Autism Society of America
- Colorado Chapter
Autism: Intervention Strategies and Synergies Conference and Exposition
September 18-21, 2002
Red Lion Denver Central
Keynote Address
Presented By: Rosemary Boon, Psychologist.
M.A.(Psych), MAPS, AACNEM, ACHC.
Grad.Dip.Ed., Grad.Dip.Ed Studies(Sch.Counsel) Bsc

This is the outline format of the presentation, to download the power point presentation and view the full graphics, please click here

• A pervasive developmental disorder - usually evident before age 3, ranging from mild to severe
• Impacts brain development in areas of social interaction, communication skills and sensory responses adversely affecting educational performance
• Approximately 80% have some degree of mental retardation and most do not reach independence as adults (Siegel 1996).
• Often includes resistance to change and repetitive or perseverative/stereotyped movements

• The incidence of Pervasive Developmental Disorders, Learning Difficulties, ADHD, Auto-Immune Disorders, and Psychiatric Disorders are increasing.
• ADHD 1:10 (10%)
• SLD 1:5 (20%)
• Autism 1:135 (USA)

• "Genetic fragility or predisposition".
  (Shattock, Durham 1999)
• A family with 1 autistic child has a 3-5% chance of having another child with autism
  - 90% concordance in monozygotic twins
  (Rogers et.al. 1999)
• A family with no autistic children has a 0.1-0.2% chance of having a child with autism
• 3 out of 4 autistic people are male

• From 2-10 genes involved (Bailey et.al. 1996)
• There may be up to 19 genes involved - 5% of autism may be quantified by a genetic syndrome.
  (Mary Coleman)
• A Genome Wide screen for Autism: Strong evidence for linkage to chromosomes 2q, 7q, 16p and 7q32 region .
  (International Molecular Genetics Study of Autism Consortium. Am. J. Hum. Genet. 69: 570-581 (2001)
• "Genes load the gun and the environment pulls the trigger" (Gupta 2002 - Mind of a Child - Sydney, Australia).

• This question is posed by Sallie Bernard et.al. in the above titled paper, submitted to the American Congress in 2000
• The summary of the comparison of characteristics of autism and mercury poisoning and their similarity is nothing short of alarming.
• Mercury toxicity is difficult to quantify

• Social structure

• deficiency of DHA (Broadhurst et.al.; Stordy; Levine; Oski)

• "Long chain polyunsaturated fatty acid deficiency at any stage of foetal and/or infant development can result in irreversible failure to accomplish specific components of brain growth - optimal brain development requires DHA and AA provided by breast milk".
  (Broadhurst et. al. British Journal of Nutrition 1998)
• …….."For every year of delay, more than 2 million formula-fed, full-term babies born annually in the United States may experience a disadvantage of 3-6 IQ points compared with breast-fed full-term babies…… the difference is even greater for infants with low weight at birth".
• Because formula-fed babies "are deprived of this essential building block (DHA/AA) there are incalculable quality of life issues"……

• Pregnancy
• more mothers smoking (27%)
• caffeine (low birth rate and breathing problems)
• alcohol (> 50% - even 1 glass/week increases the risk of delinquent behaviour)
• amalgam fillings (Bernard et.al. 2000)
• maternal stress - causes decreased blood flow and low birth weight
• 8x higher rate of antibiotic use in mothers of autistic children - ill and producing cytokines (Waring, MOA 2002)

• Individual researchers and clinicians around the world are beginning to realise that intensive multi-modal intervention designed around the individual’s unique neuro-biochemical, metabolic and genetic makeup can make a difference to outcomes.

• Diverse strategies are currently in place and continually being developed for effective early intervention as our shared knowledge base of these disorders grows.
• The complexity of ASD requires the integration of research findings so that fundamental cellular dysfunction is systematically addressed through multi modal interventions.

