a best practices model for treating autism bio medical aba therapies put into practice together...

8/8/2019 A Best Practices Model for Treating Autism Bio Medical ABA Therapies Put Into Practice Together Improve Optimal Outcomes

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Autism One 2009 Chicago

The Hopes of a Mother, the Dreams of a Father are Real.Our Children get Better

Chicago, IL May 20th - May 24th

Lauren W. Underwood, PhD

A "Best Practices" Model for Treating Autism:Biomedical & ABA Therapies

Put into Practice TogetherImprove Optimal Outcomes


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W hat is autistic spectrum disorder?

y A developmentaldisability resulting from a

neurological disorder


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That affects normal functioning of the brain . . .


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Autistic Spectrum Disorder

y A bnormal development of y Communication skillsy Social skillsy Reasoning


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affecting children in a spectrumof ways . . .


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. . . . and children affected b ehavein a spectrum of ways . .


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The tough part about autism is that there is no

definitive cure or treatmentN o one will tell you that this is something thatwill definitely

work


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Todays presentationy T reatments grounded inA pplied BehaviorA nalysis as well as

biomedical treatments haveindividually helped provideeffective treatment models for autism

y In recent years, evidence for successful outcomes with biomedical treatments has also been observed

y Ultimately, in developing a Best Practices Model, theseinterventionsmust work together to provide the bestpossibilities for optimal outcomes


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A n overview of support for the behavioral- biomedical treatment model will be

presented


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W hy behavioral AND biomedical?y Many children with autism also suffer from co-morbid

medical conditionsy T reat the underlying medical disordersy Increase reception to behavioral interventionsy T hen, the synergistic effects of behavioral and biomedical

interventions result in an increase in successful outcomes


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Synergy of biomedical and behavioralinterventions

y T herapies or interventions are designed to remedy specificsymptoms in each individual

y T he best-studied therapies include a combination of educational/behavioral, sensory and biomedical interventions

y They may not cure autism, but they often result insubstantial improvement


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My goal as an educator . . .1 st . . . T he Science . . . .y Biology

y A natomy and cell biologyy Immunologyy Biochemistry


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Then,the reasoning behindwhat can go wrongwith these

systems . . . explain how issues with these systems canaffect

y

Behaviory Behavioral interventiony Sensory intervention


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. . . to enable you to understand some of thebiological approaches currently available for the treatment of the medical conditiondescribed as autism,

. . . .so if you choose you can consider applying them responsibly


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Why consider biomedical

approaches for treating of autism?There is literature in peer review journals and

other related sources that suggests that thereare several biomedical interventions that . . .can be helpful for the treatment of thesymptoms in many autistic spectrum disorder children


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W hat does biomedical approach

mean?T he application of the natural, biologicaland physiological

sciencesto clinical medicine


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http://talkaboutcuringautism.org/medical/supplement_help.htm


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http://www.pediatrics.org/cgi/content/fu

ll/120/5/1162


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http://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/5/1221.pdf


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The Sciencey T he body is made up of specificsystems , including

skeletal, circulatory, immune, cardiovascular, nervous,digestive

y

Digestive systemy A natomy and functiony Food allergies/food intolerancesy Leaky gut/intestinal dysbiosis

y Immune system functiony Basic biochemistry


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Digestive Systemyy MouthMouthyy StomachStomachyy Small intestineSmall intestine--absorptionabsorption

DuodenumDuodenum Jejunum JejunumIleumIleum

yy Large intestine/ColonLarge intestine/Colonyy RectumRectumyy LiverLiveryy PancreasPancreas--secretes enzymes and hormonessecretes enzymes and hormones


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Digestion-digestive tract functiony Digests foody A bsorbs nutrientsy Carries vitamins and nutrients into bloodstreamy Chemical detoxificationy Excretion


