Slide 1. Slide 2. Slide 3 SPEECH LANGUAGE NUTRITION AND BEHAVIOR THERAPY FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS QUOTE AUTISM DEFINED

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1 Slide 1 SPEECH LANGUAGE NUTRITION AND BEHAVIOR THERAPY FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS Dr. Regina Enwefa, Ph.D., CCC-SLP, ND, CNHP, MFRT, CMT, Dip. NBS, MR Southern University A & M College, Baton Rouge, LA Dr. Stephen C. Enwefa, Ph.D., CCC-SLP, ND, CNHP, MFRT, CMT, Dip. NBS, MR Southern University A & M College, Baton Rouge, LA Dr. Arnold Nyarambi East Tennessee State University, Johnson City, Tennessee Slide 2 QUOTE It is not the function of our Government to keep the citizen from falling into error, it is the function of the citizen to keep the Government from falling into error. Robert Houghwout Jackson, Chief Judge at the War-crimes Tribunal in Nuremberg Slide 3 AUTISM DEFINED A neurologically-based developmental disability with onset before age of three that is defined by marked impairments n communication an social interaction and the presence of stereotyped behavior, interests, and activities. (Autism Society of America, 2004; APA, 2000)

2 Slide 4 WHAT ARE AUTISM SPECTRUM DISORDERS? A group of disorders under the category of PDD. PDD consists of: Autistic Disorder (Autism) Asperger Syndrome Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) Rett Syndrome Childhood Disintegrative Disorder Slide 5 CHARACTERISTICS OF AUTISM Delays in their physical appearance; social interaction and language capabilities Significant language impairments Social Impairments Repetitive, restrictive and stereotypical behavioral patterns, interests and activities Sensory Processing difficulties Difficulty responding to environmental change May display cognitive delays Slide 6 PREVALENCE AND INCIDENCE OF AUTISM As often as 1 in 150 babies develop into children with autism A decade ago only 1 in 2,500 were diagnosed with autism. It was 1 in 10,000 in the early 80 s. The disorder was first recognized in million Americans have autism. As many as 4 million people could have autism by It is the fastest growing developmental disability. People with autism account for nearly one-fourth of the 6.2 million special needs Americans. 1 in 68 families are impacted by autism. The National Institute of Health will spend 102 million dollars in 2005 on autism research a five-fold increase in six years. Growth comparisons during the 1990 s: U.S. population increase: 13% Disabilities increase: 16% Autism increase: 172%

3 Slide 7 PREVALENCE AND INCIDENCE OF AUTISM Autism affects 1 in 110 children in the United States Autism affects all racial, ethnic, and/or socioeconomic status SPD affects 1 in 20 children (SPD Foundation, 2010) SPD is more prevalent and severe in people with autism. Almost everyone on the spectrum has some degree of processing issues 1 in 70 boys It is the fastest growing developmental disability in the United States Boys are 4 times more likely than girls to have autism More children will be diagnosed with autism this year than with AIDS, Diabetes, and Cancer Centers for Disease and Control 2011, 2012 Slide 8 Costs of Autism on Society Autism costs the nation over $35 billion per year in which this figure will increase significantly within the next decade 1% of the population of children in the United States ages 3-17 have and autism spectrum disorder 1 to 1.5 million Americans live with autism spectrum disorders It is costing $69 billion annually 60% of costs are in adults services In 10 ears the annual cost will rise to $200-$400 billion The cost of autism over the lifespan is 3.2 million dollars per person 1 in 20 children in the United States have SPD 5-13% entering school have SPD and that 3 of 4 are boys Slide 9 DEMOGRAPHICS OF AUTISM OVER A 20 YEAR PERIOD

4 Slide 10 WHY DOES AUTISM OCCUR? No definitive answer yet, most researchers believe it is most likely due to the following sources: Neurological damage Genetic disruptions Biochemical imbalances Slide 11 THE IMPORTANCE OF GI HEALTH IN AUTISM All disease begins in the gut -Hippocrates, the father of modern medicine Our gut has constant contact with food It is a physical barrier of defense against bacteria, viruses, etc. The greatest amount of (90%) of the brain chemical serotonin is found in the GI tract It is the largest part of the IMMUNE SYSTEM (70%) found in the Gut Vitamins/minerals absorbed in the gut are cofactors for enzyme reactions, metabolism, conversion of nutrients and fats Amino acids (absorbed from protein digestion) are precursors for neurotransmitters Enwefa and Enwefa 2011, 2012 Slide 12 FUTURE CHALLENGES OF TREATING AUTISM Treating Autism is a challenge because there is no clear cut protocol. Every child is unique and responds to a different variety of treatment approaches. The food children eat today is nothing like the food children ate in previous generations. We cannot expect a child with autism to fully benefit from all therapies until their nutritional needs are met Enwefa and Enwefa, 2012

