5/13/12. Today s presentation Biomedical and Behavioral Therapies Implemented Together as a Treatment Approach for Autism

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1 5/13/12 Today s presentation Biomedical and Behavioral Therapies Implemented Together as a Treatment Approach for Autism Treatments grounded in behavioral therapy as well as biomedical treatments have individually helped provide effective treatment models for autism In recent years, evidence for successful outcomes Autism One/Generation Rescue Conference 2012 The Dawn of a New Decade: From Truth to Treatment May 23 - May 27, 2012 The Westin Lombard Yorktown Center 70 Yorktown Shopping Center, Lombard, IL with biomedical treatments has also been observed Ultimately, in developing a Best Practices model, these interventions must work together to provide the best possibilities for optimal outcomes, PhD An overview of the behavioralbiomedical treatment model will be presented My goal as an educator... 1st... The basics of autism, then the science.... Biology Anatomy and cell biology Immunology Biochemistry Then, the reasoning behind what can go wrong with these systems... explain how issues with these systems can affect behavior and behavioral interventions... to enable you to understand some of the biological approaches currently available for the treatment of the medical condition described as autism,... so if you choose you can consider applying them responsibly 1

2 Neurotypical Autism Autism Spectrum Disorders ADHD Asperger Syndrome PDD-NOS Autism Psychologically defined Communication Stereotypical behaviors Social interaction Understanding the underlying pathophysiologies that result in the biomedical conditions associated with autism Normal Development versus Autism Ø Abnormal development of Ø Communication skills Ø Social skills Ø Reasoning.... children with autism behave differently.. Autism is treatable! Ø Recent research shows that autism is treatable Ø Early interventions lead to the best outcomes Ø Be aware of symptoms, and begin addressing them as soon as possible Why behavioral AND biomedical? Many children with autism also suffer from comorbid medical conditions By treating the underlying medical disorders, Reception to behavioral interventions will increase Then, the synergistic effects of behavioral and biomedical interventions will result in an increase in successful outcomes 2

3 Educate yourself... empower yourself with knowledge! Why are behavioral interventions necessary? You know your child best Learn about the disorder Learn about treatments Make intelligent choices about what would work best for your child for it is a spectrum disorder, affecting each child differently Behavioral therapies are used because... An autism diagnosis is based upon behaviors---not medically based Generally a psychiatric/psychological diagnosis is made at months Most neurological development occurs during this time Experienced 18 months of abnormal deviant developmental behaviors... HUGE developmental gap You can not go back in time to go through this developmental period 18 month old What is the number one behavioral therapy for autism? The one that the family chooses All the programs generally focus on reaching the same goal Reduce negative behaviors Increase acceptable behaviors Optimize developmental potential for the child 3

4 Behavioral interventions and techniques ABA-Applied Behavior Analysis ACC-Augmentative and/or Assistive Communication DLT Daily Life Therapy DIR-Developmental Individual Difference Relation FC-Facilitated Communication Family Immersion PECS-Picture Exchange Communication System RDI-Relationship Development Intervention SCERTS-Social Communication Emotional Regulation Transactional Support Social Stories TEAACH-Treatment and Education of Autistic and Communication Handicapped Children Behavioral and educational therapies Often highly structured and intensive skill-oriented training that is tailored to the individual child Therapists work with children to help them develop social, play and language skills as well as remedy inappropriate behavior and reduce self-stimulatory behavior that impedes the learning process Sensory integration Behavior modifications focus on helping autistic patients cope with sensory stimulation Many autistic children suffer from sensory dysregulation Stimuli from environment is perceived differently affect your child's social skills Why is there an overlap between behavioral and biomedical interventions... Remember co-morbid biomedical conditions which can setback or slow down therapies No single treatment works for every child--what works for one child may not work for another, and A successful course of treatment often includes a combination of approaches Be aware of any change in meds or supplements this can affect behavior-applies for neurotypical as well as child with autism Why consider biomedical approaches for the treatment of autism? Biomedical treatment: the application of the natural, biological and physiological sciences to clinical medicine There is literature in peer review journals that suggests that there are several biomedical interventions that can be helpful for the treatment of the symptoms in many autistic spectrum disorder children 4

5 Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals with ASD: A Consensus Report.The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs. Buie et al, 2010, Pediatrics;125;S1-S /Supplement_1/ The Science The body is made up of specific systems, including skeletal, circulatory, immune, cardiovascular, nervous, digestive Digestive system Anatomy and function Food allergies/food intolerances Leaky gut/intestinal dysbiosis Immune system function Basic biochemistry Digestive System Mouth Stomach Small intestine-absorption Duodenum Jejunum Ileum Large intestine/colon Rectum Liver Pancreas-secretes enzymes and hormones Digestion-digestive tract function Digests food Absorbs nutrients Carries vitamins and nutrients into bloodstream Chemical detoxification Excretion How do you get nutrients from foods? Protein Foods are made up of proteins When foods are eaten and properly digested, proteins are broken down by enzymes into peptides Peptides are then further broken down into amino acids Amino acids are the building blocks of life What can go wrong with the GI? 1. Maldigestion/Malabsorption 2. Leaky gut 3. Intestinal dysbiosis a. Constipation b. Diarrhea c. Enterocolitis 4. Allergy 5

