af early warning signs

8/2/2019 Af Early Warning Signs

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From the Editors of

Early Warnings signs of

Autism in Childern.

Hope and Help for Autism Families


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THE AUTISM FILE Early Waring Signs o Autism in Children 2 www.autismfle.com

Autism: Early Signsand SymptomsWat t k r and wn t gt ryur id

By Rita Shreer, Executive Editor, Autism File

Autism rates have risen exponentially over the past twodecades with nearly one percent o children in the U.S.now diagnosed with an autism spectrum disorder. With moreand more amilies now dealing with an autism diagnosis thanever beore, one thing has become clear: the earlier that treat-ments and therapies are implemented or children with autism,the more promising the outcomes. It thereore becomes key orparents to educate themselves on the early signs and symptomsassociated with autism so that i there are concerns, appropriatetreatment protocols can be put into place.

Tere are three crucial areas o development in which thesymptoms o autism typically maniest in young children:language, social interaction, and behavior, and there are widelydivergent degrees o impairment within those categories. Tepopular saying, I youve seen one child with autism, youveseen one child with autism, carries a lot o meaning or pro-essionals who work with children on the autism spectrum.One child may be quite skilled in certain areas and have onlyslightly impaired verbal skills, while another may have an ut-ter lack o ability to communicate, yet both are on the autismspectrum. Parents, caregivers, and the medical community

need to be alert or both the obvious red ags and the moresubtle symptoms or a potential autism diagnosis to ensure thatproper care is established at the earliest possible time.

When do autism symptoms appear?

Parents tend to describe the onset o autism symptoms intwo general categories:

1. Symptoms o autism are apparent rom the time o birth2. Symptoms o autism appear ollowing an extended

period o good health and normal development, oen12 to 18 months o age

Obviously, i parents and proessionals suspect something isamiss in a childs development rom day one, protocols shouldbe put in place immediately to address the noticed decits.

Te second category is a little trickier: autism therapies maybe delayed as caregivers try to decide i the child is just expe-riencing growing pains or perhaps has caught a cold or virusand will be back on track soon. A wait and see approach isnot a viable option in getting the most rom the many areas ointervention available today or children with autism.

Tere are growing numbers o parents who report that theirchildren all into the second category o normal developmentollowed by either regression, where the child loses previouslyacquired skills, or by a stall in making urther developmentalgains. When this phenomenon is observed, parents should becareul to review their childs health history and take note oany possible triggers, i.e. exposure to toxins, ensuring that any

such triggers are removed to prevent worsening o symptomsin the coming months and years.

Red fags or language development

Developing speech and language appropriately are para-mount or human interaction and impact nearly all areas olie. Te inability to communicate eectivelyor at allwithothers is a hallmark o an autism diagnosis. Parents and care-givers need to be alert or any o the ollowing signs associatedwith lack o language skills. Report to a physician i your child:

Repeatsthesamewordsorphrasesoverandover

Talksinanabnormaltoneofvoice Uses anodd rhythmor pitch when speaking (e.g.

sing-songy, robot-like or ends sentences as i askinga question)

Referstohimselfinthethirdperson Literally interprets all speech from others (doesnt

pick up on humor or sarcasm, etc.) Respondstoaquestionbyrepeatingit,ratherthan

answering it. Uses language incorrectly:makes excessive gram-

matical errors or uses the wrong words altogether Hasdicultycommunicatingwantsorneeds

Isunabletounderstandsimplestatementsorques-tions Hasnospeechatallorhas lostpreviouslyacquired

language abilities

Parents can identiy signals o impaired language develop-ment in day-to-day activities, noting or example i a childdoesnt point to pictures in books being read to him, or doesntgesture or desired items such as ood or a toy.

Impaired Social Connectedness

Te manner in which people connect with others is inter-

twined with language development and the ability to commu-nicate eectively. I speech and language are impaired, then itoen ollows that social interactions suer as well. Tere areseveral signs parents need to recognize when considering socialdevelopment in young children and relay to their childs physi-cian so they can be addressed. Report to a health care provideri your child displays any o the ollowing:

Lackofeyecontact Failuretorespondwhenhisorhernameiscalled Resistancetoholdingandotherformsoftouch


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Apparentinabilitytohearattimes A seeming preference for being alone vs. in the

presence o others Resistancetoplayorinteractwithpeers Unawarenessofthefeelingsofothers

Some o these signs are most apparent in situations where

children encounter peers, such as play dates or outings in thepark. It is oen in these social situations that parents may no-tice or the rst time that the manner in which a child interactswith others isnt quite the norm.

