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I have a 9 year old autistic boy who on his first visit complained of chronic painful constipation as well as other symptoms commonly associated with autism. His abdomen was clearly bloated. He came to me after having previously been to various D.A.N. doctors including one with a very positive reputation. I asked the mom who wanted to pursue Hemispheric Integration Therapy if he had been worked up biomedically and if his issues had been addressed. She told me “Oh yes, I can bring in all his old lab work, he has no biomedical issues”. She said she provided me a list of the supplements he was taking. Finally, about 4 weeks later, after repeatedly asking for his lab work ( which she continuously said she forget to bring) I asked ” Are you sure he doesn’t have yeast?” That day the 9 year old , still in diapers, was constipated, bloated and screaming from the pain. She responded ” Oh yeah, he has yeast.” I asked ” Are you giving him anything for it?”. She said ” I was but I got tired of giving it to him”. Incidentally, she always came in handing the child a cookie. For those of you that don’t know, yeast love sugar. I then asked her what supplements he was taking at present. She responded that he wasn’t taking anything now. ” Then what was that list of supplements you wrote down on your intake sheet on his first day” I asked. “Oh, those are things he has taken in the past but he isn’t taking anything now” she said. FRUSTRATION!! We gave him some saccharomyces boulardii and he started feeling better by Monday. We also ordered some appropriate test to assess the child and be able to monitor his progress. I often say that Hemispheric Integration Therapy is like an exercise program for the brain. Before you begin an exercise program, you would want to make sure you did not have any serious health issues and make sure you eat enough protein to rebuild the muscles. Yeast and dysbiosis are what I call negative factors that should be addressed if you want to get the most out of the H.I.T. I think we will be stricter about bringing records prior to starting treatment. Every child I treat is an ambassador for H.I.T and this office. I want to make sure that they all make the most progress that they can. This treatment approach is a great one but it is not a miracle.
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Whenever I find something interesting or that can give you an inside perspective, I like to share it. This is a web by a parent who has experience with both hyperbaric and stem cells. I can usually handle most of the HBOT questions even though it is not something we do at our office. Stem cells and all the ins and outs relating to autism is something I really dont know much about. Here is a parent who chronicles his journey. I think this is worth the read even if you are not considering stem cells www.recoveringMatthew.blogspot.com I found him while checking out the Jenny McCarthy site.
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Another nice gluten free site had a list of gluten free candies. Once again, this site is not just for those on the autism spectrum http://glutenfreeislife.wordpress.com/gluten-free-candy-list-2008/
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Many parents who have children on the autism spectrum turn to the biomedical approach for answers. The Autism Spectrum includes A.D.D., A.D.H.D., Sensory Integration Disorder, Processing Disorders, Asperger’s Syndrome, Tourette’s Syndrome, O.C.D. and Autism. Whether I am approaching the child with the intent to use a functional neurology approach, Hemispheric Integration Therapy or as a functional medicine practitioner, the point is to treat findings. The decision as to what test to order simply comes down to three issues:
- One – What are we looking for? This should be narrowed down as to reasonable suspicions after a thorough history and functional neurological examination.
- Two - What can the child tolerate? Many times although a blood test may be the most accurate way to test for a particular problem , many children have had horrible experiences with phlebotomists, including being strapped down, and can not emotionally deal with a blood draw.
- Three - What can the parents afford?
The intestinal permeability test is a simple, relatively inexpensive urine test that can be done with little aggravation to the child and in my opinion should be near the top of the list when considering a functional medicine analysis of a child on the Autism Spectrum. Many of the lab findings with children on the Autism Spectrum such as dysbiosis, yeast, gluten/casein sensitivity, allergies, autoimmune disorders are found associated with intestinal hyperpermeability or as it is commonly known a leaky gut. The gut barrier allows assimilation and absorption of vital nutrients as well as excluding toxic substance and antigens. Increased gut permeability, leaky gut, can cause toxins to exceed the livers capacity to detoxify the body. It can also cause an overly sensitive immune system which translates to allergies. Leaky gut can also lead to autoimmune issues, the body’s immune system attacking itself including nervous tissue in responses due to cross reactivity.
