Autism One/Generation Rescue Conference 2012

The Dawn of a New Decade: From Truth to Treatment

May 23 - May 27, 2012The Westin Lombard Yorktown Center

70 Yorktown Shopping Center, Lombard, IL 60148

Lauren W. Underwood, PhD

Biomedical and Behavioral Therapies Implemented Together as a Treatment

Approach for Autism

Today’s presentationTreatments 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 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

Lauren W. Underwood

An overview of the behavioral-biomedical treatment model will be presented

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My goal as an educator . . .1st . . . The basics of autism,

then the science . . . .Biology

Anatomy and cell biologyImmunologyBiochemistry

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Then, the reasoning behind what can

go wrong with these systems . . . explain how issues with

these systems can affect behavior and behavioral

interventions

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. . . 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

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Neurotypical Autism

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ADHDAspergerSyndrome PDD-NOS Autism

Autism Spectrum Disorders

Understanding the underlying pathophysiologies that result in the biomedical

conditions associated with autism

Psychologically defined

Communication Stereotypicalbehaviors

Socialinteraction

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Normal Development versusAutismAbnormal development of

Communication skillsSocial skillsReasoning

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. . . . children with autism behave differently. .

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Autism is treatable!

Recent research shows that autism is treatableEarly interventions lead to the best outcomesBe aware of symptoms, and begin addressing

them as soon as possible

Lauren W. Underwood

Why behavioral AND biomedical?Many children with autism also suffer from co-

morbid medical conditionsBy treating the underlying medical disorders,

Reception to behavioral interventions will increaseThen, the synergistic effects of behavioral and

biomedical interventions will result in an increase in successful outcomes

Lauren W. Underwood

Lauren W. Underwood

Educate yourself . . . empower yourself with knowledge!

You know your child bestLearn about the disorderLearn about treatmentsMake intelligent choices

about what would work best for your child—for it is a spectrum disorder, affecting each child differently

Why are behavioral interventions necessary?

Lauren W. Underwood

Behavioral therapies are used because . . . An autism diagnosis is based upon

behaviors---NOT medically basedGenerally a psychiatric/psychological

diagnosis is made at 18-24 monthsMost neurological development occurs during

this timeExperienced 18 months of abnormal deviant

developmental behaviors . . . HUGE developmental gap

You can not go back in time to go through this developmental period

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18 month old

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What is the number one behavioral therapy for autism?

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The one that the family choosesAll the programs generally

focus on reaching the same goalReduce negative

behaviorsIncrease acceptable

behaviors

Optimize developmental potential for the child

Lauren W. Underwood

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

Lauren W. Underwood

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

Lauren W. Underwood

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 therapiesNo 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 approachesBe aware of any change in meds or supplements–this

can affect behavior-applies for neurotypical as well as child with autism

 Lauren W. Underwood

Lauren W. Underwood

Why consider biomedical approaches for the treatment of

autism?

Lauren W. Underwood

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

http://www.pediatrics.org/cgi/content/full/120/5/1162Lauren W. Underwood

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.”

Lauren W. Underwood

Buie et al, 2010, Pediatrics;125;S1-S18http://www.pediatrics.org/cgi/content/full/125/Supplement_1/

The ScienceThe body is made up of specific systems,

including skeletal, circulatory, immune, cardiovascular, nervous, digestive

Digestive systemAnatomy and functionFood allergies/food intolerancesLeaky gut/intestinal dysbiosis

Immune system functionBasic biochemistry

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Digestive SystemMouthStomachSmall intestine-absorption

DuodenumJejunumIleum

Large intestine/ColonRectumLiverPancreas-secretes enzymes and hormones

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Digestion-digestive tract functionDigests foodAbsorbs nutrientsCarries vitamins and nutrients into

bloodstreamChemical detoxificationExcretion

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How do you get nutrients from foods? ProteinFoods are made up of proteinsWhen 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

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What can go wrong with the GI?1. Maldigestion/Malabsorption2. Leaky gut3. Intestinal dysbiosis

a. Constipationb. Diarrheac. Enterocolitis

4. Allergy

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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