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H ow do you get nutrients from foods?Proteiny Foods are made up of proteinsy When foods are eaten and properly digested, proteins

are broken down byenzymes into peptidesy Peptides are then further broken down into amino acidsy A mino acids are the building

blocks of life


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W hat can go wrong with the GI?1 . Leaky gut2. Intestinal dysbiosis

a. Constipation

b. Diarrheac. Enterocolitis

3. A llergy


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1 . W hat is leaky-gut?D efinition: an abnormal or unfavorableincrease in

intestinal permeabilityy Epithelia are either 'tight' or 'leaky' depending on

the ability of the tight junctions to prevent waterand solute movement

y T he intestinal lining is supposed to be the protective barrier between the gut and the bloodstream

y If the intestinal lining becomes damaged-it ispossible for incompletely digested proteins and/orother by-products to leak through the intestinallining

y T hey can be recognized as foreign by the immune

system, and/or leak into bloodstream


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2 . Dysbiosisy Intestinal flora (yeast and bacteria) are a normal part of

digestive tracky Intestinal dysbiosis occurs when there is an

overgrowth/imbalance of intestinal flora(s)y Dysbiosis results from

y Increased use of antibiotics, steroids, etc.y Poor diety Diets high in sugary Stressy Immune system dysregulation


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a. Constipation/ b. Diarrheaa. Constipation-having a bowel movement

fewer than three times per weeky Stools are usually hard, dry, small in size, and

difficult to eliminate.y Can be painful to have a bowel movement andy often experience straining, bloating, and the

sensation of a full bowel

b. Diarrhea-frequent loose or liquid bowelmovements (often associated withinfection, allergy and food intolerances)


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c. Enterocolitisy Inflammation [itis](due to infection or irritation)that

affects part or all of the intestines (the small[entero]and/or large [col ] intestines)y H

yperplasia-general term for an increase in the number of thecells of an organ or tissue causing it to increase in sizey E ndoscopy -looking inside, the human body for medical reasons, by

inserting a small scope in the body


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IleonodularH

yperplasia N ormalTerminal Ileum


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Consequences of intestinal dysbiosis

or leaky gut -if left untreatedy Nutrients and vitamins arent absorbed

properly---vitamin deficienciesy Intestinal distressy Food allergies are createdy Detoxification is compromisedy Bacteria and yeast can be mobilizedy Formation of antibodies you might not want---

because of immune dysregulation


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3 . Allergyy T he most obvious place for an allergic reaction tofood to

take place is in the GI tracky Reactions can range from acute to chronicy A

large part of the immune system is located in or near theintestinal tract-to helps prevent microorganisms in theintestine from entering into the rest of the body

y 1 st line of defense against pathogensy

Defects in the immune system can lead to gastrointestinalproblemsy Food allergies vs. food sensitivies


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F ood allergies

y A n immune system response . . .to foodsy Body mistakes a protein in food as harmful, and creates a

defense against it (antibody)y A llergy symptoms appear within minutes to an hour or soafter eating the suspected food-body is battling invadingfoody Symptoms include eczema, an itchy red rash most common in the

elbow creases or behind the knees hives, nausea, swelling, difficulty breathing and/or anaphylactic shock


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F ood sensitivities/food intolerances

y Digestive system response to foodsy N ot an immune system response

y Something in food irritates digestive system or person isunable to breakdown/digest foody Can include metabolic food disorders such as lactose

intolerance (missing enzyme)y Symptoms include crapping, gas, nausea, and stomach

pain


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Overview of the immune system

White blood cells

associated withacquired immunesystem are calledlymphocytes

T CellsB Cells


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Normally, there is a balancebetween infection and immunity

infection immunity


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Immune system functionT he immune response is how your body recognizes and defends

itself against bacteria, viruses, and substances that appearforeign and harmful to the body

N ormal immune system function, depends upon proper immune system responses

1 . Protects and defends against foreign cells2. Memory-gets smarter

3. Responds appropriately4. Do no harm


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Things can go wrong with theimmune system . . .y H ypersensitivityy A utoimmunityy Inflammationy Immune system dysregulation


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Immune system dysregulation

y Immune system dysregulation causes an abnormalimmune response

y there is a shift or skewing lack of balancey T he immune system looses the ability to respond

appropriately. . . and when this happens, it is possiblethat the body develops abnormal responses to things itmight not normally react to . . .

like foods


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W hat happens if the immune system iscompromisedy Immune dysregulation

y A bnormal balance and communication between immune cellsy Chronic Inflammation

y An abnormal, persistent activation of immune cells in thetissues

y A utoimmune reactionsy A ntibodies targeting and causing injury to normal body tissues

The immune system is closely connected to virtually everyother system of the body

Disorders in the immune system can cause disease


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The liver & detoxificationy Designed to remove toxic matter from the bloodstreamy Produces biley Metabolizes proteins and fats


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W hat happens if liver function iscompromised?