Screening and diagnosis of autism ……..
(From the Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society - 2000)

• Stool Analysis
• Organic Acid Test
• Urinary Peptide Test
• Food Allergy Testing
• Intestinal Permeability Studies
• Gluten Antibody Studies (Gliadin endomesial and reticulin)
• Secretory IgA (Saliva or stool)
• Immunilogical testing (Immune markers, immunolglobulins, activated T Cell subsets (NK cells)
• Sulphation studies

• Malabsorption (J. Autism/Childhood Scizo, 1971 1(1):48-62)
  -freq. Reports acholic stools, undigested fibers, proteins, positive Sudans.
• 85% of autistics meet criteria for malabsorption (B. Walsh, 500 patients)
• Maldigestion - elevated urinary peptides
  (P. Shattock, Brain Dysfunct 1990, 338-45 & 1991, 4:323-4; KL Reicheldt, Develop Brain Dys 1994, 7:71-85, and others; Z Sun and Cade Autism 1999, 3: 67-83)
• Abnormal Intestinal Permeability
  (P. D’Eufemia Acta Pediatr 1995, 85: 1076-9)

• G.I. Symptoms reported by parents - diarrhoea, constipation, gas, belching, probing, visibly undigested food and need for rubs
• Microbial Overgrowth - fungal, bacterial and viral
  (William Shaw, Biological Basis of Autism and PDD, 1997)
  
  - Clostridium - high wheat content in diet
  (E. Bolte Med Hypoth, 1998, 51:133-144)
  
  - Aerobic Lactobacillus - high rice in diet
  (J. Child Neurology, 15: 429-435; P. Shattock & A. Broughton,
  JAG elevations; Andre Wakefield, Lancet, 1998, 351:637; T.J. Borody, Centre for Digestive Diseases, NSW, Australia)

• Fecal and urine samples from 36 patients revealed significantly lower aerobic flora (56.3%) compared to healthy controls (70-95%). By contrast lactic acid bacteria Enterococcus/Streptococcus was significantly higher in autistic subjects (40.1%) than in healthy subjects (5%).
• The excretion of C18 fatty acids was positively correlated with lactic acid bacteria. Alteration of fecal lipids significantly associated with intermediaries of the Krebs and Urea cycles, suggesting that fecal microflora may affect multi system homeostasis. (Bioscreen Pty Ltd Collaborative Pain Research Unit, University of Newcastle, Australia, 2002)

Who want’s to party??????………
(From Autism and the Human Gut Microflora - Max Bingham - University of Reading)

• Glutathione Conjugation low in 14 of 17 (mean 0.55 vs 1.4-2.9)
• Metallothionine suppression
• Peroxisomal Malfunction (P Kane, J of Orthomolec Med 1997; 12-4: 207-218 and 1999; 14-2: 103-109; Anne Moser)
• Phase II Depression (S. Edelson, DAN Conference Sept, 1997, and Toxicology and Industrial Health 14 (4): 553-563 1998)

• Sulphation Deficit in 15 of 17 (mean 5 vs. nl 10-18)
  (Biol Psych 1; 46(3): 420-4, 1999; Waring, 2000)
• Glucuronidation low in 17 of 17 (mean 9.6 vs. 26.0-46.0)
• Glycine Conjugation low in 12 of 17 (15.4 vs. 30.0-53.0)
• Increased Heavy Metal Burden
• Sulphydrate affinity for heavy metals

• Recurrent Infections (Euro Child/Adolesc Psych, 1993:2(2):79-90 J Autism Dev Disord 1987; 17(4): 585-94)
• T-cell Deficiency (J Autism Child Schizo 7:49-55 1977) - There is a shift from TH1 to TH2 cells in autism which impairs cell mediated immunity. (Gupta University of CA, MOA 2002)
• Reduced NK Cell Activity (J Ann Acad Chil Psyc 26: 333-35 '87)
• Low or absent IgA (Autism Develop Dis 16: 189-197 1986)

• Low C4B levels (Clin Exp Immunol 83: 438-440 1991)
• There is a lack of inflammation - i.e. cell death without the normal immune response (Gupta University of CA, MOA 2002)
• There are antibodies to neurological tissue proteins
  (Gupta University of CA, MOA 2002)

• Research indicates that a deficiency in any or many essential nutrients on the part of parents can contribute to L.D. and P.D.D.s
• Many foods today are subject to genetic modification, pesticide sprays and industrial processing, --- what are the potentials to health?

