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• Biomedical treatments are based on a theory about
what the underlying causes of autism are.
– Focus on pathology, biochemistry and physiology of a
– Disorders are caused by an underlying biological
• Biomedical view of autism
: Autism is a
disease resulting from underlying,biological abnormalities (pathologies).
• Behavior analytic view of autism
is a neurological disorder resulting inbehavioral excesses and deficits (Lovaas,2003).
• Question: Is there consensus about what the
– There currently are numerous theories about the
underlying biological basis of autism, but no
– This is demonstrated by the number of
biomedical treatments for autism, each based
on a different theory about the underlying cause
• Decreased “good” bacteria and increased “bad” bacteria in
• Excess Yeast in the intestinal tract.
– Low good bacteria allows yeast to proliferate– Antibiotics may stimulate yeast
– Yeast colonies attach to the intestinal walls and digest portions of
– Undigested food molecules can then “leak” through the intestinal
– Result: Increased susceptibility to allergies resulting in behavioral
• Elevated peptides in urine resulting from incomplete
breakdown of gluten (in wheat) and Casein (in dairy).
• Theory: Incomplete breakdown of gluten and casein in the
gut results in excess caseomorphines, gluteomorphines and
gliadinmorphines which are opioid like peptides.
– These opioids have abnormal leakage from the gut.
• These cross the blood-brain barrier and affect the CNS and inhibit
– These opioid peptides modulate monoamine transmitter systems.
• Unusual effects on transmitter systems may explain a variety of the
behavioral traits in autism (E.g. attention and social indifference).
• What is a Gluten-free, Casein-free (GFCF)
– Elimination of all gluten containing foods
– Elimination of all casein containing foods.
– 3 children who received secretin for gastrointestinal
problems showed significant behavioral improvementsin social and language skills.
– Non-blind, did not use standardized measures; did not
– Widely cited in newspapers, the internet, television– Lead to clinicians prescribing secretin for autism
treatment and the development and marketing of asynthetic form of Secretin for autism treatment
– A small protein produced by the cells of the small
– Function: to cause the pancreas to release bicarbonate
• Bicarbonate neutralizes stomach acid so that enzymes can
– An infusion containing either human or porcine secretin
• Children with autism do not produce enough secretin thus
impairing their digestive processes.
– Reduced secretin production may be related to gluten
• Children with autism produce a defective type of secretin that
is not capable of stimulating the pancreas.
• Secretin has some direct beneficial effect on brain functioning
• The autoantibodies against the pancreas, induced by Candida,
may be preventing the pancreas from responding to the normal
amount of secretin produced by the child’s own body.
• Abdominal cramps, bloating, diarrhea,• GI tract bleeding• Fatigue, fever, flushing• Decreased blood pressure• Bradycardia (Slow heart rate)• Excessive sweating• Nausea, hot sensation, headaches• Vomiting• Numbness• Possible seizures• Transient respiratory disease.
– The regressive form of autism represents a form of mercury poisoning.
– Symptoms of autism are similar to the symptoms of mercury poisoning. It is
believed that the cause of this may be exposure to mercury in thimerosol, the
• (a) symptom onset shortly after immunization• (b) ASD prevalence increases corresponding to vaccination increases• (c) similar sex ratios of affected individuals• (d) a high heritability rate for autism paralleling a genetic predisposition to Hg sensitivity
• (e) parental reports of autistic children with elevated Hg.
– Note: Recent publication showing a lack of association between vaccines and
• Courtney will discuss this issue in detail next week.
• We will focus on Chelation as a treatment for heavy metal toxicity.
– Testing: Hair analysis- heavy metals such as mercury
may be 250 times higher in the hair than in the blood.
• Removal of any source of heavy metal poisoning• Use of agents to remove toxic metals• Chelation agents bind to toxic metals in the blood or tissues
and the metal-chelation agent complexes are eliminated in theurine or the stool.
• Prescription drugs: BAL, DMPS, EDTA, DMSA. DSMA is
• Chelation can take 1-2 years to complete.
– Gastrointestinal side effects: nausea, vomiting, stomach
– Blood side effects: neutropenia (a disorder involving
low white blood cells), eosinophilia and increased
– Temporary regression of autistic symptoms as the
– Elevated liver enzymes and other side effects including
drowsiness, dizziness, sleepiness, rash, decreased
urination, cardiac arrhythmia, leg and knee pain and
• No clinical trials of the efficacy of mercury
• The National Institute for Mental Health – Press
• September, 2008: NIMH panel reversed it’s
approval of this study. They concluded there was
no clear evidence for direct benefit for the
participants, and the study presented more than
• Theory: Children with autism have a metabolic disorder.
– The breakdown and metabolism of food into acids and sugars is
disrupted by abnormal chemical reactions.
– This results in too much or too little of certain vitamins and
– These deficiencies or excesses of certain vitamins and minerals
effects body and brain functioning, resulting in the symptoms ofautism.
– If these deficiencies or excesses are remedied, or if the metabolic
disorder is addressed, the symptoms of autism will decrease or beeliminated.
• B6 and Magnesium – High dose pyioxine
(B6) is administered often in combinationwith magnesium.
• Folic Acid – Administered as a supplement.
• Calcium – Administered as a supplement.
• Inclusion criteria: Random assignment and controlled (placebo
– Two studies met criteria for inclusion.
– One study (Tolbert, 1993) could not be evaluated due to lack of
information and inability of the author to provide thatinformation when contacted.
– The other study (Findling, 1997) showed no significant
differences between the control group and treatment group insocial interaction, hyperactivity, impulsivity, communication orcompulsivity.
– B-Cells: Produce antibodies (immunoglobins).
– T-Cells: Kill foreign or infected tissues and produce large proteins
that regulate the immune system and enhance immune response.
• Theory: Children with autism have abnomalities or
deficiencies in T-cells, B-cells or related phagocytic cellsand proteins.
– Due to these abnormalities or deficiencies, their immune response
– They may be more susceptible to allergies, gut issues, and excess
• Types of immunotherapy treatments (most common):
– Transfer Factor: low molecular weight dialyzable molecule– Pentoxifyline: phosphodiesterase inhibitor known to have
immunomodulatory, hemorrheologic and serotonergic effects.
– Intravenous Immune Globulin (IVIG): prepared from plasma from
• Has been used in the treatment of a number of autoimmune disorders.
– To date no controlled, double blind studies evaluated the effects of
– Results of the non controlled studies that have been carried out
show mixed results (3 found support, 4 found negative results).
• Antipsychotic• The only drug approved by the FDA for the
treatment of “irritability”
– Irritability: aggression, deliberate self-injury
• FDA approval based on two, 8-week placebo
– Significantly more improvement in irritability scores
from baseline compared to the placebo group.
– Reductions in scores on the parent-rated Aberrant
– Significantly greater improvement in stereotypic
behavior, lethargy, social withdrawal, hyperactivityand/or noncompliance subscales for the treatmentgroup.
• “Irritability” : aggression, self-injury,
– Communication development– Social development– Restricted patterns of behavior
• What parts of the core deficits in autism are
– Weight gain
– Upper respiratory tract infections
– Increased salivation
controlled study showed noeffects. Most research
• Oxytocin infusion• Brain surgery• Melatonin• Tryptophan and tyrosine supplementation• Craniosacral manipulations• Hyperbaric Oxygen Treatment• Medications
• None of the Biomedical interventions aside
from Risperdal have any evidence tosupport them
• And some (chelation) have evidence of
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