Autismus
Anhang 2
Asperger syndrom
Begabung und Herausforderung
Kinder mit der milderen Form des Asperger-Syndroms können reflektieren und sind meist nicht weniger intelligent als der Durchschnitt. In vielen Fällen sind sie sogar hochbegabt und haben ein Spezialgebiet. Weil sich auch ihre Sprache normal entwickelt und sie sich manchmal sehr gewählt ausdrücken, wird das Asperger-Syndrom oft
erst nach der Grundschule diagnostiziert. Asperger-Kindern fällt der Kontakt mit anderen schwer, sie können sich nicht in sie hineinversetzen und Blicke, Gesten und
Ironie deuten. Sie benötigen Routinen und eindeutige Ansagen. Informationen müssen sie logisch verarbeiten.
Über die Ursache des Syndroms streitet die Wissenschaft, sie liegt wohl in einer zu schwachen oder zu starken Verbindung zwischen Gehirnregionen.
Nicht nur in IT-Unternehmen wie Auticon und SAP werden Autisten mit dem Asperger-Syndrom wegen ihrer Akribie und ihres oft phänomenalen Gedächtnisses sehr geschätzt. Jeder 55 Erwachsene mit dem Asperger-Syndrom findet eine Anstellung - als Techniker, Informatiker, einige auch als Professor. Unbekannt hingegen ist, wie
viele "unentdeckte Autisten" längst fest im Berufsleben stehen.
[Jean Lacombe]
Many cases of children suffering autism can be greatly improved through
homeopathy. In fact, some of the patients can have a complete recovery.
In this article I will share my experience with five cases of autism that
had been successfully treated in the past few years. There are two different
protocols offered for
dealing with autistic disorders as well as principal homeopathic
characteristics that are often found in cases of autism. A short list of
certain specific remedies which are
more effective in treating autism and recommendations of their proper
dilution will also be included. At the end of this article I will include the
level of general improvement achieved for every child.
Two homeopathic approaches in treating autism
In the last years I have developed two protocols that resulted in
significant improvement of young patients. The first is prescribing a remedy
according to the principle of “totality of symptoms” recommended by Hahnemann.
While treating my autistic patients I have noticed that in many cases the
prescription generally groups around ten homeopathic remedies.
The second approach is to “desensitize” the children from the possible
side effects of vaccines they received by prescribing the homeopathic remedy
made from the vaccine itself. This method can be recommended as an experimental
approach when parents have clearly noticed that the child’s character and
behavior changed during the days following vaccination. In many cases it
appears that MMR vaccine -measles, mumps and rubella- sometimes produces large
energetic disturbances as well as major disruptions of the defense system. When
this occurs, MMR itself in dilutions of 30C to 10M would be prescribed.
Recommendations about the potency of the remedy will be discussed later in this
article.
Characteristic Autism Symptoms in 5 Cases:
The cases of Noah (5 year old), Igor (5 year old), Sebastien (7 year
old), Raphael (4 year old), and Misma (6 year old), have a lot in common. Aside
from the fact that all
of these children had been diagnosed with autism, they also had a number
of characteristic symptoms. I have divided their symptoms into three
categories:
1st category combines
symptoms that I have found in all children;
2nd category includes the
symptoms present in at least three children;
3rd category contains
symptoms that affected only one child, but they are essential in confirming the
prescription.
Group 1: Symptoms Found In All 5 Children
Psychic hypersensitivity
Although each of the children
appears as “in a closed shell”, paradoxically, they exhibit extreme sensitivity
and often very strong reactions to the atmosphere, people (sometimes even
spontaneous aversions to a particular individual) or changes in schedule/order.
< Admonition
In circumstances when the parents have to go against their child`s will
or desire, it is necessary to approach the situation with patience. The simple
word “No” often leads to excessive crying or violent anger. With one of the
children, scolding led him to hit his head against floor or walls.
Some additional rubrics of repertory to consider are:
Crying for nothing among children
Irritability among children
Language Delay Not
surprisingly, the speech of each child is poorly developed. Two of them don`t
demonstrate any desire to communicate.
Certain delays in physical growth
The physical development of four of
the children is significantly below the average. For the younger kids it is
close to normal, but still, they are feeble.
• Concentration difficult
The concentration of these children seems pretty normal when they are
doing activities they like, such as watching TV, playing video games, etc.
However, the concentration is totally inadequate when
they have to face necessities, for example, while doing their homework
in preschool, or trying to remember directions, etc.
After putting together the symptoms of the first group, we find the best
remedies are: Carc. (10), Bar-c. Sil. Tub. (8), Calc-p. Med. and Nux-v. (7).
Group 2: symptoms presented in at least 3 children:
Aversion to talking, reserved,
doesn’t play with other children (mute, do not want to play with others)
Except for one child, the
children have problems with or have no interest in playing or sharing
activities with other children (or sometimes even with parents).
• Avoid eye contact
With the exception of one child,
these children do not seek eye contact with others and try to flee it. When
confronted with this type of interaction, they feel irritable.
• Compulsive or obsessive
behavior
These types of behaviors often expressed by one or another child …
jumping up, standing on a chair or a table and jumping to the floor, or always
keeping toys in their hands (teddy bears or small cars)
• Agitation in children
None of these children could calmly attend the consultation.
• Sensitivity to music
Most parents reported that their child vividly reacts to certain musical
tunes. Some music can make their child hum or dance.
• Autism, after vaccination
All these children had been vaccinated. In 3 cases, the parents noticed
an immediate change of character or behavior the day after or the following
week after their vaccination. Parents of the other two kids cannot remember
anything particular (Fever? Sleep disorder? Eczema or pulmonary problem? First
symptoms of autism?)
The results of repertorising the symptoms of the second group are: Carc.
(9); Cham. Merc. Nat-m. (6).
Combining all the symptoms of group 1 and 2 gives the following: Carc.
