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Effective Strategies For Autism

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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 – PowerPoint PPT presentation

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Title: Effective Strategies For Autism


1
Autism Society of America - Colorado
ChapterAutism Intervention Strategies and
Synergies Conference and ExpositionSeptember
18-21, 2002 Red Lion Denver CentralKeynote
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.orgEMAIL
rboon_at_iprimus.com.au
2
Autism is more than just geneticsit is a
multifactorial disorder requiring multimodal
interventions
Presented By- Rosemary Boon, Psychologist M.A.(
Psych), Grad.Dip.Ed., Bsc., Grad.Dip.Ed
Studies(Sch.Counsel), MAPS, AACNEM, ACHC.
rboon_at_iprimus.com.au
3
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

4
Statistics worldwide show...
  • The incidence of Pervasive Developmental
    Disorders, Learning Difficulties, ADHD,
    Auto-Immune Disorders, and Psychiatric Disorders
    are increasing.
  • ADHD 110 (10)
  • SLD 15 (20)
  • Autism 1135 (USA)
  • The California (1999) report showed a 273
    increase in the State of California between 1979
    and 1992.

5
  • Autism /ASD 150 (Aust.)
  • Classical autism 5100,000 (UK)
  • ASD 15100,000 (UK)
  • CFS 150 (2)
  • Anxiety Depression 15 (20)
  • (Mind of a Child Conference - Sydney, March,
    2002)
  • Autism is the most frequently occurring form of
    pervasive developmental disorder (PDD) (Siegel
    1996).

6
  • Numerous causes have been postulated
  • Genetics
  • Neurological Dysfunction
  • Immune Dysfunction
  • Gastrointestinal Factors
  • Environmental Factors

7
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

8
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).

9
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.

10
  • - 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)

11
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

12
  • - 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

13
  • - sound - increase in intensity of stimuli
  • - EMF radiation (mobile phones, VDUs- computers,
    TV,microwave technology, appliances etc.)
  • - hand held computer games (produce frontal lobe
    abnormalities)
  • - media and video games (affects behaviour,
    violence and suicide)

14
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)

15
  • 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)

16
  • ..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

17
  • Pregnancy
  • more mothers smoking (27)
  • caffeine (low birth rate and breathing problems)
  • alcohol (gt 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)

18
Blood brain barrier
19
Biology of behaviour...
20
The interactive factors...
Immune System
AUTISM
Gut
Brain
From Gupta - MOA 2002
21
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
    individuals unique neuro-biochemical, metabolic
    and genetic makeup can make a difference to
    outcomes.

22
  • 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.

23
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 Stress mgt, Anger mgt, Philosophy,
Self Reliance Spirituality
MENTORING SUPPORT
COACHING
ACADEMIC Literacy Numeracy Training, Thinking
Skills, Learning Styles
PSYCHOLOGY PERSONAL DEVELOPMENT
TEACHING
PRE-ACADEMICPROGRAMMES
DEVELOPMENTAL PRE ACADEMIC Developmental
Auditory Visual Skills, Language,Vision,
Spatial, Eye-hand, Sequencing Skills
DEVELOPMENTAL,VISION SPEECH THERAPY
SENSORY MOTORINTEGRATION
FUNCTIONAL Neuronal Function, Vestibular,
Occulomotor, Auditory Visual Processing, Motor
Coordination, Balance, Primitive Postural
Reflexes, Emotional Distress
EEG EMGBIOFEEDBACK
SOUND THERAPY
COUNSELLING FAMILYSUPPORT
GENETIC, STRUCTURAL, METABOLIC
NEUROPHYSIOLOGICAL Musculoskeletal, Illness,
Injury/Trauma, Toxicity, Environmental/Food,
Allergens, Disorders, Eyesight, Hearing, Diet
Nutrition
FLEXYXNEUROTHERAPY
NUTRITION SUPPLEMENTS
GUT IMMUNE SYSTEM
HEALTH MEDICAL PRACTITIONERS
ENVIRONMENTALCONSULTANT
CHIRO, OSTEO, CRANIO, BOWEN
24
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 Aspergers Scale (Garnett and
    Attwood).

