
separates itself into efficient and inefficient metabolizers. Another
2.5% of the population are thought to be non-metabolizers. Poor
metabolizers will have difficulty with the sulfoxidation of amino acids
like cysteine to sulfate (along with other sulfur containing compounds).
Impaired sulfation may be relevant to intolerance of phenol, tyramine,
and phenylic food constituents, and may be a factor in the success of
the Feingold diet.
Another popular environmental theory of autism is that it is caused by
environmentally acquired mercury, either through causal contact or
through vaccination. Mercury is thought to exert its neurological effect
on the brain. Exposure to mercury is known to cause immune, sensory,
neurological, motor, and behavioral dysfunctions similar to the traits
defining or associated with autism, and also similar to existing
abnormal findings in neuroanatomy, neurotransmitters, and biochemistry
of individuals with autism. Thimerosal, a preservative added to many
vaccines, is argued to be a major source of mercury in children who,
within their first two years, may have received a quantity of mercury
that exceeds safety guidelines. Proponents of this theory suggest that:
(i) many cases of idiopathic autism are induced by early mercury
exposure from thimerosal; (ii) this type of autism represents an
unrecognized mercurial syndrome; and (iii) genetic and non-genetic
factors establish a predisposition whereby thimerosal's adverse effects
occur only in some children.
Important to the environmental toxin theory is the reality that the
developing nervous system is exquisitely sensitive to toxic insult
during certain critical periods, precisely because they are dependent on
the temporal and regional emergence of critical processes (i.e.,
proliferation, migration, differentiation, synaptogenesis, myelination,
and apoptosis). Evidence from numerous sources demonstrates that neural
development extends from the embryonic period through adolescence. In
general, the sequence of events is comparable among species, although
the time scales are considerably different. Developmental exposure of
animals or humans to numerous agents (for example, X-ray irradiation,
methylazoxymethanol, ethanol, lead, methyl mercury, or chlorpyrifos)
demonstrates that interference with one or more of these developmental
processes can lead to developmental neurotoxicity. Different behavioral
domains (e.g., sensory, motor, and various cognitive functions) are
subserved by different brain areas. The toxic developmental
neurobiological hypothesis of autism argues that various disorders
including schizophrenia, dyslexia, epilepsy, and autism may be the
result of interference with the normal ontogeny of developmental
processes in the nervous system. Of particular concern is the
possibility that developmental exposure to neurotoxins may accelerate
age-related decline in function. This concern is compounded by
amplification of subtle damaging effects as development proceeds,
producing much larger effects later in life when the full impact of
disrupted, earlier processes become apparent. The argument here is that
amounts of mercury and other environmental toxins that would be
inconsequential to the adult brain, may have profound impacts if
encountered during critical phases of development.
Toxic chemicals in the environment--lead, polychlorinated biphenyls,
mercury, and certain pesticides--are known to cause some fraction of
neurodevelopmental disabilities, though how much is vigorously debated.
Unfortunately, too few chemicals are tested for toxicity to early brain
development, knowledge of infants' and children's special
vulnerabilities and unique exposures is scant, and paradigms for
environmental risk assessment have only begun to address the hazards
confronting infants and children.
Treatment for autism under this theory is to apply chelating agents to
extricate the toxic agents, including mercury. Utilization of the body's
own detoxification mechanisms is also important. Endogenous enteric
bacteria are argued to be the largest detoxification component of the
body, Providing an enormous detoxification reservoir, which can be
constantly and safely replenished. High-dose probiotics have been used
as an adjuvant for detoxification protocols among individuals with
autism, whatever the toxic cause may be (Brudnack, 2002; #30).
Secretin. Secretin is a 27 peptide hormone, produced in the intestines,
and commercially marketed as an aid to endoscopy. The interest in
secretin began in 1996, when Dr. Karoly S. Horvath, director of the
pediatric gastrointestinal and nutrition laboratory at the University of
Maryland, Baltimore, administered intravenous secretin while examining
an autistic child with chronic diarrhea. Several weeks later, the
child's mother, Victoria Beck, called with surprising news: her
3-year-old son Parker had started to talk and had good eye contact [1].
Subsequent infusions, obtained by the parents against medical advice,
led to further gains.
Dramatic improvement has been reported for some autistic children who
receive secretin. Typically a dose of 2-3.5 International Units per
kilogram of body weight is administered intravenously every 3-7 weeks,
depending upon the child's response and when the effects of the secretin
appear to wear off. Victoria Beck switched to transdermal administration
for her child in which the secretin is applied daily to the skin and
soaks into the body through a vehicle such as DMSO. Typically a dose of
3 to 7.5 International Units is used each day.