Behavioral Concerns

Behavioraldicultiesencompassperhaps themost chal-lenging area o concern on a day-to-day basis or parents ochildren with autism. Among the most pronounced and oen-cited characteristics o autism is a strong preerence or routine,and should this be disrupted, behavioral changes can becomequitenoticeable,oenintheformofmeltdowns.Talktoyour

physician about any o the ollowing you observe in your child:

Performs repetitive movements such as spinning,hand-apping or rocking

Develops specic rituals or routines and becomesdisturbed i these are altered

Seemstobeconstantlyinmotion Isfascinatedbypartsofanobjectsuchasspinning

wheels on toy cars Shows sensory defensiveness to sound, light, and

touch Seemsoblivioustopain

Engagesinsustainedunusualplay Unusualpostureorgait,includingtoe-walking Narrowrestrictedinterestssuchasdates/calendars,

weather, movie credits, numbers

While children are all dierent whether autism is a actor ornot, and may not match all behavioral descriptions in parent-ing books, i troubling or negative behaviors occur on a dailyor near-daily basis, the wear and tear on the amily can besignicant. Its very important to address behavioral concernsearly on to improve the childs long-term development and toreduce the stress upon the entire amily.

Keeping a diary

Chances are that i youre reading this, you already havenoticed some o the signs and symptoms typically associatedwith autism in your child. Keeping a diary to record yourobservations can be o huge assistance in determining the ar-eas o greatest concern which will in turn impact any neededinterventions.

Trackingall externalinputcanalsohelpyougureoutifthere are environmental actors behind the developmental

concerns you have or your child. Write down everything yourchild eats each day along with activities and changes in yourhome such as getting new carpet or any other renovations, andany outings you make with your child such as trips to the gro-cery store or park. Also make note o any medicines or supple-ments your child has taken or any vaccines he has received.

A growing number o parents and proessionals now be-lieve that autism is not an unavoidable genetic condition, butone that combines genetic predispositions triggered by envi-ronmental actors such as exposure to toxins and allergens.Recording all aspects o -- and changes to-- your childs envi-ronment will help in determining what medical underpinningsexist that may respond to biomedical treatment.

Trust your instincts

I you have concerns regarding any area o your childsdevelopment, schedule an appointment with a physician, ide-ally one who has clinical experience with ASD children. Be

prepared to be persistent i your childs doctor minimizes yourobservations o impaired development or unusual behaviors.While many physicians are now looking more closely at earlyred ags or autism, not all are willing to proceed with anythingother than a lets give it some time approach. Te earlierinterventions such as speech and occupational therapy, appliedbehavior analysis, and biomedical treatments are implemented,the better the long-term prognosis will be or your child.

Contact your childs doctor immediately or developmental

evaluation i you observe any o the ollowing in your son ordaughter:

elossofanypreviousacquiredlanguage,social,ormotor skills at any age

Bysixmonthsorlater:nobigsmilesorhappyexpres-sions

Byninemonthsorlater:lackoffacialexpressionsorback and orth sharing o sounds

By12months:nobabblingorback-and-forthges-tures such as reaching, pointing or waving

By16months:nowords By 24months: no meaningful two-word phrases

other than repeating or imitating what others havesaid

FurtherReading:

eAutismBook:WhatEveryParentNeedstoKnowAboutEarly Detection, Treatment, Recovery, and Prevention, byRobertSears,MD,FAAP.(Little,BrownandCompany,2010.)


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Wat i auti?And wat an I d t y idwit auti?

By Nancy OHara, MD and Gail Szakacs, MD

What is autism? Is it a developmental disordercharacterized by problems with social interactions,communication, and repetitive and restrictive behaviors?Yes, but that is a label, not a true understanding. Is ita brain disorder that is only genetically determined

anduntreatable?No,itisagenetically-inuenced,environmentally-triggered disease o the brain and bodythat involves several vicious cycles and is treatable.

Autism spectrum disorders aect approximately one inevery 91 children in the United States and one in 57 boys.It is more common than Down syndrome, spina bida,childhoodcancer,andcysticbrosiscombined.Onein6children now has a developmental or behavioral disorder.

Eachofourchildrenisatremendousgi.Forourchildren in the autism spectrum, this gi is wrapped inmany layers o wrapping paper. It is our job to begin to

unwrap each layer to let the true gis o our children shinethrough. Tese layers o wrapping paper, the vicious cycles,represent problems in the gut with digestion, absorption,nutritionaldefectsanddysbiosis(moreabnormalgermsthen good germs); problems in the immune systemwith allergies, inammation, requent inections, andautoimmune disorders; problems in the detoxicationsystem with an inability to remove germs, allergens,chemicals, and metals rom their systems, and resultantoxidative stress and mitochondrial dysunction.

All o our children live in a toxic world. Because oproblemswithglutathionemetabolism(themethylationand sulation biochemistry and their ability to detoxiy),our children are much more sensitive to the toxins thateach o us are exposed to on a daily basis. It is as i thesechildren are our canaries. Where I grew up in WestVirginia, they used to send canaries into the coal mines.

