Autism Spectrum Disorder - Latest News

June 16, 2005

Developmental Delay Biomedical Treatments
By: Richard E. Layton, M.D.
Website: www.allergyconnection.com

I. Developmental Delay – 1:6 children 4:1 Male:Female
ADHD 1:30 – 1:20
3 – 5 % 2 – 4 million children

Current Status ASD
Rate 1/04 – CDC
1990 1:2000,
2004 – 1:166,
now – 1:150
Prior to 1 year ago
CDC/NIH/AAP – genetic only

Today Show/Newsweek/AAP
Multiple Genetic Factors
Environment/Causation “The Hidden Epidemic”

Dr. Martha Herbert — Pediatric Neurologist-Harvard Medical School

  • Inflammation – Brain, GI, Immune System
  • White matter affected 2.5 X increased
  • Head size - increased 2 SD
  • Oxidative Stress
  • Affects Limbic system
  • Cerebellum – processing, connectivity
  • Definition has changed
  • Past – genetic, untreatable
  • Current – multiple genetic factors – (genetic predisposition)
  • Environment
  • Biomedical - Brain/body – metabolic, GI, Immune system
  • Treatable

Many Autisms – not just 1 – recommends term “Metabolic Encephalopathy”

  • Toxins include pesticides, PCB’s, heavy metals (mercury, arsenic, aluminum, cadmium)

II. Biochemistry

  • 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

III. Genetic Vs. Environmental – both

  1. Genetic Vulnerability – Immunizations
    • most children are immunized and do well
    • need immunization program with “common sense”
    • subset of children can’t break down heavy metals
  2. Environmental
    • Diet – casein, gluten; consider soy, corn, preservatives
    • Antibiotics/infections (viral/bacterial)
    • Environmental Toxins (chemical, heavy metals)
    • Immunizations
    • Allergies
    • Inflammation – brain, gut, immune system

IV. Sensory Integration – a major role

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

V. Lab tests most helpful – consider:

  1. Gut
    • GI Panel
    • Organic Acid Test (OAT) - Microbiology
    • Urinary Peptides – Casein/Gluten
    • IgG Foods
  2. Metals
    • Hair Analysis a screen
    • Fecal/Urine Metals
    • RBC Trace Minerals
    • Metallothionein Profile
    • CBC Platelets, Chemzyme, TSH, Iron, Ferritin
    • Cysteine
    • Glutathione
    • Vitamin A
    • Zinc, Copper
    • Lead Level
    • Celiac testing
    • MBP, NFP – Autoimmune Antibodies
    • Fragile X
    • EEG
    • Amino Acids
    • NK Cells – Immune Panel