(18); Nux-v. (12) Tub. (12). Cham. Med. Nat-m. (11)
Group 3: characteristic symptoms affecting only one child:
Grinding teeth at night
• Sleepwalking
• Nightmares
• Intolerance to milk and dairy
products
• Bad breath
Smelly stool
• Nail biting
• Warts on hands and fingers
The result of repertorising the
group 3 symptoms is: Sulph.; Ars. and Tub.; Calc.; Nat-m.
Combining all three categories of symptoms (groups 1, 2, 3) revealed a
new balance for remedies: Tub.; Sulph.; Nat-m.; Ars. Carc.
Remedy selection.
The first approach (classical homeopathy) based on the rule of totality
of symptoms considers 4 points:
After twenty characteristic
symptoms have been observed, some remedies were almost always present at every
step: Carc. Tub. Med. Nat-m.
The point mentioned above is
interesting for two reasons:
A) Carc. Tub. and Med. cover a
relatively small number of symptoms. They are present in a limited number of
Materia Medica rubrics (unlike Phos. Sulph. Calc. etc.) and yet… being the
characteristic symptoms of autism … these remedies are in the first places!
B) These three remedies belong
to the category of rather rare remedies, the nosodes.
Reflecting on the rubrics
relating to the etiology “Following vaccination”, we have found these 4
remedies (Carc. Tub. Med. Nat-m.) not only in this category but also in the
section “Autism, result of vaccination” in the repertory of Murphy (3rd
edition).
In 5 cases, the 1st approach led
to prescribe Carc., the remedy that covers best the totality of symptoms of
groups 1 and 2. In 4 of 5 cases, the treatment after Carc. was completed by
Tub. +/o. Nat-m.
Remedy selection (Approach 2).
In two of five cases, I have also tried to use another method, the sequential
therapy of Dr. Elmiger. This second approach doesn`t require any repertorising.
You just need to be sure that the child has been affected by the vaccination
and help “desensitize” the patient. The prescription should be the remedy
diluted and energized from the vaccine that caused the problems. In one case
the dose of MMR 30, 200, 1M and 10M K has been prescribed. In the second case,
we started from the last immunization at the age of 4 years and have gone
backward to childbirth. The prescribed remedies were MMR and DPT/ Sabin /
Meningitis, Hepatitis. Both vaccines in doses of 30, 200, 1M and 10M K.
Observations about the second approach:
1. The prescription is not done according to the law of similarity but
the principle of identity.
2. Despite the simplicity of this approach, results of the prescription
can be spectacular.
3. The main idea of this approach, is that a vaccine created an energy
barrier leading to appearance of the symptoms, and the remedy in potentized
form will remove that barrier.
This approach is done by prescribing the potentized vaccines in a
certain order, corresponding to the successive layers of appearance of
symptoms. If a child had been vaccinated by X vaccine, then by Y vaccine, and
finally
by Z vaccine, the order of prescription should be reversed, starting
with the vaccine Z, then give the Y, and end with the prescription of X vaccine
in proper dilution.
Results:
After a year of treatment, the diagnosis of autism was reversed for one of
the boys. The first prescribed remedy was Nat-m. 30CH. Immediately the mother
noticed that her son’s speech improved and that he had a greater desire to
communicate. Tub. and particularly Carc. in doses of 30, 200, 1M and 10M K
alleviated the symptoms of groups
1 and 2 by over 80%. The child has since been accepted into a regular
classroom.
The second patient responded very quickly to the prescription of 200K
and 1M of Carcinosinum. Most symptoms of groups 1 and 2 were improved by about
50%. The child continues to take Carc. 1M once a month.
For the 3rd patient, the symptoms of groups 1 and 2 were
reduced by more than 80% after doses of Nat-m. (30C to 10M). His treatment
lasted for 18 months.
Over a period of 8 months, the 4th child had extraordinary results
with Carc. 30, 200, 1M and 10M. Considering that we had the situation under
control with Carc we decided to continue treatment with MMR. It was clear for
the mother that the child’s personality had changed in the days following the
MMR vaccination. After administering the MMR 10M, the parents saw that their
child had become normal again! A strong desire to communicate at home and at
school, laughing, humor in the classroom. The boy refused to sit down when his
teacher asked, but looked at the teacher with open eyes and
a wide smile! He is able to sleep alone, wakes up happy now and dresses
himself. A new symptom of a bad breath appeared. Over the last three months MMR
10M was prescribed once monthly.
The boy is speaking more all the time. He looks obviously “happy.”
A last child had no reaction to the prescription of the second approach.
The successive doses of DTP vaccine (diphtheria, tetanus, pertussis), then a
dose of Sabin/Hepatiti/Meningitis/influenza vaccine, and subsequently a dose of
MMR were taken with no results, but increasing amount of stool. I then chose
the first approach and gave the boy Carc. 30, 200, 1M and 10M. There was no
significant reaction, except a new tendency to bite. Troubled by the total
ineffectiveness of these two prescriptions
I reviewed the case and prescribed a single dose of Stram. 10 M
(hyperactivity following vaccination, autism, desire to bite). The treatment is
ongoing. What a helpless feeling it was when a normally effective approach led
to a minimum of overall improvement!
The choice of the potency
The treatment of these 5 cases during the last three years was a
relatively recent experiment. Four of the five patients are still in the
process of recovery. I would like to confirm that high dilutions (1M, 10M) of
the remedies used are more effectives and provide better results. For many
years I taught my students at Quebec Homeopathic Centre the principle that
“totality of symptoms leads to the choice of remedy, as the nature of the
symptoms leads to the choice of potency.” In the case of autism the symptoms
are very characteristic and particularly intense. It looks like the vital
energy is very powerful and therefore, it would require high dilutions of the
prescribed remedies to restore balance.
