Autism Spectrum Disorder and Pervasive Developmental Disorders in ChildrenBy Stephen Cowan, MD, FAAP

from “Integrative Medicine for Children” edited by Dr. May Loo, 2008 Saunders

Terminology

1. Clinical Consideration in Autism2. Etiology :

a. Genetic Influencesb. Prenatal Influencesc. Post-natal Influencesd. Gastrointestinal Inflammation in autism

3. Conventional diagnosis of Autism4. Differential Diagnosis5. Conventional management of Autism6. CAM management considerations:

a. The "leaky gut" syndrome and autismb. Treating Dysbiosisc. Healing the Gutd. Strengthening Immunity and Detoxificatione. Chelation of Toxic Elementsf. Neuro-metabolic Fine-Tuning

7. Holistic Management Considerations (author's experience)8. Summary9. References

1

Autism Spectrum Disorder and Pervasive Developmental Disorders in Children

By Stephen Cowan, MD, FAAP

Over the past 10 years there has been a significant rise in the diagnosis of Autism

Spectrum disorder (ASD) in North America and Europe. What was previously felt to be a

rare genetic disorder with a prevalence of 1:2000 now is estimated to be as high as 1:165

children.1,2 Initial denial by the medical community of a significant rise in prevalence

has been refuted by studies that have shown this not to be due to improved diagnostics or

shifts in the criteria for diagnosis.3 4 The acknowledgement that genetic syndromes do

not rise epidemically has led researchers to search for possible alternative explanations

for this devastating syndrome.

Terminology

The term "Autism" was originally coined by Leo Kanner in 1943 and further described

by Hans Asperger in 1944. They described a somewhat heterogeneous group of children

with an unusual "social-communication syndrome" who appeared to be language-

impaired, detached and had a number of odd behaviors. In 1967 Dr. Bernard Rimland

established the Autism Research Institute (ARI), a non-profit organization, devoted to

conducting research on possible causes and treatment of autism. In 1994, the Diagnostic

and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), began referring

to Autism as a "spectrum" in order to stress the wide variation in signs and symptoms.

This has been further refined to include other neuro-behavioral disorders under the

category of Pervasive Developmental Disorder (PDD). (See DSM IV-R Table 1) The

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term "PDD- Not Otherwise Specified" (PDD-NOS) has been used to refer to children

who do not meet the specific criteria for Autism presented in the DSM IV-Revised but

nevertheless have some social-communication dysfunction. Recently the term "Autism

Spectrum Disorder" has been coined to describe this group of children.

Table 1. DSM-IV-R Diagnostic Criteria for Diagnosis of ASD5

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from

(2) and (3):

1. qualitative impairment in social interaction, as manifested by at least two of the

following:

a. marked impairment in the use of multiple nonverbal behaviors such as eye-to-

eye gaze, facial expression, body postures, and gestures to regulate social

interaction

b. failure to develop peer relationships appropriate to developmental level

c. a lack of spontaneous seeking to share enjoyment, interests, or achievements

with other people (e.g., by a lack of showing, bringing, or pointing out objects of

interest)

d. a lack of spontaneous seeking to share enjoyment, interests, or achievements

with other people (e.g., by a lack of showing, bringing, or pointing out objects of

interest)

2. qualitative impairments in communication as manifested by at least one of the following:

a. delay in, or total lack of, the development of spoken language (not accompanied

by an attempt to compensate through alternative modes of communication such

as gesture or mime)

b. in individuals with adequate speech, marked impairment in the ability to initiate

or sustain a conversation with others

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c. stereotyped and repetitive use of language or idiosyncratic language

d. lack of varied, spontaneous make-believe play or social imitative play

appropriate to developmental level

3. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as

manifested by at least one of the following:

a. encompassing preoccupation with one or more stereotyped and restricted

patterns of interest that is abnormal either in intensity or focus

b. apparently inflexible adherence to specific, nonfunctional routines or rituals

c. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or

twisting, or complex whole-body movements)

d. persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3

years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or

imaginative play.

C. The disturbance is not better accounted for by Rett's Disorder or "Childhood Disintegrative

Disorder".

Clinical Considerations:

Children on the Autistic spectrum share a common dysfunction in "relatedness". This is a

core feature that accounts for many of their odd behaviors. Though often subtle and

frequently missed by parents and clinicians in very young children, the incapacity to

"socially connect" may carry more predictive weight than delays in verbal expression.

Problems with relatedness are linked to receptive language dysfunction. Parent and

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clinicians often concentrate more on the number of words a child can say rather than

what he/she can understand. To new parents or inexperienced clinicians, it may not be

obvious that a child does not comprehend. Asking a child to use a finger to point at a

specific object in response to a command is a simple exercise that can elicit receptive

language problems . An extreme form of receptive language dysfunction involves the

inability to recognize facial expressions. It is important to recognize that a child who

confuses a smile for anger may appear to respond quite bizarrely. Receptive language

dysfunction impacts on a child's ability to "read social cues". This may be the only clue

that there is a problem in high-functioning children such as Aspergers Syndrome.

Relatedness also manifests as the inability to "reciprocally interact". Typically, autistic

children will have great difficulty "taking turns". A simple exercise to assess this skill is

to ask a parent to roll a ball to the child and observe if and how many times the child will

"get the game", rolling it back and forth. Limited ability to "pretend play" also reflects

this restricted social-communication ability in autism. These children are often unable to

"symbolically" represent the world with language. This greatly limits the capacity to

mentally transform an object or mimic adult behavior. The spontaneous development of

imagination, imagining a pencil as a rocket-ship or feeding a bowel of pretend soup to a

doll (pretend person) does not occur unless relatedness and receptive language develop.

The clinician must additionally be keenly aware of the quality of a child's sense of

humor. "Getting the joke" implies sophistication of social-language abilities that is often

lacking in the autistic child.

Lastly the clinician needs to observe the degree to which the child's repertoire of

activity is restricted. Due to the inability to understand the unpredictable world of human

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language and behavior, many children develop a rigid set of routines as self-defense.

They often show intense resistance to change that can harden into obsessive compulsive

behaviors. Many self-stimulatory behaviors develop as a way of "blocking out" the chaos

of the world. An autistic child may choose sensory input that "feels" good and withdraw

into it when they are being overwhelmed. Some children with autism seem to get caught

in the details of things, spinning shiny objects, studying the electrical circuitry of a room,

etc. They appear to be hyper-focused, studying the basic mechanisms of their

environment. Self-stimulation, (hand-flapping, spinning etc.) may also be the result of an

apparent heightened sensory awareness. Many children with autism will demonstrate

extraordinary sensory abilities. These may result from a compensatory reaction to the

limitations on the "social senses". One observes analogous abilities in the heightened

visual acuity of the hearing impaired child and the heightened sense of smell or touch

seen in the visually-impaired child.

