Effective Strategies For Autism

1
Autism Society of America - Colorado
ChapterAutism Intervention Strategies and
Synergies Conference and ExpositionSeptember
18-21, 2002 Red Lion Denver CentralKeynote
Address
Presented By-
Rosemary Boon, Psychologist. M.A.(Psych), MAPS,
AACNEM, ACHC. Grad.Dip.Ed., Grad.Dip.Ed
Studies(Sch.Counsel) Bsc SYDNEY, AUSTRALIA
WEBSITE www.learningdiscoveries.orgEMAIL
rboon_at_iprimus.com.au
2
Autism is more than just geneticsit is a
multifactorial disorder requiring multimodal
interventions
Presented By- Rosemary Boon, Psychologist M.A.(
Psych), Grad.Dip.Ed., Bsc., Grad.Dip.Ed
Studies(Sch.Counsel), MAPS, AACNEM, ACHC.
rboon_at_iprimus.com.au
3
Characteristics of ASD.

• 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
  

4
Statistics worldwide show...

• The incidence of Pervasive Developmental
  Disorders, Learning Difficulties, ADHD,
  Auto-Immune Disorders, and Psychiatric Disorders
  are increasing.
• ADHD 110 (10)
• SLD 15 (20)
• Autism 1135 (USA)
• The California (1999) report showed a 273
  increase in the State of California between 1979
  and 1992.

5

• Autism /ASD 150 (Aust.)
• Classical autism 5100,000 (UK)
• ASD 15100,000 (UK)
• CFS 150 (2)
• Anxiety Depression 15 (20)
• (Mind of a Child Conference - Sydney, March,
  2002)
• Autism is the most frequently occurring form of
  pervasive developmental disorder (PDD) (Siegel
  1996).

6

• Numerous causes have been postulated
• Genetics
• Neurological Dysfunction
• Immune Dysfunction
• Gastrointestinal Factors
• Environmental Factors

7
The genetic factors..

• 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

8
The genetic factor continued.

• 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).

9
Environmental factors...

• There is increased exposure to
• - chemicals - Sick Building Syndrome and
  pollution food additives/preservatives metal
  toxicity including mercury, lead, cadmium,
  aluminium, copper. pesticides etc.
• - mercury - amalgams(3-17ug daily) coal fired
  power stations (51) incinerators -medical
  (10), municipal (19) saltwater fish (tuna,
  swordfish, halibut, salmon) cosmetics,
  medications and personal items.

10

• - vaccinations - Thimerisol- causes neurological
  damage in infants later diagnosed with autism or
  overwhelms the immature immune systems of
  vulnerable children leading to brain infections
  by invasive microorganisms and chemicals
  (Rimland BITN-2002 Bernard - 2000 ARC Research
  -Sub. Am. Congress)

11
Is Autism a Unique Type of Mercury
Poisoning?.

• 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

12

• - antibiotics (suppression of immune system
  increased gut permeability)
• - milk (irritates gut and dairy free diet
  reduces mental symptoms in adults)
• - gluten (MRI shows inflammation of white matter
  in cerebrum and irritates gut)
• - sugar (108 ways refined sugar is detrimental to
  health)
• - GMO foods

13

• - sound - increase in intensity of stimuli
• - EMF radiation (mobile phones, VDUs- computers,
  TV,microwave technology, appliances etc.)
• - hand held computer games (produce frontal lobe
  abnormalities)
• - media and video games (affects behaviour,
  violence and suicide)

14
Social and environmental changes influencing
health and development

• Social structure
• - absence of fathers
• - babies separated from parents for sleep and
  travel
• - breast feeding reduced from 3-7 yrs to 3-6
  months
• - bottle feeding doubles risk of ADHD
• deficiency of DHA (Broadhurst et.al. Stordy
  Levine Oski)

15

• 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)

16

• ..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
• Frank Oski M.D., former chairman of pediatrics
  John Hopkins University School of Medicine.
  Nutrition 1997

17

• Pregnancy
• more mothers smoking (27)
• caffeine (low birth rate and breathing problems)
• alcohol (gt 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)

18
Blood brain barrier
19
Biology of behaviour...
20
The interactive factors...
Immune System
AUTISM
Gut
Brain
From Gupta - MOA 2002
21
1 in 5 children will develop learning
difficulties and/or pervasive developmental
disorders. What can be done?...

