•
A major part of Hemispheric Integration Therapy and the functional neurology approach to the treatment of Autism Spectrum Disorders deals with the term “Functional Disconnect Syndrome.” A Functional Disconnect Syndrome is a situation where connections between neuronal pools do not work at a level synchronized enough for normal behavioral and executive function of the human brain to take place. This may result in difficulty with language, social skills and learning among others. Allow me to attempt to clarify that in plain English. The disconnect refers to different areas of the brain not being connected in the sense that the areas do not communicate well with each other. This suboptimal communication relates to the fact that “the wires are there, they just are not working well. That is to say, if the wires between brain circuits were cut, then we would have a physical disconnect syndrome as there would be a literal disconnection. In this case, the wire are there, connected but they are not functioning well. This under functioning causes poor communication between the areas as though there were some physical damage when in reality there is not. It is for this reason that if we perform an MRI of the brain of a patient with Autism Spectrum Disorder it seems relatively normal. That is, there is no tumor, infection or vascular accident for example present to explain the child’s symptoms. Think about it, if the child did have a tumor, then his diagnosis would be “brain tumor” or “mini stroke” not autism. You would have a concrete answer for his symptoms. Something that you could see and touch and get your hands around.
Read more »
•
When I stared this blog, I originally intended to just write about Autism from the doctors perspective. I thought that this would be different and not something I had seen out on the web. My patient’s parents convinced me to broaden the scope of converstion as this subject is immense in the way that it touches peoples lives. Of course, I try to write articles now and again to educate parents of treatments that are available especially hemispheric Integration Therapy and functional medicine. This week I was inspired and encourage by the news that one of my toughest patients ( if not the toughest) had made a little progress. He is a 10 year old non verbal autistic child. He is a very sweet boy but you can feel the frustration inside him at times. He has great parents and is a happy child. He is difficult to work with because as I always say ” the more the child can do, the more I can do with him.” That is, the more tools that are available to help him. So, unfortunately it is easier to help an high functioning child than a low functioning child. Things such as no eye contact and not being able to follow instructions or mimic movements make it more difficult to apply the concepts of Hemispheric Integration Therapy for the purpose of helping a child. It is not to say that it can’t be done but it is a longer slower process we have to eventually get the child to the point where he can do more active participation. This often requires quite a bit of creativity and patience to achieve the goal. However, it can be done. Many times it is not a matter of capability but one of cooperation. That is to say, that at times, the children can do what is required but for the sake of “control ” don’t want to cooperate or at least only on their terms. This is where the parent and I get creative in trying to find various methods tho motivate the child to participate, which of course is for his own good, even if he doesn’t get it yet. Lately, with this child we have been getting more out of him at his therapy sessions than ever before. Last week this boys was clearly trying to tell me to do something, more than he ever has before. He can make sounds such as “Bah. He made several sounds and gestured but neither I nor mom could figure it out. This is a time when you could see frustration. This week his mom told me that for the first time he made two sounds in a row. That is, he was trying to say “more coke” and said “mmm kkkk.” That is exciting to me, gave me a boost of energy and had me up most of the night trying to figure out a way to enhance his treatment plan after taking into consideration what he appears to be responding to. It is not always a matter of what a child needs but also what we can do with him . In any case, I hope we are on our way to helping this child speak (a big thing) and that would thrill me almost as mush as it would thrill his mom.
•
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.
•
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.