Dr. Horvath and associates gave secretin while assessing
gastrointestinal complaints in two other autistic children, and reported
"a dramatic improvement in their behavior, manifested by improved eye
contact, alertness, and expansion of expressive language," in the next
several weeks along with relief of gastrointestinal symptoms [2].
In December 1999, Dr. Bernard Rimland of the Autism Research Institute
in San Diego, California, reported that one-half of 100 treated children
improved in behavior, sleep, and/or digestive symptoms--based on
questionnaires returned by self-selected parents.
In another series, 70% of 200 children responded positively, according
to the treating physician, with a dramatic effect among 10%. These
reports did not control for concurrent treatment, nor was diagnosis
rigorously established.
The results of a randomized, controlled trial of one dose of secretin
was reported in the New England Journal of Medicine's December, 1999,
issue by Dr. Sandlin and colleagues. Children were randomized to receive
either secretin in an appropriate dose or placebo. Change was measured
on the Autism Behavior Checklist. Both placebo and treatment group
improved equally over the course of one month. Opponents of secretin
have used this study to argue that secretin is ineffective in autism.
Secretin proponents have argued that the study was of insufficient
length to draw serious conclusions and that important variables that
change in response to secretin were not measured. The Autism Behavior
Checklist, for example, changes more slowly than one month. We
administer it every six months. This study showed no adverse reactions
to secretin, which was suspicious to me, since I see about 15% of
children reacting to secretin infusion with hyperactivity and/or
increased aggression.
I have presented a case series of secretin infusions lasting over one
year among 35 patients. About 70% of patients improved, some quite
dramatically -- again a figure within the range of what could be
expected with enthusiastic placebo. What is more remarkable to me is how
much some of these children improved. If secretin is working only
because of a change in parental expectations, we have good news. Such a
finding could open a new awareness for the need to expect more from
autistic children. If secretin is not biologically active, then what do
parents do who believe in secretin to foster such dramatic improvements
in their child? Knowing this and being able to train parents in how to
influence the course of autism would be as significant as finding an
active biological agent. Unfortunately, the developmental disorders
community tends to overlook behavioral therapies, much as most illness
communities. We modern 21st century people are still searching for pills
that will change everything. While autism may respond in this way, it is
as likely that it is a complex illness that requires multiple,
synergistic treatments, not all of which are biological.
Secretin may open the pathway for searching for other neurohormonal
therapies that activate brain receptors. We know that secretin receptors
are found in the brain, especially in the temporal lobe speech areas.
Brain-imaging studies in one of Horvath's original cases showed a
"marked" post-infusion increase in cerebral blood flow to these areas.
Secretin may also activate receptors for a related hormone, vasoactive
intestinal polypeptide or VIP, which is more widely distributed in the
brain. Secretin also stimulates pituitary adenylate cyclase which
increases intracellular cyclic adenosine monophosphate (cAMP), a
messenger molecule for brain biochemical reactions. Opioid-like peptides
are known to lower levels of cAMP. Perhaps secretin prevents this or
replenishes the missing cAMP.
Lectins may also be important in explaining the mechanism of action of
secretin. Lectins are molecules that bind to cholecystokinin (CCK)
receptors and other glycosylated (meaning attached to long-chain sugars)
membrane proteins. CCK is another gut hormone with receptors in the
brain. Lectins inhibit CCK-8-induced alpha-amylase secretion by the
pancreas. This inhibition does not occur after administration of
secretin.
There are two divergent opinions on secretin--one that high doses are
necessary to obtain binding of secretin to receptors in the brain; the
other, that only small concentrations are required. The final verdict on
secretin is not yet out.
Anti-virals.
Returning to the inflammatory theory of autism brings us to anti-viral
therapy. Proponents of this theory argue that signs of long-term or
chronic viral infection exist among autistic children, and that
treatment with anti-viral agents can improve autism.