y If detoxification systems are overloaded, destruction of nutrients necessary for proper detoxification occurs

y I

f detoxification pathways are overloaded,build up of toxins can occur y If transsulfuration is disrupted,

there is less antioxidant production, and oxidative stress can

occur


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L iver Overload

DetoxificationProblems

OxidativeStress

May treat withRx/drugs

Intestinalpermeability

Free RadicalProduction

HealthProblems

Dysbiosis

Candida

gastrointestinal distressallergyautoimmune problemsinfections

antibioticsantifungalssteroids

heavy metal exposureenvironmental toxinsforeign proteins-

incompletelybroken-down

food

T he Vicious CircleOf Chronic T oxic Overload


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Detoxification biochemistryy Methylation and sulfation

y A healthy bodys way to rid itself of toxic substancesy Methylation-transferring a methyl groupy T ranssulfation-responsible for production of glutathione-the

bodys number one antioxidant

y Children with autistic spectrum disorders often needsupplements to provide them with the raw materials their bodies need to efficiently carry out methylation and sulfation


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Lauren W. Underwood, PhD49


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Meth ionine

Homocysteine

Cysteine

G lutathione ( G SH )

MethionineSynthase

MethylTHF

THFolate

MethyleneTHFolate

MTHFR

B6

TMG

DMG

MethylB12

B12

SA M

Transsulfuration pathway

Remethylation pathway

Methionine/ G lutathioneTranssulfuration Pathway

Critical to the bodys ability to remove toxins!

SA H


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Methionine/glutathione transsulfuration

pathway in autistic children


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H ow do you treats biomedically?y Look for a physician or other healthcare practitioner who

considers an integrative approach to treatmenty combining mainstream medical therapies and CA M

(Complementary andA lternative Medicine) therapiesy N o single treatment works for every child.y What works for one child may not work for another, and a

successful course of treatment often includes a combinationof approaches


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Expected key benefits of biomedicaltreatment for autismy Improvements in immune function, resulting in healthier

children who seem to be very resistant to coughs, colds,runny noses, ear infections and who seem to getover viral infections quicker than the rest of the family.

y Improvements indigestive function, resulting in morenormal stool frequency and consistency; reduction orelimination of lower abdominal pain or discomfort;

reduction or elimination of loose stools or diarrhea.

Children seem to thrive


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Expected key benefits of biomedicaltreatment for autismy Improved appetite and a wider variety of foods tried and

consumed, increased nutritionTH EN . . .y

Better socialization and initiation of communication withfamily and peers;y Increase in morenormal social interactions and social playy Improved vocabulary and sentence structure;y Improved cognitive functiony Improved higher order functions


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Some basic biomedical interventionsy Diet

H ealthier dietSpecialized diet

Gluten-Free Casein-Free Diet (GFCF)Rotation Diets, others

y N utritional Supplementationy Detoxification

Some complementary/alternativebiomedical interventions

y H BOTy Chelation


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H ealthier Diet


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R ead labels . . . .


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Are special diets so specialand which one do I choose?

y Many autistic children suffer frominflammatory response/immune systemdysregulation

y Many autistic children dont/cant digesttheir foods efficiently

y diet options: GF/CF, SCD, BED, LOD,y Pick one that works best for you and your

familyy regardless of diet choice, it is important

to ensure proper nutrition


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Diet: Gluten-free Casein-free Diety A restrictive diet that removes all food items that contain

both gluten and casein

y

T he are two main theories currently present in scientificliterature that explain why some people with autism andPDD respond positively to a GFCF diet

improperly broken down dietary peptides

immune system dysre gulation


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Improperly broken down dietarypeptidesy Some people withA SD cannot properly digest gluten and casein,

which break down into substances that act like opiates in their bodies

y According to this theory, these "drug-like" substancealters the person's behavior, perceptions, and responsesto his environment


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Casein/casomorphin andgluten/gliadorphin

y Casein is a protein found inmilk and products containing milky Casomorphin (or caseomorhin) is a peptide derived from the milk

protein casein

y Gluten and gluten-like proteins are found inwheat and othergrains

y Gliadorphin (or gluteomorphin) is a peptide derived from thewheat protein gluten


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Immune system dysregulationy Immune system loses its ability to respond properlyy Body develops abnormal responses to things it

might not normally react toy

A n abnormal immune response can result iny A utoimmunityy Inflammationy H ypersensitivityy Allergy


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Other dieting options

y SCD diety Rotation diety

Soy and corn-free diety White diety Sarahs diet


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But bread andcheese are all mychild eats!