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

22

• 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.

23
The Pyramid of Learning, Development Wellbeing
by Rosemary Boon 1996 (Adapted From Shiel
Dyson)
All learning has an emotional base -Plato, 347
B.C.
COMMUNITY CONTRIBUTION
LIFE STYLE Self Actualisation
LIFE SKILLS Stress mgt, Anger mgt, Philosophy,
Self Reliance Spirituality
MENTORING SUPPORT
COACHING
ACADEMIC Literacy Numeracy Training, Thinking
Skills, Learning Styles
PSYCHOLOGY PERSONAL DEVELOPMENT
TEACHING
PRE-ACADEMICPROGRAMMES
DEVELOPMENTAL PRE ACADEMIC Developmental
Auditory Visual Skills, Language,Vision,
Spatial, Eye-hand, Sequencing Skills
DEVELOPMENTAL,VISION SPEECH THERAPY
SENSORY MOTORINTEGRATION
FUNCTIONAL Neuronal Function, Vestibular,
Occulomotor, Auditory Visual Processing, Motor
Coordination, Balance, Primitive Postural
Reflexes, Emotional Distress
EEG EMGBIOFEEDBACK
SOUND THERAPY
COUNSELLING FAMILYSUPPORT
GENETIC, STRUCTURAL, METABOLIC
NEUROPHYSIOLOGICAL Musculoskeletal, Illness,
Injury/Trauma, Toxicity, Environmental/Food,
Allergens, Disorders, Eyesight, Hearing, Diet
Nutrition
FLEXYXNEUROTHERAPY
NUTRITION SUPPLEMENTS
GUT IMMUNE SYSTEM
HEALTH MEDICAL PRACTITIONERS
ENVIRONMENTALCONSULTANT
CHIRO, OSTEO, CRANIO, BOWEN
24
Formal Assessment..

• 1. History, including environmental and familial
  history, pre/neonatal development.
• 2. Physical examination - skin, nails, hair,
  eyes, ENT etc.
• 3. Biomedical evaluations (e.g., as needed, EEG,
  metabolic work-up, genetic studies, and
  nutrition)
• 4. Checklists including - DSM IV criteria, ATEC
  (ARI), PDD Screening Tests I II (Seigal) The
  Australian Aspergers Scale (Garnett and
  Attwood).

25
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)

• First concerns of parents need to be checked
  into.

26
Assessment continued...

• 5. Assessment of current challenges and
  functioning, including-
• ? developmental capacity (attention, engagement
  and thinking)
• ? processing capacity (auditory visual, motor
  planning and sequencing, visual-spatial skills
  and sensory-motor integration)
• ? at home with caregivers and siblings, with
  peers in educational and social settings
• 6. Observation
• At least two 45 minute sessions with the
  caregiver or clinician to provide the basis for
  forming a hypothesis about the childs functional
  capacities

27
Formal Assessment continued..

• 7. Speech and language evaluation including
  articulation, syntax, pragmatics, semantics,
  receptive and expressive languages
• 8. Evaluation of cognitive functions, including
  neuro-psychological and educational assessments
• 9. Mental health evaluations of family members,
  family patterns, and family needs
• 10. Family and caregiver functioning

28
Laboratory Investigations.

• 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

29
Food Allergies..
From Fed Up by Sue Dengate,1999
30
Gastrointestinal factors

• 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,
  4323-4 KL Reicheldt, Develop Brain Dys 1994,
  771-85, and others Z Sun and Cade Autism 1999,
  3 67-83)
• Abnormal Intestinal Permeability(P. DEufemia
  Acta Pediatr 1995, 85 1076-9)

