This quarter I'm in a pediatrics class. I chose autism spectrum disorder for our written research project. Autism is controversial, especially with respects to the alternative medicine therapies. Many chiropractors, nutritionists, and medical doctors make fantastic claims about what can treat autism. I have been curious to know more about the research behind these claims and was glad to finally have a legitimate excuse to really read the journal articles more deeply. I wrote it pretty quickly (so it isn't as polished as I'd like) and I had to limit it to 4-5 pages even though there are many more topics I wanted to discuss.
When she was young, Temple Grandin would do something strange if she felt scared or otherwise stressed. She would run outside of her uncle's farm house, through the automated mechanical gate that she built, and continue until she got to the cattle shoot on the far side of the property. There she would crawl into the large contraption that held a cow captive during branding, and ask to have the clamps closed down on her sides. The pressure on the side of the body would quickly calm her down. She later would build a similar human sized box that she could operate herself while away at college. The simple fact that Temple can express why she acted in this way is unique among autistics, but she has many of the other peculiarities that are classic characteristics of those with Autism Spectrum Disorder.
Autism is a pervasive developmental disorder associated with a delay in behavioral development, especially communication and social interaction. The cause of Autism is unknown, though theories attribute it to a variety of body systems including neurological, metabolic, immunological, gastrointestinal, systemic inflammation and even go as far as inciting the influence of electromagnetic frequencies. There most certainly is a genetic component, as parents of a child with autism have up to a 18% chance of having a second child who is affected. The risk in identical twins is higher, reaching 95% in identical pairs. The genetic link leads to early onset of symptoms, usually before the first birthday, though official diagnoses are often delayed until 4 years of age. A reliable diagnosis can be made earlier using The Modified Checklist for Autism in Toddlers. The number of diagnoses has climbed over the years, with ongoing debate on whether this is due to improved identification tools or environmental or other causes leading to more cases. Prevalence estimates range from 1 per 1000 children to as many as 1 in 68, with boys 4-5 times more likely to be diagnosed than girls. Controversy continues over the possible connection between infantile vaccinations and autism thought to be caused by the inclusion of thimerosal as a preservative in vaccines. The original paper highlighting this correlation was written by Dr. Andrew Wakefield and published in The Lancet, and has since been retracted. Dr. Wakefield continues to defend his original work, while a meta-analysis involving 1.25 million children found no evidence for increased risk of autism following exposure to the MMR vaccine.
Common signs and symptoms include repetitive and maladaptive behaviors, limited interests and activities, and sensory processing disturbances. Gastrointestinal symptoms are common in children with Autism, but some doctors question the association, suggesting that while children may be more susceptible to GI upset, it should not be assumed as a normal symptom and should be investigated and treated as with any child.
The DSM V has modified the diagnostic criteria for autism and has grouped it with formerly distinct conditions in favor of the dimensional Autism Spectrum Disorder. Criteria include persistent deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities. Examples include the insistence on sameness - familiar routines day to day - and avoidance of eye contact. The diagnosis is further qualified by 3 levels of severity based on the amount of required support for the individual to function.
The medical approach to treating autism consists mainly of pharmaceuticals and behavioral therapy. There are two psychotropics authorized by the FDA to treat irritability in children with autism. Applied Behavior Analysis Therapy is an intensive treatment in which a therapist applies learning principles such as positive reinforcement to help children learn critical social and behavioral skills. Parents also are heavily involved in their children's treatment, learning how to employ similar therapies at home and often employing technological devices such as iPads with specialized speech communication software that allows children and adults with autism to better express their thoughts, feelings, and desires with those around them. Caring for children with autism is an expensive endeavor, amounting to estimated expenses of $3.2 million over the lifetime of an individual.
A definitive cure for autism has yet to be discovered. This does not prevent doctors, parents, and alternative health practitioners from proposing new and innovative ways to treat the condition. Due to the overwhelming responsibility of caring for an autistic child, parents are willing to go to unimaginable lengths in the hopes of seeing just a glimmer of change in their child's behavior. In the movie, The Horse Boy, Rupert and Kristin Isaacson chronicled their journey into the vast plain-lands and mountains of Mongolia to visit shaman and ritualistic healers via horseback, hoping to heal their autistic son. Despite the many options for care, scientific research supports only a handful of treatment methods.
Amongst the more favorable tools is music therapy. Autistic children appear to have increased attentional processing for music and other rhythmic sounds. Research has shown significant improvement with communication skills with the use of music in therapy. Various forms of art can also be introduced in group settings to help facilitate creative expression and non-verbal communication.
Animal therapy offers promising results, though it has yet to be proven with well designed research trials. The Isaacsons discovered the unique connection their son had with horses by accident, when he wandered into the stable of the nearby neighbor. Rowan's loud and spastic behavior did not bother the old mare, and when his father placed him bareback on the animal, he quickly calmed to a quiet meditative state, never before seen by his parents. Temple Grandin, the high-functioning autistic mentioned in the opening of this paper, is able to explain that the social behavior of animals matches that of the autistic more closely than human adults. It has been postulated that "these species show infantile characteristics that are very salient in humans, especially for children." Since autistics lack higher-level cognitive functions, they may relate to the more primal interactions offered by animals such as dogs and horses without having to process the more complicated spoken language and visual cues. Case studies and small trials show that working with dogs can help children to focus, increase attention span, and reduce frustration.