Conclusion:
In all cases of autism it is possible to reduce or eliminate many of the
distressing symptoms in autistic children. In many cases it is possible to
achieve complete recovery in these patients! At this stage of my experience I
have found that the treatment of autism does not seem to be very difficult as
long as the appropriate remedy has been chosen. The symptoms presented in the
cases are very characteristic (see groups 1 and 2) and they lead to a rather
limited number of homeopathic remedies. Additionally, when considering that the
vaccination is the trigger of the disease, the prescription of remedies such as
Carc., Tub., Nat-m. and Med. appears to be almost inevitable.
The less “classic” sequential approach can be equally effective in
treating autism. This relatively easy to use method can also give surprising
results. I hope that sharing these experiences will stimulate discussion of
these methods and lead to many more successful healings.
[Prof. Dr. Karoly Horvath] arbeitet seit 1990 an der Universitätsklinik Maryland in Baltimore, Pädiatrie - Abteilung für Kinder - Gastroenterologie.
Er ist gebürtiger Ungar, sein Forschungsschwerpunkt an der Semmelweisklinik in Budapest war Zöliakie.
Im Vortrag erläuterte er seine Doppelblindstudie über die Wirkung von Sekretin bei autistischen Kindern im Alter von ca. 2 - 6 Jahren. Sie wird voraussichtlich im Herbst 1999 fertig gestellt sein.
Er zeigte folgende Hypothesen als mögliche Ursachen von Autismus auf:
Opioid Theorie: Abbauprodukte von Gluten und Casein (Peptide) haben
Veränderungen bei Vorgängen im Gehirn zur Folge und führen zu autistischen Verhaltensweisen.
Umwelteinflüsse: Einwirkungen von Toxinen
Antibiotische Therapie: Überwachsung der Darmflora [Pilze (Candida)]
Impfungen: Mumps-Masern-Röteln-Impfung
Autoimmunerkrankung: ein Forscher in Amerika fand Auto-Antikörper gegen Gehirngewebe bei autistischen Menschen
Keine dieser Hypothesen ist jedoch wissenschaftlich fundiert nachgewiesen und er führte diesbezüglich folgende Therapien an:
Gluten- bzw. (und) caseinfreie Diät
Pilzbehandlungen
Substitutionstherapie mit Darmbakterien
Antikörper - intravenös: Gammaglobuin
psychiatrisch wirksame Medikamente
Letztere Behandlungsart wird von ihm angewendet und im Rahmen einer Gastroskopie konnten positive Veränderungen im Verdauungsvorgang und in Folge davon bei der Mehrzahl der Kinder Verbesserungen im Verhalten festgestellt werden. (Sozialverhalten, Sprache, Stereotypien)
Eine vermehrte Bildung von Verdauungssäften wurde beobachtet.
Wie bereits in der Zeitschrift der "Österreichischen Autistenhilfe" März 99, S.11 angeführt wurde, erläuterte er einen Zusammenhang des Sekretins mit den Gehirnaktivitäten, indem es die Produktion und Verwertung von Neurotransmittern anregt.
Im Zentralnervensystem gibt es verschiedene Stellen, wo Sekretinrezeptoren angesiedelt sind.
19 Gewebshormone könnten möglicherweise auch Auswirkungen auf Gehirnfunktionen haben, eines davon ist Sekretin.
Durch Tierversuche kam man zur Annahme, dass es Hormone gibt, die Nervenzellen vergrößern und die Zahl der Nervenverbindungen im Gehirn vermehren können.
Diese Beobachtungen können in eine neue Richtung bei der Forschung über Autismus weisen und möglicherweise eine Ursache für Autismus finden helfen.
[Karoly Horvath MD. PhD.* and Jay A. Perman. MD†]
Autistic disorder and gastrointestinal disease
Autistic disorder is a pervasive developmental disorder manifested in
the first 3 years of life by dysfunction in social interaction and
communication. Many efforts have been made to explore the biologic basis of
this disorder, but the etiology remains unknown. Recent publications describing
upper gastrointestinal abnormalities and ileocolitis have focused attention on
gastrointestinal function and morphology in these children.
High prevalence of histologic abnormalities in the esophagus, stomach,
small intestine and colon, and dysfunction of liver conjugation capacity and
intestinal permeability were reported.
3 surveys conducted in the U.S. described high prevalence of gastrointestinal
symptoms in children with autistic disorder. Treatment of the digestive
problems may have positive effects on their behavior.
Recent epidemiologic data indicate that autistic disorder (AD), as
defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th
edition (DSM-IV) criteria, affects as many as 1of 250 children.
This represents significant change since the early 1990s when autism was
diagnosed in 1of 1000 to 2000 children. A gender difference is seen in AD;
approximately 80% of the children are boys. Most of the recently diagnosed
cases belong to the “late onset” group: normal development in the first year of
life followed by regression in social and communication skills.
The focus in autism research has expanded from psychological studies to
exploration of the biologic basis of this pervasive developmental disorder.
Although the number of published metabolic, genetic, immunologic, and
neuroimaging studies has significantly increased, we are still far from
understanding the etiology of autistic disorder.
It is likely that no single cause exists. A generally accepted consensus
regarding the brain areas responsible for autism does not exist.
The gastrointestinal (GI) tract was a relatively neglected part of autism
research until the late 1990s, although two studies published almost three
decades ago suggested GI problems in children with AD. In 1971, a report of 15
randomly selected autistic cases described six children who had bulky, odorous,
or loose stools, or intermittent diarrhea; one patient had celiac disease.
The other study described low serum concentrations of -1 antitrypsin.
Two studies were published in 1998, which drew significant attention and
initiated a new period in the investigation of the GI tract of children with
AD. Wakefield et al. described ileal-lymphoid-nodular hyperplasia and
nonspecific colitis in 12 children with developmental disorders; for 9 of them
the diagnosis was AD. The other study, which was a case report of three
children with AD, reported the results of upper GI endoscopies.
