Autism Spectrum Disorder - Scientific Recommendations


The best way to help autistic children is for physicians to talk to parents for 1-1/2 to 2 hours and get detailed information about the gestation, delivery, infancy behavior, motor milestones, coordination (both large and fine motor), and detailed information about number of infections and antibiotics. Time needs to be spent on how the developmental delay evolved. Specifically, when did it start, was there regression or has this been a child who never did talk? Details about echolalia, scripting and delayed pointing, requests; the "who," "what," "when," "where," "why" questions; grammar use, including misuse of pronouns should be documented. Children with Autism lack spontaneity in language. Very often there can be a huge vocabulary but issues with pragmatic language are present.

Details of a child's socialization, eye contact, self-stimulatory behaviors should be discussed.

Sensory Integration is usually a major issue with Autistic children. Information about a child's sensitivity to sound, smell, touch, light, pain threshold and vestibular/ proprioceptive deficits should be documented.

I also ask questions about a child's allergies involving the nose, eyes, ears, throat, as well as gastrointestinal complaints, including diarrhea and/or constipation, muscle and joint pain and certainly behavior. Children with Autism, even those who are high functioning will have long-term problems with attention, motor planning and processing. Many of the children I see who are doing great have accomplished all that needs to be accomplished but have language deficits secondary to attention, motor planning and processing. This can certainly be affected by auditory processing or visual processing.

With a complete history the therapies that are recommended are based directly on this history. Decisions regarding dietary restriction, diagnosing and treating leaky gut, Methyl B12 injections, chelation, and nutrients for cognitive issues are based on the history.

I am optimistic that if more physicians used this approach and individualized medical care the results would be much better and many of our children who do have Autism would benefit.

Articles – Autism:

"It's Not Just in the Head" (Discovery, 2007)
"Autism's Angels" (Town and Country, August 2006)

X. Books to Read:

  1. Healing and Treating Autism – Jenny McCarthy/Dr. Jerry Kartzinel
  2. Special Kids/Special Diets – Lisa Lewis *Casein and/or Gluten-Free diet order from DDR – (301-652-2263).
  3. Unraveling the Mystery of Autism and Pervasive Development Disorder – Karyn Seroussi
  4. Biologic Treatments for Autism and PDD – William Shaw (order from DDR – 301-652-2263) *Biomedical Intervention
  5. Children With Starving Brains – Jaquelyn McCandles *Biomedical Intervention
  6. Facing Autism – Lynn M. Hamilton
  7. Conquering Autism – Reclaiming Your Child through Natural Therapies – Stephen B. Edelson, M.D.
  8. Louder Than Words and Mother Warriors – Jenny McCarthy
  9. Incredible Edible, Gluten-Free Food for Kids – Sheri Sanderson (order from www.amazon.com).
  10. The Out of Sync Child – Carol Kranowitz *Sensory Integration Disorder (order from DDR – 301-652-2263).
  11. Is This Your Child? – Doris Rapp, M.D. *Effect of Allergies on Behavior (best book to explain my medical practice)
  12. Breaking the Vicious Cycle – Elaine Gottschall *Specific Carbohydrate Diet
  13. Awakening Ashley – Sharon Ruben

XI. Websites for Biomedical Interventions

  1. ANDI – (AUTISM NETWORK for DIETARY INTERVENTIONS)
  2. www.gfcf.com (GFCF)
  3. www.autismwebsite.com (Autism Research Institute)
  4. www.talkautism.org
  5. CSB (Children with Starving Brains)
  6. Chelating Kids 2
  7. www.pecan.com (SCD)
  8. www.awakeningashley.com (Sound Therapy Systems
  9. Body Ecology Diet (BED)

Autism Spectrum Disorder –
Biomedical Protocol 2010

I. Current Status ASD
Rate 1/04 – CDC
1990 1:2000
2004 – 1:166
2007 – 1:150
Now – (1:91 – 1:110)
Other Developmental Delays – 1:6 children, 4:1 Male:Female

Prior to 2005
CDC/NIH/AAP – Genetic Only

Now Multiple Genetic Factors – Genetic predisposition
Environmental/Causation "The Hidden Epidemic"