5 Slide 13 AUTISM: IS A WHOLE BODY DISORDER Genetics, Toxicity, Vaccinations, Antibiotics, Inflammation, Gut permeability, Yeast Overgrowth, Immune, Mercury, Live viruses THE BRAIN IS DOWNSTREAM Yeast toxins Undermethylaed neurotransmitters Brain inflammation Increased toxicity Nutrient deficiencies Opiates Enwefa and Enwefa, 2011 Slide 14 HOW CAN DIET AND NUTRITION HELP CHILDREN WITH AUTISM? Supports digestions and biochemistry Leaky gut and gut inflammation Remove foods that inflame the gut Add foods that heal the gut Add foods that supply beneficial bacteria Nutrient deficiencies Increase the quality of food digestibility Yeast overgrowth Remove sugars Remove starches Add probiotic rich foods Toxicity and Poor Detoxification Avoid food additives Avoid toxins in food supply and meal preparation Enwefa and Enwefa, 2010 Slide 15 COMMON GI SYMPTOMS IN CHILDREN WITH AUTISM HX of antifungal use in childhood Dairy intolerance Poorly formed stools Food sensitivity Poor weight gain Low stomach acid Dry skin Fatty acid deficiency Irregular stool Vitamin deficiency Chronic constipation Poor sleepy habits Aggression Colic or reflux Thrush/HX of diaper rash Bloating Abdominal distension

6 Slide 16 TRANSIT TIME FOR FOOD AND THE GUT Mouth- 1 minute Esophagus- 4-8 seconds Stomach-2-4 hours Small Intestine- 3-5 hours Colon- 10 hours to Several Days Slide 17 HOW NUTRITION CAN HELP CHILDREN WITH AUTISM Leaky Gut and Gut Inflammation Remove foods that inflame the gut Add foods that reduce inflammation and heal the gut Add foods that supply beneficial bacteria Nutrient deficiencies- increase the quality of food and digestibility Yeast overgrowth- remove sugars, reduce refined flour products and starches Add probiotic rich foods Toxicity and poor detoxification- avoid food additives, avoid toxins in food supply and meal preparation Slide 18 MANUFACTURERS ARE ROBBING US OF NUTRITIOUS FOODS If a child is lacking basic nutrients in his diet, his brain and immune, gastrointestinal and detoxification systems will not function to the best of their ability. Protein, carbohydrates, fat, vitamins, minerals, and water are important basic nutrients the child needs. Getting a child with autism to eat a diet that includes all of the basic nutrients is challenging for parents and professionals that work with this population.

7 Slide 19 NUTRIENT DEFICIENCIES AND CHALLENGES The majority of children with autism eat a very limited diet accepting less than 5 or 10 different foods within their diet. They crave carbohydrates Refuse new foods Throw tantrums when offered unfamiliar foods Suffer from numerous vitamin/mineral deficiencies Sensory problems impact their acceptance of certain textures, flavors, and smells of foods Majority dehydrated- this can easily be missed because the child does not recognize the sensation of thirst and may not ever ask for water. Slide 20 LISTS OF CONCERNS REGARDING THE DIET OF CHILDREN WITH AUTISM SPECTRUM DISORDERS Synthetic Food Additives Artificial Colors Artificial Flavors Preservatives Artificial Sweeteners Slide 21 UNHEALTHY CHOICES AND FOODS TO AVOID THAT IMPACT CHILDREN WITH AUTISM INGREDIENTS TO AVOID THAT DO HARM TO OUR CHILDREN AND US Artificial colors/flavors and Preservatives- Candy, Cereal, kids foods MSG (hydrolyzed protein, yeast extracts, broth, bouillon cubes, soups, meat flavored foods) Pesticides- non-organic produce and meat Aspartame and other artificial sweetenerssodas and other foods Trans fats- partially hydrogenated oil, commercial margarine, mayonnaise, peanut butter Nitrates/Nitrites- Bacon, Hot dogs, Lunch Meats The Health of the GI System Determines The Healthy Function of Body Enwefa and Enwefa, 2011, 2012 These ingredients can cause: Hyperactivity Inattentiveness Aggression Irritability Headaches/pain Trigger asthma Overload detoxification