• Lower serum Magnesium than controls
  (Mary Coleman, The Biology of Autistic Syndromes 197-205, 1976)
  Lower RBC Magnesium than controls
  (J. Hayek, Brain Dysfunction, 1991)
• Low activated B6 (P5P) in 42%.
• B6 and Magnesium therapeutic efficacy --multiple positive studies (Am J Psych 1978;135: 472-5)
• B12 deficiency suggested by elevated urinary methylmalonic acid (Lancet 1998; 351: 637-41)
• Low Methionine levels not uncommon
  (Observation by J. Pangborn)

• Dietary analysis revealed below-RDA intakes in Zinc (12 of 12 subjects), Calcium (8 of 12),
  Vitamin D (9 of 12), Vitamin E (6 of 12) and
  Vitamin A (6 of 12) (G. Kotsanis, DAN Conf., Sept, 1996)
• Higher in serum copper. (Nutr. and Beh 2:9-17, 1984)
  Higher Copper/Zinc ratios in autistic children.
  (J. Applied Nutrition 48: 110-118, 1997)
• Low Derivative Omega-6 RBC Membrane Levels 50 of 50 autistics assayed through Kennedy Krieger had GLA and DGLA below mean. Low Omega-3 less common (may even be elevated)
  (J Orthomolecular Medicine Vol 12, No. 4, 1997)

• Lowered glutamine (14 of 14), high glutamate (8 of 14) (Invest Clin 1996 June; 37(2): 112-28)
• Reduced sulphate conjugation & lower plasma sulphate. (Dev. Brain Dysfunct 1997; 10:40-43)
• Hypocalcinurics Improve with Calcium Supplementation - Lower Hair Calcium in Autistics Reported (Dev Brain Dysfunct 1994; 7: 63-70)

• Full blood count
• Metabolic Biochemical Analysis (MBA)
  - Full iron studies
  - Thyroid function
  - Urine analysis
  - Stool Analysis
  - Lipid and Peroxisomal Studies (Kennedy Kreiger, Kane)
  - Mineral levels (Zinc/Copper, ceuroplasma )
  - Vitamin levels (especially B6 function)

• 50% improved with Zinc (6% worsened)
• 49% improved with Vitamin C
• 46% improved with Magnesium and B6 (5% worsened)
• 58% improved with Calcium (Later survey 42%)
• Further research is needed

• EMF: Our environment is now filled with man-made electro magnetic radiation that did not exist 100 years ago.
  - Many research studies indicate that amongst other things, our immune system is depleted by continued EMF exposure.
• Sick Building Syndrome: Increased use of plastics, awareness of drinking water content, toluene, cleaning fluids, carpets, paints, toiletries, ‘air conditioning’ etc.
• In light of the concerns raised, it makes sense to try to limit exposure to EMF's and other household pollutants as much as possible while still enjoying all that technology has to offer.

• Teaching parents basic massage techniques in combination with gentle blends of oil - calming or stimulatory depending upon need - can help develop bonding and attachment where previously there was little or none.
• Many children respond well to this technique, and will voluntarily initiate contact where previously, no recognition was present.

• Bowen was developed in Geelong, Australia by the late Tom Bowen in the 1950’s and is now in use worldwide.
• Bowen Therapy is a gentle muscle and connective tissue technique which addresses the whole body response by utilising precise moves across particular sites of the body in which the golgi tendon organ and neurovascular bundles are concentrated.
• With an experienced practitioner addressing such sites, an impulse is sent to the central nervous system, (think of the reset button on your computer) allowing balance in the autonomic nervous system (homeostasis).
• The moves are light and can be done through light clothing.

• Explanation of the difficulties and the criteria for diagnosis affords family members a better understanding of the child’s disorder.
• Be specific about strengths and weaknesses.
• Outline medical and complementary strategies available, including nutritional advice and the likely prognosis.
• Explanation of the value of genetic testing.
• Support groups
• Practitioner network and continuing education of all educational/health care personnel who work with children, esp. neonates.