Dr. Martha Herbert – Pediatric Neurologist – Harvard Medical School

  • Inflammation – Brain, GI, Immune System – Hopkins Study
  • White matter affected 2.5 x increased
  • Head size – increased 2 SD
  • Oxidative Stress
  • Affects Limbic system
  • Cerebellum – processing, connectivity
  • Mitochondrial damage
  • Definition has changed
  • Past – genetic, untreatable
  • Current – Multiple genetic factors – (genetic predisposition)
  • Environment – "unknown causes" + heavy metals, pesticides/pollutants
  • Biomedical – Brain/body – metabolic, GI, Immune system
  • Treatable

Many Autisms – not just 1 – recommend term "Metabolic or Toxic Encephalopathy"

  • Stress Factor can activate Autism
  • Stress factors and toxins include: pesticides, PCB's, heavy metals (mercury, arsenic, aluminum, cadmium) – 80,000 chemicals, also viruses (Retrovirus) – Testosterone, Phenol as a preservative in vaccines.
  • Biochemistry Defects such as Methylation Oxidative Stress, Inflammation
  • Defects in biochemical pathway – Methionine
    • Methylation
    • Glucaronidation
    • Transsulfuration
    • Folation
  • Studies Document
    • Neuro Inflammation – Johns Hopkins, Yale, Harvard
    • Decreased Glutathione – Dr. Jill James
    • Decreased Cysteine (80% ASD) – Dr. Jill James
    • Oxidative Stress
    • Loss of neuronal symmetry (neural processing) – Dr. Deth
    • Retrovirus (40% of children with ASD)
  • Genetic vs. Environmental – both
    1. Genetic Vulnerability – Immunizations
      • Most children are immunized and do well
      • Need immunization program with "common sense"
      • Subset of children cannot breakdown heavy metals, unable to detoxify
    2. Environmental
      • Diet – casein, gluten, soy, corn, preservatives – Specific Carbohydrate Diet
      • Antibiotics/infections (viral/bacterial)
      • Environmental Toxins (chemical, heavy metals)
      • Immunizations
      • Allergies
      • Inflammation – brain, gut, immune system

Sensory Integration – a major role

  • Sound, smell, tactile, pain threshold, vestibular/proprioceptive
  • Attention/Motor Planning/Processing – the most difficult problem to help and most frequent finding.

II. Lab Tests – Impaired Detoxification, Oxidative Stress, and Inflammation, Mitochondrial defect.

Lab tests most helpful – consider:

  1. Gut
    • GI Panel – to include Lactobacillus, Bifidobacter, Yeast Culture, Parasites, Inflammatory Lysozyme, Calpopectin, Eosinophil Protein X.
    • Organic Acid Test (OAT) – Microbiology
    • Urinary Peptides – casein/gluten
  2. Metals
    • Urinary Porphyrins (Fractionated)
    • Hair Analysis – a screen
    • Fecal/Urine Metals
  3. Blood Panel
    • CBC, Platelets, Metabolic profile
    • TSH
    • Iron
    • Ferritin
    • RBC Minerals
    • Plasma Zinc, Copper
    • Lead
    • Celiac panel
    • 25 Hydroxy/vitamin D
    • PANDAS (ASO and AntiDNase strep titers)
    • Vitamin A
    • Cholesterol
    • Ammonia
    • Lactic Acid
    • Methylmalonic Acid
    • Glutathione
    • Cysteine
    • Sulfate
  4. NutraEval Metabolic Profile
  5. Oxidative Stress – Cysteine, Sulfate, Glutathione, 80 Hd6 and 80 H6, RNA/RNA damage.
  6. Mitochondria – Pyruvate, Lactate, Carnitine (Free/Total), Ammonia, Creatinine Kinase
  7. Methylation and Transulfuration – affect Cysteine, Homocysteine, Glutathione.
  8. Also:
    • IgG Food Panel
    • Metallothione profile – Pterins (Neopterin/Biopterin)
    • MBP, NFP – Autoimmune Antibodies
    • Fragile X
    • EEG
    • Amino Acids (include Taurine)
    • NK Cells – Immune Panel
    • Viral Titers – EBV, HHV6, CMV, Mycoplasma
    • B12/Folate

