Indroduction

The Broad Spectrum of Autism

Kenneth A. Bock, MD, FAAFP, FACN, CNS

The spectrum of autism related disorders is quite broad, with diagnoses ranging from low functioning frank autism to pervasive developmental disorder (PDD) and higher functioning Asperger’s Syndrome. A minority opinion also holds ADHD as an even higher functioning subset on this spectrum. Since autism spectrum disorders manifest with neurobehavioral symptomatology , their diagnoses have remained ensconced in the psychiatric Diagnostic and Statistical Manual (DSM IV). This is unfortunate, because they are unquestionably neurological disorders, with neurobiological and neurotoxic correlates. Additionally, in these disorders, dysfunction is seen in many other areas, especially the gastrointestinal, metabolic, and immunologic systems.

Although the causes are not definitively known, there is a very plausible hypothesis, with increasing scientific support, that these affected children have a genetic susceptibility or vulnerability , to environmental triggers/ insults. The most damaging environmental insult has been felt to be the mercury containing preservative thimerosal, which was present in most childhood vaccinations until its suggested removal in 1999 and its mandated removal in 2002 (except for the flu vaccine). Exposure to this neurotoxin and immunotoxin increased dmmatically in the 1990’s with the mandatory increase in the number of vaccinations containing thimerosal, and this is believed to be related to the dramatic increase in autism spectrum disorders during that time. However, awareness is increasing regarding additional environmental insults, especially chemical toxicity , which is felt to contribute to the neurotoxicity of these children. It is known that since the Second World War, the number of chemicals introduced into the environment has been growing steadily and, unfortunately, without adequate safety studies. New information about synergistic toxicity between chemicals, as well as between heavy metals, has led to the awareness that lower doses of multiple toxins can have adverse effects, even though the level of the individual toxin is below that previously thought to be toxic.

Children with genetic polymorphisms which code for less efficient enzymes in the methylation and glutathione detoxification cycles will be more vulnerable to these increased environmental insults. The resulting toxicity can present itself as inflammation, at least in part mediated by reactive oxygen species, presenting across organ system lines, i.e.: we see evidence of inflammation in the brain, the gastrointestinal system and the immune system. Interestingly enough, many of these children have inflammation of the skin (atopic dermatitis), as well as inflammation of the lungs, in the form of asthma. Approaches to inflammation must include discovering and subsequently eliminating the source of inflammation, such as antigens or infectious agents, as well as quieting the inflammation. Additionally, attention must be given to dysfunction in the gastrointestinal system~ as well as nutritional, biochemical and metabolic imbalances. In certain children, immunological dysfunction in the form of immune deficiencies and/or autoimmunity, is paramount, and must be addressed.

The key to evaluation and effective treatment of these children is an integrative medicine approach, and I mean a truly integrative approach. This means that all of the children must pursue behavioral, therapeutic and educational interventions. The essence of the treatment paradigm involves detoxification of the neurons, gastrointestinal system, liver and immune system, as well as optimal nutrition for the neurons to help them function better and ultimately respond more effectively to the behavioral and educational therapies. The treatment program needs to be individualized because one size does not fit all. Although we know there are similarities between many affected children, we also know that the most effective treatment program is one that is tailored to each child after a careful and detailed history, physical examination and laboratory evaluation. The interwoven etiologic factors and accompanying dysfunction can present much complexity in creating treatment programs and therefore, attention to detail is paramount. Parents are strongly advised to work in concert with .a physician, as well as other health care practitioners who are knowledgeable in this field, to croft and implement this individualized treatment program for their child. These children tend to be metabolically fragile and it is important to recognize that some children will have transient adverse effects with treatments that may help a majority of other children. Having the appropriate support systems in place will better enable parents, along with their physicians, to evaluate these adverse effects, and move forward with the child’s treatment program.

With earlier recognition of these disorders, and the clinical application of evolving scientific research~ comprehensive, individualized, integrative treatment programs are bearing more fruit and helping more and more children on their road to recovery .