31
Gastrointestinal factors continued...

• 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,
  51133-144)- Aerobic Lactobacillus - high rice
  in diet(J. Child Neurology, 15 429-435 P.
  Shattock A. Broughton, JAG elevations Andre
  Wakefield, Lancet, 1998, 351637 T.J. Borody,
  Centre for Digestive Diseases, NSW, Australia)

32
Gastrointestinal factors continued...

• 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/Strepto
  coccus 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)

33
Factors affecting gut flora.
Levels of endogenous and exogenous
nutrients (Mucin, gut proteins, biliary
secretions, sloughed cells,gluten and casein -
zinc, glutathione and metallathione)
Bile Acids
Antibiotics
Gut Flora
Vaccinations
Age
Bacterial Interactions
pH
Bacterial Interactions (SCFA, Bactereocins)
Drugs
Disease
Redox Potential
Leaky Gut
(From Autism and the Human Gut Microflora - Max
Bingham - University of Reading)
34
Gastrointestinal factors continued..
From Autism and the Human Gut Microflora - Max
Bingham - University of Reading
35
Who wants to party?????? (From Autism
and the Human Gut Microflora - Max Bingham -
University of Reading)
36
The digestive system...
37
What is Leaky Gut Syndrome?..

• Leaky gut or LGS is a poorly recognised but
  extremely common problem. It is rarely tested
  for. Essentially, it represents a hyperpermeable
  intestinal lining.
• Large spaces develop between the cells of the gut
  wall, and bacteria, toxins and food leak in to
  where they shouldnt.
• If the gut is not healthy, neither is the rest of
  the body. It is the point of fuel and nutrient
  entry.

38
Leaky Gut Syndrome
39
Detoxification Weakness

• 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)

40
Detoxification pathways of the liver.
Environmentaltoxins
Immune Complexes
Bacteria
Non-end product metabolite
Boweltoxins
Kupffer cells
Cytochrome P450
PHASE I
Activated Intermediaries
Destroyed
PHASE II
Sulphation
Conjugation
Glucuronidation
FILTERING
EXCRETION
41
Detoxification continued..

• 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

42
Permeability and Gastrointestinal Support.

• The 4R? approach to gut rehabilitation
• Remove - pathogens, xenobiotics, allergens
• Replace - digestive enzymes, Factors, HCl
• Reinoculate - Pre probiotics, FOS, inulin
• Repair - low irritant diet, nutrients to support
  growth repair

43
Immunological Factors..

• Recurrent Infections (Euro Child/Adolesc Psych,
  19932(2)79-90 J Autism Dev Disord 1987 17(4)
  585-94)
• T-cell Deficiency (J Autism Child Schizo
  749-55 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)

44
Immunological Factors continued..

• 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)

45
Prevention is better than cure. Nutrition is the
cornerstone of health and wellbeing..

• 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?

46
Nutritional Factors..

• 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 1978135 472-5)
• B12 deficiency suggested by elevated urinary
  methylmalonic acid (Lancet 1998 351 637-41)
• Low Methionine levels not uncommon
  (Observation by J. Pangborn)

47
Nutritional factors continued..

• 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 29-17,
  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)

48
Nutritional factors continued..

• 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 1040-43)
• Hypocalcinurics Improve with Calcium
  Supplementation - Lower Hair Calcium in Autistics
  Reported (Dev Brain Dysfunct 1994 7 63-70)

49
Nutritional Assessment Protocol....

• Nutritional/Biochemical work-up
• 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
Nutritional Protocol..