Perinatal exposure to infectious agents and toxins is linked to the
pathogenesis of neuropsychiatric disorders, but the mechanisms by which
environmental triggers interact with developing immune and neural
elements to create neurodevelopmental disturbances are poorly
understood. Among animals, a model for investigating disorders of
central nervous system development based on neonatal rat infection with
Borna disease virus, a neurotropic noncytolytic RNA virus. Infection
results in abnormal righting reflexes, hyperactivity, inhibition of
open-field exploration, and stereotypic behaviors. Architecture is
markedly disrupted in hippocampus and cerebellum, with reduction in
granule and Purkinje cell numbers. Neurons are lost predominantly by
apoptosis, as supported by increased mRNA levels for pro-apoptotic
products (Fas, caspase-1), decreased mRNA levels for the anti-apoptotic
bcl-x, and in situ labeling of fragmented DNA. Although inflammatory
infiltrates are observed transiently in frontal cortex, glial activation
(microgliosis > astrocytosis) is prominent throughout the brain and
persists for several weeks in concert with increased levels of
proinflammatory cytokine mRNAs (interleukins 1alpha, 1beta, and 6 and
tumor necrosis factor alpha) and progressive hippocampal and cerebellar
damage. The resemblance of these functional and neuropathologic
abnormalities to human neurodevelopmental disorders suggests the utility
of this model for defining cellular, biochemical, histologic, and
functional outcomes of interactions of environmental influences with the
developing central nervous system.
The most commonly used agent is Valtrex, though some also have used
Zovirax, which is known best for its use in treating herpes virus
infections. Some parents have even reported improvements in their
autistic children from the use of antibiotics. At this time, I know of
know trials that show true biological efficacy of anti-virals for
autistic children. Nevertheless, we can't yet discount this therapy. It
may also be that autistic children have immune defects and are more
prone to chronic viral infections. Treatment of these viral infections
could relieve some of the physiological stress of infection and result
in an improvement. Chronic illnesses (including autism) or so much more
complex that most physicians would like to acknowledge. Once a disease
process is started, effects follow upon many other organ systems. Even
if viral infection is not the precipitating insult of autism, it may be
important once autism is established, and treating chronic viral illness
may be helpful. If this is so, however, it would only be helpful for
those children who have a chronic virus. There are risks to anti-viral
medications, and there are herbal alternatives. Herbs boost the immune
system instead of attacking the virus directly. Common immune boosting
herbs include echinacea, astragalus, garlic, plant tannins, uva ursi,
and berberis. These herbs can also treat Candida, again by strengthening
the immune system.
Immunotherapy. We know that autistic children have defects in their
immunity, especially cellular immunity (the kind that involves the
direct action of cells; as opposed to humoral immunity which involves
immunoglobulin molecules released into the blood stream.). The white
blood cells (lymphocytes, macrophages, natural killer cells) of autistic
children can be sluggish and weak. Antibodies to brain proteins
(especially myelin basic protein) are also more prominent among autistic
children, suggesting an auto-immune process, in which the body is
attacking itself.
Levels of substances which indicate excess immune activity directed at
the self have been found elevated among autistic children. These include
gamma-interferon, alpha-interferon, interleukin 6 and 12, alpha tumor
necrosis factor and others.
Immunological studies of autistic patients have revealed features also
found in patients with other autoimmune diseases. Autoimmune diseases,
including Grave's thyroid disease, rheumatoid arthritis, and
insulin-dependant diabetes, show some genetic predisposition. Similarly,
autism is higher among identical twins than in the normal population.
Autism is four to five times more prevalent in boys than in girls - a
gender factor also found in other immune diseases, including systemic
lupus erythematosus, Grave's disease, and ankylosing spondylitis.
Autoimmune disease may be triggered by infections with bacteria or
viruses. In autism, coincidental findings indicate infections with
congenital rubella and cytomegalovirus. ,
Treatment is more difficult. The most popular treatment is intravenous
immunoglobulin G, given in varying protocols. The most aggressive
protocol gives the immunoglobulin approximately every other day, in
progressively increasing dosages, starting at 1 gm/kg, and increasing to
5 gm/kg. The more conservative protocol begins with 1 gm/kg, increasing
to 2-7 gm/kg at monthly doses. An intermediate intensity protocol is 5
gm/kg, administered monthly. Several studies have shown benefit to
treating children with immunoglobulin, though it is uncertain if all
children would benefit, or only those with chronic viral infections,
frequent bacterial infections, fungal infections, or other immune
deficiencies. Dr. Gupta at the University of California, Irvine, is
conducting clinical trials on the use of immunoglobulin therapy for
autistic children, and will have more data soon.
Other immune enhancing therapies include vitamin C,
oligoprocyanthocyanidins (OPC-3), and anti-inflammatory fatty acids,
along with the herbs already discussed.
