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Most times when patients most times when parents present to my office with a child who is on the autism spectrum they have already tried the gluten free casein free type diets.D.A.N.! Defeat Autism Now! is by far the largest “alternative medicine” organization available and forum on the Internet and this is a big part of their protocol. GFCF is one of the mainstays of their program. The gluten and casein sensitivity and its association with autism spectrum disorders is fairly common. Logically a GFCG diet would follow. This is a big part of the Biomedical treatment approach that parents come across in their search to help their children. This link has a nice article on how to get started with the GCFC diet as well as a link to a list gluten-free items. http://glutenfreequestions.com/ask-gfq-how-do-i-start-the-gluten-free-diet/
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Children on the autism spectrum have a tendency to be much more sensitive with regard to interaction with their environment. A major part of this interaction is there diet and overall food intake. Here is a link to a blog post in which the author describes a multitude of detrimental effects to having sugar in your diet. One of the things that I like to do is take information not directly related to autism spectrum disorders and adapt them to these conditions and present them to you. At times, this may require you to take a little bit of a leap or move your thinking a step further. Usually, I try to make this a small step. Thus if sugar is detrimental to a normal and healthy body, we can expect it to be even more detrimental to a child on the autism spectrum. This of course is particularly relevant if the child has or is prone to yeast infections. Here is the link to 76 ways sugar can ruin your health
http://www.freeads13.com/blogs/index.php/20090828-793/76-ways-sugar-can-ruin-your-health/
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I almost forgot to mention our last support group meeting in Tampa, www.hitautism.net. What a great meeting. We had a new member to the group who introduced herself and then said “ I don’t know what to do.” She was referring to not knowing how to go about finding resources for assistance in treatment, schooling, socializing, etc. of her recently diagnosed ASD child. Immediately the more experienced moms joined in and began helping her with tips, advise, links and resources. The new mom had a paper and a pen and began to write down all of her newly acquired information. There were some questions for me regarding biomedical treatments and Hemispheric Integration Therapy. You could see that she left the meeting uplifted and feeling better than when she came. It was beautiful and inspiring. Many times we see parents who have lost hope, are confused or just plain overwhelmed. And when we can share our experience and enthusiasm, we see the light and energy come back. We also discussed a movie play date, a bowling play date, another planet bounce play date as well as getting a team together for the buddy baseball league. I thought, “This is what I wanted, not just a commisaration or validation group but an organization that actually helps families and is uplifting”. It is so fulfilling to experience what is happening in our meet-up group.
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Autism is something that affects different children in different ways. Some of the sensory integration issues can be quite unique while others are complaints that seem to weave a common thread for children on the spectrum. This case is about a six-year-old boy who had emergency surgery at three years old for hydrocephalus (water on the brain.) He also had febrile seizures at 13 months. At 15 to 18 months he began to experience speech regression. So the child in addition to being diagnosed with autism also cause the history of hydrocephalus and seizures. Presently his speech is limited to mostly 1 to 2 word phrases. He tends to pull the parents toward what he wants to express himself. It has been determined that his issues are more expressive and receptive. This means that he can understand more than he can say. He is in diapers.
These parents met me at a statewide conference that I spoke at over the summer. They live approximately 2 hours away. Those of you that know me, know that I am not a big fan of distance type treatments. The reason for this is that there is less quality control as more and more of the therapies and exercises are pushed off toward the home. Even parents that treat with me locally and are giving home exercises will tend to make errors in these exercises when we periodically check to see if they were being performed correctly. Fortunately, when someone is treating locally the error only continues for a few days before we catch it not weeks or months. If you understand the concept of plasticity and that we can make changes in the brain, then you understand the changes can be made both in a positive and negative fashion. These children as a group have delicate nervous systems and tend to overreact to various stimuli. So it is important to do the right stimulation at the appropriate time and in the appropriate order for that particular child. The last thing that anyone wants to do is make any of these children worse. For children that are simply doing the functional medicine approach to autism spectrum disorders, the distance treatments are something that can be done in a quality fashion. For those using functional neurology and Hemispheric Integration Therapy the issue of quality becomes more significant. Functional neurology and Hemispheric Integration Therapy also have the risk of over stimulation, as well as doing the wrong stimulation at the wrong time. Therefore, there are many aspects that can be done inappropriately.