Nutritional therapies provide some of the most varied options and are also more difficult to evaluate. Trends show a focus on gut health, namely probiotics, high doses of fish oil or other essential fatty acids, Vitamin A, B6, or D, and restrictive diets avoiding refined sugars and gluten. Few of these approaches have been validated and cannot yet be generalized to all patients. However, low levels of omega-3 fatty acids have been shown in autistic children and basic science is clear that these nutrients are essential for brain development. Similar studies show low levels of Vitamin D, but the research on Vitamin B6 is less favorable, failing to show any benefit by supplementation. Still, many doctors are convinced that the gut plays a key role in the development of autism symptoms and encourage parents to investigate any GI distress as they would in any child. "GI disorders can actually produce behavioral effects that look like autistic behaviors. [… these] may actually be related to underlying GI disturbances or disorders" and should not be ignored as part and parcel with the diagnosis of autism. The great difficulty is that "there is no one autistic child that is the same as another." Each family may need to find a diet that benefits their child, keeping in mind that there may be no diet to actually improve their situation. Jim Laidler explains the long journey his family took into and then back out of alternative medicine in a Wired article. While trying to help their two autistic sons, they saw fast improvements with a strict gluten-free diet, avoiding refined sugars as well. But on a trip to Disneyland, one child gorged on waffles at a buffet. Despite their fears, they did not notice a regression in symptoms. "When they returned home, the Laidlers took David off his restrictive diet, and he continued to improve—rapidly."
Lastly, chiropractic treatments have been used to change neurological function in autistic children. Little more than several case reports have been offered, other than a small, poor quality randomized control trial comparing upper cervical to full-spine adjustments in 14 autistic children. Improvements on the Autism Therapy Evaluation Checklist were seen in 6 of 7 children receiving upper cervical, but only 5 of 7 children receiving full-spine adjustments. A systematic review on chiropractic care of autistic patients suggests that the chiropractic adjustment may help "attenuate sensorimotor integration based on somatosensory evoked potentials," but this addresses only one of the many theoretical causes of autism. Chiropractors with specializations in nutrition or functional neurology are running trials of care with experimental treatments.
Autism is a complicated and mysterious condition to understand, and the selection of treatments can present just as difficult of a challenge. No medical treatment offers the best care, and complementary and alternative therapies can be included to ameliorate behavioral symptoms. These can be prohibitively expensive and often fruitless. The most rational approach may involve a trial of medical, behavioral, activity, and nutritional components, avoiding treatments that require serious sacrifices. Patients should focus on the management of behavior while patiently addressing social skills with trained therapists. Chiropractic care is not contraindicated and may provide physical benefits as with unaffected children.
Alcantara, Joel, Alcantara, J. D., & Alcantara, J. (2011). A systematic review of the literature on the chiropractic care of patients with autism spectrum disorder. Explore (New York, N.Y.), 7(6), 384–390. http://doi.org/10.1016/j.explore.2011.08.001
Hart, J., Bock, K. A., Cartaxo, A., Converse, J., & Ferro, P. (2015). Roundtable Discussion: The Impact of GI and Nutritional Issues on Autism. Alternative and Complementary Therapies, 21(2), 84–89. http://doi.org/10.1089/act.2015.21207
Herbert, M. R., & Sage, C. (2013). Autism and EMF? Plausibility of a pathophysiological link - Part I. Pathophysiology : the Official Journal of the International Society for Pathophysiology / ISP, 20(3), 191–209. http://doi.org/10.1016/j.pathophys.2013.08.001
Herbert, M. R., & Sage, C. (2013). Autism and EMF? Plausibility of a pathophysiological link part II. Pathophysiology : the Official Journal of the International Society for Pathophysiology / ISP, 20(3), 211–234. http://doi.org/10.1016/j.pathophys.2013.08.002
Horowitz, S. (2015). Trends, Theories, and Treatments for Autism. Alternative and Complementary Therapies.
Khorshid, K. A., Sweat, R. W., Zemba, D. A., & Zemba, B. N. (2006). Clinical efficacy of upper cervical versus full spine chiropractic care on children with autism: a randomized clinical trial. J. Vertebral Subluxation Res.
Clinical Roundup: Selected Treatment Options for Autism. (2015). Alternative and Complementary Therapies, 21(2), 92–97. http://doi.org/10.1089/act.2015.21208
Autism: An Integrative Approach: A Natural Medicines Monograph. (2015). Alternative and Complementary Therapies, 21(2), 90–91. http://doi.org/10.1089/act.2015.21202
Other Cited Resources
The Horse Boy. www.horseboymovie.com
An Alternative Medicine Believer's Journey Back to Science. http://www.wired.com/2015/04/alternative-medicine-believers-journey-back-science/