25
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)
  • First concerns of parents need to be checked
    into.

26
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 childs functional
    capacities

27
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

28
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

29
Food Allergies..
From Fed Up by Sue Dengate,1999
30
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,
    4323-4 KL Reicheldt, Develop Brain Dys 1994,
    771-85, and others Z Sun and Cade Autism 1999,
    3 67-83)
  • Abnormal Intestinal Permeability(P. DEufemia
    Acta Pediatr 1995, 85 1076-9)

31
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,
    51133-144)- Aerobic Lactobacillus - high rice
    in diet(J. Child Neurology, 15 429-435 P.
    Shattock A. Broughton, JAG elevations Andre
    Wakefield, Lancet, 1998, 351637 T.J. Borody,
    Centre for Digestive Diseases, NSW, Australia)

32
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/Strepto
    coccus 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 of
    Newcastle, Australia, 2002)

33
Factors affecting gut flora.
Levels of endogenous and exogenous
nutrients (Mucin, gut proteins, biliary
secretions, sloughed cells,gluten and casein -
zinc, glutathione and metallathione)
Bile Acids
Antibiotics
Gut Flora
Vaccinations
Age
Bacterial Interactions
pH
Bacterial Interactions (SCFA, Bactereocins)
Drugs
Disease
Redox Potential
Leaky Gut
(From Autism and the Human Gut Microflora - Max
Bingham - University of Reading)
34
Gastrointestinal factors continued..
From Autism and the Human Gut Microflora - Max
Bingham - University of Reading
35
Who wants to party?????? (From Autism
and the Human Gut Microflora - Max Bingham -
University of Reading)
36
The digestive system...
37
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 shouldnt.
  • If the gut is not healthy, neither is the rest of
    the body. It is the point of fuel and nutrient
    entry.

38
Leaky Gut Syndrome
39
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)

40
Detoxification pathways of the liver.
Environmentaltoxins
Immune Complexes
Bacteria
Non-end product metabolite
Boweltoxins
Kupffer cells
Cytochrome P450
PHASE I
Activated Intermediaries
Destroyed
PHASE II
Sulphation
Conjugation
Glucuronidation
FILTERING
EXCRETION
41
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

42
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

43
Immunological Factors..
  • Recurrent Infections (Euro Child/Adolesc Psych,
    19932(2)79-90 J Autism Dev Disord 1987 17(4)
    585-94)
  • T-cell Deficiency (J Autism Child Schizo
    749-55 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)

44
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)

45
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?

46
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 1978135 472-5)
  • B12 deficiency suggested by elevated urinary
    methylmalonic acid (Lancet 1998 351 637-41)
  • Low Methionine levels not uncommon
    (Observation by J. Pangborn)

47
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 29-17,
    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)

48
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 1040-43)
  • Hypocalcinurics Improve with Calcium
    Supplementation - Lower Hair Calcium in Autistics
    Reported (Dev Brain Dysfunct 1994 7 63-70)

49
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)

50
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

51
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 EFAsFirst 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 overgrowthsPre Probiotics-
    Lactobacillus GG, bifidobacteria etc.

52
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 individuals metabolic changes.

53
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

54
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.

55
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.
  • Craniosacral Therapy
  • Aromatherapy Massage
  • Bowen Therapy

56
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.

57
The Autonomic Nervous System...
58
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

59
Bowen Therapy...
  • Bowen was developed in Geelong, Australia by the
    late Tom Bowen in the 1950s 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.

60
Golgi continued... (From Tortora Grabowski -
2000)
SITES OF CONCENTRATIONOF THE GOLGI TENDON ORGAN
61
Counselling Family Support..
  • Explanation of the difficulties and the criteria
    for diagnosis affords family members a better
    understanding of the childs 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. neonates.