This paper described increased pancreaticobiliary secretory response
following intravenous secretin administration, coinciding with a significant
amelioration of the GI symptoms and improvement in eye contact, alertness, And
expansion of expressive language. This review summarizes the GI symptoms, and
histologic and functional abnormalities reported in children with AD.
ISSN 1040–8703 ©2002 Lippincott Williams & Wilkins, Inc. DOI:
10.1097/01.MOP.0000030221.71203.46 583
Gastrointestinal symptoms in children with autistic disorder Population
surveys can provide a picture of the magnitude of GI problems in children with
AD.
Three surveys (a total of 1280 subjects with AD) have been reported from
Arizona, California, and the middle Atlantic region.
Agreement was found among the surveys that close to 20% of these
children had chronic diarrhea. Our detailed survey in which children with AD
were compared with their siblings found the following GI symptoms:
diarrhea (three or more loose or
watery stools per day, persisting longer than 2 weeks);
constipation (two or fewer bowel
movements per week hard in consistency; foul smelling stools; gaseousness (two
to three times per week);
abdominal bloating (at least one
time per week);
abdominal discomfort (at least one
time per week);
food regurgitation (more than once a
week).
Table 1shows the prevalence of GI symptoms in
112 consecutively examined children with AD and their nonautistic,
age-matched siblings living in the same household. Overall, 76% of the autistic
patients had at least one GI symptom as compared with 30% of the healthy
siblings. Most the children with AD (64%) had two or more symptoms. A high%age
of children more than 4 years of age with autism (48%) were not yet toilet
trained, compared with 2% of their siblings.
Nongastrointestinal symptoms suggestive of digestive disease
Children with AD frequently have reflux esophagitis.
Infants and children with gastroesophageal reflux disease more frequently
have sleep disturbance than the normal population.
Nighttime wake-up with pain, abdominal discomfort, or both is common
feature of gastroesophageal reflux and reflux esophagitis in children. We found
a higher prevalence of sleep disturbances and sudden irritability in children
with AD who had GI symptoms.
Sleep disturbances
Children with neurologic, neuropsychiatric, and developmental
disabilities are predisposed to sleep disturbances.
Sleep problems (interrupted sleep and limited hours of sleep) were reported
in one third of handicapped children.
Another study of children with autistic disorder reported a 64%
prevalence of sleep problems.
The most common problem was
difficulty falling sleep (41%),
frequent awakening (34%)
early morning awakening (20%).
Our study found disturbed sleep with nighttime wake up in 52% of the
patients with autism versus only 7% of the healthy siblings (P < 0.001).
Children with AD and GI symptoms had a higher prevalence of sleep disturbances
(55%) compared with those who did not have GI symptoms (14%). In our series of
36 children with autistic spectrum disorder, 61% of those with AD and reflux
esophagitis had nighttime wake-ups compared with 13% of those without reflux
esophagitis.
Sudden irritability or aggressive behavior
It is difficult to assess the cause of sudden irritability manifested as
unexplained crying and aggressiveness in these nonverbal children with AD. More
than 1/3 of the parents reported these symptoms in their children.
Although these features are not part of the DSM-IV criteria of autistic
disorder, many experts consider them as autistic symptoms. We found that 43% of
28 children with esophagitis had daytime unexplained irritability versus 13% of
those who had normal esophageal histology.
Whereas 24-hour pH probe measurements are necessary to establish a close
correlation between acidic refluxes and irritability, it is technically not
feasible to perform this procedure in most of these children.
Functional gastrointestinal abnormalities
Disaccharidase activities
Low activities of disaccharidase enzymes (lactase, maltase, sucrase,
palatinase, and glucoamylase) were present in 21of the 36 children (58%) with
AD. The most frequent finding was a low lactase level, which was present in 14
of 36 patients. Ten children had decreased enzyme activities in two or more
enzymes. Children with low enzyme activities had loose stools, gaseousness, or
both. Functional studies of carbohydrate malabsorption to prove the clinical
significance of the disaccharidase findings would require that these children
cooperate for breath hydrogen testing, which is not feasible in this
population.
Pancreatic enzyme activities
Astroenterology and nutrition dases) consistent with pancreatic
insufficiency. This patient’s sweat chloride test result was normal. For the
remaining children, no difference was seen in the fasting
pH of the duodenal fluid nor in the prestimulatory and poststimulatory
enzyme activities between those who were autistic and those who were not.
Pancreaticobiliary fluid secretion
Because secretin has a secretory effect on both pancreatic duct cells
and the biliary epithelium, the fluid response (mL/min) represents a
combination of these two fluids. We observed increased volume of secreted fluid
following secretin administration (2 cu/kg body weight [BW], intravenous,
during endoscopy). Average pancreaticobiliary fluid output was significantly
higher (3.8 ± 2.2 mL/min) for the autistic group compared with controls (1.46 ±
0.57 mL/min; P < 0.05). Of the 36 children studied, 75% had a fluid output
1SD above the values of the patients who were not autistic. Typically, the
children with AD with chronic diarrhea had a higher fluid output compared with
those without diarrhea (4.8 ± 2.3 vs 2.4 ± 1.3 mL/min; P < 0.05).Increased
response to administration of a hormone is suggestive of the upregulation of
the receptors for that hormone. The reason for the increased response warrants
further investigation.
Intestinal permeability
D’Eufemia et al. reported that 43% of the children with AD without
evident GI symptoms had increased intestinal permeability (lactulose/mannitol
[L/M] test) as compared with none of the 40 controls. We performed permeability
studies by using L/M tests in 25 children with AD and GI symptoms. Of the
children, 76% (19/25) had a LM ratio above the cutoff value (0.03).
Sulfation deficit in the liver
Abnormal serum liver function tests have not been described in children
with AD. Waring et al. studied the conjugation (sulfation and glucuronidation)
process in the liver by using acetaminophen as substrate, and reported that the
sulfate conjugation of acetaminophen was diminished in children with AD
compared with those of age-matched children. We performed three acetaminophen
tests on the same 26 children with AD.