• Decreased cerebral blood flow
• EEG abnormalities (frontal, temporal, parietal lobes and insular cortices; auditory ERPs at P50, P300)
• Altered neurotransmitters (serotonin, dopamine)
• Poor communication between cortical areas (angular gyrus, inferior frontal extrastiate occipital)

• Seizures are found in approximately 35-45% of all cases - 70% temporal lobe. (Olsson, Steffenberg & Gillberg, 1988)
• Structural imaging studies reveal:
  - Cerebral atrophy (Courchesene et.al. 1988)
  - Ventricular Dilation (Gaffney & Tsai, 1987)
  - Abnormal ventral temporal cortical activity during face discrimination among individuals with autism and Asperger’s Syndrome (Shultz et.al. Arch Gen Psychiatry. 2000;57:331-340)
• - Various abnormalities of cellular migration (Piven et.al. 1990)

• Anterior and medial temporal lobe abnormalities (Bauman& Kemper, 1985; Bolton & Griffiths, 1997; Chugani et.al. 1996; Maurer & Damasio, 1982; Bachevalier 1994)
• Decreased neuronal size and increased cell packing density has been observed in the hippocampus, entorhinal cortex and amygdala suggesting cells are fixed at an earlier stage of brain maturation. (Miller et.al. 1999)

Neural networks in autism…….. (Zimmerman & Gordon 2001)

• An advanced form of EEG biofeedback.
• It is non-invasive and painless, and requires only sitting in a comfortable chair and wearing dark glasses that generate feedback via transducers.
• This is not a conscious learning task and attentional capabilities are not necessary.
• Reduces the electrical "noise" in the brain (EEG slowing). These changes are the equivalent of greater neurological and behavioural "flexibility".
• When EEG slowing is reduced, symptoms can decrease and even disappear.

• Is a learning strategy that works to improve the brain's ability to produce certain brainwaves. It can be considered "aerobics for the brain".
• Sensors are placed on the scalp and ears and brainwave activity is amplified and monitored by a computer. The computer feeds back the signal in the form of a game.
• When information about a person's own brainwave characteristics is made available to him/her, they can learn to change them.
• Specific protocols are designed according to QEEG analysis.
• 100-200 sessions (approximately 30 minutes a session) of neurofeedback are required for the autistic child.

Reading cont’d………..

• SAMONAS® SOUND THERAPY
• THE LISTENING PROGRAM®
• AUDITORY INTEGRATION TRAINING®
• TOMATIS®

• The auditory & visual sequence threshold decreases
• Speech and language improves
• Visual function problems improve
• Motor balance and gross and fine coordination problems improve
• Behaviour & sleep problems improve
• General learning ability & classroom performance improve
• Hypersensitivity to sound decreases
• Reduced levels of anxiety

• Are survival reflexes occurring sequentially in the first few weeks of foetal development
• automatic, stereotyped movements, directed by a very primitive part of the brain (brain stem).
• executed without involvement of higher levels of the brain (the cortex).
• ideally short lived and as each fulfils its function is replaced by more sophisticated structures (Postural Reflexes) which are controlled by the cortex
• retained if they do not fulfil their function
• considered aberrant and evidence of an immaturity within the CNS if present beyond their time.

• A Reflex inhibition program:
• is based on the theory of replication ie. it is possible to replicate specific stages of development through the repetition of movement patterns based upon early development
• gives the brain a "second chance" to pass through the stages which were omitted or incomplete in the first year of life

• establishes neural connections and sets the "neural clock" to the "correct time".
• consists of specific physical, stereotyped movements practiced for approximately 5 to 10 minutes per day over a period of nine to twelve months.
• once begun should not be abandoned mid stream
• should only be given under careful and qualified supervision.

• Detection of primitive reflexes can help isolate the causes of a child's problem so that remedial training can be targeted more effectively. Craniosacral correction may also be necessary to re-establish central nervous system functioning.
• Aberrant reflex activity needs to be addressed in order to facilitate normal development and eliminate many of the physical, academic and emotional problems their presence caused.

