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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.
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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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Last night we had our monthly support group meeting here in Tampa at Casa Mexicana in Tampa. As usual, I got to enjoy myself and learn more about the community. We have a group of parents that know so much about things such as I.E.P.s, home schooling and parking permits. One of our most experienced parents with an adult child who has been all over the country and has tried various treatments told me that even she picked up a few tips. A Few good pediatricians and therapist will be added to our resource list as some new names were recommended by new members of the group. I answered a few questions , mostly regarding Hemispheric Integration therapy. The best part is always the sharing and fellowship. Its nice to see the look on some faces who usually do not get a night out and if so not with others that understand their situation. If you are in Tampa remember that next week we are having a family outing at planet bounce for support group members. This is a special time reserved for our group for just families with children on the spectrum. Another outing for the parents and some much needed social time for the kids. For more information about our support group go to www.hitautism.net
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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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Here is some interesting information from the site http://physician-assistant.advanceweb.com/editorial/content/editorial.aspx?CC=41662
The summary relates to those with ADHD and speaks to the effectiveness of current medications as well as some contraindications. Often I must remind parents that these are spectrum disorders and there is much overlap among conditions. That is, for example, one can have a child with OCD and ADHD or Asperger’s Syndrome with ADHD. In this case, the warning is to those with Tourettes Syndrome and ADHD. Be careful of the conditions that your child may have and the medications they are given. The paragraph below speaks to a contraindication for the ADHD medication group if you have tics or Tourettes. Just in the last 3 months we have had 2 patients treating in our Hemisperic Integration therapy Program with that exact combination.
ADHD Drug Performed Well in StudyTreatment with once-daily Metadate CD (methylphenidate) Extended-Release Capsules by Celltech Pharma was more effective in children with attention deficit hyperactivity disorder (ADHD) than treatment with another frequently used drug, according to a study recently published in the online edition of the journal Pediatrics (Swanson JM, Wigal SB, Wigal T, et al. A comparison of once-daily methylphenidate formulations in children with attention-deficit/hyperactivity disorder in the laboratory school [the COMACS study.] 2004;113:e206-e216).
Metadate CD was more effective than the other drug during the morning hours and the two drugs performed similarly during afternoon hours, according to a company press release. Both formulations provide an initial dose of immediate-release methylphenidate. The initial dose is followed by an extended, controlled delivery of methylphenidate. The study included 184 children between the ages of 6 and 12 with ADHD.
Metadate CD Capsules are contraindicated in patients with marked anxiety, tension and/or agitation; in patients with glaucoma, tics or Tourette’s syndrome; and within 14 days of using monoamine oxidase inhibitors. Metadate CD Capsules should be used with caution in patients with a history of psychosis, drug or alcohol dependence, seizures, hypertension or cardiovascular disease.
The most common adverse reactions are headache, abdominal pain, decreased appetite and insomnia.
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I just got home from our summer conference here in Tampa. Everyone I talked to said they got a lot of information. I spoke regarding Hemispheric Integration Therapy as well as Functional Medicine with regard to Biomedical Interventions for the Autism Spectrum. Dr Knaus gave us some backround on himself as well as gave us some information regarding HBOT. Nancy Bentley informed us with regards to fermented foods and a diet which promotes digestive and general health. Suzanne Azizi ( I am a mother first) provided a passionate and inspiring story about her daughter and dealing with the educational system, IEPs and the law. The faciliies at the Children’s Board were excellent. Everyone seemed to have a good time a well as came away with some good information and it was free to all. So, I am happy with our first conference. Look for our next one!!
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To my delight, one of our moms came in this week and said that her 12 year old had recognized some words for the first time. Apparently, she was scrolling down the DVR in order to watch one of her shows. As she did this the child said “Barney” and she said “we are not watching Barney.” Then he said “Dora” and she said “no we are not watching Dora.” She then figured out that he was recognizing the words on the screen. So she pointed to them and he read them. “I almost cried” she said. Appparently, he has been at the pre reading stage for 3 years. This child is very low functioning. Since he started Hemispheric Integration Therapy with me about 3 months ago his speech therapist and O.T. have been impressed with his progress ( it all works together.)This is what makes treating these children better than anythng I have ever done.The kids and the moms are amazing.
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Last week we had our support group meeting here in Tampa. I am so amazed and impressed with the store house of knowledge that some of our parents have regarding this broad and life encompassing subject that is the autism spectrum community. This subject is immense. I spend my time where I feel it is best allocated reading diligently about neurology or functional medicine. I have a family. I have a practice. Yet I still try to read at least an hour a night and more on the weekends. Yes, some people say I am a bit nerdy or boring because of this. For this reason I am so thankful to these parents that are really expert in subjects like I.E.P.s, home schooling, the law and legislative process and advocating for their children. Just listening to them share and help other parents is like having a private tutor on this subject. Thanks to all those who help, share and educate me and others.
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We recently had a mom who took her child in for allergy testing. The child is a low functioning autistic boy. She wanted to see if there was anything relating to food etc. that she should be avoiding in order to help her child progress. The child had standard allergy testing with all the little needle sticks in his back. After the testing, this child who had been making substantial progress with his hemispheric integration treatment (H.I.T), regressed back to almost the way he was on his first visit. He had more vocalizations and just overall regressed in many ways. The testing was negative and should then theoretically have had no affect on the child. The allergist was aware of the regression as he had noticed the child’s overall improvement since beginning the hemispheric integration treatment several weeks prior to the testing. He stated that he had notced the same type of regression reaction in some other children. He was going to talk to some colleagues about doing a study regarding this reaction. Most importantly for all of you is that he said there is a way to get allergy testing through a blood draw. By using a blood draw test as opposed to a needle stick test no foreign substances would be introduced into the patient’s body and therefore this regression could be avoided. I hope that this is the type of information that will be helpful to my bloggers and I hope to share with the community in addition to my knowledge of Hemispheric Interation Therapy, functional medicine and biomedical interventions. There are hundreds of stories like this out there that we can share and possibly help someone else somwhere else in the world. Please post. Please share. Please help.