How does this test work? First a urine sample is taken. Then the patient drinks a solution containing two sugars. For simplicity, one sugar, a smaller molecule should be absorbed and pass through to the urine and another larger molecule should be only slightly absorbed. The urine is then collected over the next six hours. The amount of the two sugars in the urine sample is then measured. Too much of the large sugar and you have a leaky gut. Too little of the small sugar and you may have some malabsorption. Obviously, other factors have to be considered but you now have an intro 101 to intestinal permeability testing.
Here is the important part regarding leaky gut and supplements. If the gut is inflamed due to a leaky gut, you probably have absorption issues. Which means that even if you are giving your child five million milligrams of vitamin D, it may not be getting through. You may be just as well pouring the supplements down the toilet. That is where they are ending up anyway. I am in Florida and we have patients that come from other states and other doctors and a substantial amount have never had an intestinal permeability test done. This does not mean that your doctor should not be looking at many other possible problems such as yeast. Yes, if yeast is found, it would be a top priority. It does mean that treating your child is a little more complicated than finding out that he tested low for vitamin “x” and giving it to him. Or that if a new study comes out showing an association between a mineral “z” deficiency and Autism you should automatically run out to the health food store to purchase it. Let us use our energy and resources, including money efficiently. Why is he or she deficient in vitamin “x”? Perhaps, it is due to a leaky gut or gut inflammation or perhaps something else. Always investigate so you do not end up feeling frustrated or worse yet quit an approach that may have helped your child if applied properly.
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I think I have heard it so often that it seems to be pervasive, no pun intended. A parent says ”If I could only know what he or she is thinking, just for a moment, maybe I could find peace”. So, when I find a good description of what someone on the spectrum feels, like written by a person who is actually on the spectrum, I think it is worth noting and sharing. http://www.autisable.com/708704103/self-awareness/
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Many times I am asked about things that one can do to help a child from a functional medicine stand point that does not involve testing. Let’s face it, if we test every thing it can start to get expensive. Some parents have a lot of money and want to know exactly what is wrong with their child in order to have the most accurate and efficient treatment possible. Others are limited in funds but not in passion or the amount of effort they are willing to put out for their child. The elimination rotation diet deals with food sensitivities and we all know that kids on the spectrum have issues with food sensitivities and allergic responses. Frankly, this diet is something that we all could do and would benefit from. Here is a nice post on a web site that gives a nice explanation regarding what this diet is all about. http://www.nourishmd.com/index.php?option=com_content&view=article&id=260:elimination-rotation-diet-plan-&catid=206:food-allergies&Itemid=557
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In my opinion, the gluten free diet is brutal but it seems everyday it is getting easier with all the new sites and recipes.
http://tried-and-truecookingwithheidi.blogspot.com/2009/07/bodacious-sugar-free-gluten-free.html
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Attention Deficit Disorder and A.D.H.D. has been linked to associated negative social ramifications such as increased rates of incarceration,substance abuse, higher pregnancy rates anxiety and depression. This month we had an interesting case present to the office regarding a young adult male with ADHD who was looking at jail time. He was on probation for being in the wrong place at the wrong time. His parents came seeking treatment as the judge had said if he appears before him again he will get five years of jail time.
My wife had sent one of her friends an email regarding one of our conferences on Hemispheric Integration Therapy for the treatment of Autism Spectrum Disorders. We view the spectrum as starting with A.D.D. and including A.D.H.D. , Sensory Integration Disorder, Processing Disorders, Asperger’s Syndrome, Tourette’s Syndrome, O.C.D. and Autism. An over simplified explanation is that these conditions are termed functional disconnect syndromes meaning that different areas of the brain are under functioning or not communicating with each other properly. This timing issue or desynchronization as it is frequently called causes a loss of the higher functions of humanity. There are several common suspects in these cases, the cerebellum, basal ganglia and prefrontal cortex, although the functional lesion can be anywhere and clinically only a detailed functional neurological examination will give the answer as to where the patients problem lies.
In this case, we had the benefit of having a SPECT scan available as his parent’s had already taken him to the AMEN Clinic when he was younger. A SPECT Scan, single photon computerized tomography is a type of nuclear imaging test that can show blood flows to your brain to determine what areas of the brain are active. The scan showed an under active right prefrontal cortex. The right prefrontal cortex is an area of the brain that among other things is responsible for empathy, judgement and impulse control.
