Autism Spectrum Disorders (ASD) encompass disorders such as Autism, Aspergers, and Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS). All of these disorders involve difficulties in social interaction, repetitive behaviors and verbal and non-verbal communication, however no two cases are exactly alike. Each person with ASD is like a unique snowflake, each with their own neurological, metabolic and genetic predispositions and abilities.
Autism and ASD involve the entire body, but clinically four (well, really three) of the most important areas to evaluate and treat tend to be the brain and nervous system, the immune system and the gut (which go hand in hand), and the liver and it's detoxification pathways. Below I will describe things I personally look for in persons with ASD.
1. Brain and the nervous system
I evaluate the nervous system three ways.
First, before a patient's first appointment I ask that a loved one or parent fills out the Master Hemispheric Checklist on my website. This breaks down symptoms and characteristics into right and left-brain dominant traits that helps me assess which hemisphere is dominant. The Master Hemispheric Checklist was adopted from the book Disconnected Kids by Robert Melillo, a book I recommend all my parents of Autistic children to read. In-house, I go through a battery of neurological tests with my patients. After doing these tests, I can usually identify one part of the nervous system that is not working as well (is "disconnected", if you will) and tailor my treatment to fit that individual. Treatments may involve neurological exercises (in-house or to do at home), specific chiropractic adjustments, or exercise. Last but not least, I assess the nervous system in a way that all chiropractors do by assessing the spine for subluxations. I find that this three-pronged approach gives me a better assessment of how the nervous system is doing, rather than simply relying on spinal subluxations alone.
If I feel that the patient can benefit from different neurological exercises such as neurofeedback or using an interactive metronome, I refer them to SIRRI in Tempe, AZ. Their program is very well-rounded and effective, and the man who is in charge is incredibly bright. I feel very fortunate to have such a great facility near by to refer to.
2. Gut and Immune System
Because 70% of your immune cells live in and around your gut, I find that treating the gut is an excellent way to work with the immune system. Only after I work from this angle will I consider doing other things to modify the patient's immune response.
When working with patients with ASD I immediately look for gluten and casein sensitivities because they are so, so common. The problem with traditional "gluten" panels is that they only test for Celiac Disease, a disease that makes up a very small fraction of those who are sensitive to gluten. I run a comprehensive gluten sensitivity panel on my patients through Cyrex labs in addition to other panels. If you or your child is sensitive to gluten you can bet your bagels that we'll find out on this test.
After we identify food triggers and remove them from the diet, I will often prescribe supplements to help sooth the gut and repair it. This may include probiotics, vitamin D, or a glutamine and herb product that I use to heal leaky guts.
3. Liver and Detoxification Pathways
The liver is critically important and is your body's detoxification organ. Weather you need to detoxify and get rid of drugs, pharmaceuticals, excess hormones, poisons, or other chemicals, your liver probably has a pathway for that. Finding out weather or not you have a problem in one of these pathways can be accomplished using two methods.
First of all, we can look at genetic screenings to determine if the patient has any genetic variations that make them less able to detoxify or use certain vitamins. For example, one's ability to use B vitamins is very important to the liver, so a polymorphism like the MTHFR SNP can play a big role here. Luckily there is a test available from 23 and Me that is very reasonably priced ($99). I recommend that not only the patient with ASD get this test, but the entire family as well. After all, you inherit your genes from your mother and father and your siblings may have a similar genetic trait. Best of all, if you order more than one test, 23 and Me gives you a discount on additional tests!
Unfortunately, the liver is one of those systems that is really tricky to assess using blood work. For example, I can measure glutathione (an antioxidant that is abundant in the liver), but I really have no way of knowing how much glutathione you need. If you're really inflamed, your need for this antioxidant is going to be much, much greater than someone who is less inflamed. For this reason, I typically rely on symptoms and history for this part of my exam, although occasionally I will order more in-depth testing if I see a need. For example, a good indication that you have a compromised ability to detoxify is if you have multiple chemical or environmental sensitivities.
Lastly, I'd like to point out what I do not do when addressing the liver- Chelation. Chelation involves the administration of chelating (binding) agents with the goal of removing heavy metals from the body. While it is true that many of us have heavy metals in our bodies, and many feel that metals such as mercury play some role in the development of ASD, I generally do not recommend chelation therapy in my patients with ASD. Research has repeatedly shown that while chelating agents free heavy metals from the bone and fat tissue, these metals are largely not excreted from the body. Instead, chelating agent have been shown to redistribute heavy metals in the body and preferentially dump them in the brain and liver- the last two places we want them going in patients with ASD.
As you can see, ASD is a complex condition that really requires careful examination and testing and a lot of time and TLC. There is no one magic bullet; no one therapy that will work for everyone. However, with a proper work-up and diligence I am confident that I can make a tremendous impact in people with ASD's health.