• 70% of information the brain receives for processing is through the eyes.
• Distortions, stress related to lights, colours, patterns, high contrast or movement will affect the other senses and a child’s ability to interact with the environment.
• Essential fatty acids, behavioural optometry and The Irlen Method® can help address peripheral vision issues and scotopic sensitivity in many instances.

• Lindamood-Bell®, Spalding® etc.
• Speech therapy is most beneficial after CAP issues have been addressed and...
• when applied intensively and consistently in all settings throughout the course of the child’s day. A 20 minute session of speech therapy 3 times per week is simply not enough.

• ABA
• TEACCH
• PECS
• DIR/"Floor Time"
• INCLUSION
• SOCIAL STORIES
• The Miller Method

• The acquisition of literacy and numeracy skills can only begin once the areas of affect, attention and sensory motor issues have addressed.
• Remedial interventions which target the appropriate developmental level will be necessary for continued learning & development. (eg. IEP, teacher’s aides, inclusion strategies etc.).

• Encouragement toward self esteem
• Functional independence
• Goals and goal setting

• Early intensive, multimodal interventions that target the fundamental deficits offer the best hope of ‘recovery’ from autism.
• Following the model presented, a systematic multidisciplinary approach allows clinicians the opportunity to dynamically evaluate, apply and modify a course of action according to best practice and to accommodate specific needs.

• Robert is 11 years old and could quite easily be fitted to any of the PDD criteria/checklists including autism……….

Laboratory Resources
(as listed by Kirkman Laboratories)

• AAL Reference Laboratories, Inc. Tel (800) 522-2611
  (714) 972-9979
  Fax (714) 543-2034
  1715 E. Wilshire #715
  Santa Ana, CA 92705
  www.aalrl.com
• Doctor’s Data, Inc. Tel (800) 323-2784 (630) 377-8139 Fax (630) 587-7860
  P.O. Box 111
  West Chicago, IL 60186
  www.doctorsdata.com
• Great Plains Laboratory Tel (913) 341-8949
  Fax (913) 341-6207
  11813 West 77th
  Lenexa, KS 66214
  www.greatplainslaboratory.com
• Great Smokies Diagnostic Laboratory Tel (800) 522-4762
  (828) 253-0621
  63 Zillicoa Street
  Asheville, NC 28801 Fax (828) 252-9303
  www.gsdl.com
• Immuno Laboratories Tel (800) 231-9197
  (954) 486-4500
  Fax (954) 739-6563
  1620 West Oakland Park Boulevard
  Fort Lauderdale, FL 33311
  www.immunolabs.com
• Immunosciences Lab, Inc. Tel (800) 950-4686
  (310) 657-1077
  Fax (310) 657-1053
  8693 Wilshire Boulevard
  Beverly Hills, CA 90211
  www.immuno-sci-lab.com
• Dr. John Criticos Tel (+61 2 9560 3154)
  Fax (+61 2 9569 8027)
  79 Silver Street, Marrickville
  NSW 2204, Australia Email a8761@ozemail.com.au
• Dr. Ian Brighthope Tel (+61 3 9589 6088)
  Fax (+61 3 9589 5158
  President of The Australian Complementary Health Care Council & Director of The Australian College Of Environmental And Nutritional Medicine.
  13 Hilton St
  Beaumaris, Victoria 3193, Australia
  www.acnem.org email: mail@acnem.org
• MetaMetrix Clinical Laboratory Tel (800) 221-4640
  (770) 446-5483
  Fax (770) 441-2237
  4855 Peachtree Industrial Boulevard
  Norcross, GA 30092
  www.metametrix.com
• Karl Reichelt, MD, PhD Tel 011-47-23-07-29-85
  Director, Clinical Chemistry
  Department of Pediatric Research
  Rikshospitalet – The National Hospital
  N 0027 Oslo, Norway
• Smith Kline Beecham Laboratories Tel (888) 825-5249
  (919) 483-2100
  P.O. Box 13398
  Research Triangle Park, NC 27709
  www.us.gsk.com
• US BioTek Laboratories Tel (206) 365-1256
  Fax (206) 363-8790
  13758 Lake City Way NE
  Seattle, WA 98125
  www.usbiotek.com

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