Etiology

The etiology of autism at present is unknown. This may be largely due to the fact that

Autism is a "symptom complex" and not a single entity. No single cause has as yet

been identified but recent research is beginning to reveal pieces to the puzzle.

1 Bertrand J, et al: Prevalence of autism in a United States population: the Brick Township, New Jersey investigation. Pediatrcis 108: 1155-1161, 2001

2 Newschaffer CJ, et al: National autism prevalence trends from United States special education data. Pediatrcis 115:e277-e282, 2005

3 Byrd, RS, Report to the Legislature on the Principal Findings from the Epidemiology of Autism in California: A Comprehensive Pilot Study. San Diego:

MIND Institute, University of California, Davis; 2002. The Epidemiology of Autism in California: A Comprehensive Pilot Study

4 Yeargin-Allsopp M, et al: Prevalence of autism in a US metropolitan areas. JAMA 289:49-55,2003

5 Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Revised (DSM-IVR), American Psychiatric Association, 2000

6

1. Genetic and Metabolic Factors: Chromosomal abnormalities account for less than

1% of children with autistic features6,7. These involve aberrations in chromosome

15q (15q11-q13)8,9 Conventional texts report that less than 5% of autistic children

show evidence of in-born metabolic disorders.10 Family studies in children with

autism have noted an increased prevalence of autoimmune disease, inflammatory

bowel disease, depression, obsessive–compulsive disorder, anxiety disorder, bipolar

disorder, social phobia and language disorders.11 12 13 14 There is some evidence that

relatives of autistic children show mild social, communicative or repetitive behaviors

that may place them on the "normal end" of the autistic spectrum. There is a 3:1

predilection for males over females in autism, which may indicate some genetic

influence or may be related to the relative strength of social/empathy skills generally

demonstrated by girls. Twin studies of autistic children show a 60-90% incidence of

autism in monozygotic twins.

Recent research has shown important evidence that multiple gene-loci may be

involved in the expression of autistic characteristics.15 Studies have shown an

6 Weidmer-Mikhail E et al, Chromosomes in autism and related pervasive developmental disorders: a cytogenetic study. J Intellect Disabil Res 1998;42:8-

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7 Schroer RJ et al. Autism and maternally derived aberrations of chromosome 15q. Am J Med Genet 1998;76;327-336

8 Cook Eh et al. Autism or Atypical autism in maternally but not paternally derived proximal 15q duplication. AM J Hum Genet 1997;60:928-934

9 Weidmer-Mikhail E et al. Chromosomes in autism and related pervasive developmental disorders: a cytologic study. J Intellect Disabil Res 1998;42:8-12

10 Dykens EM, Volkmar FR. Medical conditionsassociated with autism. In: Cohen DJ, VOlkmar FR, eds. Handbook of autism and pervasive

developmental disorders, second edition. New York, NY: John Wiley & sons, 1997:388-410.

11 Comi AM, Zimmerman A et al, 'Familial clustering of autoimmune disorders and evaluation of medical risk factors in autism', Journal of Child

Neurology, 1999, Vol. 14, pp. 388-394

12 Broader autism phenotype: evidence from a family history study of multiple-incidence autism families J Piven, P Palmer, D Jacobi, D

Childress and S Arndt Department of Psychiatry, University of Iowa College of Medicine, Iowa City, USA. Am J Psychiatry 1997; 154:185-190

13 The Broad Autism Phenotype Findings from an Epidemiological Survey N. Micali et al, Autism, Vol. 8, No. 1, 21-37 (2004)

14 Comi A. M., Zimmerman A., et al. Familial clustering of autoimmune disorders and evaluation of medical risk factors in autism. J Child Neurol 1999;

14: 388-394.

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increased number of genetic variants (polymorphisms) associated with the enzyme

activity of Methylenetetrahydrofolate Reductase (MTHFR) in children with Autism.16

This enzyme is essential in the Methionine Synthase reaction, a major biochemical

component of the detoxification process associated with production of glutathione,

methylB12 , folate/follinic acid activation and dopamine formation. This may have

great importance in understanding the etiology of Autism as a spectrum related to

potential neuro-toxic exposures. Current thinking in genetics understands the

complexity of human neuro-social development to result form the "organic" nature of

genes which are turned on and off by various environmental stressors.

2. Prenatal Influences: Over the past 5 years, the term "Regressive Autism" has begun to

be used to differentiate a subtype of children who are developmentally normal until 1-2

years of age and then begin to lose milestones or plateau in developmental progress.17 18 19

20 21. Retrospective studies have found a number of associations with the development of

Autism. These include: exposure to epidural anesthesia, the older age of parents at the

time of conception, elective or emergency caesarian section, use of pitocin for labor

induction, and threatened abortion, 22 23

15 Muhle R, et al: the genetics of autism. Pediatrcis 113:e472-486,2004

16 Boris M, James, J et al, Association of MTHFR gene variants and Autism, Journal of Amercian Physicians and Surgeons Vol 9, No. 4, Winter 2004

17 Miles JH, Takahashi TN, Bagby S, Sahota PK, Vaslow DF, Wang CH, Hillman RE, Farmer JE Essential versus complex autism: definition of fundamental prognostic subtypes. Am J

Med Genet A. 2005 Jun 1;135(2):171-80.

18 Rogers SJ. Developmental regression in autism spectrum disorders. Ment Retard Dev Disabil Res Rev. 2004;10(2)139-43

19 Rogers SJ, DiLalla DL Age of symptom onset in young children with pervasive developmental disorders. J Am Acad Child Adolesc Psychiatry. 1990;

29:863-872

20 Tuchman R, Rapin I Regression in pervasive developmental disorders: seizures and epileptiform electroencephalogram correlates. Pediatrics. 1997;

99:560-566

21 Schopler E, Reichler RJ, DeVellis RF, Daly K ; Toward objective classification of autism. J Aut Dev Dis 1980; 10:91

22 Burd L, Severud R, Kerbeshian J, et al. Prenatal and perinatal risk factors for autism. J Perinat Med 1999;27:441-450.