VI. Treatment – Except for diet and Methyl B12 injections research is ahead of therapies.

  1. Diet
    • Casein-free x 1 month
    • Gluten-free x 3 months
    • Consider soy/corn – chemical additives/preservatives
    • SCD (Specific Carbohydrate Diet)
  2. Gut – leaky gut/yeast
    • Probiotics/colostrum/Three Lac
    • Antifungals/antiparasitics, (rarely antibiotics)
  3. Methyl B12 SQ injections
    • Dr. Neubrander – claims “75% to 96% of children improve. Half do really well.”
    • My opinion 20-40 percent get A or B – sticking your child every 3 days – want A or B.
  4. Glutathione – TD or Liposomal, IV, Nebulized.
  5. Supplements to consider - Response varies. Do one at a time.
  6. High rate of irratibility, insomnia, behavior worse. What may be great for one child can cause side effects in another.
    • Vitamin A – Cod Liver Oil
    • Digestive Enzymes- w/DPP IV – Enzyme Complete2/Carb Digest or Houston Enzymes
    • Super Nuthera
    • DMG or TMG with Folic/Folinic Acid
    • Carnosine
    • 5 HTP
    • Taurine
    • Zinc
    • C, E, Selenium, Ca, Mg
    • Carnitine
    • NAC – N-Acetyl cysteine– ( caution - can flare leaky gut)
    • Melatonin
    • GABA
    • Essential Fatty Acids (Omega 3-6 & GLA) – Omega Brite, Nordic Naturals Cor Omega
    • Bethanechol
    • LDN – Low dose Naltrexone (for inflammation)
  7. Secretin IV, Transdermal, Sublingual
  8. Inflammation - Curcumin (Tumeric)
  9. IVIG
  10. Meds
    • Antifungals – Nystatin safest – also Diflucan, Sporanox, Nizoral
    • Antivirals
    • Antiparasitics – Flagyl, Nitazoxanide
    • Anti Colitis meds – (Sulfasalazine and Colozal)-high rate of side effects
    • ADD – Low dose Strattera (Stimulants – Amphetamines and Methylphenidate generally poorly tolerated)
    • Risperdal (or Abilify) – can be great – may soon get FDA approval – increased side effects
    • SSRI’s – Lexapro/Zoloft
    • Tenex – for hyperactivity
    • Clonidene – sleep, tics
    • Mood Stabilizers – Trileptal, Neurontin, Depakote, Tegretal
    • Singulair – allergies and gut inflammation
    • Reflux meds – Prevacid, Pepcid
    • Prednisone
    • Allergy meds – Claritin, Zyrtec, Allegra,
    • Allergy Testing/ Immunotherapy
    • Actos ??
  11. For Methylation with sulfation-The Therapeutic Quintet to augment chelation
    • Methyl B12 injection
    • Glutathione
    • TTFD
    • Folinic Acid
    • DMG or TMG
  12. Mercury Toxicity
    1. Avoid Tuna, Swordfish – (foods containing mercury)
      • Epsom Salt Baths
      • Magnesium Sulfate Cream
      • Cilantro, garlic in diet
    2. Metal-free, NDF, PCA-RX – milder chelators
      • TTFD – “skunk cream”
      • Infrared sauna
    3. Higher rate of success/risk
      • DMSA – Prefer DMSA TD 5 mgm/kgm 3x/day 3 days on 11 days off or 3 days on 7 days off
      • DMPS – prefer DMPS TD (Dr. Buttar, modified) - Start .2 of recommended dose and increase gradually over two months CBC, platelets, liver & kidney function monitor every 3 months; trace minerals, gut (OAT & GI Panel), Urine and/or Fecal Metals – periodically follow.
      • Alpha Lipoic Acid
      • Others - EDTA (I don’t use), No IV chelation
  13. VII.

    1. Early Intervention – extremely important. (Dr. Landa-Kennedy Krieger)
      • “Parental Hunch”
    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 Metronone– Computer
      • Berard – 10 day program
      • Tomatis

    VIII. MY OPINION

    1. Need to set aside differences/avoid rigidity and listen to other parents open minded – no place for “medical religion”
    2. An epidemic – no such thing as “genetic epidemic”
    3. Many parents need a co-captain - listening to the individual medical history is best way for MD to help.
    4. This is most difficult, complex, confusing medical problem of all
      • Nobody knows a lot.
      • I rely on parents, opinion, child observation.
      • Who does this child remind me of?
      • Studies of 1 –
        • Common sense
        • Clinical judgement
      • Medical history determines medical recommendation

    ASD 1:2000 ---- 1:166 WHY???
    Developmental Delay 1:6
    ADHD 1:30 – 1:20

    IX. Books to Read

    1. Children With Starving Brains – Jaquelyn McCandless * Biomedical Intervention
    2. Biologic Treatments for Autism and PDD – William Shaw
      Order from DDR – (310) 652-2263 * Biomedical Intervention
    3. Unraveling the Mystery of Autism and Pervasive Developmental Disorder
      Karyn Seroussi
    4. Special Kids/Special Diets – Lisa Lewis *Casein and/or Gluten-free diet
      Order from DDR – (301) 652-2263
    5. Breaking the Vicious Cycle – Elaine Gottschall * Specific Carbohydrate Diet
    6. Incredible Edible, Gluten-free Food for Kids – Sheri Sanderson – order from Amazon.com
    7. Conquering Autism – Reclaiming Your Child through Natural Therapies – Stephen B. Edelson, M.D.
    8. Facing Autism – Lynn M. Hamilton
    9. Is This Your Child? – Doris Rapp, M.D. *Effect of Allergies on Behavior (best book to explain my medical practice)
    10. The Out of Sync Child – Carol Kranowitz *Sensory Integration Disorder - Order from DDR – (301) 652-2263
    11. Unblocking the Potential of Secretin – Victoria Beck * Secretin Information – Contact Autism Research Institute – Dr. Bernard Rimland Address: 4182 Adams Ave., San Diego CA 92116.
      Phone: (619) 281-7165.
    12. Awakening Ashley – Sharon Ruben * Auditory Integration Training

    X. Websites for Biomedical Interventions

    1. ANDI – (Autism Network for Dietary Interventions)
    2. www.gfcf.com (GFCF)
    3. www.pecan.com (SCD)
    4. Chelating Kids 2
    5. CSB (Children with Starving Brains)
    6. www.autismwebsite.com (Autism Research Institute)
    7. www.talkautism.org