• Start with gluten and casein elimination.
• Eliminate processed foods and soft drinks with
  additives, preservatives, sugar, aspartame,
  pesticides, hormones potential allergens
• Eat as much organic food as possible - Biodynamic
  is even better. Build up proteins, vegetables,
  fruit
• Clean filtered water
• Big Breakfast - Low Glycemic Index Foods - High
  Protein, Frequent Meals

51
Nutritional Protocol continued...

• Gut Care Digestive enzymes (Betaine
  Hydrochloride - TMG DMG), amylase, lipase,
  peptidases, supplements and complementary
  remedies - milk thistle protects the liver,
  cranberry, grapefruit seed, papain bromelain.
• Address EFAsFirst Omega 6 (Evening Primrose for
  GLA) then Omega 3 Cod Liver Oil (Provides Vit A
  and D plus EPA/DHA) Fish Oil for additional
  Omega 3 Other B12, Biotin, Taurine, MSM,
  Folate, DMG, Amino Acids, Mb
• Address bacterial overgrowthsPre Probiotics-
  Lactobacillus GG, bifidobacteria etc.

52
Nutritional Protocol continued...

• Enhance detoxification pathways including Epsom
  salts bath - sulphates better absorbed via skin
  than food.
• Start with the following incrementally, and
  monitor Zinc with Manganese B6 (and/or P-5-P)
  with Magnesium Calcium Vitamins C and E
• Continue monitoring and modifying as necessary to
  the individuals metabolic changes.

53
ARI parent survey for therapeutic responses by
autistic children

• 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

54
Immediate environmental factors

• 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.

55
Structural and Somatic Work.

• The value and benefit of human touch is beyond
  question, but in autism, it may require a
  considerable period of desensitisation before
  such therapies may be of value. The issues of
  comfort zone and development of trust can be
  major obstacles initially.
• While traditional chiropractic and osteopathic
  moves may be of benefit in cases requiring such
  adjustment and manipulation, in autism, subtle
  and gentle therapies such as the following have
  been used with some success.

• Craniosacral Therapy

• Aromatherapy Massage

• Bowen Therapy

56
Aromatherapy Massage...

• 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.

57
The Autonomic Nervous System...
58
Craniosacral Therapy...

• John Upledger in conjunction with the Autism
  Research Institute, developed craniosacral
  techniques which can be used successfully with a
  number of autistic children.
• Restrictions in the dural tube of the spinal cord
  and brain can impede the flow of CSF which
  nourishes the brain and nervous system. Children
  with classical autism were found to have similar
  restrictions in the craniosacral motion.
• In the hands of skilled and experienced
  practitioners this gentle and subtle, hands-on
  technique applied with just a slight amount of
  pressure (about 5 grams) encourages body systems
  (particularly musculoskeletal and the ANS) toward
  homeostasis.
• - Upledger Institute- Milne Institute

59
Bowen Therapy...

• Bowen was developed in Geelong, Australia by the
  late Tom Bowen in the 1950s 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.

60
Golgi continued... (From Tortora Grabowski -
2000)
SITES OF CONCENTRATIONOF THE GOLGI TENDON ORGAN
61
Counselling Family Support..

• Explanation of the difficulties and the criteria
  for diagnosis affords family members a better
  understanding of the childs 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.

62
Brain Section
63
Sagittal of skull and brain
64
Neurological factors...

• 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)

65
Autism and the brain.
From The Brain In The News, The Dana
Foundation, 2002
66
Neurological factors continued.

• 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
  Aspergers Syndrome (Shultz et.al. Arch Gen
  Psychiatry. 200057331-340)
• - Various abnormalities of cellular migration
  (Piven et.al. 1990)

67
Neurological factors continued.

• 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)

68
Entorhinal cortex.
Subic.
CA1
FORNIX
CA3
Dentate Gyrus
Other Cortex
ENTORHINAL CORTEX
PerirhinalCortex
ParahippocampalCortex
Unimodal and polymodal Association Areas
69
Neural networks in autism.. (Zimmerman Gordon
2001)
PrefrontalCortex
Thalamus
DysfunctionalPlasticity
CaudateNucleus
FunctionalPlasticity
NucleusAccumbens
AnteriorCingulate
GlobusPallidus
LimbicSystem
Cerebellum
Inferior Parietal Lobe
AutonomicCentres
Autism?
Autism?
Disconnection Syndrome
70
(No Transcript)
71
FLEXYX Neurotherapy

• 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.