23Glasson, EJ, B.Psych., B.Sc. (Hons), Ph.D Arch Gen Psychiatry. 2004;61:618-627

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3. Post-natal Influences: In order to explain the apparent exponential rise in prevalence of

autism in recent years, researchers have been looking at a number of potential

environmental causative factors. Over the past decade, many articles have suggested a

possible role of mercury exposure in autistic-like neurologic disorders. Remarkable

similarities between mercury toxicity and autism have been noted. 24 25 26 Mercury has

been shown to compromise the detoxification mechanism mediated by glutathione and

methionine synthase. 27 28 29 It has also been noted that mercury toxicity causes

impairment of the immune system and increased risk of autoimmunity.30 31 A significant

source of methyl-mercury has been found in Thimerisol-containing vaccines and there is

some evidence that cumulative exposures have the potential for neurologic sequelae.32 33

34Based on the VAERS and US Department of Education data, Geier demonstrated a

linear statistical relationship between the incidence rate of neurodevelopment disorders

after childhood immunization and increasing thimerisol in vaccines. 35 36 37. In light of the

literature acknowledging the potential risks to the infant exposed to mercury during

infancy in the context of the increasing prevalence of autism spectrum disorder,

pharmaceutical companies have begun removing thimerisol from vaccines. 38 39 40

4. Gastrointestinal Inflammation in Autism: In 1999, Horvath published evidence of an

apparent inflammation of the gut in children with Autism.41 The following year

Wakefield demonstrated biopsy evidence of chronic enterocolitis in autistic children.42

Recent studies have shown abnormal gut mucosal immune infiltration and impaired

intestinal permeability in autistic children. 43 44 45 46 Emerging research ofver the past

twenty years has generated a new field of study linking brain and gut function. Much of

this has concentrated on the immune effects of stress on the gut.47 48 49 The reverse

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relationship, where inflammation of the gut affects brain dysfunction has also been found

in children with autism and the term "Autistic Entero-colonic Encephalopathy" has begun

to be used. 50 51 52 53 54 Evidence of impaired gut immunity associated with Candida

overgrowth in children with autism has been demonstrated with increased excretion of

urinary arabinose and analogs of Krebs cycle metabolites.55 56 57 58

24 Aronow R, Fleischmann L , ‘Mercury Poisoning in Children’ Clinical Pediatrics, 1976 Oct, Vol.15, No.10, 936-945

25 Aschner M, Aschner JL, ‘Mercury Neurotoxicity: Mechanisms of Blood-Brain Barrier Transport’, Neuroscience & Behavioral Reviews, 1990, Vol. 14,

169-176

26 Clarkson TW, ‘Mercury: Major Issues in Environmental Health’, Environmental Health Perspectives vol. 100, pp. 31-38, 1992

27 Richard C. Deth, Ph.D. Effects of Mercury on Methionine Synthase: Implications for Disordered Methylation in Autism  DAN! 2003 Philadelphia

http://64.202.182.52/powerpoint/dan2003/RichardDeth.htm

28 Bernard S, Enayati A, Roger H, Binstock T, Redwood L. The role of mercury in the pathogenesis of autism. Mol Psychiatry. 2002;7 Suppl 2:S42-3.

PMID: 12142947

29 Alberti A, Pirrone P, Elia M, Waring RH, Romano C, ‘Sulphation deficit in “low-functioning” autistic children: a pilot study’, Biol Psychiatry 1999

Aug 1; 46(3):420-424

30 Bagenstose LM, Salgame P, Monestier M, ‘Mercury-induced autoimmunity in the absence of IL-4’, Clin Exp Immunol, Oct 1998, 114(1):9-12

31 Cagiano R, De Salvia MA, Renna G, Tortella E, Braghiroli D, Parenti C, Zanolie P, Baraldi M, Annau Z, Cuomo V, ‘Evidence that exposure to methyl

mercury during gestation induces behavioral and neurochemical changes in offspring of rats’, Neurotoxicol Teratol 1990 Jan-Feb;12(1):23-28

32 Geier MR, Geier DA.  Neurodevelopmental disorders after thimerosal-containing vaccines: a brief communication. Exp Biol Med 2003 228(6):660-4

33 Baskin DS et al.  Thimerosal induces DNA breaks, caspase-3 activation, membrane damage, and cell death in cultured human neurons and fibroblasts.

Toxicol Sci. 2003 Aug;74(2):361-8. Epub 2003 May 28. 

34 Deyab P, Gochfeldbc M, Reuhlabca K, 'Developmental Methylmercury Administration Alters Cerebellar PSA-NCAM expression and Golgi

sialyltransferase Activity', 1999

35 Geier DA, Geier MR. An assessment of the impact of thimerosal on childhood neurodevelopmental disorders. Pediatr Rehabil. 2003 6(2):97-102

36 Geier DA, Geier MR. A comparative evaluation of the effects of MMR immunization and mercury doses from thimerosal-containing childhood

vaccines on the population prevalence of autism. Med Sci Monit. 2004 Mar;10(3):PI33-9. Epub 2004 Mar 01.

37 Geier MR, Geier DA. Autism and thimerosal-containing vaccines: analysis of the Vaccine Adverse Events Reporting System (VAERS). IOM

presentation, Feb 9, 2004.

38 CDC, ‘Recommendations regarding the Use of Vaccines That Contain Thimerosal as a Preservative’, MMWR November 5, 1999 / 48(43); 996-998

39 American Academy of Pediatrics and US Public Health Service, July 8, 1999, Thimerosal, a Mercury-containing Preservative used in Some Vaccines

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington D.C., American Psychiatric

10

In 1998, Wakefield published the highly controversial findings of a possible link

between Measles virus and the gut-inflammation found in children with Autism. This

was based on biopsy identification of genomic measles RNA in lymphoid follicles of gut

mucosal in children with regressive autism. 59 Based on previous studies that have

demonstrated a known relationship between measles infection and Crohns disease and

other inflammatory bowel diseases60 61 62 , he proposed that live measles virus vaccines

such as the MMR may play a role in the immunologic etiology of autism. Other studies

have failed to confirm this association.63 64 65. Singh et al have recently published a

number of articles showing evidence, however, of an abnormal hyper-immune response

to measles in children with autism which may represent a mercury-induced autoimmune

response to live virus exposure.66 67 68 There is mounting evidence of increased

autoimmunity in Autism. 69 70 71 72 73 Clearly further studies are needed to clarify the

relationship between viral immunity and autism.