I the canaries died, that meant the mine was too toxic orthe miners. Because o their decreased ability or inabilityto detoxiy, children with autism are our canaries. We needto help our children remove these germs, allergens, andtoxins rom their system in order to reach theirull potential.

Letslookateachofthemedicalproblemsthatourchildren may be acing. Tere have been our majorchanges over the last ew decades that I believe have ledtotheproliferationofautism.Forourchildren,thereisa genetic susceptibility, then repeated toxin exposures(asafetus,exposurestomaternaltoxins,amalgams,sh

consumption, and vaccinations; and as an inant and child,exposures to antibiotics, vaccinations, and toxins in ourenvironment and oods). Tere is nutritional deterioration,a dependence upon nonorganic, processed, and renedoods. Tere is an increase in the number o vaccinationsfrom3to>34duringinfancyandearlychildhood.Finally,and most importantly or our children, there is an increasedsusceptibility to all o these toxins because o a decreasein their ability to detoxiy due to metabolic dysunction,including increased oxidative stress and glutathionedepletion as well as mitochondrial dysunction. Tere aremultiple clinical signs that indicate that these children have

increased susceptibility in inancy and early childhood.

So where do we begin? With each child, look at whathe or she may need to get or get rid o to reach his or herfullestpotential.Heorshemayneedtogetmorenutrients,enzymes,orantioxidantslikevitaminsA,C,D,andEandglutathione.Heorshemayneedtogetridofgermssuchasyeast or viruses, allergens such as gluten or phenolic oods,or metals such as lead or mercury. Tis can be a dauntingprocess, but begin by building the oundation, and buildonestepatatime.Letsstartwiththegut.

AsEmersonhassaid,Whatliesbehindusandwhatlies

beore us are small matters compared to what lies withinus.Hecouldhavebeenreferringtothegut.Wheneverwebegin a discussion about the treatment o autism, we needto start with the gut. Many o our children have problemswithgutinammation(ared,irritated,andinamedgutlining),withdysbiosis(toomanybadgermsascomparedtogoodgerms)andabnormalpermeability(becauseofthegerms and the inammation, molecules or allergens thatare not supposed to be absorbed outside the gut are andcause allergies and sensitivities).


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What are some o the clues that my child may have

gut problems?

Diculty breasteeding

Persistent colic

Gastroesophageal reux

Food sensitivities

Failure to thrive Wasted buttocks

History o requent antibiotics

Abnormal posturing

Hands in pants/probing/anal itching

Sel-injurious behavior

Unexplained tantrums/crying

Irritability (especially prior to bowel movements)

Poor sleep

Diarrhea

Constipation

Bloating

Pain

As Dr. Michael Gershon points out in his book TeSecond Brain, everything that uels and eeds our braingoes through our gut. When we talk about neurologicproblems, such as autism, we must rst start in the gut.So,whatdoescleaningupthegutmean?First,itmeanstreating constipation. We cannot appropriately absorband use nutrients or eliminate toxins unless we are havingregular and daily bowel movements. Constipation is anobstacle to all urther treatment options. So, rst reestablisha rhythmic and repaired bowel pattern and then look at theunderlying causes such as voluntary withholding, colon

laxityorspasms,orabnormalora(germs).

Guide to treating constipation

(in order o success):

Fluids, prunes

Fiber

Magnesium citrate

Vitamin C

Senna

Oils (olive, mineral, caster)

Probiotics (benefcial germs)

Antimicrobial/antiungal remedies

Enemas/suppositories Prescription medications

Te next step in treating the gut is changing the childsdiet. Tere is no such thing as junk ood; it is either junkorfood.Havingadietthatisasfreeofprocessedfoods,preservatives, added sugars, additives, and llers isessential.Avoidexcitotoxins(e.g.,caeine,MSG,anddyes),avoidphenolicfoodsifyourchildseemssensitive(e.g.,grapesandstrawberries),andavoidallergenicfoods(kidscravethatwhichtheyaresensitiveto).Eatorganicallyasmuchaspossible(especiallychicken,pears,apples,peppers,celery, strawberries, cherries, grapes, spinach, lettuceand potatoes).

It may also be important to remove those oods thatare hardest to digest, like milk, gluten, and complexcarbohydrates(starches).Ifthegutisinamed,hastoomanybadgerms(dysbiosis),ordoesnothavetherightenzymes to process oods, then it will not absorb anddigest oods appropriately. Tink o a ood like milk as along paper clip chain. I the gut is working well, then thepaper clip chain is broken down into two little paper clips(calledaminoacids)andthisisabsorbed,seenbythebodyas milk, and used as uel appropriately or the brain. I theenzymes are not adequately present, the gut is inamed,or there are too many dysbiotic germs, then the long paper

clip chain is only broken down to a shorter chain. Tischain(calledapeptide)isseenbythebodyasanallergen,something oreign, is not used eectively by the body, andcan mimic other opiate-like molecules leading to symptomso brain og, poor cognition, and abnormal behaviors likehyperactivity and rigidity. All o this happens because thebody cannot eectively break down certain oods and usethem as uel.