Homeopathy.
I have also used homeopathy to treat the symptoms of autism. Homeopathy
is controversial among conventional physicians, but is occasionally very
effective in my experience. Is this effectiveness due to the remedy, to
the placebo effect, or to the Pygmalion Effect? I cannot say, but have
especially used sulfur for hyperactive and aggressive behavior, along
with a variety of other remedies as appropriate to homeopathic theory.
Homeopathy has the advantage of having minimal risk. It either works or
it doesn't. When it doesn't work, it doesn't harm. The debate will
continue for some time about whether homeopathy works, though a recent
analysis published in The Lancet, reviewed all of the recent clinical
studies of homeopathy and concluded that it is significantly more
effective than placebo. The downside noted by the review was that
homeopathy was not as reliable as some other treatments. This has also
been my clinical experience. When it works, it's wonderful, but it isn't
always predictable whether or not it will work.
Homeopathic detoxification is popular with some parents and physicians.
In this approach, small amounts of toxic substances are used to
stimulate the body to heal itself from these substances. The approach
may be combined with dietary modifications to faciliate the release of
toxins. For example, alkaline diets seem helpful for agitated children,
at times, and are thought to aid detoxification. Alkalinizing agents in
the diet include spinach, cucumber, carrot, beet, and celery. These are
juiced and used alongside food or used instead of food in an alkaline
fast. Avoiding acidic foods can also be helpful. These foods include
tomatoes, red meats, and simple carbohydrates, to name a few.
Allergic theories and treatments.
Lurking in the background throughout complementary and alternative
medicine lies the question of allergies. Though some physicians feel
allergies are over-stressed, the concept is important. I typically use
the ELISA/ACT Test from Serammune Physicians Laboratories in Virginia,
to test for food allergies. The acronym stands for Enhanced Lymphocyte
Immunostimulation Assay. Blood is drawn and the patient's lymphocytes
are incubated with various substances to determine what cell-mediated
reactions the patient is having. Cell-mediated reactions are more
important for food allergies than humoral reactions (immediate antibody
reactions in the blood stream).
Some more alternative physicians use applied kinesiology or an off-shoot
called Neuro-emotional technique, or N.E.T., to test for allergies.
Others place the substances within the patient's "energy field," and
test for changes in Chinese Meridians using pulse diagnosis. Offending
substances are identified and eliminated from the diet or the
environment. Nambuprihad Allergy Elimination Technique (N.E.A.T.) aims
to reduce the patient's allergic reaction by balancing the energy
meridians with the offending substances in the patient's energy field.
I have seen these approaches work and not work. We are all impressed
when they work. We are not so impressed, when they are ineffective. I
know of no rigorous clinical studies of the role of allergy treatment in
autism, but suspect that some will some be forthcoming. Certainly
eliminating foods and other substances that produce allergic responses
in the autistic child can't be harmful, and may be helpful in other
ways, even if these approaches show no effect on autism in rigorous
trials. These approaches can help the gastrointestinal problems of
autistic children, which is no small feat. Perhaps that will be where
their utility will lie.
Body therapy and manipulative therapies.
A study from the University of Miami showed effectiveness of touch
therapy for autistic children. Children's attentiveness and receptivity
increased after treatments. In a subsequent study, 20 children with
autism, ages 3 to 6 years, were randomly assigned to massage therapy or
to a reading attention control group. Parents in the massage therapy
group were trained by a massage therapist to massage their children for
15 minutes prior to bedtime every night for 1 month and the parents of
the attention control group read Dr. Seuss stories to their children on
the same time schedule. Conners Teacher and Parent scales, classroom and
playground observations, and sleep diaries were used to assess the
effects of therapy on various behaviors, including hyperactivity,
stereotypical and off-task behavior, and sleep problems. Results
suggested that the children in the massage group exhibited less
stereotypic behavior and showed more on-task and social relatedness
behavior during play observations at school, and they experienced fewer
sleep problems at home.
Other studies have also reported positive results for massage therapy
for autism and developmental delays. Generally, the massage therapy has
resulted in lower anxiety and stress hormones and improved clinical
course. Having grandparent volunteers and parents give the therapy
enhances their own wellness and provides a cost-effective treatment for
the children.