The Conventional Diagnosis of Autism

There is no doubt that the earlier a child is evaluated for possible Autism Spectrum

Disorder, the better the prognosis. The American Academy of Pediatrics has recently

highlighted the need for early diagnosis with the A.L.A.R.M. policy which encourages

early evaluation, diagnosis, referral and parent education. 74 The diagnosis of autism

spectrum disorder is typically based on the criteria described by the DMS-IV-R. (see

table1). With the recent increase in the prevalence of Autism, the American Academy of

Association, 1994

40 CDC, ‘Thimerosal in vaccines: a joint statement of the Amercian Academy of Pediatrics and the Public Health Service’, MMWR Morb Mortal Wkly

Rep 1999 July 9; 48(26):563-565

11

Pediatrics has adopted recommendations made by the American Academy of Neurology

and the Child Neurology Society which developed practice guidelines to help the

clinician.75 (This information has been endorsed by the American Academy of

Audiology, the American Occupational Therapy association, The American speech-

Language-Hearing association, the Autism National Committee, Cure Autism Now, the

National Alliance of Autism Research and the Society of Developmental Pediatrics).

The initial assessment of a child suspected of having Autism begins in the

clinician's office where routine developmental screening should be a part of general

41 Horvath K et al: Gastrointestinal abnormalities in children with autism disorder. J Pediatrc 135:559-563

42 Wakefield AJ, Anthony A, Murch SH, et al. Enterocolitis in children with developmental disorders. Am J Gastroenterol 2000;95:2285-2295

43 Torrente F et al.  Small intestinal enteropathy with epithelial IgG and complement deposition in children with regressive autism. Mol Psychiatry.

2002;7(4):375-82, 334.

44 Furlano RI et al. Colonic CD8 and gamma delta T-cell infiltration with epithelial damage in children with autism. J Pediatr. 2001 Mar;138(3):366-72.

PMID: 11241044

45 Ashwood P et al: Intestinal lymphocyte populations in children with regressive autism: evidence for extensive mucosal immunopathology. J Clin

Immunol 23:504-17, 2003

46 D'Eufemia P et al.  Abnormal intestinal permeability in children with autism. Acta Paediatr. 1996 Sep;85(9):1076-9. PMID: 8888921

47 Drossman, DA, Corazziari E, Talley NJ, et al (eds). Rome II: The functional gastrointestinal disorders. 2nd ed. McLean, Virginia: Degnon and

Associates, 2000.

48 Soderholm JD, Yang PC, Riddell R, Ceponis P, Sherman PH, Perdue MH. Chronic psychological stress induces mast cell-dependent bacterial

adherence to the epithelium and initiates mucosal inflammation in rat intestine. Gastroenterology 123:1099-1108, 2002.

49 Soderholm JD, Yates DA, Gareau MG, Yang PC, MacQueen G, Perdue MH. Neonatal maternal separation predisposes adult rats to colonic barrier

dysfunction in response to mild stress. Am J Physiol 283:G1257-63, 2002. 

50 Wakefield AJ. The gut-brain axis in childhood developmental disorders. J Pediatr Gastroenterol Nutr:34;S14-7,2002

51 D’Eufemia P, Celli M, Finocchiaro R, Pacifico L, Viozzi L, Zaccagnini M, Cardi E, Giardini O, ‘Abnormal intestinal permeability in children with

autism’, Acta Pædiatr 1996:85:1076-1079

52 Horvath K, Papadimitriou JC, Rabsztyn A, Drachenberg C, Tildon JT. Gastrointestinal abnormalities in children with autistic disorder. J Pediatr

1999;135:559-63.

53

54 Horvath K, Perman JA. Autistic disorder and gastrointestinal disease. Curr Opin Pediatr. 2002 Oct;14(5):583-7. PMID: 1235225

55 Finegold SM et al. Gastrointestinal microflora studies in late-onset autism. Clin Infect Dis 35; s6-16,2002

56 Shattock P & Savery D, (1996).  Urinary profiles of people with autism: Possible implications and relevance to other research. In: Procedings of

Conference on Therapeutic Interventions in Autism: Perspectives from Research and Practice. 309-325.

57 Shaw W, (1999) Role for certain yeast and bacteria byproducts discovered by organic acid testing in the etiology of a wide variety of human diseases.

Bulletin of The Great Plains Laboratory. Overland park, KS 66204 (913) 341-8949.

58 Shaw W, Kassen E and Chaves E, (1995).  Increased excretion of analogs of Krebs cycle metabolites and arabinose in two brothers with autistic

features.  Clinicla Chemistry 41: 1094-1104.

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health supervision. There are a number of developmental screening tools available that

have some sensitivity in picking up children with developmental problems. These

include: The Ages and Stages Questionnaire, the BRIGANCE screens, the Child

Development Inventories and the Parents' Evaluations of Developmental Status.76 Of

note, the Denver-II (DDST-II), which is widely used by pediatricians as a screening tool

has been shown to detect only 30% of children with language impairments and 50% of

children with mental retardation.77 78. The importance of listening to parents' concerns

about developmental issues cannot be overstressed and there have been studies

demonstrating the high sensitivity and specificity this carries in detecting global

developmental deficits.79 80 Optimum screening combines attention to parents' concerns

and observations coupled with appropriate screening tools.

Important signs that raise suspicion of a autism and require immediate

evaluations include:

1. No babbling, pointing or gesturing by 12 months of age

2. No single words by 16 months of age

3. No two-word spontaneous phrases (not echolalia) by 24 months

4. Any loss of any language or social skills at ANY age

Following the identification of a child "at risk" for a developmental disorder like

autism, it is recommended that the child be referred for formal audiologic evaluation and

lead testing if pica is present. Because there are no biologic markers for autism, a

number of screening tools have been developed to look "specifically" for signs of Autism

Spectrum Disorders. These include: "The Checklist for Autism in Toddlers" (CHAT),

and the "Autism Screening Questionnaire (ASQ)". Newer screening tools are currently

13

being developed to increase specificity such as the PDDST-II-stage 1 and the Australian

Scale for Aspergers syndrome. It is recommended that a clinician experienced in the

diagnosis and treatment of autism be consulted for an accurate diagnosis. The formal

evaluation of a child for autism should include:

1. A family history

2. A Parent interview (Gilliam Autism Rating scale, the Parent Interview for

Autism, the PDDST-Stage 3, The Autism diagnostic interview, Revised, The

Childhood Autism Rating Scale, the Screening Tool for Autism)