III. DIET

  • Casein Free x1 month
    Craving, picky, regression, GI, high pain threshold, spacey.
    1A. Gluten Free x3 months
    Craving, picky, regression, GI, high pain threshold, spacey.
  • SCD – consider 1st
    Gas, GI, diarrhea, inflammation – Yeast overgrowth, bacterial imbalance. DO NOT use with increased Ammonia.
  • Feingold – Stage I and II – no artificial flavorings, colorings, preservatives – consider no salicylates, Phenols – red cheeks/ears, hyperactivity, lethargy, inappropriate laughter, sensory issues.
  • Corn Free/Soy Free
  • Low Oxalate – Urinary, GI pain, BM's/Gas, decrease growth
    Supplement Ca, Probiotics
    Only moderate success with SCD,CF/GF
    Avoid NUTS (peanuts, cashews, pecans, almonds), SOY, BERRIES, Spinach, Chocolate, Wheat Bran, Beets
  • Body Ecology Diet – Gas, Foul smelling BM's, Itchy, spacey, act "drunk" – anti-yeast diet. Add fermented foods – coconut, kefir, kombucha, nut milk yogurt, raw sauerkraut, and add Bio Kult probiotic.

IV. GUT

(1) Probiotics – Therbiotic Complete Powder VSL 3 Super Pro Bio 75 – Pro Bio Gold – Pro Bio Defense Three Lac Theralac (prebiotic)

(2) Digestive Enzymes – Enzyme Complete II HNZyme Prime / Peptizyde / No Phenol – Houston (enzymes) Trienza – Houston (enzymes) Enzylase

(3) Transfer Factor \ IgG 2000 Colostrum Products Colostrum Gold / Aloe Vera

(4) EFA

(5) Calcium / Magesium – Zinc, Cod Liver Oil, Vitamin A, Glutathione, Folic Acid or Folinic, vitamin D3, B5

(6) Enhansa (advanced Curcumin) – anti-inflammatory, antifungal, and antiviral

(7) S. Boulardii – 3 billion qd – BID or 250 mgm BID, do not use with antifungal + may need Activated Charcoal. – Use for increased IgA

(8) Natural Antifungals – Yeast Aid, Oil of Oregano (.2 ml BID), 1/3 adult dose Grapefruit Seed Extract, Garlic, 500-1000 mgm Caprylic (with meals), Olive Leaf Extract, Berberine, Tannins, S. Boulardii 3-4/day, Biocidin.

(9) Kefir

(10) Singulair – anti-inflammatory

4-6 month program
(11) Antifungals -> Antifungal Parade x 10 days S. Boulardii 3-6/day x 3 months
-Recommended by Dr. Sidney Baker

*Diflucan200 mgm BID400 mgm BID
*Ketoconazole200 mgm qd400 mgm qd
*Sporanox100 mgm BID200 mgm BID
*Amphotericin B250 mgm QID x 10 days -> 500 mgm QID x 10 days
*Lamisil250 mgm QID x 10 days -> 500 mgm QID x 10 days
*Nystatin1 million QID

*DAN PROTOCOL

(12) Antiparasitic – Metronidazole (Flagyl), Nitazoxamide, Yodoxin, Vermox, Alinia, Humatin

(13) Antivirals – Valtrex, Acylovir, Famvir V. SUPPLEMENTS – add 1 at a time. Side effects – sleep (lower), Hyperactivity (increase), Irritability.

(1) COGNITIVE
Diet: CF/GF – SCD – lower Sugars / Colorings – EF/SF/CF

  1. Methyl B12 – injectable every 3 days (75 micrograms/kilogram/dose)
  2. Glutathione – Essential nebulized or TD 250 mgm/ml. 1 ml. q AM -> 2x/day
  3. Enhansa – (advanced Curcumin) - anti-inflammatory, antifungal, antiviral
  4. Omega 3 EPA – Pro Omega or Pro EPA
  5. Zinc
  6. Cod Liver Oil
  7. DMG/Folinic Acid/B12 or TMG/Folinic Acid/B12 – Folic Acid
  8. Super Nuthera or Nuthera B6/P5P
  9. Multivitamin – Spectrum Complete, ASD, Syndion, Brainchild
  10. Minerals - Brainchild
  11. Phosphatidyl Choline
  12. Carnosine
  13. Attention – CoQ10, DMAE, Theanine, Gingko
  14. LDA – Allergy treatment
  15. Other: GABA, Taurine, Ca/Mg, Glycine 250 mgm BID and increase, Inositol, C, E, Se