I the above measures, including removal o allergenicfoodsaswellascasein(100%foratleast3weeks)and


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gluten(100%foratleast3months),doesnothelpalleviatebehavioral symptoms or heal the gut, then consider otherhealingdietssuchasGAPS(GutandPsychologySyndromebyDr.NatashaCampbell-McBride),BED(BodyEcologyDietbyDonnaGates),orSCD(SpecicCarbohydrateDietbyElaineGottschall).esediets,SCDforinstance,aremeant to stop the cycle o malabsorption and dysbiosis

byremovingthemicrobesfood.Disaccharides(complexsugars) are harder to digest, not immediately absorbedand, thereore, le in the damaged gut to eed the badgerms(yeast,Clostridia,andparasites).SCDdependsononly simple sugars in ruits, vegetables, and honey as wellas meats and other proteins to heal the gut and eventuallyallow proper digestion.

In addition to gut problems, our children may also havesigns o immune system irregularities, such as a amilyhistoryofautoimmunedisease(thyroiditis,diabetes,inammatory bowel disease); chronic ear, sinus, andthroat inections; and ood and environmental allergies

and sensitivities. Tey may also have evidence o seasonalworseningofbehavioralsymptomsand/orcognitiveimprovement with evers. Tese are all signs o immunedysregulation.

Clues o immune dysregulation:

Eczema

Allergic shiners

Allergic rhinitis

Chronic mouth breathing

Sleep apnea

Asthma

Warts Molluscum contagiosum

Herpes

Thrush/ungal skin inections

I your child has evidence o immune dysregulation, therst step is still to heal the gut. Other options to considermaythenbeanti-inammatories(achildwhosetantrumssubside with ibuproen is a good candidate or urtherinvestigation and treatment o the immune system) andotherimmunemodulators(e.g.,TSO,gammaglobulins,PPAR agonists, pycnogenol, curcumin, essential atty acids,

quercetin, and stinging nettles, to name a ew).

In addition to gut and immune problems, our childrenmay also have metabolic problems. Metabolic problemsare deects in the biochemical pathways o our body thatcausestress.Forexample,astheresearchofDr.S.JillJameshas shown, we know that the chemistry o methylation(theprocessoftakingfoodmethionineandturning it into homocysteine and then ultimately to glutathione)is damaged in our children. One site o injury in thispathwayismethioninesynthase(MS)whichrecycles

homocysteine back to methionine and is prone to damageby mercury and other heavy metals. As a result o thisinjury, methionine supplies run short. As a urtherconsequence,thereisashortageofglutathione(the sticky sulury molecule that is our bodys chie detoxiyingmolecule and a major antioxidant). A shortage oglutathione results in an unhappy milieu in the body, in

more oxidative stress. Tis is where olinic acid, methylB-12,andothermethyldonors(suchasbetainea/k/aTMGortrimethylglycine)areneededtotreatunderlyingproblems.AntioxidantssuchasvitaminsA,C,D,Eandespecially glutathione are essential in decreasing the stress.

When there is oxidative stress, there is increasedsusceptibility to toxins, chemicals, heavy metals,and pesticides, increased susceptibility to allergiesand inections, and decreased production o glutathioneand impaired efux o toxins. What all this leads to ismitochondrial dysunction. Te mitochondria are theenergy cells o our bodies and are central to all processes,

neurologic and otherwise. Mitochondrial unction isaectedbyheavymetals(mercury,arsenic,lead, cadmium, aluminum), pesticides, diesel exhaust, PCBs,germsandinfection,poornutrition,andoxidativestress/low glutathione.

Clues o mitochondrial dysunction include:

Low muscle tone weak suck, drooling, poor

head control

Constipation

PICA

Movement disorders posturing, writhing, jerking

Hypotonia/hypertonia Seizures (acute, recurrent, hypoglycemic)

Hypermobile/hyperexible joints

Decreased activity tolerance

Curved back when sitting

Diculty knowing sel in space

Gross and fne motor delays

Poor eye-hand coordination

Speech (expressive and receptive) delays

GI dysmotility, constipation, reux

Migraines

Abnormal sweating

Neurologicsymptomsofmitochondrialdysfunction maybexedorincreasedduringstress(e.g.,fasting,inections, exercise). Symptoms may be due to disturbedfatandcarbohydratemetabolism(aswithgutmalabsorptionanddysbiosis),hypoglycemia(thebraindependsonacontinualsupplyofsugar/glucoseforfuel),andfreeradicalproduction(asinoxidativestress).