59 Wakefield AJ et al Ileal LNH, non-specific colitis and pervasive developmental disorder in children. Lancet 1998;351:637-641

60 Ward B, Dewals P. Association between measles infection and the occurrence of chronic inflammatory bowel disease. Can Commun Dis Rep

1997;23:1-5

61 Early measles virus infection is associated with the development of inflammatory bowel disease. Pardi DS, et al. Am J Gastroenterol. 2000

Jun;95(6):1480-5

62 Balzola FA, Khan K, Pera A, et al. Measles IgM immunoreactivity in patients with inflammatory bowel disease. Ital J Gastroenterol Hepatol

1998;30:378-382

63 Makela A, Nuorti JP, Peltola H. Neurologic disorders after measles-mumps-rubella vaccination. Pediatrics. 2002 Nov;110(5):957-63

64 Peltola, et al. “No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study.”

Lancet 1998; 351:1327-1328

65 Taylor B et al. Autism and measles, mumps rubella vaccination: no epidemiologic evidence fro a causal association. Lancet 1999;353:2026-2029

66 Singh VK, Jensen RL. Elevated levels of measles antibodies in children with autism. Pediatr Neurol.  2003 Apr;28(4):292-4. 

67 Singh VK et al. Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism. J Biomed Sci.  2002 Jul-Aug;9(4):359-

64. 

68 Singh VK et al. Serological association of measles virus and human herpesvirus-6 with brain autoantibodies in autism. Clin Immunol Immunopathol 

1998 89(1):105-8.

69 Vojdani, A, Pangborn,J; binding of Infectious agents, toxic chemicals, and dietary peptides to tissue enzymes and lymphocyte receptors are instigators

of autoimmunity in Autism; Int J of Immunopathology and Pharmacology, 2003

70 Warren R. P., Margaretten N. C., Foster A., Reduced natural killer cell activity in autism. J Am Acad Child Adolesc Psychiatry 1987; 26(3): 333-335.

71 Warren R. P., Margaretten N. C., Pace N. C., Foster A. Immune abnormalities in patients with autism. J Autism Dev Disord 1986; 16(2): 189-197.

72 Singh V., Warren R., Odell J., Warren W., Cole P. Antibodies to myelin basic protein in children with autistic behavior. Brain Behav Immun 1993;

7(1): 97-103.

73 Page T., Coleman M. Purine metabolism abnormalities in a hyperuricosuric subclass of autism. Biochim Biophys Acta 2000; 1500(3): 291-296.

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3. Past medical history (birth history, milestones, regressions, seizures, pica)

4. Physical/neurologic evaluation: head circumference (there is an increased

prevalence of macrocephapy in autism), presence of dysmorphic features, gait

disturbance, hypotonia, and presence of focal neurologic signs.

5. Genetic evaluation for Fragile X syndrome and Tuberous sclerosis (children with

these syndromes may exhibit autistic characteristics)

6. Verbal and Non-verbal communication assessment

7. Cognitive Assessment of adaptive skills

8. Sensory-motor and occupational therapy evaluation

9. Neuropsychological and behavioral assessment

10. Selective metabolic testing: (inborn errors of metabolism may be associated with

autistic behaviors though the prevalence is less than 5%)81

11. EEG studies: the prevalence of seizures in autism is estimated at 7-14%.82

Electrophysiologic studies should be reserved for children who demonstrate

clinical or subclinical seizures and have a history of regression in development.

12. CT and MRI studies: inconsistent findings in neuro-imaging studies of children

with autism make these studies unwarranted as routine unless there are specific

neurologic concerns83

Differential Diagnosis:

AS a child develops, the nervous system is constantly being remodeled by environmental

stimulae through a process known as Apotosis or "neurologic pruning". This permits the

15

most efficient neural pathways to be fortified while those that are inefficient are

destroyed.84 The constantly changing nervous system may present the clinician with a

confusing picture when diagnosing a child with autism. Early on, many developmental

problems may present with similar characteristics of autism but as the nervous system

matures characteristics may change or subside. This is in no way a reason to delay

evaluation and treatment but it is wise to remember that a diagnosis of autism can only be

taken as a "snapshot" of a moment in the constantly adapting child's life. Odd behaviors

such as "self-stimulation" and "echolalia" may not be specific to children with autism but

may be non-specific signs of other developmental language disorders. Careful evaluation

and tracking is essential to determine the accuracy and prognosis for each child. See

Table 2 for examples of related syndromes to consider.

Table 2: Differential Diagnosis

Rett's Disorder;

Childhood Disintegrative Disorder

Asperger's Disorder

Schizophrenia

74 AAP Committee on Children with Disabilities: The Pediatrician's Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children.

Pediatrics 107:1221-1226, 2001

75 Filipek PA et al. Practice parameters: Screening and diagnosis of autism. Neurology 2000;55:468-479

76 American Academy of Pediatrics Committee on Children with Disabilities. Screening infants and young children for developmental disabilities.

Pediatrics 1994;93:863-5

77 Glascoe FP et al. Accuracy of the Denver-II in developmental screening

78 Greer S et al, The Denver Developmental Screening Test: how good is its predictive validity? Dev Med Child Neurol 1989;31:774-781

79 Glascoe FP et al. Value of Parents' estimates of children's developmental ages. J. Pediatrics 1995;127:831-835

80 Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrcis 1995;95:829-836

81 Rutter M et al. Genetic influences and Autism in: Cohen DJ, Volkmar FR eds. Handbook of Autism and Pervasive Developmental disorders. Second

edition. New York, NY john Wiley & sons 1997:330-337

82 Tuchman RF, Rapin I, Shinnar S. Autistic and dysphasic children. II. Epilepsy. Pediatrcis 1997;88:1219-1225

83 Damasio H et al. Computerized tomographic scan findings in patients with autistic behavior. Arch Neurol 1980;37:504-510

84 Honig LS, Rosenberg RN. Am J Med. 2000 Mar;108(4):317-30. Apoptosis and neurologic disease.  

16

Selective Mutism

Expressive Language Disorder

Mixed Receptive-Expressive Language Disorder

Semantic Pragmatic Language Disorder

Verbal Apraxia

Non-Verbal Learning Disability

Mental Retardation

Stereotypic Movement Habit Disorder

The Conventional Management of Autism :

Early diagnosis is imperative in order to start treatment as early as possible. As

with other developmental disorders, prognosis is improved with early detection and

treatment. 85 86 The first-line of management is referral to early intervention services for

neuro-development support. Controversy over treatment has changed through the years.

