Autism Strategies by ecm33842

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									         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
                      SYDNEY, AUSTRALIA
             WEBSITE: www.learningdiscoveries.org
                EMAIL: rboon@iprimus.com.au


1
                                            Autism is
                                          more than just
                                           genetics……
                                       it is a multifactorial
    Presented By:-
                                        disorder requiring
                                             multimodal
    Rosemary Boon,
    Psychologist
    M.A.(Psych), Grad.Dip.Ed., Bsc.,
    Grad.Dip.Ed Studies(Sch.Counsel),       interventions
    MAPS, AACNEM, ACHC.




                        rboon@iprimus.com.au
2
    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
3
    Statistics worldwide show...
    • 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)


    The California (1999) report showed a 273%
    increase in the State of California between 1979 and
    1992.

4
    • Autism /ASD               1:50 (Aust.)
    • “Classical” autism        5:100,000 (UK)
    • ASD                     15:100,000 (UK)
    • CFS                       1:50 (2%)
    • Anxiety & Depression 1:5          (20%)
                     (Mind of a Child Conference - Sydney, March, 2002)

    Autism is the most frequently occurring form of
    pervasive developmental disorder (PDD)
    (Siegel 1996).


5
    Numerous causes have been postulated
                 • Genetics
         • Neurological Dysfunction
           • Immune Dysfunction
          • Gastrointestinal Factors
          • Environmental Factors




6
     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


7
    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).



8
    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.




9
     - 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)




10
      “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


11
     - 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
12
     - sound - increase in intensity of stimuli


     - EMF radiation (mobile phones, VDU‟s- computers,
     TV,microwave technology, appliances etc.)


     - hand held computer games (produce frontal lobe
     abnormalities)


     - media and video games (affects behaviour,
     violence and suicide)


13
        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)
14
     • “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)


15
     •……..“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

16
     • 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)



17
     Blood brain barrier




18
     Biology of behaviour…...




19
     The interactive factors…...
              Immune System




                 AUTISM

       Gut                           Brain

20                            From Gupta - MOA 2002
      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 individual‟s unique neuro-
       biochemical, metabolic and genetic makeup
       can make a difference to outcomes.


21
     • 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.



22
        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
                                                                                    MENTORING
                               COACHING             Stress mgt, Anger mgt,
                                                                                     SUPPORT
                                                   Philosophy, Self Reliance
                                                         & Spirituality
                                                         ACADEMIC                             PSYCHOLOGY
                       TEACHING                Literacy & Numeracy Training,             PERSONAL DEVELOPMENT
                                               Thinking Skills, Learning Styles
                                                                                                 PRE-ACADEMIC
         DEVELOPMENTAL,                  DEVELOPMENTAL & PRE ACADEMIC                            PROGRAMMES
     VISION & SPEECH THERAPY
                                     Developmental Auditory & Visual Skills, Language,
                                        Vision, Spatial, Eye-hand, Sequencing Skills
                                                                                                        SENSORY MOTOR
                                                                                                         INTEGRATION
                                                       FUNCTIONAL
          EEG & EMG
         BIOFEEDBACK                     Neuronal Function, Vestibular, Occulomotor,
                                Auditory & Visual Processing, Motor Coordination, Balance,                 SOUND THERAPY
                                      Primitive & Postural Reflexes, Emotional Distress
 COUNSELLING
   & FAMILY               GENETIC, STRUCTURAL, METABOLIC & NEUROPHYSIOLOGICAL                                     FLEXYX
   SUPPORT                           Musculoskeletal, Illness, Injury/Trauma, Toxicity,                        NEUROTHERAPY
                        Environmental/Food, Allergens, Disorders, Eyesight, Hearing, Diet & Nutrition


        NUTRITION &           GUT &              HEALTH & MEDICAL             ENVIRONMENTAL               CHIRO, OSTEO,
23
        SUPPLEMENTS       IMMUNE SYSTEM           PRACTITIONERS                 CONSULTANT                CRANIO, BOWEN
       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
     Asperger‟s Scale (Garnett and Attwood).


24
     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)




25    • First concerns of parents need to be checked into…….
     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 child‟s functional capacities
26
     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


27
     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
28
                          From “Fed Up”
                          by Sue Dengate,
                               1999

     Food Allergies……..




29
     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, 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)


30
       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, 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)



31
     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/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
32       of Newcastle, Australia, 2002)
       Factors affecting gut flora…….
             Levels of endogenous and exogenous nutrients
          (Mucin, gut proteins, biliary secretions, sloughed cells,
         gluten and casein - zinc, glutathione and metallathione)

      Antibiotics                                                                                       Bile Acids


     Vaccinations                                                                                          Age
                                                    Gut
        Bacterial                                  Flora
      Interactions
                                                                                                           pH
           Bacterial
         Interactions
     (SCFA, Bactereocins)                                                                                 Drugs

                         Disease                          Redox Potential
33
                                                                                                        Leaky Gut
                     (From Autism and the Human Gut Microflora - Max Bingham - University of Reading)
     Gastrointestinal factors continued……………………………..




