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“Sought Autism Treatment”
Here’s a video clip from a story WFLA the local NBC affiliate did on us.
The success story of a mom in a desperate search to find treatment for her autistic child.
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Autism Spectrum Disorder: A Functional Disconnect Syndrome
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.
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He Tries to Bite Me
I have a ten year old autistic boy as a patient who occasionally tries to bite me. He used to try it much more when we first started treatment but lately not as much, in fact rarely. I always say that what the practitioner of Hemispheric Integration Therapy does often does not look like much but many times what we ask of the child can be a very powerful stimulus and quite demanding. It is why and when we are doing something that is the art. Pushing a child to”exercise the weak part of the brain may require mommies help also as no one know that child like mommy( most moms are great.) But often what the child needs can be difficult to do and very frustrating . Also, to once again make the working out analogy, it has to be hard enough but not too hard. But the sessions can not be too easy either. I ran across the term alpha rage on a blog relating to my experience with the biting. I hope this expands your awareness.
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Autism Resource in Tampa
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 Spectrum Disorders: Motor Cognitive Binding
Functional neurology and hemispheric integration therapy in the treatment of autism spectrum disorders at times uses a concept called the motor cognitive binding in the treatment of these children. This is based on the fact that balance and coordination are the number one comorbidity associated with these types of conditions. That is to say that the most common finding you see associated with autism spectrum disorders is a lack of coordination and difficulty with balance. If we look at the feed up system from the sensory receptors in the body to the brain we find out the motor system is a major input to brain stimulation. Proprioception, joint position sense and balance drive a considerable amount of electrical activity in the brain. One must know what position their body is in and where their body is in space in order to survive on this planet. Where your joints are, how fast your muscles or moving and where you are in relation to gravity are all important inputs that drive brain activity.
We know that the same pathways and circuits that smooth and coordinate movements also smooth and coordinate thoughts. This is the essence of motor cognitive binding. I like to tell people in my presentations, whether I am speaking to parents or professionals, that if you look at a child on the autism spectrum and observe how uncoordinated his movements are, this gives you a window into how uncoordinated their thoughts might be. The beauty of this concept is that it works backwards also. By smoothing and coordinating their movements ,we tend to smooth and coordinate their thoughts also. So we can use this as a window into the child’s mind in order to help him synchronized the timing and processing of sensory inputs and thoughts. This concept is partially responsible for some of the results of studies that one may read regarding the interactive metronome and improvements with regard to children with ADHD. Thus, any activity which improves coordination, rhythm, timing and targeting tend to be helpful in these cases.
This is a generality of course. Whether I am speaking to parents or professionals, I am always trying to make the point that specificity is the key with regard to helping these children. There are few generalities but each child tends to be different and unique with regard to his signs and symptoms. For this reason, when stimulating any sensory receptor in order to drive brain activity is imperative to be specific as you may inadvertently stimulate an area which can cause the child to regress or overstimulate that child and cause a regression also. Therefore, I always recommend before undertaking any type of activity involving a functional neurology approach that the patient consult with not only a doctor trained in functional neurology but also one that has experience dealing with children on the autism spectrum.
When dealing with children on the autism spectrum two common questions often come into play. They are “what does the child need to do to improve” and “what can the child do.” The second question at times can be further subdivided into “what the child can or cannot do and/or what will the child do.” Many times the children are capable of performing the exercises but are not willing to do so. This may be a matter of motivation and/or the child’s way of trying to maintain some control over the situation. Therefore, many times we use rewards in order to motivate the child to cooperate. I always say that the parents are the ones that know the child best and here is where they can be a great help. Thus, you have to find appropriate motivation for the particular child you are treating at the time. Also, the doctor must take into account that is the child advances and matures in thought. Therefore the same reward that motivated him in month one may not be enticing in month two. One particular reward that we like to use if possible with children is the Whac-a-mole game. We tend to use this toward the end of the treatment session or between activities which the child finds difficult. This game tends to be fun for the child and serves as a dual purpose of requiring some coordination, rhythm and timing. There are unlimited ways to stimulate various weakened pathways and circuits that are found in these children. The job of the doctor is to find out which path way needs to be stimulated, design a therapy to stimulate that pathway and then match it to the child’s level of function and behavior. We always like to make the therapy sessions fun so that the children do not dread coming in for therapy. This makes it pleasant for all involved. Below is a link to the Amazon site where the Whac-a-mole game can be purchased. Maybe you can use it to help motivate your child. Please remember that although this is a toy, if you’re using it for therapeutic purposes it is not a toy.