10 years ago, conventional neurology/psychiatry considered treatments such as Applied

Behavioral Analysis (ABA) and Sensory Integration Therapy (SI) to be "alternative

therapies" but these have now become standards of care in many areas. Early

intervention services for autism typically include: Special education, Speech therapy,

Occupational therapy, Physical therapy and Social skills therapy. Based on evaluation of

a child's particular deficits and sensitivities, additional therapies may include: Auditory

Integration Therapy, Sensory Integration Therapy, Visual Training Therapy, Music

Therapy, Cranio-Sacral therapy.

17

At present there are no specific indications for the pharmacologic treatment in

autism. Conventional medicine has relied on the pharmacological management primarily

for the management of aggressive or compulsive behaviors in autism. Medications such

as Risperidone, Abilify, Prozac, Paxil, Adderall, Depakote, Propranolol and other

psychotropic medication are currently being used on an experimental basis by the

psychiatric/neurology specialists.

Complimentary and Alternative Management Considerations:

Because of the unknown nature of autism, parents and practitioners have explored

a wide range of CAM practices over the years. Since 1967, The Autism Research

Institute has been supporting research in alternative treatments in autism. The ARI

recognized that many parents may feel significant desperation in their search for a "cure"

which puts them at particular risk for trying many treatments simultaneously which can

lead to exorbitant expense as well as confusion as to what is actually working. In the past

ten years, a number of clinicians and researchers have developed the "D.A.N. protocol"

(Defeat Autism Now!) in an attempt to assess the efficacy of various alternative and

nutritional therapies in autism.87 Parents should be advised to seek qualified, informed

professionals such as clinicians who have been trained in the D.A.N. protocol and are

listed on the ARI website. http://www.autismwebsite.com/ari/index.htm

Based on the accumulating etiologic evidence in the scientific literature, the

D.A.N. protocol has proposed that autism results from the cumulative effects of repeated

85 Osterling J, Dawson G: Early recognition of children with autism: a study of first birthday home videotapes. J Autism Dev Disorders 24:247-257. 1994

86 Werner E, et al: Brief report: Recognition of autism spectrum disorder before one year of age: a retrospective study based on home videotapes. J Autism

Dev Disorders 30: 157-162,2000

87 Autism Research Institute http://www.autismwebsite.com/ari/index.htm

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toxic exposures in genetically predisposed children.88 Recent evidence of impaired gut

immunity and function in autism has led CAM practitioners to treat this disorder as a

toxic inflammation of the neuro-digestive system. Understanding the etiologic sequence

(see table 3) that leads up to the full blown expression of Autism is essential to

developing a treatment strategy for each child: (see table 4). The sequence and dosages

of supplements listed below are meant only as a general guide to practitioners and are by

no means specific for one particular patient. Variations in clinical presentation,

laboratory data and responses to interventions must always be taken into consideration by

the CAM practitioner when choosing an intervention.

Table 3. Etiologic Sequence of Autism

Genetic Predisposition↓

Perinatal Factors↓

Impaired Detoxification↓

Gut Inflammation↓

Yeast overgrowth↓

"Autistic Enterocolitis, Encephalitis Syndrome"

Table 4. Treatment Sequence in Autism

1. Treat Dysbiosis 2. Heal the Gut 3. Strengthen Immunity and Detoxification 4. Chelation of Toxic Elements5. Neuro-metabolic Fine-Tuning.

1. "The Leaky Gut Syndrome" and autism: A major component of the immune-

regulatory system in the infant is located in the digestive tract. In genetically-predisposed

88 Jaquelyn McCandless, Children with Starving Brains, second edition, Bramble Books 2004

19

children, repeated exposures to toxins results in a chronic inflammation of the intestinal

wall with subsequent "hyper-permeability" that allows increased absorption, ("leaking

in"), of macromolecules, diasaccharides, antigens and toxins resulting in neuro-immune

dysfunction.89 90 91 A viscous cycle of gut mucosal damage is set up by repeated mercury

exposure or antibiotic use which leads to abnormal gut-flora overgrowth "dysbiosis"

(yeast, pathogenic bacteria like clostridia etc.). This further damages the gut mucosa

leading to absorption of the toxic by-products of abnormal gut flora (lactic acid, organic

acids, arabinose, biologically active peptides etc.) which aggravate brain function leading

to progressive neurologic damage.92 93 94 95 96 A host of non-specific symptoms may be

early signs of "leaky gut". These include eczema, bloating, colic, hives, reflux, wheezing,

diarrhea, and constipation. Treatment of "leaky gut" syndrome is an essential component

of the CAM management of autism although its presence is not specific to autism.

2. Treating Dysbiosis: One of the first steps in the CAM management of a child with

Autism is to treat abnormal gut flora (dysbiosis) if present.97 Organic acid tests are

89 Manahan B. A brief evidence-based review of two gastrointestinal illnesses: irritable bowel and leaky gut syndrome. Altern Ther Health Med. 2004 Jul-

Aug;10(4):14

90 Kiefer D, Ali-Akbarian L. A brief evidence-based review of two gastrointestinal illnesses: irritable bowel and leaky gut syndromes. Altern Ther Health

Med. 2004 May-Jun;10(3):22-30

91 Verdu EF, Collins SM. Microbial-gut interactions in health and disease. Irritable bowel syndrome. Best Pract Res Clin Gastroenterol. 2004

Apr;18(2):315-21

92 Jyonouchi H, Sun S, Itokazu N. Innate immunity associated with inflammatory responses and cytokine production against common dietary proteins in

patients with autism spectrum disorder. Neuropsychobiology. 2002;46(2):76-84

93 Shattock P & Lowdon G, (1991).  Proteins, Peptides and Autism. Part 2: Implications for the education and care of people with autism.  Brain

Dysfunction 4(6): 323-334.

94 Reichelt K-L, Hole K, Hamberger A, Saelid G, Edminson PD, Braestrup CB, Lingjaerde P & Orbeck H, (1981).  Biologically active peptide containing

fractions in schizophrenia and childhood autism.  Advances in Biochemical Psychopharmacology 28: 627-643.

95 Gupta S, Aggarwal S and Heads C (1996). Dysregulated immune system in children with autism: beneficial effects of intravenous immune globulin on

autistic characteristics.  Journal of Autism and Developmental Disorders 26(4): 439-52.