Of the 26 children, 22 (85%) had basal acetaminophen sulfate:
glucuronide ratio less than 1. Although slight fluctuations were seen, the
individual ratios stayed in the same range in the two repeat tests performed at
6-week intervals. These measurements suggest a persisting defect in the
sulfation capacity of the liver (unpublished data). This decrease in the
sulfation, if present in the brain and small intestine, may influence the
activation and catabolism of certain hormones and neurotransmitters.
Histopathology of the gastrointestinal tract
Gross upper GI endoscopic findings (ulcers, erosions) are rarely found
in these children. On routine histologic examination, reflux esophagitis
(25/36; 69%) was the most frequent finding in 36 consecutive children with AD
who had upper GI endoscopy. The clinical symptoms correlated well with the
histologic findings. Of the children with reflux esophagitis, 93% had at least
one of the following symptoms: signs of abdominal pain, nighttime
wake-up, and sudden daytime irritability.
Chronic gastritis was reported in 15 of 36 children. Of the 36 children,
24 had chronic duodenitis. Although increased numbers of lymphoid aggregates
and lymphocytic infiltrate in the mucosa with mild distortion of the surrounding
glands were present in the stomach, none of the children had Helicobacter
pylori infection. Only 2 of the 36 children had mild villous blunting in the
duodenum, but the histologic features were inconsistent with celiac disease. We
have tested the sera of more then 400 children with AD, and none of them had
serologic evidence of celiac disease (unpublished data).
A gluten- and casein-free diet is generally used in patients with AD.
This practice is based on two hypotheses. The first is that autistic behavior
can be partially caused by a dysfunction in the brain opioid system. The second
is based on the fact that both gluten and casein have potentially opioid
segments called “gliadorphins” and -casomorphins, respectively. It is presumed
that because of the “leakiness” of the intestine these peptides pass the
intestine and reach the brain.
However, scientific confirmation of these two hypotheses is warranted.
Routine histology showed increased staining at the base of crypts where
Paneth cells are localized. Paneth cells produce many factors (eg, lysozyme,
lactoferrin, defensin), which may play a role in local immune defense.
A morphometric analysis of Paneth cells was performed on the biopsies of
all the 36 children with AD and 22 agematched controls who were not autistic.
An elevated number of Paneth cells per crypt were found compared with the
control group (3.09 ± 0.46 vs 2.07 ± 0.32; P < 0.05). Our recent
immunohistochemical studies combined with digital image analysis revealed that
the lysozyme content was much higher in the Paneth cells of autistic subjects
than in controls (unpublished data). No clear explanation exists for the
changes in the Paneth cells in children with AD. It may be the consequence of
either
a dysfunction in local immune defense or in the digestive system.
Wakefield et al. obtained ileocolonic biopsies from 60 consecutive
children with developmental disorders, 83% of whom had AD. 59% had one or more
GI symptoms (eg, abdominal pain, constipation, diarrhea, changing stool
consistency [constipation # diarrhea], or bloating. All were well nourished
with height and weight within the normal range. Colonic endoscopic findings
included segmental swelling, hyperemia, superficial erosions, and nodularity.
On histologic Autistic disorder and gastrointestinal disease Horvath and Perman
585 examination, mild to moderate ileal lymphoid nodular hyperplasia (LNH) was
described in 93% of the developmentally delayed and autistic children examined.
In the colon, 30% had LNH. Histologic signs of chronic colitis were identified
in 53 of 60 children (88%). An increase in the number of intraepithelial
lymphocytes was present in 13% of the children. None of these findings was
compatible with an inflammatory bowel disease.
The same research group performed immunohistochemical staining on
transverse colonic biopsies of 21children with AD and in four control groups:
normal controls (n = 8), patients with LNH (n = 10), ulcerative colitis (n =
14), and Crohn disease (n = 15). The main findings in children with AD were (1)
a significant increase in the basement membrane thickness; (2) increase in the
mucosal gamma/delta cell density; (3) increased number of CD8+ (suppressor
cell) cells; and (4) intraepithelial lymphocytes.
In addition, the density of CD3+ cells and plasma cells and the crypt
proliferation ratio were higher in children with AD than in normal controls.
Disruption of epithelial glycosaminoglycans was detected with special
staining. The epithelium in children with autism was HLA-DR negative, which is
suggestive of a predominantly type 2 T-helper response. These two studies
concluded that a new variant of inflammatory bowel disease is present in
children with autism and other developmental delays.
Torrente et al. reported IgG deposition on the basolateral surface of
the intestinal epithelial cells in 23 of 25 autistic children. The IgG deposits
were colocalized with complement C1q, which was not seen in patients with
celiac disease or in normal controls. The IgG-C1q colocalization was accompanied
by increases in mucosal lymphocyte density and crypt cell proliferation, which,
together with the epithelial IgG deposition, are suggestive of an autoimmune
process.
Histologic and immunohistochemistry studies performed on the intestinal
biopsies of children with AD, thus, demonstrate the presence of chronic
inflammation in the GI tract. As mentioned, a recent immunohistochemical study
raised the possibility of an autoimmune pathomechanism in the autistic gut.
Also, serologic data indicate a possible autoimmune pathogenesis. Cell-mediated
immune response of peripheral lymphocytes to the brain myelin basic protein was
reported in 13 of the 17 patients with autism. Antibodies to myelin basic and
neuronaxon filament proteins were present in the sera of autistic patients, and
patients with positive measles and herpes virus 6 antibody titers more likely
had autoantibodies to these brain proteins. If the autoimmune process is
proved, the described GI inflammation may be the consequence of a multiorgan inflammatory
process.
Conclusions
Autism is a dysfunction of the brain areas responsible for
communication, language, and social interaction. It is apparent that the
children with AD have a high prevalence of various GI symptoms and
dysfunctions.