Although it was originally thought that only a smallpercentage o children with autism had mitochondrial


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dysunction, recent studies indicate that the numbers mayexceed40-50%ofourchildren.OnestudybyShonerindicatedthat78%ofchildrenwithASDhaddefectsofoxidative phosphorylation, one type o mitochondrialdysunction.

Tereore, i, in addition to GI and immunologic

dysunction, you suspect mitochondrial dysunction, theollowing labs and interventions should be considered:

Labs Mitochondrial

Isolated elevation o AST or ALT

Lactate, pyruvate (serum, CSF)

Ammonia

Creatinine kinase

Amino acids (elevated alanine:lysine ratio> 2.5)

Organic acids (elevated atty acids metabolites)

Carnitine, ree and total

Skin biopsy (fbroblasts 50% inaccurate)

Muscle biopsy (histiopath, EM, mtDNSA, OXPHOS)

Mitochondrial Interventions/Cocktail

CoQ10

Carnitine

Riboavin

Antioxidants (vitamins A, C, D, E,

and GSH)

B-6 and magnesium

Other B vitamins (B-12, olinic acid, thiamin)

What can I do to help my child

with autism?

1. Heal the gut treat constipation, dysbiosis,

infammation

2. Avoid what harms additives, toxins, allergens

3. Give what heals nutrients, probiotics, essential

atty acids (EFAs)

4. Fix metabolic and mitochondrial issues

methyl B-12, olinic acid, B-6, magnesium,

reduced glutathione (GSH), antioxidants, anti-

infammatories.

Autism is a label. Your child is not a label but a personsuering rom medical problems that need to be discovered,addressed,andtreated.Findthesecluesinyourchild,andnd

clusters o other children and amilies that help you embarkonyourjourney.Findapractitionertodiscussallofthesigns,tests,andinterventionsforyourchild.Trustyourgutandyourchilds! Good luck in your journey toward health and recoveryin your child!

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lymphocyte populations in children with regressive autism: evidence or extensive mucosal

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DSouza Y, Fombonne E, Ward BJ. No evidence o persisting measles virus in peripheral

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Jyonouchi H, Geng L, Ruby A, Reddy C, Zimmerman-Bier B. Evaluation o an association

between gastrointestinal symptoms and cytokine production against common dietary

proteins in children with autism spectrum disorders;J Pediatr. 2005 May;146(5):605-10.

Pellicano R, Bonardi R, Smedile A, Saracco G, Ponzetto A, Lagget M, Morgando A, Balzola

F, Bruno M, Marzano A, Ponti V, Debernardi Venon W, Ciancio A, Rizzetto M, Astegiano.

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Immune System

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association o HLA A2-DR11 with CD4 naive decrease in autistic children; Diabetes Technol

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Lucarelli S, Frediani T, Zingoni AM, Ferruzzi F, Giardini O, Quintieri F, Barbato M, DEuemia P,

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autoimmunity in children with autism; J Biomed Sci. 2002 Jul-Aug;9(4):359-64.

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Metabolic & Mitochondrial Systems

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autistic children: a pilot study; Biol Psychiatry. 1999 Aug 1;46(3):420-4.

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DIAgnosIs AutIsm:

noW WhAt?A sImplIfIeD BIomeDIcAl AppRoAch

By Dan Rossignol, MD, FAAFP

In2002,myolderson,Isaiah,wasdiagnosedwithautism.At the time I had been practicing as a amily physicianor about fve years. Prior to his diagnosis, Isaiah loved toget down on the oor and spin objects, and I thought itwascool,soIhelpedhim.Healsousedtoshakehishandsback and orth in the air or hours. When I tried to shakemy hands like him, I tired out in a couple o minutes. Icouldntgureouthowhecoulddoitforhours!Hehadasignicantspeechdelayandwalkedverylate.However,despitealloftheseproblems,IdidnothaveaCLUEthathe had autism. I remember when my wie and I went to

his psychological evaluation to determine what was wrongwithhim.Hewasevaluatedbyapediatricneurologistandseveral psychologists, and we spent the morning with himduring the testing. We were then told to go to lunch whilethe team met to determine a diagnosis. I remember as wesatinMcDonaldseatingFrenchfriesandcheeseburgersthat my wie and I discussed that maybe the team wouldsay he had autistic tendencies. It was quite a shock to uswhenIsaiahwasactuallydiagnosedwithautism!Forthefrst year aer his diagnosis, my wie started looking intobiomedical treatments, which I considered quackery. Iremember asking some pediatric neurologists about the

gluten-free/casein-free(GF/CF)dietandbeingtoldthatNOevidenceexistedinthemedicalliteratureastowhether or not this diet worked. When I fnally realizedthat I needed to look into the medical literature or mysel,IdiscoveredsomestudieswhichreportedthattheGF/CFdietappearedtobebenecialinsomechildrenwithautism1,2.Shortlyaerthis,mysecondson,Joshua,wasalso diagnosed with autism. I now realize that Godallowed us to have two children with autism to give meanewcareer(takingcareofchildrenwithautism)andto give us the ability to help other parents who also havechildren with autism.