However, this family is a great family. Two loving and hard-working parents with two loving and very supportive grandparents desiring to help this child. So I explained to them why I do not like to do a distance programs as I stated above. But I could see the concern, love and dedication that this family showed for this child. I explained to them that with a distance program, progress would probably be slower and they would have to be more patient. The fact that the risk of over stimulation is possible would cause me to give them a slightly watered-down program compared to what we would do in office. This family was disciplined and dedicated and wanted to proceed. They also had not pursued any biomedical options. So we first suggested the basics, a probiotic, a multivitamin and essential fatty acids. I explained to them some of the biomedical aspects such as leaky gut, food sensitivities and the like.
On this child’s first visit he had considerable hyperactivity, he displayed some screaming and patterns. I explained to the parents that with this type of treatment, the more that the child can do with regard to the therapy and stimulations, the more he will progress. That is to say that if we cannot get any cooperation from the child in performing certain types of activities then his progress would be limited. We can always begin with passive activities in which the child does not have to cooperate or participate much; however, even these activities still require some cooperation from the child. I demonstrated a few techniques that they should be trying at home. This was done in the office with myself and supervision. This child’s level of cooperation was not the best and to be quite honest this was going to be something difficult. However, I could see that this family had a wonderful mix of love and discipline. I thought that they would be able to find a way to get the child to perform the activities. After all, nobody knows the child as well of the family. No one knows how to motivate the child as well as the family.
The child recently presented after approximately 6 weeks of treatment. He was not hyperactive in the consultation. He did not scream throughout the entire consultation. He was fairly cooperative. The parents observed he was keeping his clothes on more. One of the child sensory issues is that he does not like to have clothes on. On his last visit, it was reported that the child allowed a family friend to hold him for over five minutes. That is the first time that this has been accomplished. His coordination is improving. His eating habits are improving. He is able to repeat words more appropriately. He is having fewer tantrums. One of the most obvious examples of this is getting a haircut. Apparently, once even approaching the barbershop, he would begin screaming and flailing. His last haircut he went fairly smoothly to the surprise of both his father and the barber. Is it the feeling of the clippers that the child does not like? Is it the sound of the clippers that the child is not like? Is there too much noise in the barbershop? We really don’t know. What we do know is that this child is making improvements with regard to his sensory integration issues and this is affecting his normal daily activities.
How far can we get with this child? Only time will tell, however, he is young, he has a great family and support group, and he is improving. Again, I repeat, the more the child can do, the better chance we have of helping him. So as he becomes more cooperative and is able to follow more instructions, this will put more tools into play that we can use to augment his progress. So, right now I am hopeful. A child getting a haircut, a small thing but a big thing. I am often asked questions such as “ when can a child begin Hemispheric Integration Therapy” or “We don’t live in Tampa can we still do H.I.T or functional medicine interventions at a distance?” I hope this gives everyone a feel for those answers.
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If you can’t eat out due to the gluten free diet, here is a restaurant review of a nice meal. Hopefully you live near one of these restaurants. http://glutenfreeislife.wordpress.com/
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Many in the autism community, especially those interested in biomedical solutions are familiar with the concept of leaky gut or intestinal hyper permeability. Many however, are not familiar with the concept of a leaky brain. I was asked the other day by the mom of a child with ADHD if she should give her child GABA, gama amino butyric acid, to help. The thought being if we could get him to calm down then we could get more out of the hemispheric integration therapy sessions he was participating in. In order to get the most benefit from hemispheric integration therapy the patient must be able to participate in the treatment program. That is, the more he can do, the more we can do for him and the better it works. In this particular case, the child’s attention span is so short that it is difficult to get him to perform a particular therapeutic exercise long enough for it to be of benefit to him. This led me to discuss GABA, the GABA challenge and a leaky brain.