Future research should clarify whether digestive inflammation is part of
a unique multiorgan, probably autoimmune, process.
Pending answers, clinicians can treat most GI symptoms in children with
autism by using conventional GI treatment options. In our experience, treatment
of the GI problems (eg, reflux, colitis) often has beneficial effects on the
behavior of children with autistic disorder.
A Pediatrician's Insight on Autism
LILIPOH (= an acronym for Life Liberty and the Pursuit of Happiness
through Health) Please give us a short introduction to your practice.
Dr. Allen: I have been a pediatrician for 21 years, and I am board
certified in anthroposophic medicine, holistic medicine, and traditional
pediatrics. In 2008, my wife and I set up an anthroposophic healing center near
Fair Oaks, California, The Center for Living Health. We work with Susan
Johnson, MD, and William Bento, PhD, as well as eurythmy, craniosacral, art,
and extra lesson therapists.
LILIPOH: Do you see an increasing number of autistic children in your
practice?
Dr. Allen: Yes, I have seen a significant increase in the number of
children with autism in my practice and in the world at large since the late
1990s.
LILIPOH: Could you please outline the basic characteristics of autism,
or the spectrum that is currently described with this word. How has it changed
over the last few years?
[Dr. Allen]
Autism spectrum disorders (ASD) are characterized by:
1. Social-interaction difficulties such as: failure to respond to their
names, reduced interest in people, and delayed babbling. By toddlerhood, many
children with autism have difficulty playing social games, don’t imitate the
actions of others, and prefer to play alone. They may fail to seek comfort or
to respond to parents' displays of anger or affection in typical ways.
2. Communication challenges. Young children with autism tend to be
delayed in babbling and speaking and learning to use gestures, and exhibit an
inability to understand body language, tone of voice, and expressions that
aren’t meant to be taken literally. For example, even an adult with autism
might interpret as sarcastic, “Oh, that's just great!” as meaning it really is
great.
3. A tendency to engage in repetitive behaviors. Common repetitive
behaviors include hand flapping, rocking, jumping and twirling, arranging and
rearranging objects, and repeating sounds, words, or phrases. Sometimes the
repetitive behavior is self-stimulating, such as wiggling fingers in front of
the eyes.
However, symptoms and their severity vary widely across these three core
areas. Taken together, they may result in relatively mild challenges for
someone on the high- functioning end of the autism spectrum. For others,
symptoms may be more severe, as when repetitive behaviors and lack of spoken
language interfere with everyday life.
Historically, according to the American Psychological Association, the
term autism was first coined by Swiss psychiatrist, Paul Eugen Bleuler in 1908.
He used it to describe a schizophrenic patient who had withdrawn into his own
world. The root of the word autism is from the Greek "autos" which
means "self." Combine that with the Greek suffix "ismos"
which means “action or state of being,” and you get an original root meaning
that roughly translates to a state of being absorbed by one's self or withdrawn
within oneself. This makes sense today because people with autism often seem to
be lost in themselves.
The pioneers in research into autism were Hans Asperger and Leo Kanner,
who worked separately in the 1940s. The American child psychiatrist, Leo
Kanner, studied children who had features of difficulties in social
interactions, difficulty in adapting to changes in routines, good memory,
sensitivity to stimuli (especially sound), resistance and allergies to food,
good intellectual potential, echolalia or propensity to repeat words of the
speaker, and difficulties in spontaneous activity. These were children who were
severely affected. Hans Asperger studied a different group of children. His
children also resembled those Kanner studied but they differed in one important
respect: the children he studied did not have echolalia as a linguistic
problem. Rather, they spoke like grownups. He also mentioned that many of the
children were clumsy and different from normal children in terms of fine motor
skills. These were very able children.
In addition, beginning around the 1940s, parents of autistic children
began receiving blame for their child's autism, particularly the mothers, who
were called "refrigerator mothers.” The whole idea behind the refrigerator
mother concept was that children become autistic because of the mother’s
frigidity. The mothers were supposedly "cold" to their child and
didn't interact or play with them and didn't cuddle them. Of course, we now
know that this is a ridiculous theory and the product of doctors being too
quick to jump to a conclusion.
It wasn't until the 1960s that autism was established as a separate
disorder, distinguished from others such as schizophrenia and retardation. Up
to then, autism was treated very similarly to those disorders. From the 1960s
through the 1970s, research into treatments for autism focused on medications
such as LSD, electric shock, and behavioral change techniques. The latter relied
on pain and punishment. During the 1980s and 1990s, the role of behavioral
therapy and the use of highly controlled learning environments emerged as the
primary treatments for many forms of autism and related conditions. Other
treatments were added as needed. Currently, the cornerstone of autism therapy
is behavioral therapy.
The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th
ed, 1994, the current edition of American psychiatry's diagnostic guide)
identified a set of separate Pervasive Developmental Disorders that are
considered “autism spectrum disorders” (ASDs). These include Autistic Disorder,
Asperger’s Disorder, Pervasive Developmental Disorder Not Otherwise Specified
(PDD-NOS), Rett’s Syndrome, and Childhood Disintegrative Disorder.
However, one of the most significant changes with the new DSM-V, which
will be formally unveiled in May 2013, is that the separate diagnostic labels
of Autistic Disorder, Asperger’s Disorder, PDD-NOS, and Childhood
Disintegrative Disorder, will be replaced by one umbrella term “Autism Spectrum
Disorder.” The new Autism Spectrum Disorder will have new criteria to qualify,
and Rett’s Syndrome is no longer included. These changes are already sparking
quite a controversy in the autism community.
LILIPOH: Is the increase in the number of diagnosed “cases” a function
of improved diagnosis, or could it be linked to increased stimulation, changes
in the ability of teachers—or is there a basic genetic change?
Dr. Allen: There is a real increase in the number of children with
autism. It is true that we are all now better at recognizing them, and even at
younger ages, but that is a direct result of the epidemic of new cases. In
1960, the prevalence of autism was 1:4000. In 2000 it was 1:2000. Now it is
1:88 children in the U.S.
