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Autism, an Extreme Challenge to Integrative Medicine

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Autism, an Extreme Challenge to Integrative Medicine A utis m R e vie w Autism, An Extreme Challenge to Integrative Medicine. Part 1: The Knowledge Base Parris M. Kidd, PhD Abstract inflammation and autoimmunity. Coagulation Autism, archetype of the autistic spectrum abnormalities have been reported. Part 2 of this disorders (ASD), is a neurodevelopmental review will attempt to consolidate progress in disorder characterized by socially aloof integrative management of autism, aimed at behavior and impairment of language and improving independence and lifespan for social interaction. Its prevalence has surged people with the disorder. in recent years. Advanced functional brain (Altern Med Rev 2002;7(4):292-316) imaging has confirmed pervasive neurologic involvement. Parent involvement in autism Introduction management has accelerated understanding In 1943 the psychologist Leo Kanner pub- and treatment. Often accompanied by epilepsy, lished case histories of a childhood developmen- cognitive deficits, or other neurologic tal disorder he called autism. He defined three impairment, autism manifests in the first three symptom patterns: (1) failure to use language for years of life and persists into adulthood. Its communication, (2) abnormal development of etiopathology is poorly defined but likely social reciprocity, and (3) desire for sameness, as multifactorial with heritability playing a major seen in repetitive rituals or intense circumscribed role. Prenatal toxic exposures (teratogens) are interests.1 Autistic children seem abnormally with- consistent with autism spectrum drawn, almost self-occupied, and out of touch with symptomatology. Frequent vaccinations with reality. As a group they score significantly lower live virus and toxic mercurial content on measures of adaptive or life skills than the gen- (thimerosal) are a plausible etiologic factor. eral population.2 Autistic children frequently have abnormalities Individuals with autism tend to have ex- of sulfoxidation and sulfation that compromise treme difficulty learning from experience and liver detoxification, which may contribute to the modifying their behavior to accommodate vary- high body burden of xenobiotics frequently ing situations.2 Coping with the unpredictability found. Frequent copper-zinc imbalance implies of the social world is especially demanding, even metallothionein impairment that could overwhelming, for adults with autism; associated compound the negative impact of sulfur anxiety exacerbates the problem.2 Adult individu- metabolism impairments on detoxification and als with autism have life outcomes that range from on intestinal lining integrity. Intestinal complete dependence to (rarely) successful em- hyperpermeability manifests in autistic children ployment. Most are able to benefit from structured as dysbiosis, food intolerances, and exorphin training programs with marked improvement in (opioid) intoxication, most frequently from their quality of life.3 casein and gluten. Immune system abnormalities encompass derangement of Parris Kidd, PhD (cell biology, University of C alifornia at antibody production, skewing of T cell subsets, Berkeley) – C ontributing Editor, Alternative Medicine Review; health educator and biomedical consultant to the aberrant cytokine profiles, and other supplement industry. impairments consistent with chronic C orrespondence address: 847 Elm Street, El C errito, C A 94530 Page 292 Alternative Medicine Review ◆ Volume 7, Number 4 ◆ 2002 Copyright©2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission R e vie w A utis m Autism has become epidemic in the in- Diagnosis, Classification, Epidemic dustrialized societies. In the United States, autism Prevalence was relatively rare until the early 1990s, after which its prevalence increased by at least double, The modern concept of autism recognizes and more likely 3-5 times.2 Similar steep increases Kanner’s “classic autism” as autism, autistic dis- in prevalence have been recorded in the United order or AD, and subsumes this within a broader Kingdom.4 The gender ratio is 3-4:1 boys to girls.2 category called autistic spectrum disorders or Since every autistic child has a major impact on ASD. For the physician these distinctions can be the family, school system, and community, this hard to make. In this review, use of the term au- epidemic calls for compassion, sensitivity, and tism will refer to AD and the broader category will maximum assistance from society as a whole. be referred to as ASD, unless otherwise specified. There is a great deal of debate in the healthcare world over the existence of an autism Emergence of the Disorder epidemic and the possible contributing factors. Autism begins very early in