72
Neurofeedback...

• 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.

73
Functional Improvements observed with
Neurofeedback...

• Medications often reduced. Previous
  "memorised" speech replaced by some original
  thought expression of own ideas and questioning.
  Speech and language begin to develop/improve.
  Attention improves. Initiates touch less
  sensitive to light, sound, and textures.
  Interacts more and able to do some group work at
  school. Responds more appropriately to parental
  directions. Improved balance and gross motor
  control. Decrease in hyperactivity and
  impulsivity. More aware of feelings, emotions,
  and humour. Less resistant to change. Less
  mood swings/depression/anxiety

74
The sense of hearing...
75
SOUND THERAPY contd..

• Hearing - external canal, drum (Tympanogram),
  otic bones and cochlear, the auditory nerve and
  the auditory cortex.-No timing, sequencing or
  Central Auditory Processing (CAP) involved.-It
  is the volume needed to hear each frequency
  (audiogram)

76
Sound therapy continued..

• Listening - requires good hearing plus the
  ability to efficiently sequence and process the
  sounds (40-60 msec) Sounds are processed and
  linked to auditory memory for meaning ie central
  auditory processing.
• When listening ability is reduced resultant
  problems with decoding, blending, reading,
  spelling, auditory memory, visual input, visual
  memory and compliance occur.
• Reading - normal reading requires a complex
  mixture of processes to occur.

77
SOUND THERAPY.
78
Reading contd..

• Poor auditory processing abilities were recorded
  in poor readers particular difficulties were
  posed by tasks requiring spectral distinctions,
  the simplest form of which was pure tone
  frequency discrimination.
• In absolute terms, the greatest deficits were
  recorded in tasks in which stimuli were presented
  in brief forms and in rapid succession.
• Psychoacoustic difficulties are largely retained
  throughout adulthood and may be the source of
  retained reading difficulties.(Ahassar et. al.
  -2000 Proc. Natl.Acad.Sci. USA.)

79
Reading contd..

• This means ..
• The ability to understand verbally presented
  language requires fast processing of the sequence
  of sounds (vowels and consonants) and accurate
  identification of those individual sounds.
• If accurate identification is due to the ability
  to detect small differences in frequency
  (spectral differences), then the ability to
  sequence these sounds is due to the ability to
  detect the time gap between the spectral peaks
  (temporal processing).

80
Sound Therapy.

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

81
How SAMONAS Sound Therapy Works..

• The understanding of how SST works has two main
  bases.
• 1. The Brain itself i. Inherent neuroplasticity
  (King et. al. -2000)ii. The effect of music on
  the auditory cortex (Horowitz et.al. -1998)iii.
  The anatomical connections between auditory and
  other neurological systems.
• 2. SSTi. Types of music selected (Full spectrum
  of the audible range)ii. The combinations of
  specific technical changes made to the music. A)
  Spectral activation - increase in multiple
  frequencies of the same pitch B) Temporal
  variation of the music C) Spatial localisation
  of the musical instruments D) Emphasis on the
  dominant ear E) CDs take advantage of the right
  left side input crossover in brain F) Enhances
  the receptive mood of the listener G) Bone
  conduction applied to the mastoid bone changes
  sound to vibration directly affecting the
  vestibular system.

82
Benefits of SST

• 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

83
Sensory Motor Integration...
... the motor act is the cradle of the mind. -
C.S. Sherrington..

• Problems with sensory integration in autism
  present as-
• Tactile sensitivity
• Proprioception
• Vestibular perception
• Gross Fine Motor difficulties
• Visual motor difficulties
• CAPD (central auditory processing disorders)
• Interventions that address these difficulties
  include sensory-motor integration, primitive
  reflexes, auditory training/sound therapy,
  neurofeedback, facilitated communication, speech
  and occupational therapy.

84
Primitive reflexes.

• 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.

