Autism - Naturopathic Treatments

Autism is a neurodevelopmental and biologically based disorder that falls within the category of pervasive developmental disorders.^[1] Some consider it to be the most severe type of spectrum disorder.^[2] Autism spectrum disorders include autism, Asperger syndrome, pervasive developmental disorder (not otherwise specified), childhood disintegrative disorder, and Rett syndrome.^[1] Each unique spectrum disorder can be differentiated based on symptom presentation and other clinical features. Autism presents with qualitative differences and impairments in social interaction and communication. Restricted interests as well as rigid and repetitive behaviours are also characteristic of the condition.^[3] Symptoms of autism may resemble or arise with intellectual disability, attention-deficit hyperactivity disorder, and/or obsessive-compulsive disorder.^[1]

Autism is a lifelong condition that has great impact on the affected individual as well as family members. The condition is estimated to be four times more common in males than females.^[4] Autistic behaviors are typically present in early childhood, but are not always apparent until circumstances change. For example, characteristic behaviors may become noticeable once the child goes to school for the first time. Meanwhile, a diagnosis of autism is strongly associated with a number of coexisting conditions. Recent studies show that approximately 70% of autistic individuals also meet diagnostic criteria for another psychiatric disorder that further impairs psychosocial functioning. Autism was once thought to be an uncommon developmental disorder but recent studies report increased prevalence and autism is now thought to occur in at least 1% of children.^[3] Autism spectrum disorders are diagnosed in children, young people and in adults as defined by the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders DSM-IV Fourth Edition (Text Revision) (DSM IV-TR).^[3]

Causes

The exact cause of autism is unknown. Certain vitamin and/or mineral deficiencies may play a role in its progression.^[5] Recent studies also show that autism is likely to have a genetic cause which involves the interplay of multiple genes and gene expression.^[4] The environment is known to play an important role in gene expression: psychological experiences and aspects of the physical environment can turn genes on or off during stages of development. The expression of certain genes can positively or negatively impact a person’s well-being during a particular stage of life and beyond.^[1] Meanwhile, a common genetic cause is not seen in all cases, suggesting the disorder is likely to involve a number of factors.^[4] Clinical genetic assessment might include laboratory studies ordered by the primary care practitioner or referral to a clinical geneticist. Genetic laboratory studies can include routine karyotype and molecular DNA testing, comparative genomic hybridisation, or both.^[1] Environmental factors such as heavy metal toxicity, subclinical viral infections, gastrointestinal pathology and bacteria, as well as toxins produced by metabolic processes have also been suggested as playing a role in the etiology of the disorder.^[4]

Diagnosis

A diagnosis of autism is made based on symptom presentations which fall under specified diagnostic criteria. A comprehensive diagnostic assessment should also be made. A comprehensive diagnostic assessment should include an appropriate physical examination as well as medical investigation for causes and associated diagnoses.^[1] Manifestations of autism include atypical development and behaviors in the following areas evident within the first three years of life:

1. impaired social interaction, as shown by: a) marked impairment in the use of non-verbal communicative behaviors (ie. eye contact, facial expression, body postures); b) failure to develop age appropriate peer relationships; c) a lack of spontaneous sharing of affect and interest with others; and d) lack of social or emotional reciprocity (limited interest in or awareness of others’ reactions, interests, or feelings).
2. Qualitative impairment in communication skills, shown by: a) delays in, or lack of, language acquisition (absence or reduced frequency of early language development such as babbling and playing with sounds, and absence of phrase speech); b) inability to initiate or maintain a conversation; c) stereotyped and repetitive use of language or idiosyncratic language; and d) lack of development of age appropriate pretend or imitative play.
3. Presence of restricted and repetitive patterns of behavior, interests and activities, as shown by: a) pronounced preoccupation with one or more unusual and restricted interests: b) inflexible adherence to specific routines or rituals; c) motor stereotypies (hand flapping, finger licking, pacing, and jumping); and d) preoccupations with parts of objects.^[5]

Natural Treatments

Treatments for autism focus on improving social communication, addressing challenging behaviors, treating attention and sensory difficulties, promoting functional independence, and improving overall quality of life. There is no cure for autism at this present time.^[6]