life. Almost Parents, supported by progressive healthcare pro- all autistic patients are normal in physical appear- fessionals, are on one side pointing at vaccines ance, but physiologic abnormalities can become manufactured with known toxic ingredients. On evident within mere months of birth.8 The three the other side are governmental and private orga- primary symptom patterns first defined by Kanner nizations seemingly unwilling to institute reform. manifest by 36 months. This characteristic triad The annual monetary cost of autism in the United may be accompanied by sensory and motor dys- States is estimated to be $26 billion.5 functions, or by cognitive or other mental process- From the clinical-biological perspective, ing deficits.9 Neurological abnormalities dominate this disorder or spectrum of disorders, is extremely autism. complex and multifaceted. Its expression, pathol- In the majority of autism cases the disor- ogy, etiology, and management rank it among the der first becomes apparent as a parent notices the most perplexing disorders known. Autism chal- growing child is not using words to communicate, lenges the intellect and research skill of investi- even though the child usually can recite the al- gators obtaining funding support to investigate it. phabet. In a minority of cases, autism appears as Yet despite all the limitations, real progress has developmental regression: parents report their been made within the last decade toward helping child was developing normally, then regressed – autistic people become productive members of so- occasionally abruptly – in language, sociability, ciety. and play.10 In rare cases motor skills also regress. The Autism Research Institute, founded After a plateau that lasts for some months, devel- by Dr. Bernard Rimland, and its Defeat Autism opment resumes, but in most cases never returns Now! (DAN!) initiative, have successfully ad- to its previous level. vanced medical management of autism to the de- Some autistic children make little progress gree that some children largely recover and can throughout their life, remaining nonverbal, se- have somewhat normal lives.6,7 Within the broader verely withdrawn, and mentally deficient, while medical community, diagnosis and assessment others fare better, although complete recovery is have also markedly improved, as have the pace rare.11 While 75 percent of AD cases are mentally and intensity of research. This review (Part 1 of retarded, only 50 percent of ASD cases exhibit 2) seeks to define the features of the disorder and retardation. As many as one in 10 autistics are sa- its core abnormalities. Part 2 will address the va- vants – gifted in areas such as music, drawing, riety of approaches to its medical management, memorization, or calculations. They have “islands along with priorities for future research. of genius” in skills that require attention to detail, memory, or computations such as calendrical cal- culating or perfect pitch.12,13 Tentative suggestions have been made that risk of autism may be greater Alternative Medicine Review ◆ Volume 7, Number 4 ◆ 2002 Page 293 Copyright©2002 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission A utis m R e vie w Diagnosis and Figure 1. Conceptual Interrelationships of the Autistic Classifications 16 Autism is diag- Spectrum Disorders nosed generally at around two years of age, when the child should begin to par- ticipate in organized social activities. Social deficits become evident when the child is compared with peers of the same age. The young child with autism is unlikely to seek out others AUTISM when he is happy, show or point to objects of interest, or call his parents by name. CHILDHOOD The child is, in a sense, ab- DISINTEGRATIVE ASPERGER'S normally self-occupied. DISORDER DISORDER During preschool years, re- petitive behaviors begin to develop. These could in- RETT'S clude using peripheral vi- DISORDER sion to look at lines or wheels, or peculiar hand and finger movements. From the early in- ATYPICAL AUTISM / PDD-NOS fant stage, children with au- tism are likely to be devel- opmentally delayed. Trained observers can de- tect movement abnormali- ties at four months.15 The in families where one or both parents has selected autistic child is observed to be less adept at mak- a field of interest emphasizing focus and atten- ing eye contact with another person, has poor abil- tion to detail.14 ity to make facial expressions, and is less able to Persons with autism have reduced life coordinate his vocalizations with his intentions, 5 compared to children within the normal develop- expectancy. Those with the most severe mental 8 retardation tend to die soonest. Those with mild mental range. or no mental retardation still die earlier than the In concept, the diagnosis of autism has not general population, most often
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