If I take away thosefoods, . . .theyll starve!


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Consider this . . . .

Although at the beginning the diet may seemdifficult, it maybe infinitely easier to try the diet,and end up having a happier healthier higherfunctioning autistic child, than living with abad/poorly functioning one!!!


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Nutritional supplementation


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W hy nutritional supplementation?1 . N utritional deficiency

y involves a lack of one or more nutrients obtained from foodessential for normal cell and body function

y occur due toy Mal-absorption/poor absorption in the small intestiney Unhealthy eating, ory Self-imposed/imposed dietary restrictionsy Poor utilization of nutrients because of genetic or environmental factors

2. Oxidative Stress


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There are nutritional deficiencies

associated with diseasey Rickets-vitamin D deficiencyy Scurvy-vitamin C deficiencyy Beriberi-thiamine deficiencyy Pellagra-niacin deficiencyy Goiter-iodine deficiency


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Signs and symptoms associated

with nutritional deficiencyy N eurological symptomsy Memory lossy Psychosisy Bruisingy Confusiony Impaired learningy

Growth retardationy Loss of appetitey Poor immune function

H

ow can achild attend, focus, and learn?


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Commonly deficient nutrientsy V itamin B1 2y V itamin B6y Folate or folic acidy V

itaminA

y V itamin Cy V itamin Dy Zincy Magnesiumy Omega 3 fatty acids


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Nutritional Supplementation

y Supplementationy Enzymesy Methyl b1 2y A ntioxidantsy T MG/DMGy Essential fatty acidsy

Glutathioney Folic acidy Melatonin


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Nutritional supplementation to

combat oxidative stressy V itamin E Calciumy V itamin C Seleniumy Zincy V itamin B6 or

its activated form,

pyridoxal-5-phosphate (P5P)with Magnesium


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W hy detoxification?y To prevent injury to the cells and

ultimately cell deathy Cell injury and cell death is bady In autism, toxins may be a cause of the

neurological and immune dysfunctiony Detoxification may help the cells torecover which will enable for healing

y If toxins accumulate too rapidly,without bein g safely eliminated , theycan cause damaging effects uponcells and tissues of the body


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H ow does your body detoxify?y Designed to remove/eliminate toxic substances from the

bodyy Primary function of liver and kidneyy G lutathioney Once toxins are bound they are eliminated via bile and

uriney Can also be achieved via artificial (chelation) or

supplementary (sauna) means or through hyperbaricoxygen therapy (H BOT ) . . .


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Complementary interventions:y H BOT

Effective way to get more oxygen into the body at the cellular level byusing pressurized air chambersy healing the gut and brain inflammation (two that may be separate issues or

experienced simultaneously)y blood flow to key areas of the brainy dealing with gut parasites, yeast or bacteriay or if it helps all four areas

y

ChelationChemical process in which a substance is used to bind molecules, such as heavymetals metals (arsenic, lead, mercury) and hold them tightly so that they can be removed from the body


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H ow do you implement a detoxificationprogram?y Should be done under the direction of an experience

physician or other practitionery Support the bodys own detoxification system

nutrients,y Methyl B12y G lutathioney DM G/ TMGy Folic acid

y Remove accessible toxinschelationy Monitor closely


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M aximize metabolism;

normalize biochemical pathways


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U nderstanding the overlay

of biomedical and behavioralinterventions . . .


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W h id b h i l h


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W hy consider behavioral therapyprograms?y A n autism diagnosis is based upon behaviors---N OT

medically basedy Generallya psychiatric / psychological diagnosis is

made at 18 -24 monthsy Most neurological development occurs during this timey Experienced18 months of abnormal deviant

developmental behaviors . . .H UGE developmental gapy

You can not go back in time to go through thisdevelopmental period


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18 month old


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W arning signs that might reflectbiomedical issuesy A ny shift in behaviory Looks for patterns of behavior changey Look for signs and sources,red flags:

y Changes in sleepy Increased irritabilityy Rashesy

Red earsy A ll discipline strategies can be affected by biomedicalissues/conditions