1. Maldigestion/Malabsoprtion

Lauren W. Underwood

Lauren W. Underwood

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

If the intestinal lining becomes damaged-it is possible for incompletely digested proteins and/or other by-products to “leak” through the intestinal lining

They can be recognized as foreign by the immune system, and/or “leak” into bloodstream

Lauren W. Underwood

3. DysbiosisIntestinal flora (yeast and bacteria)

are a normal part of digestive trackIntestinal dysbiosis occurs when

there is an overgrowth/imbalance of intestinal flora(s)

Dysbiosis results fromIncreased use of antibiotics, steroids, etc.Poor dietDiets high in sugarStressImmune system dysregulation

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Potential intestinal dysbiosis or “yeast” symptoms

DiarrheaBloating and gasAbdominal pain and crampingFatigueInsomniaLethargySensory disturbancesChemical sensitivities

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a. Constipation/ b. Diarrheaa. Constipation-having a bowel

movement fewer than three times per weekStools are usually hard, dry, small in

size, and difficult to eliminate. Can be painful to have a bowel

movement andoften 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)

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If a child suffers from GI distress, like constipation, diarrhea

Cramping, bloating causes distractionPosturing to relieve painPain may cause distressPain may lead to self-injurious

behavior

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c. Enterocolitis

Inflammation [itis](due to infection or irritation) that affects part or all of the intestines (the small [entero]and/or large [col] intestines) Hyperplasia-general term for an

increase in the number of the cells of an organ or tissue causing it to increase in size

Endoscopy-looking inside, the human body for medical reasons, by inserting a small scope in the body

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Ileonodular Hyperplasia

Normal Terminal Ileum

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Consequences of intestinal dysbiosis or “leaky gut”-if left untreated

Nutrients and vitamins aren’t absorbed properly---vitamin deficiencies

Intestinal distressFood allergies are createdDetoxification is compromisedBacteria and yeast can be mobilizedFormation of antibodies you might not want---

because of immune dysregulation

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If digestive issues continue untreatedImproperly broken-down foods can have an

affect upon behaviorEssential nutrients for biochemical

pathways and maximum metabolism are not available for proper cell function-can affect all systems of the body

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Behaviors that can be associated with gastrointestinal disease…

CryingUnexplained tantrumsNight time wakeningGeneral irritabilityVocalizing complaintsPosturing Irritability just prior to bowel movementHyperactivity and distractibility Self injurious behavior

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4. AllergyThe most obvious place for an allergic reaction to

food to take place is in the GI trackReactions can range from acute to chronicA 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

1st line of defense against pathogens  Defects in the immune system can lead to

gastrointestinal problemsFood allergies vs. food sensitiviesLauren W. Underwood

Food allergiesAn immune system response . . . to foodsBody mistakes a protein in food as harmful, and

creates a defense against it (antibody)Food intolerances

Digestive system response to foodsNot an immune system responseSomething in food irritates digestive system or person

is unable to breakdown/digest foodCan include metabolic food disorders such as lactose

intolerance (missing enzyme)Symptoms include crapping, gas, nausea, and

stomach pain

Food allergy vs. Food intolerance

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If a child suffers from allergies

Focus and concentration can be affected

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Immune system

1. Protects and defends against foreign cells

2. Memory-gets smarter

3. Responds appropriately

4. Do no harm

Lauren W. Underwood

Lauren W. Underwood

Normal immune system function, depends upon proper immune systems responses

The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful to the body.

Normally, there is a balance between infection and immunity

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Things can go wrong with the immune system . . .

Hypersensitivity/AllergyInflammation

Immune system dysregulationAutoimmunity

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AllergyAllergy-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 allergenIt may involve eczema (atopic dermatitis), allergic

conjunctivitis, allergic rhinitis and asthma There appears to be a strong heredity component

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Immune system dysregulation

Immune system dysregulation causes an abnormal

immune response There is a “ shift or skewing” – lack of balanceThe immune system looses the

ability to respond appropriately. . .