Inflammation

Anti-inflammatories

  1. Glutathione
  2. Probiotics
  3. Omega 3 EFA
  4. Vitamin D3
  5. Vitamin C
  6. Selenium
  7. Vitamin A
  8. Vitamin E
  9. B6
  10. Quercetin
  11. Melatonin
  12. Bromelain
  13. Grape Seed Extract
  14. Enhansa (Curcumin)
  15. Pycnogenol
  16. Spironalactone
  17. Green Tea Extract
  18. Ibuprofen
  19. Singulair
  20. S. Boulardii
  21. Oxytocin
  22. Prednisone (last resort)
  23. Minocycline
  24. HBOT
  25. IVIG
  26. Actos / Namenda (I do not use Celebrex)
  27. TDNicotine
  28. LDN

To enhance Glutathione

NAC – 100 mgm qd TD
ALA (be careful)
C,E
MB12
DMG or TMG with Folinic Acid
Glutathione – Essential, TD, IV

VI. CHELATION avoid Tuna, Swordfish (foods high in Mercury)

(a) Before Chelation

  • Diet
  • Methyl B12 injections/Glutathione
  • Vitamins – especially C+E+B6
  • Minerals – Zinc, Selenium, Calcium, Magnesium
  • DMG or TMG with Folinic or Folic Acid
  • Antioxidants
  • Adequate Cysteine / Sulphate / Glutathione
  • Gut – good control – probiotics, IgG 2000, Enzymes

(b) Monitor – Zinc, Selenium, Calcium, Magnesium
CBC
Metabolic Profile
Also monitor Organic Acid Microbio / Stool Culture

(c) Epsom Salt Baths / Mg SO4 / increase Garlic, Cilantro, Curcumin (Tumeric)

(d) Mild Chelation

  • Detoxamine Ca EDTA
  • Metal Free 4-8 sprays / day
  • Biochelate EDTA
  • NDF+, PCA Rx
  • Homeopathy (Sequential)
  • Zeolite (NCD)

(e) Stronger chelation – DMPS, DMSA, Calcium EDTA
DMPS TD — 1.5 mgm/kgm QOD Hg best for: Arsenic, then Lead, CO, Antimony, Tin
Or Rectal — 3-5 mgm/kgm QOD or 3 days on / 11 days off

DMSA— 10 mgm/kgm TID 3 days on / 11 days off x14 days
Suppositories 10-20 mgm/kgm to increase Glutathione
Lead, Organic Mercury
2-3 x/week
Best for: Antimony, Tin,
Then inorganic Mercury, Arsenic

Rectal EDTA 375 -> 750 mgm (10-50 mgm/kgm)
(< 5 years)         (> 5 years)
100-300 mgm for small child

Best for: Lead, Cadmium, Antimony, Tin, Then inorganic Mercury,
OK AC

Rectal DMPS 3-5 mgm/kgm

ALA Alpha Lipoic Acid

IV Chelation – EDTA, 10-50 mgm./kgm. every 2 weeks.
DMPS, 2-3 mgm./kgm. every 2 weeks.