6 1. Maldigestion/Malabsoprtion Maldigestion -malfunctions with the digestive system which cause it to work improperly i.e. poor motility, insufficient enzyme function Malabsorption-an inability of the nutrients required from diet to fuel the cells and tissues of the body, and consequently health problems result 2. What is leaky-gut? Definition: an abnormal or unfavorable increase in intestinal permeability The intestinal lining is supposed to be protective barrier between the gut and the bloodstream Leaky gut/increased permeability Ø If the intestinal lining becomes damaged-it is possible for incompletely digested proteins and/or other by-products to leak through the intestinal lining Ø They can be recognized as foreign by the immune system, and/or leak into bloodstream 3. Dysbiosis Intestinal flora (yeast and bacteria) are a normal part of digestive track Intestinal dysbiosis occurs when there is an overgrowth/imbalance of intestinal flora(s) Dysbiosis results from Increased use of antibiotics, steroids, etc. Poor diet Diets high in sugar Stress Immune system dysregulation Potential intestinal dysbiosis or yeast symptoms Diarrhea Bloating and gas Abdominal pain and cramping Fatigue Insomnia Lethargy Sensory disturbances Chemical sensitivities a. Constipation/ b. Diarrhea a. Constipation-having a bowel movement fewer than three times per week Stools are usually hard, dry, small in size, and difficult to eliminate. Can be painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel b. Diarrhea-frequent loose or liquid bowel movements (often associated with infection, allergy and food intolerances) 6

7 If a child suffers from GI distress, like constipation, diarrhea Cramping, bloating causes distraction Posturing to relieve pain Pain may cause distress Pain may lead to self-injurious behavior c. Enterocolitis Ø Inflammation [itis](due to infection or irritation) that affects part or all of the intestines (the small [entero]and/or large [col] intestines) Ø Hyperplasia-general term for an increase in the number of the cells of an organ or tissue causing it to increase in size Ø Endoscopy-looking inside, the human body for medical reasons, by inserting a small scope in the body Ileonodular Hyperplasia Normal Terminal Ileum Consequences of intestinal dysbiosis or leaky gut -if left untreated Nutrients and vitamins aren t absorbed properly---vitamin deficiencies Intestinal distress Food allergies are created Detoxification is compromised Bacteria and yeast can be mobilized Formation of antibodies you might not want--- because of immune dysregulation If digestive issues continue untreated Improperly broken-down foods can have an affect upon behavior Essential nutrients for biochemical pathways and maximum metabolism are not available for proper cell function-can affect all systems of the body Behaviors that can be associated with gastrointestinal disease Crying Unexplained tantrums Night time wakening General irritability Vocalizing complaints Posturing Irritability just prior to bowel movement Hyperactivity and distractibility Self injurious behavior 7

8 4. Allergy The most obvious place for an allergic reaction to food to take place is in the GI track Reactions can range from acute to chronic A large part of the immune system is located in or near the intestinal tract-to helps prevent microorganisms in the intestine from entering into the rest of the body 1 st line of defense against pathogens Defects in the immune system can lead to gastrointestinal problems Food allergies vs. food sensitivies Food allergy vs. Food intolerance Food allergies An immune system response... to foods Body mistakes a protein in food as harmful, and creates a defense against it (antibody) Food intolerances Digestive system response to foods Not an immune system response Something in food irritates digestive system or person is unable to breakdown/digest food Can include metabolic food disorders such as lactose intolerance (missing enzyme) Symptoms include crapping, gas, nausea, and stomach pain If a child suffers from allergies Focus and concentration can be affected Immune system 1. Protects and defends against foreign cells 2. Memory-gets smarter 3. Responds appropriately 4. Do no harm Normal immune system function, depends upon proper immune systems responses Normally, there is a balance between infection and immunity The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful to the body. 8

9 Things can go wrong with the immune system... Hypersensitivity/Allergy Inflammation Immune system dysregulation Autoimmunity Allergy Allergy-is a disorder of the immune system that is often referred to as hypersensitivity affecting parts of the body not in direct contact with the allergen It may involve eczema (atopic dermatitis), allergic conjunctivitis, allergic rhinitis and asthma There appears to be a strong heredity component Immune system dysregulation Immune system dysregulation causes an abnormal immune response There is a shift or skewing lack of balance The immune system looses the ability to respond appropriately... If their are immune system issues Increased infections, inflammation can affect attention and concentration Allergic reactions can cause pain, irritation and distraction What happens if the immune system is compromised Immune dysregulation Abnormal balance and communication between immune cells Chronic Inflammation An abnormal, persistent activation of immune cells in the tissues Autoimmune reactions Antibodies targeting and causing injury to normal body tissues The liver and detoxification designed to remove toxic matter from the blood stream The immune system is closely connected to virtually every other system of the body Disorders in the immune system can cause disease 9