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If their are immune system issues

Increased infections, inflammation can affect attention and concentration

Allergic reactions can cause pain, irritation and distraction

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What happens if the immune system is compromisedImmune dysregulation

Abnormal balance and communication between immune cells

Chronic InflammationAn abnormal, persistent activation of immune cells

in the tissuesAutoimmune reactions

Antibodies targeting and causing injury to normal body tissues

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The immune system is closely connected to virtually every other system of the body

Disorders in the immune system can cause disease

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The liver and detoxification

designed to remove toxic matter from the blood stream

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 occurIf transsulfuration is disrupted,

there is less antioxidant production, and oxidative stress can occur

Lauren W. Underwood

Basic Biochemistry

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Why is detoxification important?

To prevent injury to the cells and ultimately cell death Cell injury and cell death is bad In autism, toxins may be a cause of the neurological and

immune dysfunction Detoxification may help the cells to recover which will

enable for healing If toxins accumulate too rapidly, without being safely

eliminated, they can cause damaging effects upon cells and tissues of the body

Lauren W. Underwood

Lauren W. Underwood

Detoxification biochemistry

Methylation and sulfation: two of the healthy body’s natural means of ridding itself of toxic substances: methylation-transferring a methyl grouptranssulfuration-responsible for production of

glutathione-the body’s number one antioxidant

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Dietary Proteins

Methionine

Homocysteine

Cysteine

Glutathione (GSH)

Methionine Synthase

MethylTHF

THFolate

MethyleneTHFolate

MTHFR

B6

TMG

DMG

MethylB12

B12

Transsulfurationpathway

Remethylationpathways

Methionine/Glutathione Transsulfuration Pathway

Critical to the body’s ability to remove toxins!

SAH

SAM

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Methionine/glutathione transsulfuration pathway in autistic children

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If biochemical pathways compromised

Neurotransmission can be under or over stimulated

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If detoxification problemscompile . . .

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

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Children with autism often need supplements to provide them with the raw materials their

bodies need to carry out methylation and sulfation

B6Methyl B12DMG/TMGFolic acid/folinic acidGlutathione

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Signs and symptoms associated with nutritional deficiencyNeurological symptomsMemory lossPsychosisBruisingConfusionImpaired learningGrowth retardationLoss of appetitePoor immune function

How can a child attend,

focus, and learn?

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How do you treats biomedically?Look for a physician or other healthcare

practitioner who considers an integrative approach to treatmentcombining mainstream medical therapies and CAM

(Complementary and Alternative Medicine) therapies

No single treatment works for every child.  Optimal treatment often includes a combination of

approachesEducate yourself

Lauren W. Underwood

Expected key medical benefits of biomedical treatment for autismImprovements 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.

Children seem to thrive Lauren W. Underwood

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 functionImproved higher order functions

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Why do behavioral and biomedical interventions go

hand in hand?

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Because all discipline strategies can be affected by biomedical

issues/conditions left untreated

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Warning signs that might reflect biomedical issues

Any shift in behavior Looks for patterns of behavior change

Red flags: changes in sleepincreased irritabilityrasheshyperactivity

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Look for and treat underlying medical conditions

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1. Posturing2. Bloated belly3. Toileting issues4. Irritability5. Abdominal pain

Signs of gastrointestinal distress

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1. Eczema2. Rashes3. Allergy4. Infection5. Irritability

Signs of immune system distress

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Signs of detoxification issues1. Sleep issues 2. Hyperactivity3. Lethargy4. Irritability5. Increased sensory sensitivities

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A happier, healthier child is

going to be more responsive

to behavioral, social and sensory

interventions

Lauren W. Underwood

Lauren W. Underwood

What next?

A new paradigm in autismAutism 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!

Lauren W. Underwood

Take home lessons1. Behavioral therapies are necessary because of

missed developmental stages2. 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

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Most importantly, understand that biochemical and behavioral

interventions need to be implemented together to enable

more successful treatment results and outcomes

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And this is how you feel now . . .

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Don’t try to do everything all at once!!!!

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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

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Remember, . . .Be patientBe inspiredHave strengthNever give up hope, andNever give up courageLove your child!

Lauren W. Underwood

Questions?

Lauren W. Underwood