http://www.amazon.com/Hasbro-40509-Whac-A-Mole-Game/dp/B0001GDP00
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Autism and Alzheimers
Many times after I make a presentation regarding Autism Spectrum Disorders and functional neurology or Hemispheric Integration Therapy and I am asked, how I was able to pick this up so quickly. The answer is that for many years those of us who were practicing functional neurology were doing the same types of exams and treatments on adults for years. In my case, since 1989, when I first got certified. It is actually easier, in my opinion, to see these signs on adults, especially the elderly. The difference is that the elderly have problems with neurodegeneration as opposed to neuro development. The elderly have a large population of people with vestibular and balance disorders. The the number one comorbidity with children on the autism spectrum is incoordination and balance issues. I will expand on this concept at a later date. In any case, here is a post from a site making some of the comparisons mentioned above. http://throughtheeyesofautism.wordpress.com/2009/07/29/living-with-alzheimers-while-raising-autism/
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Autism Spectrum Disorders: The Sixth Sense
The functional neurology and Hemispheric Integration Therapy model for Autism Spectrum Disorders views sensory input as a major factor affecting and influencing those with Autism. I often say that most people are aware of the fact that if you damage the brain you will see changes in the body. We are all familiar with someone that has a stroke and changes in his posture with regard to his arm and his legs when walking. Someone who has had a stroke may also have a drooping of the face. So, we see how the brain can affect the body. Many times people are not aware that the body also affects the brain. That is, we need input and stimulation from the environment in order to drive brain activity. Input comes by way of our senses. The five senses are sight, sound, smell, touch and taste. What is often referred to as the sixth sense is balance. However, balance and vestibular input is a major driving factor to the brain. An animal in the jungle, that cannot balance itself, will not live long. Ask someone who has had vertigo if he would rather be deaf or have vertigo. The answer will be that one can adapt to being deaf although this is limiting. However, if you are continuously out of balance and spinning, you cannot function in any way. Many patients with vertigo cannot get out of bed nor do something as simple as turn their head.
This relates to Autism Spectrum Disorders in that many children with autism in fact do have sensory integration issues with regard to their vestibular system. So, if we look at the fact that the senses feed the brain and we have sensory integration issues then as is often said in the computer world “garbage in, garbage out.” I have many parents that when asked if the child has any vestibular issues respond “Oh no, he can spin and spin and spin and never get dizzy.” They also tell me how they can go to amusement parks and never get dizzy. But is this a normal response? If I take a neuro typical child or adult and spin him in a chair should he not get dizzy and perhaps nauseous? The answer of course is yes. So, this is an actual weakness and not strength with regard to these children. If vestibular input is a strong input to the brain and these children are not getting any vestibular stimulation then it follows that their brains may not be functioning optimally.
Such is the case with a 10-year-old boy that I’m currently treating. The most obvious issues that the child has upon meeting him is that he scripts (repeats verbiage from movies and video games) as well as toe walks. This child has wonderful parents who are both hard-working and a great support system relating to their grandmother and aunt. My approach to functional neurology with regard to the nervous system is that the lower areas are cleared up first. That is we look at the nervous system from the outside in, for example, we ask the question, “Is it in the receptor, peripheral nerve, spinal cord, brain stem, etc?” So if you look at comparative anatomy between the species, we see that lower life forms have brain stems and vestibular systems while only humans have well developed prefrontal cortex. The vestibular system is really fairly low on the comparative anatomy scale, as I stated previously, all animals need to balance in order to survive. So, in my opinion in this child’s case, his vestibular system was the starting point. In our office, we sometimes have parents tell us that they see changes after one visit. Perhaps after a couple of weeks or a couple of months. This particular child has been very difficult to treat. His response has clearly been slower than expected. This child has been treating for approximately 6 months. He has shown some small vague type signs of improvement, but has not really made the typical improvements that we are accustomed to seeing in the office. We have seen his scripting going from out of context to in context. That is to say, that previously he might have been scripting a happy birthday scene from a movie while we were doing therapy. More recently he has begun to script a scene where a cartoon character is scared of the dark if we shut the lights off in the treatment room. That’s not what I call huge progress.
His mom is amazing with her compassion and dedication to her children. But what she does most well and is helpful to me, is that she knows when her child is just avoiding behavior and when he cannot do something. She has a great sense of how to motivate him to do the activities necessary to make him improve. She also has been very consistent with this treatment even though the progress has been less than expected. Consistency is a major factor with regard to making changes in the brain using the techniques of Hemispheric Integration Therapy.
Within the last few weeks after vestibular stimulation the child has been wanting to lay on the floor. This is a very typical vestibular response. That is, when you feel you are losing your balance or the world is spinning, you tend to want to get closer to the earth. Those that have had vertigo will be able to relate to this statement. But that was still vague in that we weren’t sure if this was a new behavior or that if he was finally feeling the vestibular stimulation. More recently after his last three visits the child did not want any further vestibular stimulation and was nauseous even vomiting on one occasion. For me, this is a sign to celebrate. This signifies that we have finally reached a threshold with regard to his vestibular system and that our stimulation is finally getting through and registering in his brain.