1. Fish oil (omega-3 essential fatty acids) supplementation provides a number of health benefits: improvements in cognitive function being one. Autistic children have been shown to have reduced levels of docosahexaenoic acid (DHA) and total omega-3 fatty acid levels in the plasma compared to mentally retarded children. Parents have reported improvements in their children in terms of general health, sleeping patterns, cognitive and motor skills, concentration, eye contact, sociability, as well as reductions in irritability, aggression, and hyperactivity with omega-3 supplementation.^[7]
2. Vitamin A in conjunction with omega-3 fatty acids may be a superior choice to omega-3 fatty acids. Cod liver oil is a good choice because of its vitamin A content. It has been suggested that autism might be caused by disruption of the G-alpha protein, which subsequently affects the retinoid receptors in the brain. Vitamin A may reconnect the retinoid receptors that are essential for adequate vision, sensory perception, language processing, and attention.^[7]
3. Vitamin B6 has shown positive effects when supplemented in autistic children. Vitamin B6 improves eye contact, reduces self-stimulatory behavior, increases interest, reduces tantrums, and increases speech.^[7] Autism in many cases is thus considered a vitamin B6 dependency syndrome.^[8]
4. Vitamin B15 (pangamic acid and/or calcium pangamate) functions as a methyl donor and improves oxygenation to the tissues and cells of the body. It specifically improves verbal and speaking ability in autistic children.^[7]
5. Magnesium supplementation offsets its depletion which can be induced by vitamin B6. Magnesium reduces the irritability, sound sensitivity, and bed-wetting that can result from taking vitamin B6.^[8]
6. N,N-Dimethylglycine (DMG) is a derivative of the amino acid glycine. It has been shown to improve verbal communication, social interaction, energy, and the ability to give affection in autistic children.^[7]
7. Probiotics replenish the gut mucosa with beneficial bacteria. They also aid in the detoxification of psychoactive compounds and other xenobiotic agents. Probiotics help maintain gut mucosa integrity which is thought to be compromised in autistic patients. Lactobacillus rhamnosus is a specific strain that breaks down proteins derived from wheat and dairy. This might be helpful for those who excrete high amounts of urinary proteins.^[7]
8. Wheat and Dairy Elimination can reduce autistic behaviors and improve social and communicative skills. Autistic patients have defects in their ability to breakdown the proteins derived from wheat and dairy. This leads to the absorption of opiate-like compounds. An overproduction of these opiate-like compounds is linked to some neuropsychiatric manifestations of autism. It is not uncommon for autistic children to have damaged mucosal surfaces, leading to an increased uptake of these opiate-like compounds, due to unrecognized wheat or dairy allergies/intolerances.^[7]
9. Empowerplus is a micronutrient treatment that when given to autistic children lowers activity levels, decreases social withdrawal, anger, irritability, and self-injurious behaviors. The combination consists of 16 minerals, 14 vitamins, 3 amino acids, and 3 antioxidants.^[7]
10. Glutathione is an intracellular peptide with a wide range of functions, including: detoxification of xenobiotics and their metabolites; and maintenance of intracellular reduction-oxidation reaction balance. Glutathione is a major antioxidant produced within the body to combat free radical/oxidative stress. Glutathione levels are likely to be lower in children with autism; the oxidized form of glutathione (glutathione disulfide) is often present in higher than normal concentrations. This finding leads to the hypothesis that oxidative stress may play a role in the progression of autism.^[4]

Conclusion

Autism is one type of spectrum disorder where the cause of each individual case may differ. Autism is a multifactorial condition where both environmental and genetic factors are thought to contribute to its presentation. Deficiencies in vitamins and/or minerals may also be a contributing factor. Autism often presents alongside other psychiatric disorders and can have a tremendous impact on the individual affected as well as the family unit. Specific diagnostic criteria must be met (usually within the first three years of life) in order for a diagnosis to be properly made. There is no cure for the condition at this present time. Evidence-based medicine suggests that complementary and alternative medicine may be effective in improving the symptoms of autism. However, it is important to ensure that an intervention is safe before commencing. A naturopathic doctor can determine which intervention(s) may be best suited for each individual patient based on a thorough case history and proper assessment.