NowthatIlookbackonthings,Irealizethatwe(memore so than my wie) wasted precious time because Ididnt know what to do or my child. And I am aphysician,andmywifeisanursepractitioner!Fortunately,there are currently many resources available to parentso a child with autism such as websites, books, andconferences.However,navigatingthroughallofthesepossibilities can be daunting. Te purpose o this articleis to empower you, as a parent o a child with autism, byproviding a starting point or biomedical treatments oryour child.


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Initially, the diagnosis o autism or other orms oautism, such as pervasive developmental disorder-nototherwisespecied(PDD-NOS,alsocalledhigh-unctioning autism or mild autism), will generally comerom a developmental pediatrician or a neurologist. Mostneurologistswillperformgenetictesting(includingchromosomal analysis and checking or ragile Xsyndrome),anMRIscan(toexcludesometypeofbrain

structuralproblem),andanEEG(tolookforseizureactivity).AnEEGisespeciallyimportantbecause newer studies arereportingthatabout60%ormore o children with autismhave subclinical seizure activity

(subclinicalmeansthatyouarenotaware o this seizure activity) 3,4.We fnd signifcant improvements,especially in speech, in somechildren with autism when wetreat seizures with medication.

Aer the initial diagnosis,there are specifc laboratorytests that can be very helpulin either checking or othermedicalconditions(thatcouldbe exacerbating the autistic

behavior) or defning underlyingbiomedical problems. Sinceautism is diagnosed basedupon examination o the childsbehavior, the actual diagnosisdoes not point to the underlyingcause(s)ofthedisorder.Wendthat some o the core problems inautismincludetoxicity(includingelevated levels o heavy metals,pesticides, and other chemicals)5,6,inammation(potentiallyinthe

gastrointestinal tract and brain)

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,oxidativestress(damagetotissuecaused by ree radicals, which areneutralized by antioxidants suchasvitaminsCandE)10, impairedglutathioneproduction(whichisthe bodys main natural detoxiferand antioxidant)10, and impairedmitochondrialfunction(whichare responsible or producingATP,orenergy)11. An in-depthdiscussion o each o thesebiomedical problems is beyond the

scope o this article, but we willreview simple laboratory tests andnutritional supplementation that

any parent o a child with autism could start and whichcould potentially alleviate these problems and improveautistic behaviors.

Initial treatments:

Tere are certain treatments that parents can use to helpimprovecertainbehaviorsinchildrenwithautism(andADHD).eidealtreatmentwouldbeonethatiswell-

Initial laboratory testing:

In many cases, a physician will need to order these tests or you.

The Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) check oranemia, platelet count (a high count is consistent with inammation), and liver andkidney unction.

Thyroid. We nd a signicant number o children with autism who havehypothyroidism, which can mimic some o the symptoms o autism and impair

development. A simple blood test called TSH can check or this problem.Iron defciency can cause inattention and concentration problems12. Low iron is alsolinked to lowered IQ13. Iron supplementation in children with attention decithyperactivity disorder (ADHD) who have low iron levels has been shown to improveattention compared to a placebo 14, and iron supplementation in children with autismhas been shown to improve sleep15.

Ammonia and lactic acid are initial tests that can help determine i mitochondrialdysunction exists, which can lead to low energy production and hypotonia (lowmuscle tone)11and is potentially treatable with supplements like coenzyme Q10and L-carnitine.

Cholesterol. A cholesterol count less than 145 mg/dl in typical children has been shownto increase deance and irritability and increase the chances o school suspensionby three-old16. Supplementation with cholesterol in some children with autism maybe benecial 17.

Cysteine is the precursor to glutathione and is the rate-limiting step or glutathioneproduction. Low levels o cysteine reect impaired glutathione production orincreased glutathione utilization due to oxidative stress18.

Lead has been shown in some studies to contribute to autistic behaviors in somechildren19,20. An elevated blood lead level reects ongoing exposure and shouldprompt an investigation to nd possible sources o lead in the house or environment.

Magnesium has a calming eect, and lower levels have been ound in children withADHD21 and autism22. Magnesium supplementation can decrease hyperactivity23andimprove certain autistic behaviors22.

Testosterone. A small percentage o children with autism have elevated testosterone24,which can lead to aggression.

The organic acid panel (OAT) is a specialized test that can measure markers o yeast,Clostridia, and other markers such as vitamin levels and mitochondrial unction.