8 Slide 22 SYMPTOMS DIET AND NUTRITION MAY IMPROVE Ability to focus Eye contact Aggression Gastrointestinal problems Language Sleep difficulties Toilet training Rash or eczema may improve Behavior Slide 23 Autistic Spectrum Disorders are caused by genetic predispositions combined with environmental factors that create disordered biochemistry and damaged organs & systems Nutrition Affects The Chemistry and the Body Slide 24 SATURATED FATS AND CHOLESTEROL Brain-important for brain development Bones-helps the body put calcium in the bones Liver- protects the liver from poisons Lungs- protects against asthma Immune system- fights infection Essential Fatty Acids- work together with saturated fats

9 Slide 25 BENEFITS OF CHOLESTEROL Brain development and function Boosts mental performance Aids digestion Builds strong bones Builds muscle Building block for hormones Regulates your blood sugar Repairs damaged tissue Protects against infectious diseases Slide 26 MOST IMPORTANT NUTRIENTS FOR BRAIN DEVELOPMENT Vitamin A - Cod liver oil; liver, butter and egg yolks from grass-fed animals Vitamin D - Cod liver oil; lard, butter and egg yolks from grass-fed animals Choline - Cod liver oil, egg yolks DHA - Cod liver oil; liver, butter, egg yolks from grass-fed animals Zinc - Red meat of grass-fed animals, shellfish Tryptophan - Meat of grass-fed animals Cholesterol - Dairy foods, eggs, seafood, meat of grass-fed animals Slide 27 PARADIGM SHIFT FOR SLPS FOR THE FUTURE 1. Internalize that nutrition makes a difference in a child s developmental and educational needs. 1. Educate parents and professionals of the role of nutrition. 1. Advocate to include nutrition therapy into the child s IFSP and IEP. 1. Provide appropriate strategies and techniques for classroom management Enwefa and Enwefa, Nyarambi, 2012

10 Slide 28 GFCF (Gluten-free and Casein-free) DIET OPTIONS TO CHOOSE FROM FOR ASD POPULATIONS No gluten (wheat, rye, barley, spelt, kamut, and oats) or casein (dairy) Food Sensitivity Elimination Eliminating all other food sensitivities: Soy, corn, eggs, citrus, peanuts, chocolate, cane sugar Feingold Diet/Low Phenols Restricts high phenolic foods, including all artificial ingredients and high salicylate fruits SCD (Specific Carbohydrate Diet) Restricts carbohydrates to only fruits, non-starchy vegetables, and honey. No grains, starchy vegetables, or mucilaginous fibers Body Ecology Diet Anti-yeast diet combining principles of anti-yeast diets including no sugar, acid/alkaline, fermented foods Nourishing Traditions/ Weston A. Price Good quality fats, soaking and fermenting for digestion Low Oxalate Diet Restricts high oxalate foods (nuts, beans, greens) Slide 29 NUTRITIONAL FACTORS FOR ASD POPULATIONS AND SPEECH LANGUAGE THERAPY Help the entire treatment team including the child understand how nutrition affects symptoms Nutritional knowledge is in the public domain and public schools are obligated to teach it to children You do not need a professional degree in a nutrition-related field in order to provide the necessary level of instruction to help the child Strive for having the child receive seven classes of nutrients needed daily for human brains are listed below: Amino Acids Vitamins Minerals (Chelated) Water Oxygen Slide 30 PICKY EATERS AND THE SLP Always provide food child likes in addition to "new" food. Only offer one new food at a time. Include small portion of new food and serve everyone at the table. Involve your children in food preparation of "new" food. Small taste ~ 1/2 teaspoon. Let child determine amount. Inform them. Let child know whether it is sweet, salty or sour. Let them spit it out. Try new food in a texture they prefer - crunchy, smooth, etc. Avoid being emotionally attached - children sense anxiety. Keep mealtime calm. Visualize child eating/enjoying new foods. Avoid forcing or pushing - maintain trust. Choose rewards or other encouragement. Make sure the whole family participates. Make it fun!

11 Slide 31 BEHAVIOR THERAPY FOR CHILDREN WITH ASD Before we try to work with and understand the child let s look at our own attitude-both overall and in the moment. First in the moment- Be REAL & BE POSITIVE Slide 32 SLPS AND OTHER PROFESSIONALS LETS CHECK OUR OWN BEHAVIOR AND ATTITUDE Behavior is Communication Misconceptions about behaviors Labeling a Behavior Avoiding/Escape Behavior Self-Stimulation Behavior Slide 33 BEHAVIOR THERAPY Could Your Attitude be a Barrier to working with children with ASD?