62
Brain Section
63
Sagittal of skull and brain
64
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)

65
Autism and the brain.
From The Brain In The News, The Dana
Foundation, 2002
66
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
    Aspergers Syndrome (Shultz et.al. Arch Gen
    Psychiatry. 200057331-340)
  • - Various abnormalities of cellular migration
    (Piven et.al. 1990)

67
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)

68
Entorhinal cortex.
Subic.
CA1
FORNIX
CA3
Dentate Gyrus
Other Cortex
ENTORHINAL CORTEX
PerirhinalCortex
ParahippocampalCortex
Unimodal and polymodal Association Areas
69
Neural networks in autism.. (Zimmerman Gordon
2001)
PrefrontalCortex
Thalamus
DysfunctionalPlasticity
CaudateNucleus
FunctionalPlasticity
NucleusAccumbens
AnteriorCingulate
GlobusPallidus
LimbicSystem
Cerebellum
Inferior Parietal Lobe
AutonomicCentres
Autism?
Autism?
Disconnection Syndrome
70
(No Transcript)
71
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.

72
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.

73
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

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The sense of hearing...
75
SOUND THERAPY contd..
  • 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)

76
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.

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SOUND THERAPY.
78
Reading contd..
  • 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.)

79
Reading contd..
  • 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).

80
Sound Therapy.
  • SAMONAS SOUND THERAPY
  • THE LISTENING PROGRAM
  • AUDITORY INTEGRATION TRAINING
  • TOMATIS

81
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. SSTi. 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.

82
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

83
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 communication, speech
    and occupational therapy.

84
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 time.

85
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

86
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.

87
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.

88
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 childs 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.

89
Wenicke-Gershwind Model
90
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 childs
    day. A 20 minute session of speech therapy 3
    times per week is simply not enough.

91
(No Transcript)
92
Pre-academic Programmes...
  • ABA
  • TEACCH
  • PECS
  • DIR/Floor Time
  • INCLUSION
  • SOCIAL STORIES
  • The Miller Method

93
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,
    teachers aides, inclusion strategies etc.).

94
Psychology Personal Development.
  • Encouragement toward self esteem
  • Functional independence
  • Goals and goal setting


95
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.

96
  • 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.

97
Robert..
  • Robert is 11 years old and could quite easily be
    fitted to any of the PDD criteria/checklists
    including autism.

98
Mary...
Australian Womans Weekly , Aug, 2002
99
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.
100
Laboratory Resources (as listed by Kirkman
Laboratories)
  • AAL Reference Laboratories, Inc. Tel (800)
    522-2611 (714) 972-9979 Fax
    (714) 543-20341715 E. Wilshire 715 Santa Ana,
    CA 92705www.aalrl.com
  • Doctors 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 66214www.greatplainslaboratory.com

101
  • Great Smokies Diagnostic Laboratory Tel (800)
    522-4762 (828) 253-0621 63 Zillicoa
    Street Asheville, NC 28801 Fax (828)
    252-9303www.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) 657-10538693
    Wilshire Boulevard Beverly Hills, CA 90211
    www.immuno-sci-lab.com

102
  • Dr. John Criticos Tel (61 2 9560 3154)
    Fax (61 2 9569 8027)79 Silver Street,
    Marrickville NSW 2204, Australia Email
    a8761_at_ozemail.com.au
  • Dr. Ian Brighthope Tel (61 3 9589 6088) Fax
    (61 3 9589 5158President of The Australian
    Complementary Health Care Council Director of
    The Australian College Of Environmental And
    Nutritional Medicine.13 Hilton StBeaumaris,
    Victoria 3193, Australia www.acnem.org
    email mail_at_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

103
  • Karl Reichelt, MD, PhD Tel 011-47-23-07-29-85Dire
    ctor, Clinical ChemistryDepartment of Pediatric
    ResearchRikshospitalet The National HospitalN
    0027 Oslo, Norway
  • Smith Kline Beecham Laboratories Tel (888)
    825-5249 (919) 483-2100 P.O. Box
    13398 Research Triangle Park, NC
    27709www.us.gsk.com
  • US BioTek Laboratories Tel (206) 365-1256
    Fax (206) 363-8790 13758 Lake City Way NE
    Seattle, WA 98125www.usbiotek.com

104
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
  • www.bowtech.com
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