Urinary porphyrin concentrations can reect increased heavy metal or pesticide levels inthe kidney and are markers o the metal burden in the body5.

Urinary neopterin is a marker o inammation and tends to reect autoimmunity insome children with autism25. Elevated neopterin oten predicts positive responses toanti-inammatory treatments.

Urinary oxidized DNA and RNA are markers o oxidative stress inside the cell26, and childrenwith elevated levels oten have improvements with antioxidants.

Urinary isoprostane is a marker o oxidative stress outside the cell 26. Again, antioxidantscan be helpul when this is elevated.

Stool testing can check or the presence o inammation, dysbiosis (increased levels o

yeast and abnormal bacteria), digestion, and absorption.


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studied, proven to be eective compared to a placebo, nottoo expensive, sae and tolerable, and can be done at home.Notmanynutritionalsupplementstintothiscategory

but several do. Many o these supplements are antioxidantsthat help to lower oxidative stress, which is a commonndinginbothADHD 27 and autism18. With the use o anevidence-based medicine approach, parents can get startedwith some simple biomedical treatments based upon theabovelaboratorytestingand/orthechildsbehaviors.Forexample, i oxidative stress is elevated, then antioxidantscan be added. I a child has an attention problem, thensupplements or dietary changes could be made that havebeen shown to improve attention.

Diet: Several studies have shown improvements in certain

autistic behaviors, such as social isolation, communication,andoverallbehavior,withtheuseofagluten-free/casein-ree diet1,2,28.Foodadditives,colorings,andpreservativescan increase hyperactivity in typical children 29, so avoidingthese products can be helpul. In children with autism,testing or ood allergies and eliminating reactive oodshas been shown to improve certain autistic behaviors 30.An organic diet can be helpul in eliminating pesticideexposures in children 31. A ketogenic diet can be helpulin some children with autism32. It should be noted that theuse o specialized diets should be closely monitored by aphysician or nutritionist.

Sleep: I this is a problem, I usually start with tryingto improve sleep because autistic behaviors are usuallyworsened with sleep deprivation33. One recent studyrevealedadefectintheASMTgenethatresultedinlessmelatoninproductioninsomechildrenwithautism(thisdeect was also ound in some o the parents)34. Severalstudies have shown improvement in sleep with the use omelatonin in autism35,36andADHD37. Melatonin at doses o1-3 mg at bedtime is sae.

Multivitamin: A general moderate-dose multivitamin has

been shown to improve sleep and gastrointestinal problemsin children with autism when compared to a placebo38.

Vitamin C: In a double-blind, placebo-controlled study,vitaminC(about100mg/kg)wasshowntoreducestereotypicalbehavior(stimming)inindividualswithautism compared to a placebo39.

Methylcobalamin and folinic acid:Twostudieshave reported some improvements in certain autisticbehaviors with the use o subcutaneous methylcobalamininjections(75mcg/kg,requiresaprescription)andoralsupplementationoffolinicacid(400mcgtwiceaday)10-40.Methylcobalamin can also be given orally.

Zinc: Deciency has been correlated with inattentioninchildrenwithADHD41. Zinc deciency has also beenreported in autism42.Inonestudyof400children,theuseofzincsulfate(150mg/daythatprovided40mg/dayofelementalzinc)wasshowntoimproveADHDsymptoms

compared to a placebo43.

Magnesium and vitamin B-6:euseofthese(giventogether) has been shown to improve autistic behaviors,including social interaction, communication, andstereotypical behaviors22, and improve hyperactivity insome children44.Typicaldosesare:magnesiumat6mg/kg/dayandvitaminB-6at0.6mg/kg/day22; sometimes higherdoses are used under physician supervision.

Pycnogenol: Tis has been shown to increase glutathionelevelsinchildrenwithADHD45, decrease oxidative stress46,

and improve attention, coordination, concentration, andhyperactivity compared to a placebo47. A typical dose is 1-2mg/kg/day.

Carnitine: Deciency has been described in some childrenwith autism48 and can impair mitochondrial unction11.InonestudyofchildrenwithRettsyndrome,L-carnitinesignicantlyimprovedsleepeciency,energylevel,andcommunication49. Carnitine has also been shown toimproveattentionandaggressioninchildrenwithADHD 50as well as lessen hyperactivity51.Generally,weuse50-100mg/kg/dayofL-carnitineorAcetyl-L-carnitine(preferringthe latter as it penetrates into the brain better).

Carnosine: Tis has strong antioxidant properties and alsohas been shown to decrease seizure activity. In one study,L-carnosine(400mgtwiceaday)improvedspeechandsocial behavior compared to a placebo in children withautism52.