VII. INTERVENTIONS SUMMARY

  1. Diet – CF/GF, SCD – soy/corn – Feingold – Low Oxalate, BED
  2. Methyl B12 – injectable
  3. Gut – Probiotics, Enzymes, IgG 2000, Colostrum, antiparasitic, antiviral, natural antifungals, S. Boulardii, Biotin
  4. Cognitive – MB12, DMG/Folinic (125 mgm., 1-6/day), Glutathione, B6/P5, Zinc, Phoschol, CLO, Pro Omega/Pro EPA, Multivitamin/mineral, Iron, Carnosine, Taurine, C, E, Selenium, Calcium, Magnesium, Vitamin D3, BRAINO, CoQ10, Carnitine (L and Acetyl)
  5. Allergy – Low Dose Allergen (LDA) or allergy program (meds) including Singulair
  6. Inflammation
    • Enhansa
    • Oxytocin
    • Spironalactone
    • Minocycline
    • Singulair
  7. Glutathione – Essential, TD, Neb, IV, Suppository
  8. Melatonin – Anti-inflammatory / sleep
  9. Antifungal Parade + S. Boulardii / Activated Charcoal / Enhansa, Biotin 300 mcg qd.
  10. Chelation – DMPS/EDTA/DMSA+ALA, Metal Free
    1/2 cup Baking Soda, 1/2 cup Epsom Salt Baths, Mq SO4 Cream.
  11. Supplements – Zinc, DMG/Folinic, Omega 3, Phoschol.
    Sleep – GABA, Taurine, Mg, 5HTP, Trazodone.
  12. Antiviral Therapy – Enhansa, Valtrex, Acyclovir
  13. Antiparasitic / Clostridia – Metronidazole / S. Boulardii / Nitazoxamide
  14. Secretin, IV/Intranasal
  15. IVIG
  16. NAC – Nacetyl Cysteine
  17. HBOT
  18. 5HTP - Mood
  19. GABA/Inositol - Anxiety
  20. Reflux Meds – Prevacid, Pepcid, Zantac
  21. decrease sIgA – S. Boulardii, IgG 2000 or Transfer Factor
  22. Amino Acids – esp. Taurine, Arginine, Lysine
  23. Activated Charcoal – to counteract die-off (yeast treatment)
  24. Meds
    • Deplin – high dose Folic Acid for mood
    • Antifungals – Nystatin safest – also Diflucan, Sporanox, Nizoral, Amphotericin, Lamisil
    • Antivirals – Valtrex, Acyclovir, Famvir
    • Antiparasitics – Flagyl, Nitazoxanide;Yodoxin
    • Clostridium – Flagyl
    • Anti-Colitis meds – Sulfasalazine
    • ADD – Low dose Strattera and Stimulants – Amphetamines and Methylphenidate – can be poorly tolerated
    • Risperdal (or Abilify) – can be great – FDA approval – but increased side effects - major positives and negatives
    • SSRIs – Celexa/Zoloft / Prozac/Lexapro
    • Buspar – Anxiety
    • Tenex – hyperactivity/impulsivity
    • Clonidine – sleep, tics
    • Mood stabilizers – Trileptal; also Neurontin, Depakote, Tegretal, Lamictal
    • Singulair – allergies and gut inflammation
    • Reflux meds – Prevacid, Pepcid, Zantac
    • Prednisone
    • Allergy meds – Claritin, Zyrtec, Xyzal, Allegra, Chlorpheniramine, Benadryl
    • Allergy Testing/Immunotherapy + Low Dose Allergen (LDA)
    • Actos – concern with side effects

VII A. PANDAS – Antibiotics (Penicillin/Zithromax/Omnicef), Prebiotics, also Probiotics, S. Boulardii, Antimicrobial, Herbs, Colostrum, IgG 2000, LDN, HBOT, Mushroom Extract/plant sterols.

VIII. CONCEPTS:

Inflammation, Oxidative Stress, Detoxification, Mitochondrial Defects

Oxidative Stress

TH2 -> Th1 – affected by Mercury; LDA helps

IX. NON-BIOMEDICAL MODALITIES

  1. Early Intervention – extremely important (Dr. Landa – Kennedy Krieger)
  2. Education – Individualized to the individual child. PECS – TEECH
  3. ABA/Play Therapy
    RDI
    CARD (Center for Autism and Related Disorders)
  4. Speech – OT – PT
  5. Auditory Integration Training
    Home:
    — Earobics, Samonas – Music Therapy
    — Fast Forward, Interactive Metronome – Computer
    — The Listening Program
    Out of Home:
    — Berard – 10 day program
    — Tomatis

My Opinions:

  1. Need to set aside differences/avoid rigidity and listen to parents.
    • Open minded – no place for "medical religion"
  2. Autism is an epidemic – no such thing as "genetic epidemic"
  3. Many parents need a co-captain – listening to the individual medical history is the best way for MD to help.
  4. Many Autisms –
    • This is the most difficult, complex, confusing medical problem of all.
    • Nobody knows a lot.
    • Research to date is poor
    • I rely on parent's opinion and observation of child
    • Who does this child remind of? Studies of "1" – use common sense and clinical judgment
  5. Medical history determines medical recommendations

1:2000 ---- 1:150 ---- 1:91 ---- WHY???