Here is the heart of this story. The young man apparently drove of in a car leaving his parole officer’s office. The problem is he no longer had a license. Therefore he violated his parole and was now looking at five years in prison for a parole violation. The young man had had an initial consultation with me and had completed one treatment when this occurred. The report of my initial consultation was presented to the patient’s lawyer and the judge. In the report I explained how a a patient with an under-active right prefrontal cortex will have limited ability to control his impulses as the area of the brain responsible for regulating those impulses is not working adequately. Thus, it may not be that he doesn’t want to listen to the judge’s orders, but that he cannot. This is something we go over with parents of young children with A.D.D. and A.D.H.D who are treating at the office. I always advise the parent of these children to consider the fact that it may be that the child can’t help it when you are considering punishing him for his actions. Here a similar situation is occurring with the judge. Please consider the fact that he can’t help it, yet.
His parents are now talking to the judge regarding putting the young man in a half way home – a much better alternative than prison. This would allow the patient to come to the office to receive treatment. The patient’s father also said that he would have child rescanned with another SPECT scan after the treatment was completed, in which case further details of this case will be published in a scientific journal. For now, be aware that the children with A.D.D. and A.D.H.D are more likely to get into all sorts of trouble. When punishing them take into account the fact that they may not be capable of controlling their impulses. Realize also that this is a spectrum of disorders that can mix and match. There is much overlap with these neurobehavioral conditions. Your child may have Tourette’s syndrome and A.D.D. or O.C.D. and A.D.H.D. Finally, as these children get older their actions may lead to more serious consequences than be not being allowed to participate in recess because they did into behave in class today.
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I am not a big fan of chelation for reasons I will discuss in a later post but here is a web site with a nice concise intro 101 on chelation and autism http://www.autisminfoblog.com/about-chelation-autism/
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I got a call from a long time friend of the family this week. Now, this has nothing to do with the Autism Spectrum directly but highlights 2 good points.He asked me if I would see his brother in law who was having severe leg pains.The brother in law walked in with a cane. He had severe leg pains and cramps especially at night which started about 2 days before he saw me.
My friend thought that he might have neuropathy which is a condition that is known to cause numbness and pain in the feet. We treat neuropathy with high power laser therapy.
The patient was worried that he might have suffered a stroke of some sort.
His wife thought he may have sciatica, a condition of the sciatic nerve which can cause intense leg pain.
Let’s look at some of the differential reasoning. Strokes and T.I.A.s ( transient ischemis attacks) dont usually cause pain in both legs, more commonly they cause one sided problems i.e. the left side of the body, left face and arm etc.
You have 2 sciatic nerves, one in each leg. For the sciatic nerve to be the culprit he would have had to pinch both nerves, unlikely but we can check this on exam.
Neuropathy doesn’t typically have a sudden onset, it usually comes on gradually over years.
Central canal stenosis could cause pain in both legs. Stenosis is narrowing of the canal where the spinal cord is before the nerves branch off into 2 sciatic nerves.This is a possiblilty an something that can be checked on exam.
Phlebitis an inflamation of the veins in the calf can cause sudden intense pain and is very dangerous as a blood clot can dislodge and move through the circulatory system.
On examination he did not have any signs of stenosis or back tenderness. the sciatic notch was nontender. His vitals i.e. blood pressure were fine. His cranial nerves exam ( the nerves in his head that go to your eyes,face etc. ) were okay (lookin higher up.) There was only mild soreness in the calf from cramping and Homan’s sign a test for phebitis was negative.
Ther is an old saying in medicine that goes like this ” when you hear hooves, think of horses not zebras.” The most common and easiest to remedy, cause of leg cramps at night is a calcium deficiency. I asked him if he drank any milk or diary products and he said not really. So we gave him a good multivitamin and a calcium supplement and told him to take an increased dose and come to see me again on Monday. I just found out that he still doesn’t feel great yet but had no cramps last night.
The facts I gave you were generalized and over simplyfied but I think it gives you an idea of how a doctor thinks when you present with any problem including an Autism Spectrum Disorder. Localizing a lesion, going through the possibilities. It also shows how basic nutients can cuase serious problems, in this case pain and disabilty. Now as a good functioal medicine practitioner I most go back and make sure there is no reason for the calcium issue.