When I first started practicing in 1992, I worked in a large,
traditional pediatric practice where we would see 250 or more kids every day.
In a practice that large, you get an accurate pulse on the health, or lack of
it, in the community at large. Trends in health are identifiable, such as the
increase in diabetes and other autoimmune disorders in children that we have
witnessed in our practice. We were not seeing these children with ASD in the
early 1990s—autism was still rare!
Then, in the late 1990s, I started to notice more children who were not
incarnating in a typical way. These children lacked sparkle in their eyes, and
instead, there was dullness there, as if covered with a veil. These youngsters
did not regard the human face with recognition and connection, and smile, but
simply looked at me as if I were one of the many inanimate objects in the room.
I was deeply moved. It made such an impact on me that 15 years later, I can
still remember the first child I saw with what would later be diagnosed as
autism. When I first started seeing these children, my colleagues and I were
unable to diagnose them, but I would make a note in their chart about their
eyes. Shortly thereafter, autism became very familiar to me and to the rest of
the world.
The increase in diagnosis of autism is not simply the result of
overstimulation (and/or other reactive disorders that might reveal mild
symptoms similar to ASD), or the inability of teachers. True, teachers are
having a hard time with these children, but it is not because they are any less
capable than teachers of the past. It is because there is an epidemic of these
children who are not incarnating typically, and we are all still learning about
their gifts and challenges.
A genetic component has been identified, as there are more mutations in
the genetic make-up of kids later diagnosed with autism versus kids that are
not, when testing cord blood samples. However, this is true in some of the kids
diagnosed with autism, but not all of them.
LILIPOH: What treatments have been found to be supportive in a child’s
life after the diagnosis (therapy, stimulation, art, music, physical activity,
medications, etc.)?
Dr. Allen: Each child or adult with autism is unique, so each autism
intervention plan should be tailored to address specific needs.Traditional
intervention can involve behavioral treatments, medicines or both. Many persons
with autism have additional medical conditions such as sleep disturbance,
ADD/ADHD, anxiety, seizures and gastrointestinal (GI) distress. Addressing
these conditions can improve attention, learning, and related behaviors.
This can be traditionally done as follows: sleep disturbance (healthy
sleep training, melatonin, or medications); ADD/ADHD (medication); anxiety
(Cognitive Behavioral Therapy CBT and/or medications); seizures (medication)
and gastrointestinal (GI) distress (dairy and gluten sensitivity/allergy—food
restriction, probiotics). Objective scientific studies have confirmed the
benefits of two methods of methods of comprehensive behavioral early
intervention. They are the Lovaas Model based on Applied Behavioral Analysis
(ABA) and the Early Start Denver Model.
Studies indicate that early intensive behavioral intervention improves
learning, communication and social skills in young children with autism. While
the outcomes of early intervention vary, all children benefit. Researchers have
developed a number of effective early intervention models that work best if the
intervention focuses on the core areas affected by autism (social skills,
language and communication, imitation, play skills, daily living, and motor
skills); if it provides the child with opportunities to interact with typically
developing peers; and if the program actively engages parents in the
intervention, both in decision making and the delivery of treatment.
Parents and therapists also report success with other commonly used
behavioral therapies, including music therapy, floor time, pivotal response
therapy, and verbal behavior therapy. Anthroposophic treatments that have been
found to be beneficial include anthroposophic remedies, eurythmy, rhythmical
massage, art therapy, and speech therapy. Rudolf Steiner said, in Education for
Special Needs, that whenever we give treatment to a handicapped child, we are
intervening in karma, and that this work of the gods
we must undertake as a benefit to us all.
The basic lessons we learn from our Waldorf kindergarten teachers -the
benefits of adequate warmth, sleep, decreased media and overstimulation and
good nutrition- are instrumental in helping all children, especially those with
autism.
Growing evidence suggests that a small minority of persons with autism
progress to the point where they no longer meet the criteria for a diagnosis of
autism spectrum disorder (ASD). Various theories exist as to why this happens.
They include the possibility of an initial misdiagnosis, the possibility that
some children mature out of certain forms of autism and the possibility that
successful treatment can, in some instances, produce outcomes that no longer
meet the criteria for an autism diagnosis. I believe that when a child has an
interruption in their incarnation process, they may reveal symptoms that
resemble ASD. If we can meet them and support them anthroposophically, we can
intervene in their karma and help them to heal.
LILIPOH: How can an anthroposophic medical outlook help us to understand
autism?
Dr. Allen: Autism can be looked at as an atypical incarnation process.
This specific “abnormality” reveals itself in the pattern of symptoms we call
autism. Yet, one should ask, what is the purpose of autism? In anthroposophy,
Steiner said that we prepare for our upcoming incarnation in the time between
death and rebirth. The interweaving of the cosmos, the individual soul, and our
specific karma come together as we make plans for what we want to work on in
our upcoming incarnation.
Is the purpose of autism one of altruism, to serve as a sacrificial
mirror (see below) or as a springboard for the individual soul to form a future
earthly life, as Steiner indicated in his book, Education for Special Needs?
The essence of autism is a disharmony of the ego function. The ego does
not engage the lower organization (metabolism) sufficiently from the periphery inward.
This is reflected into the consciousness pole, as the centering of the ego in
the upper organization is also deficient. The disturbed relationship of the ego
results in a weakened etheric stream from the lower organization, which is too
little for a healthy relationship to the soul forces. Thus, thinking, feeling,
and willing cannot be brought together. 2 In a mild case, this might manifest
as a bright child with autism who is hyper-focused on one topic but has
difficulties with others, can’t read social cues, can’t feel love, has delayed
speech, and repeatedly engages in hand-flapping. A child may come into this
life with autism, or autism may develop from a vaccine or other physical
injury, either to the brain or to the gut. If the injury is in the brain, then
it causes a reflected injury in the gut, or if the original injury is in the
gut, then the reflected dysfunction occurs in the brain.