96 Breaking the Vicious Cycle: Intestinal Health Through Diet by Elaine Gloria Gottschall, Kirkton Press; Rev edition (August 1, 1994) ISBN:

0969276818

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available to determine the presence and degree of dysbiosis98. An IgG Food Sensitivity

test will give indirect evidence of "leaky gut syndrome" and serve as a guide to what

foods to avoid. Often simply "lightening the load" of foods that are "toxic" to a leaky gut

will have a beneficial effect on behavior. 99 Placing a child on a Gluten-free, Casein-free

diet reduces the burden on the digestive system.100 In some cases, the reduction of

casomorphin absorption is enough to improve developmental progress.101 102 The

treatment of Candida yeast overgrowth may require pharmaceutical antifungals such as

Nystatin or Diflucan. Although this will often have a significant effect on developmental

progress, antifungal drugs can have a compromising effects on liver function and must be

used with great care. Natural antifungals include Garlic, Grapefruit seed extract and

Saccharomyces Boulardii. Parents should be counseled to watch for symptoms of "die

off" (the effects of absorption of toxins from killed yeast). These may include behavioral

regressions, loose stools, increased self-stimulation, abdominal pain, and rashes. The

addition of probiotics is essential to gut health, replacing pathogenic organisms with

"good bacteria".103 A trial of Elaine Gottshalts's Specific Carbohydrate Diet (SCD) has

proven to be beneficial in treating dysbiosis. The basic premise of the SCD is to limit the

availability of carbohydrates that pathogenic intestinal microbes require for energy. By

depriving their food source, the bacteria will gradually decrease in number. As the

number of microbes decreases so do the toxic by-products they create.104

97 DAN 2004 Spring Conference, Washington DC, Autism Research Institute

98 Finegold SM et al. Gastrointestinal microflora atudies in Late onset autism. CLin Infect Dis 2002, 35: S6-16

99 Seroussi K. Dietary Intervention For Autism SAN! 2003 Philadelphia http://216.117.159.91/powerpoint/dan2003/KarynSeroussi.htm

100 Kidd PM. An approach to the nutritional management of autism. Alternative therapies 2003;9:22-29

101 Knivsber AM et al. Reports on dietary intervention in autistic disorders. Nutr Neurosci. 2001;4(1):25-37

102 Braly J, Hoggan R. Gluten sensitivity as a neurologic illness. J Neurol Neurosurg Psychiatry 2002 May;72(5):560-3

103 Kidd PM. Autism, an extreme challenge to integrative medicine Altern Med Rev. 2002 Dec;7(6):472-99

104 http://www.pecanbread.com/scd-autism-summary.html

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3. Healing the Gut: In addition to probiotics, the gut lining can be strengthened with some

basic nutritional supplements that include: (Approximate dosages based on DAN

protocol, individual considerations are required)105 106

Zinc: picolinate form is most absorbably 10-50mg/day

Calcium: 250-1000mg/day

Magnesium: glycinate form is most absorbable, 100-300mg/day)

Vitamin B6: in activated P5P form 50mg < 5 years old

Vitamin C: up to 1000 mg /day

Vitamin A: as cod liver oil or as supplement 1000-5000 iu/day

Selenium: 50-150mcg high doses may be toxic

Supplements that reduce inflammation of the gut include:

L-Glutamine: up to 3500 mg/day

Licorice root: in deglycyrrhized form up to 500 mg/day

Aloe barbadensis: up to 50mg/day

Omega 3 Essential Fatty Acids (EFA): 750-1200mg/day

Coenzyme Q 10: 30-60mg/day,

Grape seed extract,

Vit B12 as methylcobalamin 750-2500mcg as subcutaneous injection

DMG (Dimethylglycine): 125-250mg/day

Digestive enzymes improve absorption and should be given with meals.

105 McCandless J. Children with Starving Brains, Bramble Books 2004:120-122

106 DAN 2004 Spring Conference, Washington DC, Autism Research Institute

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Authors note: It is this author's experience that it is wise to start autistic children at

lower doses for all supplements because of heightened sensitivities. Often in fact, lower

doses may give paradoxically better responses than higher doses.

4. Strengthening Immunity and Detoxification Support : Reducing the oxidative stress on

the body has been shown to improve both gut and neurologic function.107 Reduced

Glutathione (oral 150 mg BID, topical 125 mg BID or IV 300-600 mg)108 has both anti-

inflammatory functions as well as being supportive in the detoxification mechanism. It is

available in both oral form and as a topical gel which may be better tolerated and better

absorbed. In addition, high dose Vitamin C, Carnosine, Vitamin B6, Magnesium, Zinc,

Selenium, and Folinic acid support biochemical pathways involved in the protection

against oxidative damage.

5. Chelation of Toxic Elements: The removal of heavy metals has been utilized in the

treatment of lead poisoning for many years. Based on evidence that children with autism

may have faulty immune function, it has been hypothesized that they cannot handle the

increased exposure to heavy metals known to have neurologic effects such as mercury

found in vaccines and environmental pollutants. With this in mind, provoking an

excretion of these metals with a chelating substance such as DMSA would determine the

need for removal by chelation.109 Since chelation is a potentially dangerous procedure,

support of both the digestive and immune systems is essential before trying to remove

potentially toxic elements. Careful monitoring for adverse reactions from both the

chelating agents and the mobilization of toxic elements is required. Hematologic and

liver function monitoring is recommended and the procedure often requires mineral

107 W.McGinnis MD, Oxidative Stress in Autism, Alt Ther Nov/Dec 2004 Vol10 NO 6,22-36

108 ARI DAN! 2004 Physician Training Session

109 Edelson, SB. Cantor DS Autism xenobiotic influences. Toxicol Ind Health 1998;14: 553-563

23

supplementation. Bone marrow suppression and impaired hepatic function although rare

have been reported during the chelation process.110 Allergic reactions and seizures have

also been reported. 111 A single-dose challenge of a chelator like DMSA (10mg/kg)

followed by measurement of urinary metal excretion will determine the need for

chelation. (Authors note: It has been this author's experience that many parents seek

quick treatment solutions and rushing into chelation should be avoided because it can

result in making a child sicker if the child is not adequately prepared and monitored by

an experienced clinician.) Natural detoxing agents such as Garlic, Cilantro, Chlorella,

Chitosan and Hyaluronic acid have been used in the treatment of heavy metal toxicity.