Omega-3 fatty acids: Deciency has been shown toincrease hyperactivity, conduct problems, anxiety, andtemper tantrums in typical children53. Inants not receivingomega-3 atty acid supplementation in breast milk or inant


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formulaareabout2-4timesmorelikelytodevelopautism 54.Several studies have demonstrated improvements with theuse o omega-3 atty acids in children with developmentalcoordination disorder55,ADHD56, and autism57,58.Omega-3 atty acids can also have anti-seizure eects [59].Iusuallyrecommendabout800mgofEPAand800mgofDHA(sometimeshigher),whichistheapproximate

dose used in a recent double-blind placebo-controlledstudy o children with autism showing improvements inhyperactivity and stereotypical behavior58. I also generallyrecommend starting antioxidants beore omega-3 atty acidsupplementation.

Eventhoughthesetreatmentsareavailablewithoutaprescription, it is best to be under a physicians supervisionwhen using these supplements and implementing signifcantdietarychanges.Furthermore,aphysicianmayberequiredto obtain certain laboratory tests and methylcobalamininjections.However,thesupplementslistedinthisarticleare generally well-tolerated and can be helpul in improving

certainbehaviorsinchildrenwithautismandADHD.Iwould recommend sitting down with your childs physicianto discuss these potential treatment options. May Godbless you and your child as you journey together towardsimprovements and, I pray, eventual healing.

Table 1

Doses o antioxidants and other supplements (basedon the studies reviewed):

Vitamin C: 100 mg/kg/day

Acetyl-L-carnitine: 50-100 mg/kg/day

L-carnosine: 200-400 mg twice a dayPycnogenol: 1-2 mg/kg/day

Methylcobalamin injections: 75 mcg/kg 2-3 times perweek

Folinic acid: 400 mcg twice a day

Omega-3 atty acids: approx. 800 mg/day EPA andapprox. 800 mg/day DHA

Zinc: 20-40 mg/day o elemental zinc

Melatonin: 1-3 mg, 30 minutes beore bedtime

Magnesium: 6 mg/kg/day

Vitamin B-6: 0.6 mg/kg/day

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decit hyperactivity disorder (ADHD). Positive response to magnesium oralloading test. Magnes Res, 1997. 10(2): p. 149-56.24Geier, D.A. and M.R. Geier, A clinical trial o combined anti-androgen andanti-heavy metal therapy in autistic disorders. Neuro Endocrinol Lett, 2006. 27(6):p. 833-8.25Sweeten, T.L., D.J. Posey, and C.J. McDougle, High blood monocyte countsand neopterin levels in children with autistic disorder. Am J Psychiatry, 2003.160(9): p. 1691-3.26Ming, X., et al., Increased excretion o a lipid peroxidation biomarker inautism. Prostaglandins Leukot Essent Fatty Acids, 2005. 73(5): p. 379-84.27Ross, B.M., et al., Increased levels o ethane, a non-invasive marker o n-3atty acid oxidation, in breath o children with attention decit hyperactivitydisorder. Nutr Neurosci, 2003. 6(5): p. 277-81.


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28Millward, C., et al., Gluten- and casein-ree diets or autistic spectrumdisorder. Cochrane Database Syst Rev, 2008(2): p. CD003498.29McCann, D., et al., Food additives and hyperactive behaviour in 3-year-oldand 8/9-year-old children in the community: a randomised, double-blinded,placebo-controlled trial. The Lancet, 2007. 370(9598): p. 1560-7.30Lucarelli, S., et al., Food allergy and inantile autism. Panminerva Med, 1995.37(3): p. 137-41.31Lu, C., et al., Organic diets signicantly lower childrens dietary exposure toorganophosphorus pesticides. Environ Health Perspect, 2006. 114(2): p. 260-3.32Evangeliou, A., et al., Application o a ketogenic diet in children with autistic

behavior: pilot study.J Child Neurol, 2003. 18(2): p. 113-8.33Schreck, K.A., J.A. Mulick, and A.F. Smith, Sleep problems as possiblepredictors o intensied symptoms o autism. Res Dev Disabil, 2004. 25(1): p.57-66.34Melke, J., et al., Abnormal melatonin synthesis in autism spectrum disorders.Mol Psychiatry, 2008. 13(1): p. 90-8.35Andersen, I.M., et al., Melatonin or insomnia in children with autismspectrum disorders.J Child Neurol, 2008. 23(5): p. 482-5.36Garstang, J. and M. Wallis, Randomized controlled trial o melatonin orchildren with autistic spectrum disorders and sleep problems. Child Care HealthDev, 2006. 32(5): p. 585-9.37Van der Heijden, K.B., et al., Eect o melatonin on sleep, behavior, andcognition in ADHD and chronic sleep-onset insomnia.J Am Acad Child AdolescPsychiatry, 2007. 46(2): p. 233-41.38Adams, J.B. and C. Holloway, Pilot study o a moderate dose multivitamin/mineral supplement or children with autistic spectrum disorder.J Altern

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