GABA is an inhibitory neurotransmitter in the central nervous system. Inhibitory meaning that it encourages nerve cells not to fire, as opposed to excitatory which encourages neurons to fire. Thus, GABA supplements have the reputation of acting as a calming agent. This was the rationale behind the mom’s suggestion to give him GABA before his treatments in order to calm him down and thus we could get more work done during the time of his treatment sessions.
The problem with this theory is that our brains are considered very precious and therefore have a special barrier to protect them from substances circulating in the blood and the rest of the body. This is called the blood brain barrier. The blood brain barrier is semipermeable meaning that it allows some substances to get through while prevents other substances from crossing over to the environment of the brain. Therefore, the blood brain functions to protect the brain from foreign substances circulating in the blood that could be harmful to the brain. This semipermeable function is similar to the way the intestinal barrier that acts as a screening portal of entry from the outside world to the body. For example, the blood brain barrier is very effective in protecting the brain from bacterial agents in the blood and body. These bacterial agents are screened out by the blood brain barrier and not allowed to cross into the environment of the brain making infections of the brain very rare.There is an issue when the semi-perm permeable blood brain barrier becomes too permeable and allows substances that should not pass through to the brain, into the brain and its environment. This is obviously of significant importance when dealing with patients on the autism spectrum.
In the case of testing for a leaky gut barrier we give the patient two sugars in a solution to drink. One sugar should be absorbed and one sugar should not.We then collect the patient’s urine. If the sugar that should not have been absorbed appears in the urine then the gut barrier was not doing its job and is leaky. To test for a leaky brain or hyper permeable blood brain barrier we use a similar concept. This is called the GABA challenge. GABA taken orally should not be able to cross the blood brain barrier assuming that the barrier is intact. That is, when the doorman of the brain(the barrier) is at the door deciding who gets to go in and who should be kept out, GABA should be kept out. A healthy blood brain barrier should not allow GABA to cross into the environment of the brain. It is impractical to measure cerebral spinal fluid before and after administering GABA to see if there has been a significant change. However we do know the effects of GABA and we can observe for those. That is to say, if GABA did cross the blood brain barrier we would expect to see a calming effect on the individual who took the GABA. This is the basis for the GABA challenge. A GABA supplement is given to the patient and if within a two-hour period the patient becomes more relaxed, then we make the assumption that the GABA crossed the blood brain barrier and had its inhibitory/calming effect. This suggests a leaky blood brain barrier.
So the leaky brain may answer the question as to why some people take GABA and it has a calming effect, while the same GABA does not have any effect on others. Therefore, in this case, if mom gives her son some GABA in order to calm him down so that we may have more effective hemispheric integration therapy sessions with the child and this is effective, then we have unearthed another problem. Although this may help us have more effective sessions, we will have discovered the issue of a leaky blood brain barrier. A leaky brain is a serious problem which needs to be dealt with particularly in relation to autism spectrum disorders. We do not want a weak blood brain barrier leaving the brain susceptible potential bacteria, toxins and inflammatory reactions.
As always, these illustrations are simplified examples with many other factors that need to be taken into consideration and performing tests such as a GABA challenge should only be done with appropriate physician supervision.
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There is a new social networking web site for gluten free dieters that functions like face book. Share recipes, stories and frustration. The web site seems to be geared toward celiac disease but gluten free is gluten free. It has blogs and forums. It has events listed in different cities around the country. The emphasis doesn’t appear to be on the Autism Spectrum but I am sure you can find ideas here to make your life easier.It really looks like a good place to get some gluten free info. Here it is http://www.glutenfreefaces.com/