LILIPOH: What are the social/spiritual implications arising from the
fact that so many children are being diagnosed with autism?
Dr. Allen: According to educator Eugene Schwartz, if we look at
illnesses as mirrors for the age, we see in our current mirror, indifference,
social isolation, timidity, and lack of empathy. In autism we find individuals
who share these “inbreathing” characteristics, and serve as sacrificial mirrors
to reflect our time.
Ours is a time of materialism. This excessive materialism distracts us
from our spiritual development. People with autism are handicapped in a way
that prevents their spiritual development. This is a sign of our times. The
purpose of autism is to balance out this excessive materialism. Thus autism can
be seen as both the result of, and the remedy for, excessive materialism. We
are suffering from the inability to develop spiritually and deeply connect with
our fellow human beings. Autism reveals this to us, and gives us the
opportunity to step away from ourselves and our immersion in the materialistic
world, and focus on helping our children with autism and the world at large. We
have to be sensitive, caring, and loving enough to open ourselves to the gifts
that these individuals bring to the world. With healthy empathy and tolerance,
we can support them and learn the meaning and balance of their incarnation. In
the process, we learn to strive for healthy social connection and continue
developing our potential as spiritual human beings.
LILIPOH: Can you explain what Rudolf Steiner and Karl Koenig, MD, said
about what these individuals bring to their incarnation?
Dr. Allen: People who are handicapped bring in karmic blessings and
karmic work for parents, siblings, caregivers - anyone and everyone who has a
relationship with them in any way. This is a real Christ healing impulse to
learn social connection, and how to care for our fellow human beings. Each
handicap brings a specific lesson for the individual, parents, family and
community.
R.S. once said that when we see a child with an “abnormality” and we
immediately want to “fix” them, trying to get rid of the “abnormality,” we in
fact are both not learning the lesson they bring, and might just be driving out
a fragment of genius. I believe this is true, as my own son, Kieran, which
means “beam of light,” came into this world as
an angel - a wake-up call to put me and my family back on our spiritual
path when we were lost in the sea of materialism.
He was born with cerebral palsy and later developed seizures.
Conventional medications failed, so Kieran led me on a holistic journey,
including my introduction to anthroposophy, as I searched for things to heal my
son. What I discovered in the process is that they helped to heal me.
Kieran’s quality of life improved, and he remained with us long enough
to complete our life lessons. Then, two weeks after his seventh birthday, he
developed pneumonia and unexpectedly passed. This was the hardest lesson for me
as a father, as a pediatrician, and as a human being, to learn. Yet, I was
grateful for his teachings and for the awareness of his gift even during his
lifetime. It was both the most difficult and the most gratifying experience of
my life.
Kieran was a beam of light, an angel on this earth, who deeply touched
everyone who was exposed to him. I believe that children with autism, like my
son, are here to be our teachers.
LILIPOH: What happens to the parents? I understand that divorce rates
are very high in families with children with autism. Are there resources to
support the families?
Dr. Allen: Parents of children with autism are generally exhausted,
isolated and frustrated. The physical, emotional and financial burdens are
enormous, and friends and family shy away. However, the reported 80% divorce
rate of parents with autistic children is erroneous. Recent studies have found
that 64% of children with an autism spectrum disorder have two married
biological or adoptive parents, while 65% of children who do not have an autism
spectrum disorder had two parents. Another study revealed a 24% chance of
divorce between autistic parents of autistic children versus a 14% chance of
divorce between parents of non-autistic kids. Whichever study you believe is
more correct, they are both much lower than 80%.
There are many resources available to families of autistic children and
adults. These range from advocates to financial, diagnostic, books, diets,
caregivers, support groups, social programs, education, parental support,
blogs, and attorneys, etc. Some of these can be accessed through the Resource
Guide by Autism Speaks (see below), that offers resources available specific to
one’s state and zip code. www.autismspeaks.org/family-services/resource-guide
LILIPOH: What happens when autistic children grow up to be adults?
Dr. Allen: It all depends on their level of function and how well we've
been able to help them to integrate with the world. A lot has to do with early
intervention, understanding individuals with their specific gifts and
challenges, and then putting enough support in place so that these individuals
are able to reach outside of themselves, tolerate their surroundings and be able
to interact with them.
Things generally improve as children with autism get older, yet nearly
seven years after high school, 35% of autistic young adults still had no paid
employment or education beyond high school. The statistics are dramatic: within
a decade or so, more than 500,000 children diagnosed with autism will enter
adulthood.
Some of them will have the less severe variants like Asperger’s syndrome
or “high-functioning autism” and may be able to live more independent and
fulfilling lives. But even this subgroup will require some support, and the
needs of those with lower-functioning varieties of autism will be profound and
constant as some will forever live in a supported environment, whether at home
or in a group home, and will never hold a job.
There may be others who lead not only normal, but incredible lives,
having so much to offer the world in the way of creativity and knowledge, as
they share their gifts and passions, making the world a better place for all of
us. We just have to be “open” to them, and to give them the opportunity without
our traditional “limiting” boundaries.
LILIPOH: What research is happening that will let us project into the
future?
Dr. Allen: Research is revealing that the risk of autism increases
linearly with BOTH the age of the father AND the age of the mother at
conception. Increased risk also happens with low folic acid levels, fever and
flu during pregnancy, etc. There are both genetic and environmental factors
currently being investigated. In addition, there
is significant research being done on the gut-brain connection (which is
supported by Steiner’s view of the interaction or reflection between the upper
and lower forces).
An autism tsunami is on the way. With the numbers of children diagnosed with
autism skyrocketing, we will soon have over half a million young adults 18 or
older in the United States with autism.
This is a global wake-up call!
Vorwort/Suchen. Zeichen/Abkürzungen. Impressum.