Again, vestibular stimulation, proprioception (joint position sense) and balance are powerful stimulations to one’s brain. And with this system now providing more appropriate stimulation to his brain, we hope to see more positive changes in the future. So yes, I am celebrating the fact that I was able to make a 10-year-old boy vomit. So if you have a child who is on the Autism Spectrum notice if he ever gets dizzy or if you can make him dizzy. If you cannot, this is not a normal response and is an important sign.
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Autism Spectrum Disorders: A Child Gets a Haircut
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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Asperger’s Syndrome: Tips From a Recent Case
Asperger’s Syndrome is a milder condition on the autism spectrum where the individuals are known for being highly intelligent yet have difficulty with social situations. Often as a child they are known as “Little professors” as they are smart and may show interest in scientific subjects such as dinosaurs or science fiction themes such as Star Wars. These individuals tend to be able to integrate into society fairly well as their verbal skills may be quite high and again the major deficiency relates to social interaction and social awkwardness i.e. little Johnny can’t seem to make friends. They may have difficulty with displaying appropriate sensitivity to others’ feelings. It is difficult at times for them to understand abstract concepts such as humor. Reading facial expressions and maintaining eye contact may be an issue. Usually, they show coordination difficulties and are not considered very athletic as children i.e. the goalie on the soccer team not the star forward.
This particular case relates to an adult with Asperger’s Syndrome. When someone with Asperger’s syndrome grows up they tend to be attracted to computer fields. Such was the case in this situation. The reason for this being that many times these individuals are very detail oriented and intelligent while they tend to avoid social interaction. Therefore, many computer-related jobs fit those aspects comfortably. Many computer-related jobs can be done at home on a computer without having to go to an official workplace on a daily basis. This allows them to feel accomplished at work, intellectually, while avoiding social contact with others.
The problem is that screen time, television, video games and the Internet have been shown to have negative effects on individuals that are on the autism spectrum(attention deficit disorder, attention deficit hyperactive disorder , Sensory Integration Disorders, Processing Disorders, Asperger’s Syndrome, Tourette’s syndrome , Pervasive Developmental Disorder and Autism.) This particular patient who also has attention deficit disorder relates to “being on the computer and then coming out of an almost trance like state realizing 20 hours have gone by and more than 20 tabs are open.” He also has made statements such as “now that I’m aware of the issue with screen time, I feel as if the computer screen is like kryptonite, sucking the life out of me.” In a perfect world, the best thing for this patient would be to discontinue all screen time.” The problem is he is now in his thirties and this is how he makes a living.
In a hemispheric integration model, Asperger’s Syndrome tends to be a right hemisphere deficiency. This does not mean that all Asperger’s Syndromes are a right hemisphere deficient and certainly the only way to determine this is with an appropriate functional neurological examination. In this particular case however, he did indeed have a right-sided deficiency with the basis of his issues localized to a left vestibular lesion. He in fact had played football in college. He was a running back. At first, I thought this somewhat unusual as Asperger’s patients tend not to be athletic. However, upon further questioning it was determined that the reason he was a running back was that he could not catch a ball. This then tended to fit in well with the common associations of balance issues and uncoordination with Asperger’s patients. Apparently, he was tough and determined but not the most coordinated. This was confirmed throughout the physical examination process . This was addressed with appropriate modalities relating to functional neurology and hemispheric integration therapy. These treatments were performed at the office on a regular basis during his therapy sessions.
The issue was that he had to go back home and go back to work. That meant that in this imperfect world, he would have to continue working at a job that required him to be on a computer to earn living. This was the only way he could maintain the standard of living that he was accustomed to. He may be able to make long-term changes into a field that does not require so much screen time, however in the near future that was not an option. In the hemispheric model postural muscles and proprioception are extremely important as is the side of the lesion. He did in fact work from home. This gave us a little bit more flexibility. Together we discussed what his workday was like and tried to come up with some adaptations he could make to lessen the impact of the computer screen on his condition. A treatment program at our office always involves in office treatments and what we like to term “homework” for the patient. We were able to come up with five adaptations which were helpful for him.
These were as follows:
- He was to use the mouse with his left hand.
- He was to do some core exercises for several minutes every hour as they break away from the screen.
- He was to use a standing desk.
- If he was in a sitting position he was to sit on a Swiss ball.
- He was to place the screen slightly off center to the left.
These seemingly small and insignificant changes had a considerable effect in his ability to concentrate and be productive at work as well as his overall Asperger’s condition. As always, this is an illustration of home modifications that were made on a particular case. This is not to imply that all Asperger’s Syndromes are right functional hemisphere deficiencies of left vestibular origin and should be treated and prescribed the same home modifications. These types of changes should only be done with appropriate physician supervision.