10 What happens if liver function is compromised? If detoxification systems are overloaded, destruction of nutrients necessary for proper detoxification occurs If detoxification pathways are overloaded, build up of toxins can occur If transsulfuration is disrupted, there is less antioxidant production, and oxidative stress can occur Basic Biochemistry Why is detoxification important? Ø To prevent injury to the cells and ultimately cell death Ø Cell injury and cell death is bad Ø In autism, toxins may be a cause of the neurological and immune dysfunction Ø Detoxification may help the cells to recover which will enable for healing Ø If toxins accumulate too rapidly, without being safely eliminated, they can cause damaging effects upon cells and tissues of the body Detoxification biochemistry Ø Methylation and sulfation: two of the healthy body s natural means of ridding itself of toxic substances: Ø methylation-transferring a methyl group Ø transsulfuration-responsible for production of glutathione-the body s number one antioxidant Methionine/Glutathione Transsulfuration Pathway Methylene THFolate MTHFR THFolate Methyl THF Remethylation pathways Methionine Synthase B12 Methyl B12 Dietary Proteins Methionine DMG TMG Homocysteine B6 Cysteine SAM SAH Transsulfuration pathway Critical to the body s ability to remove toxins! Glutathione (GSH) 10

11 Methionine/glutathione transsulfuration pathway in autistic children If biochemical pathways compromised Neurotransmission can be under or over stimulated If detoxification problems compile... Build-up of toxins can build up in the body, which leads to increased oxidative stress, Oxidative stress affects systems of the body-symptoms develop affect attention Additional health problems can develop Children with autism often need supplements to provide them with the raw materials their bodies need to carry out methylation and sulfation Ø B6 Ø Methyl B12 Ø DMG/TMG Ø Folic acid/folinic acid Ø Glutathione Signs and symptoms associated with nutritional deficiency Neurological symptoms Memory loss Psychosis Bruising Confusion Impaired learning Growth retardation Loss of appetite Poor immune function How can a child attend, focus, and learn? How do you treats biomedically? Look for a physician or other healthcare practitioner who considers an integrative approach to treatment combining mainstream medical therapies and CAM (Complementary and Alternative Medicine) therapies No single treatment works for every child. Optimal treatment often includes a combination of approaches Educate yourself 11

12 Expected key medical benefits of biomedical treatment for autism 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 get over viral infections quicker than the rest of the family. Improvements in digestive function, resulting in more normal stool frequency and consistency; reduction or elimination of lower abdominal pain or discomfort; reduction or elimination of loose stools or diarrhea. Then, behavioral benefits include Better socialization and initiation of communication with family and peers; Increase in more normal social interactions and social play Improved vocabulary and sentence structure; Improved cognitive function Improved higher order functions Children seem to thrive Why do behavioral and biomedical interventions go hand in hand? Because all discipline strategies can be affected by biomedical issues/conditions left untreated Warning signs that might reflect biomedical issues Any shift in behavior Looks for patterns of behavior change Red flags: changes in sleep increased irritability rashes hyperactivity Look for and treat underlying medical conditions 12

13 Signs of gastrointestinal distress 1. Posturing 2. Bloated belly 3. Toileting issues 4. Irritability 5. Abdominal pain Signs of immune system distress 1. Eczema 2. Rashes 3. Allergy 4. Infection 5. Irritability Signs of detoxification issues 1. Sleep issues 2. Hyperactivity 3. Lethargy 4. Irritability 5. Increased sensory sensitivities A happier, healthier child is going to be more responsive to behavioral, social and sensory interventions What next? A new paradigm in autism Autism is an environmental illness with a genetic component. It is a complex metabolic disease, not just a developmental disability. Autism is treatable, but... must continue fighting for a cure! 13

14 Take home lessons 1. Behavioral therapies are necessary because of missed developmental stages 2. There are biomedical options for treatment; basic immunology and biochemistry can explain how things can go wrong in the body, and that many autistic children suffer from real clinic symptoms that are treatable, and nutritional supplementation may be necessary to replace necessary building blocks for proper cell function and system functions If detoxification is not functioning properly, it may be necessary to supplement with co-factors to bypass deficiencies. These include methyl B12, folic acid, B6, DMG and/or TMG Most importantly, understand that biochemical and behavioral interventions need to be implemented together to enable more successful treatment results and outcomes And this is how you feel now... Don t try to do everything all at once!!!! More and more autistic children are 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 journey towards recovery Remember,... Be patient Be inspired Have strength Never give up hope, and Never give up courage Love your child! 14

15 Questions? 15