One popular form of touch therapy is craniosacral therapy, in which the
bones of the skull are adjusted along with subtle adjustments of the
spine, all the way to the sacrum. Craniosacral therapy, or CST, is
different from chiropractic manipulation in that the adjustments are
very subtle and are aimed at improving the flow of cerebrospinal fluid
down the spinal canal. This fluid has been demonstrated to cycle with a
pulse of 12 beats per minute. This pulse can be felt in the area of the
sacrum (near the tail bone). The goal of craniosacral therapy is to
improve the ease with which the cerebrospinal fluid circulates and to
help hold the skull bones and the spine in adjustment. The study showed
improved concentration, socialization, and less self-stimulation
behavior after a course of craniosacral therapy. This has been my
experience, as well, watching children receive the therapy.
Chiropractic manipulation has been used for autistic children. I know of
no formal clinical studies on its effectiveness, but have referred
children for this therapy and been pleased with the results. Naturally,
without clinical studies, the results could be do to the parents
expecting it to work, so we cannot say for sure that the technique works
of its own. Sometimes techniques work by giving opportunities for
natural healers and patients to interact. Unlike drugs,which can be more
obviously separated from the prescriber, body therapies are more fused
with the person administering the treatment. Some body therapists are
more inspired than others. Nevertheless, a developing literature is
finding body therapies very effective for many medical conditions.
Holding children with autism, even when they resist, has been reported
effective in improving social interaction and responsivity. In one
study, 7 autistic children were selected at random from a group of 14
and treated with modified holding therapy (MHT) for 4 weeks. The
remaining 7 children (control group) were not treated during this 4-week
waiting period. Four of these children were then treated with MHT. The
children's parents assessed positive behavior changes (increases in
desirable behavior and decreases in undesirable behavior) and negative
changes on a behavior rating scale. Significantly more positive changes
in behavior problems were reported for the treatment group than for the
untreated group in each of the four symptom categories assessed
(disturbances in perception, speech, social interaction, and
obsessive-compulsive or ritualistic behavior). The 4 children in the
control group who were later treated with MHT showed behavior changes
that correlated highly with those reported for the experimental group.
We have been doing a pilot study of reiki massage for autistic children.
The preliminary results are encouraging, especially when the parents are
taught to do the reiki along with visualization in between formal
appointments with the therapist. The use of reiki by parents and
therapist appears to encourage communication, especially non-verbal
communication. Children are more calm and have less self-stimulation.
Important to remember with healing methods that are non-pharmacological,
is that their effectiveness is a complex mixture of technique,
therapist, expectation, and communication.
Sensory Integration Therapy
Once considered alternative and innovative, sensory integration
therapy's use is becoming more and more common among occupational
therapists who treat children with autism. In this treatment, children
receive multiple, simultaneous stimuli in different sensory modalities,
pushing them to integrate these disparate inputs. Sensory processing
disturbance is a predictor of response to sensory integration therapy.
In one study, 10 autistic children, ages 3-1/2 to 13 years (mean, 7.4
years), were evaluated in regard to their hypo-, hyper-, or normal
responsivity to visual, auditory, tactile, vestibular, proprioceptive,
olfactory, and gustatory stimuli. After evaluation, each child received
therapy that provided somatosensory and vestibular stimulation and
elicited adaptive responses to these stimuli. At the end of one year of
therapy, each child's progress was judged in relationship to that of the
others, and the group was divided into the six best and the four poorest
respondents. Stepwise discriminant analysis identified which initial
test variables predicted good or poor responses to therapy. The good
respondents showed tactile defensiveness, avoidance of movement,
gravitational insecurity, and an orienting response to an air puff. The
children who registered sensory input but failed to modulate it
responded better to therapy than those who were hypo-responsive or
failed to orient to sensory input.
Another report dealt with simultaneous communication and multisensory
input in the treatment of six autistic and communication disordered
children. The children, aged 5 to 12, were taught manually signed
English and speech using a multisensory-intrusion approach. The
hypothesis was that such a technique would serve to alleviate the
children's difficulties in information processing, organization of
experience, and affect. The dependent measures were behavioral ratings
derived from both structured (teaching) and unstructured (free play)
sessions. The results indicate that the children manifested a consistent
acquisition of sign lanuage, which in some cases transferred into verbal
communication skills. Moreover, statistical analyses of some of the
observed socioaffective behaviors (i.e., nonsolitary play, interaction
with peers and adults, exploration, and detachment) revealed tendencies
supportive of the hypothesis. The variability of the data preclude any
categorical statement in relation to the hypothesis. However, the
preliminary results strongly support the continuation of the study.