34
                                                   From Autism and the Human Gut Microflora - Max Bingham - University of Reading
     Who want‟s to party??????………
     (From Autism and the Human Gut Microflora - Max Bingham - University of Reading)




35
     The digestive system…...




36
     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 shouldn‟t.
     • If the gut is not healthy, neither is the
       rest of the body. It is the point of fuel
       and nutrient entry.

37
     Leaky Gut Syndrome




38
     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)
39
     Detoxification pathways of the liver…….
                    Environmental                        Immune
                        toxins                 Bacteria Complexes
       Non-end product           Bowel
         metabolite              toxins

                                                  Kupffer cells
     PHASE I       Cytochrome P450



                Activated Intermediaries
                                                   Destroyed
     PHASE II
          Sulphation           Conjugation


                    Glucuronidation                      FILTERING




40                   EXCRETION
       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

41
     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


42
       Immunological Factors………..
      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)



43
     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)




44
     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?


45
       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 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)

46
     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 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)


47
     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; 10:40-43)

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




48
       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)




49
     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


50
     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 EFAs
         First 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 overgrowths
         Pre & Probiotics- Lactobacillus GG, bifidobacteria etc.


51
     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 individual‟s metabolic
         changes.


52
      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

53
     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.


54
     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.

         •Aromatherapy Massage          •Craniosacral Therapy



                           •Bowen Therapy
55
     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.

56
     The Autonomic Nervous System……...




57
     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
58
      Bowen Therapy………...
     • 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.
59
     Golgi continued…... (From Tortora & Grabowski - 2000)




60                  SITES OF CONCENTRATION
                   OF THE GOLGI TENDON ORGAN
     Counselling & Family Support……..
      • 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.
61    neonates.
     Brain Section




62
     Sagittal of skull and brain




63
       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)

64
     Autism and the brain…….




       From “The Brain In The News”, The Dana Foundation, 2002




65
     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 Asperger‟s Syndrome (Shultz et.al. Arch Gen Psychiatry.
        2000;57:331-340)


     • - Various abnormalities of cellular migration (Piven
        et.al. 1990)

66
     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)




67
     Entorhinal cortex….
                                       Subic.

                                CA1             FORNIX

                        CA3

       Dentate Gyrus


                                                  Other
                   ENTORHINAL CORTEX
                                                  Cortex


      Perirhinal           Parahippocampal
       Cortex                   Cortex



          Unimodal and polymodal
68
             Association Areas
     Neural networks in autism…….. (Zimmerman & Gordon 2001)


         Prefrontal                            Dysfunctional
                                               Plasticity
                                                               Thalamus
          Cortex
                                       Caudate         Functional
                                       Nucleus         Plasticity


                    Anterior          Nucleus
                   Cingulate         Accumbens             Globus
                                                           Pallidus


      Limbic
      System
                                                                Cerebellum
      Autism?                    Inferior                              Autism?
                Autonomic      Parietal Lobe
                 Centres
69                                                     =Disconnection Syndrome
70
       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.

71
     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.



72
       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

73
     The sense of hearing…...




74
       SOUND THERAPY cont‟d………..




     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)




75
      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.



76
     SOUND THERAPY……….




77
     Reading cont‟d………..


     “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.)




78
     Reading cont‟d………..


     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).


79
     Sound Therapy…….

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




80
     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. SST
        i. 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.
81
     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
82
      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
83     communication, speech and occupational therapy.
     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
84
        time.
     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


85
     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.
86
     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.
87
     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 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.

88
     Wenicke-Gershwind Model




89
     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 child‟s day. A 20 minute session of
          speech therapy 3 times per week is
          simply not enough.


90
91
      Pre-academic Programmes…...
     • ABA
     • TEACCH
     • PECS
     • DIR/“Floor Time”
     • INCLUSION
     • SOCIAL STORIES
     • The Miller Method




92
     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, teacher‟s aides,
       inclusion strategies etc.).


93
     Psychology & Personal Development…….
      • Encouragement toward self esteem
      • Functional independence
      • Goals and goal setting



                          Coaching
                  (parents, teachers, peers etc.)




                         Mentoring
                          (workplace)


94
     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.


95
     • 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.


96
     Robert……..



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




97
     Mary……...




98
                 Australian Woman‟s Weekly , Aug, 2002
     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.
99
       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
100
      • 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
101
      • 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
102
      • 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


103
      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

104   •www.bowtech.com

								
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