Allithiamine (a synthetic form as thiamine tetrahydrofurfuryl disulfide: TTFD) is a garlic

derivative that may potentiate removal of heavy metals and has been recommended as a

topical application.112

6. Neuro-Metabolic Fine-Tuning: Impaired function of methionine synthase impacts on

the bio-activity of SAMe, B12 and glutathione, all of which play a role in the chemical

mediators of brain function. Supplementation with DMG (dimethylglycine), TMG

(betaine), Methyl B12, Amino Acids, DMAE, L-theanine, Acetyl-L-Carnitine, Coenzyme

Q10, and specific neurotransmitter precursors like tyrosine and 5 HTP and Tryptophan

can support proper brain function. Tests are available to indirectly assess relative

imbalances in neuro-transmitters113.

110 ARI DAN! Mercury Detoxification Consensus Group Position Paper, May 2001, http://www.autism.com/ari/mercurydetox.html

111 Oral chelators for childhood lead poisoning. Pediatr Ann. 1994; 23 (11):616-9

112 Lonsdale D et al. treatment of autism spectrum children with thiamine tetrahydrofurfurl disulfide: a pilot study. Neuroendocrinol Lett. 2002 Aug;23

(4): 303-8

113 www.Neuroscienceinc.com

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Other Holistic Management Considerations:

It has been this author's experience that the challenges facing a clinician in the

treatment of children with autism require a holistic perspective that takes into

consideration the complex interactions of both internal and external environments.

Chinese medicine offers a complete system of medicine that provides a novel model for

understanding autism in the framework of disharmonies and imbalances. Although there

are no published studies on the use of Chinese medicine in autism, the author has found

practical applications in conceptualizing etiology and designing treatment options

through TCM.

In traditional Chinese Medical texts, children with mental disorders that bear

similarities to Autism are described as resulting from "phlegm misting the mind".114 The

origin of this phlegm is thought to be internal trauma, excessive wetness, inappropriate

diet, and food stagnation. Stagnation in the spleen network is a common source of

phlegm in children due to intense activity during the formative years of growth. The

Spleen's importance in transforming food into qi and differentiating "clear" and "dirty"

fluids in the digestive processes cannot be overstated in children.115 Spleen dysfunction

corresponds well with the "leaky gut" model described above. Furthermore, the spleen is

considered to be the residence of thought, influencing introspection, and focus, factors

that are impaired in autism.

In the Five Phase Model (see diagram) described in Chinese medical texts116, 117

118 there is a regulatory (ke) relationship between the Spleen and Kidney (Jing which is

114 Autism by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

115 Pediatric Acupuncture by May Loo, Churchill Livingston Press2002

25

responsible for the inherited capacity to develop and thrive). This is well-illustrated by

the etiologic relationship between causative environmental agents and genetic

predisposing factors found in autism.

When the spleen network is weakened or stagnant, phlegm begins to "mist the

mind". Consequently it cannot support the Lung/Large Intestine system (sheng cycle)

with resultant signs of constipation, diarrhea and eczema. With further toxic exposures

and damage, the kidney network decompensates, leading to an "ungrounding" of

developmental drive with apparent plateaus and regressions in development. As the five-

phase system uncouples, the Liver network show signs of dysfunction resulting in motor-

planning problems, balance issues and agitated "fight or flight" behaviors. Ultimately,

with "rebellion of the Liver", the Heart network, the so-called "Emperor" loses rule over

the governing of physical, emotional, and spiritual aspects of the being. Speech, which is

governed by the Heart is blocked and shen is unstable. Thus autism can be understood as

a multi-system failure, resulting in the unpredictable and disconnected nature of the child.

Treatment is aimed at first re-establishing harmony between the Spleen qi and

Kidney/jing, (dietary management, treating dysbiosis, supporting the immune system),

strengthening the Lung/Large Intestine (re-establishing membrane boundaries, healing

the gut) followed by strengthening the Liver/hun (detoxification and chelation) and

ultimately comforting the Heart/shen (support of neuro-metabolic fine-tuning). A

treatment plan which incorporates this model allows the practitioner to integrate chinese

dietary principles, herbs and acupuncture/acupressure into the D.A.N. protocol.

116 The Yellow Emperor's Classic of internal medicine translated by Ilza Veith, University of California Press 2002

117 Nan-Ching translated by Paul Unschuld, University of California Press 1986

118 "Between Heaven And Earth by Harriet Beinfield and Efrem Korngold, Ballantine Books 1992

26

Having treated a large number of children with autism over the past 10 years, this

author has found this method very effective. It is important to note, however, the dangers

of doing "too much too fast". "Too much" acupuncture may be overstimulating to the

overly sensitive autistic child and making changes too fast can have a destabilizing effect

on the delicate balance of development. It is the author's experience that Laser

acupuncture also tends to provide excess stimulation while tuning fork stimulation of

particular acupuncture points and the use of gold-plated magnets has a beneficial effect.

In particular, the treatment of "Shen Men" ear points with magnets, foot massage (tui na)

of K1 and LV3 and gentle acupuncture at K3, SP6, St 36, LI11, TB5 have beneficial

regulatory effects and appears to work synergistically with some of the other treatments

outline above. Herbs that promote harmony between Spleen and Liver (such as

Bluperium root, cyperus, licorice root, unripe citrus peel etc.) and Kidney and Heart

(such as rehmannia root, sciszandra, salvia root, and lotus seed) have been particularly

helpful. 119

Summary

CAM treatments can be of great benefit in the management of Autism. In light of the

rising prevalence of this disorder and the limited treatment options offered by

conventional medicine, practitioners should be encouraged to explore alternative

treatment options that have proved successful. Developing a holistic treatment plan

requires an understanding of autism as a cumulative series of insults to the neuro-

immunologic system. The complex relationship between genetic predispositions and

toxic exposures may account for the wide variations in symptoms encountered in this

119 Chinese Modular Solutions, a handbook for professionals by Harriet Beinfield and Efrem Korngold, Chinese Medicine works, san Francisco, 1992

27

syndrome. This may have great importance in preventive management when counseling

siblings of children with autism. Early non-specific symptoms such as eczema and

chronic loose stools associated with language delays may be subtle signs of impending

developmental dysfunction. Since no single cause of autism has been found, research

must be aimed at considering multiple variables together. A careful history and tracking

of symptoms is essential for diagnosis, management and prognosis. An approach to

management that respects the highly sensitive nature of children with autism can result in

profound improvements in behavior and development.

28