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W hy is there an overlap betweenbehavioral and biomedicalinterventions . . .y Remember co-morbid biomedical conditions which can

setback or slow down therapiesy N o single treatment works for every child--What works

for one child may not work for another, andy A successful course of treatment often includes a

combination of approachesy Be aware of any change in meds or supplementsthis can affect

behavior- applies for neurotypical as well as child withautism

W h d b h i l d bi di l


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W hy do behavioral and biomedicalinterventions go hand in hand?

y If a child suffers fromallergiesy Focus and concentration can be affected

y If a child suffers fromG I distress , like constipation,

diarrheay Cramping, bloating will distract themy Pain may lead to self-injurious behavior

y If their are immune system issuesy I

ncreased infections, inflammation can affect attention andconcentrationy If biochemical pathways compromised

y N eurotransmission can be under or over stimulated

W hy do behavioral and biomedical


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W hy do behavioral and biomedicalinterventions go hand in hand?y If a child suffers fromdigestive issues

y Improperly broken-down foods can have an affect upon behavior

y N ot receiving essential nutrients for biochemical pathways andmaximum metabolism

y If a child hasdetoxification problemsy Build-up of toxins, increased oxidative stress, symptoms

affect attention


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y

Look for signs :y Posturingy Bloated bellyy Eczemay

A llergyy Sound sensitivity

Treat underlying medical conditions


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Look for symptoms associated with


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Look for symptoms associated witha bdom inal pain y Cryingy Unexplained tantrumsy Night time wakeningy General irritabilityy

Vocalizing complaintsy Posturingy Irritability just prior to bowel movementy Hyperactivity and distractibilityy

Self injurious behavior


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y Look for signs :y Sleep issuesy Toileting issuesy Tantrumingy Irritabilityy H yperactivityy Self-injurious behavior

Treat underlying medical conditions


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A happier, healthier child is going tobe more responsive to behavioral, social

and sensory interventions


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P aradigm switch

autism is not a psychological condition

it is a neuro -gastro -immunological disorder resulting from an genetic susceptibility andan environmental insult


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T he abnormal metabolic profile in children with autism isconsistent with the abnormal genetic profile andstrengthens the hypothesis that may predispose thesechildren genetic susceptibility to oxidative stress and reduced methylation capacity to neurolo gical ,immunolo gical , and gastrointestinal dysfunction thatoccurs with autism D r. Jill James

Maybe there is a genetic


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Maybe there is a geneticsusceptibility . . .and environmental factors can affect trigger

effects


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A new paradigm in autismy A utism is an environmental illness with a genetic

component.y It is a complex metabolic disease, not just a

developmental disability.y A utism is treatable, but . . .y W e must continue fighting for a cure!

Understanding Autism for


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Understanding Autism for Dummies

S. Shore, L. Rastelli,T. Grandin

P rovides the simple breakdown of behavioral, medical and other interventionOffers practical advice on how toeducate children, as well asinsights on helping people withautism maximize their potential


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Take home lessons1 . T here are many behavioral therapy options-pick one

that works best for you and your family2. T here are biomedical options for treatment3. Basic immunology and biochemistry can explain how

things can go wrong in the body, andthat many autistic children suffer from real clinic symptoms thatare treatable, andnutritional supplementation may be necessary to replacenecessary building blocks for proper cell function and systemfunctions


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Take H ome Lessons4. If detoxification is not functioning properly, it may be

necessary to supplement with co-factors to bypassdeficiencies.T hese include methyl B1 2, folic acid, B6,DMG and/or T MG

5. Most importantly, understand that biochemical and behavioral interventions need to be implementedtogether to enable more successful treatment resultsand outcomes


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And this is how you feel now . . .

Dont try to do everything all at


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Dont try to do everything all atonce!!!!


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Baby Girl: 12 weeks


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Baby girl: 9 months


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Baby girl: 12 months


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After interventions:


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After interventions:4 year old girl


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Same child: Age 10 and 12


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Baby boy: 12 weeks old


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Baby boy: 13 months old


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Boy after interventions


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y

3 years old 5 years old

More and more autistic children are


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getting better every day,

and although there is no guarantee . . .

there are more reasons to be hopeful that your

child could be part of the extraordinary journeytowards recovery


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Remember, . . .y Be patienty Be inspiredy H ave strengthy N ever give up hope , andy N ever give up couragey Love your child!


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a best practices model for treating autism bio medical aba therapies put into practice together...

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