Psychological Therapies, including Behavior Therapy.
A tactile prompting device (the Gentle Reminder) has been studied as a
means for prompting children with autism to make verbal initiations
about play activities. The device served as an effective, unobtrusive
prompt for verbal initiations during play contexts and during
cooperative learning activities. More importantly, it showed that
learning received from the use of the device would generalize to other
contexts and activities.
Seeing adults imitate the behaviors of children with autism leads to
increased social behavior in the children. Twenty children were
recruited from a school for children with autism to attend three
sessions during which an adult either imitated all of the children's
behaviors or simply played with the child. During the second session the
children in the imitation group spent a greater proportion of time
showing distal social behaviors toward the adult including: (1) looking;
(2) vocalizing; (3) smiling; and (4) engaging in reciprocal play. During
the third session, the children in the imitation group spent a greater
proportion of time showing proximal social behaviors toward the adult
including: (1) being close to the adult; (2) sitting next to the adult;
and (3) touching the adult. These data suggested the potential
usefulness of adult imitative behavior as an early intervention.
Music Therapy. Music has been an element in medical practice throughout
history. There is growing interest in music as a therapeutic tool. There
is no generally accepted standard for how, when and where music should
be applied within a medical framework. Traditionally, music has been
linked to the treatment of mental illness, and has been used
successfully to treat anxiety and depression and improve function in
schizophrenia and autism. The role of music in medicine is primarily
supportive and palliative. Music is well tolerated, inexpensive, with
good compliance and few side effects.
Naturalistic Behavior Therapy. Most practitioners in the autism world
have heard of Lovass' technique of applied behavioral analysis. This
approach is based upon teaching the child skills through interaction in
discrete trials in which the child is rewarded for the correct response.
Rewards often include food, sometimes, unfortunately, foods to which the
child may be allergic (M and M candies are frequently used!). Studies
from the Autism Research Center at the School of Education at the
University of California at Santa Barbara, have shown that naturalistic
behavior therapies are better than the applied behavioral analysis at
changing autistic behaviors. This approach incorporates natural
situations in which the child is already interacting and rewards the
child through creating opportunities to do more of what the child
already enjoys doing. Non-autistic children may be recruited to be part
of the therapeutic process. Examples of therapies in the classroom
include a teacher developing a game for the entire class when her
autistic student was obsessed with maps. The game consisted of the
children dividing into teams and drawing states on sidewalks with chalk
as fast as possible, including locating the capitol of the state. The
autistic student was excellent at this game and was soon desired as a
team member, thereby improving his opportunities for interaction with
other children. A book has been published about this approach, entitled
Teaching Children with Autism. We are more excited about this method
than the applied behavior analysis, though ABA as it is often called,
has helped many children.
Other more permission therapies exist such as those offered by the
Options Institute in Western Massachusetts, in which parents are helped
to appreciate the special talents and uniqueness of the autistic child,
and to learn to love the child as he or she actually is. These are often
healing for families, especially when coupled with naturalistic behavior
therapy and the other therapies mentioned here.
Stem cells.
Hyperbaric oxygen
Conclusions. Many options exist within complementary and alternative
medicine for the treatment of autistic children. We have not discussed
drugs that can help autistic children, but rather have focused upon
non-drug therapies. This is not to say that medications cannot be
helpful, because they can. But many parents are interested in
alternatives to medications, especially when there are side effects, and
other parents have found that the medications are not helpful or that
alternative therapies can add much benefit beyond what medications can
do.
My approach is to present this menu to parents, suggesting that they
decide what makes the most sense to try first. If parents don't know or
can't decide, I proceed in an orderly fashion through nutritional
therapies, to body therapies (craniosacral and reiki, especially),
through educational and behavior therapies, and through Chinese
medicine. By the time we have reached Chinese medicine, parents have
learned more about these alternatives, and typically have definite
opinions about what will work.
I monitor the outcomes of treatments carefully, asking parents to record
daily counts of desirable behaviors (eye contact, appropriate use of
language, etc.) and undesirable behaviors (self-stimulations,
non-responsiveness, aggression). I use the Achenbach Child Behavior
Checklist and the Autism Behavior Inventory on a regular basis also to
document progress. With any therapy, conventional or alternative,
accurate data are needed to prove that the treatment is worth the
expense and the side effects (if there are any). Fortunately, the
majority of the alternative therapies have no side effects.
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发表于 2004-3-25 15:03:11
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