85
Retained reflexes continued...

• 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

86
Retained reflexes continued...

• 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.

87
Retained reflexes continued...

• 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.

88
Developmental Vision Speech Therapy..

• 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 childs 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.

89
Wenicke-Gershwind Model
90
Vision speech therapy continued..

• 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 childs
  day. A 20 minute session of speech therapy 3
  times per week is simply not enough.

91
(No Transcript)
92
Pre-academic Programmes...

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

93
Teaching.

• 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,
  teachers aides, inclusion strategies etc.).

94
Psychology Personal Development.

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

95
In Summary...

• A healthy brain is fundamentally based on a
  healthy biochemical/nutritional, ecologic and
  biomagnetic environment within each and every
  cell of the human body. (Brain Allergies -
  Philpott Kalita - 2000).
• The consensus of opinion indicates that Autistic
  Spectrum Disorders result from neurological
  problems occurring during prenatal development
  and/or within the first years of life whilst
  neural connections are still being made.

96

• 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.

97
Robert..

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

98
Mary...
Australian Womans Weekly , Aug, 2002
99
Perhaps in the future, with continued global
interdisciplinary research, collaboration and
sharing,the puzzle of autism can be solved so
that individuals with ASD can function and live
to their full potential.
100
Laboratory Resources (as listed by Kirkman
Laboratories)

• AAL Reference Laboratories, Inc. Tel (800)
  522-2611 [phone] Fax
  (714) 543-20341715 E. Wilshire 715 Santa Ana,
  CA 92705www.aalrl.com
• Doctors Data, Inc. Tel [phone] (630)
  377-8139 Fax [phone] P.O. Box 111
  West Chicago, IL 60186 www.doctorsdata.com
• Great Plains Laboratory Tel [phone]
  Fax [phone] West 77th Lenexa,
  KS 66214www.greatplainslaboratory.com

101

• Great Smokies Diagnostic Laboratory Tel (800)
  522-4762 [phone] 63 Zillicoa
  Street Asheville, NC 28801 Fax (828)
  252-9303www.gsdl.com
• Immuno Laboratories Tel [phone] (954)
  486-4500 Fax [phone] West
  Oakland Park Boulevard Fort Lauderdale, FL 33311
  www.immunolabs.com
• Immunosciences Lab, Inc. Tel [phone]
  [phone] Fax [phone]
  Wilshire Boulevard Beverly Hills, CA 90211
  www.immuno-sci-lab.com

102

• Dr. John Criticos Tel [phone])
  Fax [phone] Silver Street,
  Marrickville NSW 2204, Australia Email
  a8761_at_ozemail.com.au
• Dr. Ian Brighthope Tel [phone]) Fax
  (61 3 9589 5158President of The Australian
  Complementary Health Care Council Director of
  The Australian College Of Environmental And
  Nutritional Medicine.13 Hilton StBeaumaris,
  Victoria 3193, Australia www.acnem.org
  email mail_at_acnem.org
• MetaMetrix Clinical Laboratory Tel (800)
  221-4640 [phone] Fax
  [phone] 4855 Peachtree Industrial
  Boulevard Norcross, GA 30092 www.metametrix.com

103

• Karl Reichelt, MD, PhD Tel [phone]Dire
  ctor, Clinical ChemistryDepartment of Pediatric
  ResearchRikshospitalet The National HospitalN
  0027 Oslo, Norway
• Smith Kline Beecham Laboratories Tel (888)
  825-5249 [phone] P.O. Box
  13398 Research Triangle Park, NC
  27709www.us.gsk.com
• US BioTek Laboratories Tel [phone]
  Fax [phone] Lake City Way NE
  Seattle, WA 98125www.usbiotek.com

104
For neurofeedback

• www.snr-jnt.org
• www.flexyx.com
• www.eegspectrum.com

• For Samonas Sound Therapy
• www.samonas.com
• For Craniosacral Therapy
• www.upledger.com
• www.milneinstitute.com
• For Bowen Therapy
• www.bowtech.com