Autism Society of America Colorado Chapter Autism Intervention

Autism Society of America - Colorado Chapter Autism: Intervention Strategies and Synergies Conference and Exposition September 18 -21, 2002 Red Lion Denver Central Keynote Address Presented By: Rosemary Boon, Psychologist. M. A. (Psych), MAPS, AACNEM, ACHC. Grad. Dip. Ed. , Grad. Dip. Ed Studies(Sch. Counsel) Bsc SYDNEY, AUSTRALIA WEBSITE: www. learningdiscoveries. org EMAIL: rboon@iprimus. com. au 1

Autism is more than just genetics…… Presented By: Rosemary Boon, Psychologist M. A. (Psych), Grad. Dip. Ed. , Bsc. , it is a multifactorial disorder requiring multimodal interventions Grad. Dip. Ed Studies(Sch. Counsel), MAPS, AACNEM, ACHC. 2 rboon@iprimus. com. au

Characteristics of ASD…………. A pervasive developmental disorder - usually evident before age 3, ranging from mild to severe Impacts brain development in areas of social interaction, communication skills and sensory responses adversely affecting educational performance • Approximately 80% have some degree of mental retardation and most do not reach independence as adults (Siegel 1996). • Often includes resistance to change and repetitive or perseverative/stereotyped movements 3

Statistics worldwide show. . . • The incidence of Pervasive Developmental Disorders, Learning Difficulties, ADHD, Auto-Immune Disorders, and Psychiatric Disorders are increasing. • ADHD 1: 10 (10%) • SLD 1: 5 • Autism 1: 135(USA) (20%) The California (1999) report showed a 273% increase in the State of California between 1979 and 1992. 4

• Autism /ASD 1: 50 (Aust. ) • “Classical” autism 5: 100, 000 (UK) • ASD • CFS 15: 100, 000 (UK) 1: 50 (2%) • Anxiety & Depression 1: 5 (20%) (Mind of a Child Conference - Sydney, March, 2002) Autism is the most frequently occurring form of pervasive developmental disorder (PDD) (Siegel 1996). 5

Numerous causes have been postulated • Genetics • Neurological Dysfunction • Immune Dysfunction • Gastrointestinal Factors • Environmental Factors 6

The genetic factors…………. . • ”Genetic fragility or predisposition”. (Shattock, Durham 1999) • A family with 1 autistic child has a 3 -5% chance of having another child with autism - 90% concordance in monozygotic twins (Rogers et. al. 1999) • A family with no autistic children has a 0. 1 -0. 2% chance of having a child with autism • 3 out of 4 autistic people are male 7

The genetic factor continued……. • From 2 -10 genes involved (Bailey et. al. 1996) • There may be up to 19 genes involved - 5% of autism may be quantified by a genetic syndrome. (Mary Coleman) • A Genome Wide screen for Autism: Strong evidence for linkage to chromosomes 2 q, 7 q, 16 p and 7 q 32 region. (International Molecular Genetics Study of Autism Consortium. Am. J. Hum. Genet. 69: 570 -581 (2001) • “Genes load the gun and the environment pulls the trigger” (Gupta 2002 - Mind of a Child - Sydney, Australia). 8

Environmental factors……. . . There is increased exposure to: - chemicals - Sick Building Syndrome and pollution; food additives/preservatives; metal toxicity including mercury, lead, cadmium, aluminium, copper. ; pesticides etc. - mercury - amalgams(3 -17 ug daily); coal fired power stations (51%); incinerators -medical (10%), municipal (19%); saltwater fish (tuna, swordfish, halibut, salmon); cosmetics, medications and personal items. 9

- vaccinations - Thimerisol- causes neurological damage in infants later diagnosed with autism or overwhelms the immature immune systems of vulnerable children leading to brain infections by invasive microorganisms and chemicals (Rimland BITN-2002; Bernard - 2000 ARC Research -Sub. Am. Congress) 10

“Is Autism a Unique Type of Mercury Poisoning”? ………. • This question is posed by Sallie Bernard et. al. in the above titled paper, submitted to the American Congress in 2000 • The summary of the comparison of characteristics of autism and mercury poisoning and their similarity is nothing short of alarming. • Mercury toxicity is difficult to quantify 11

- antibiotics (suppression of immune system & increased gut permeability) - milk (irritates gut and dairy free diet reduces mental symptoms in adults) - gluten (MRI shows inflammation of white matter in cerebrum and irritates gut) - sugar (108 ways refined sugar is detrimental to health) - GMO foods 12

- sound - increase in intensity of stimuli - EMF radiation (mobile phones, VDU’s- computers, TV, microwave technology, appliances etc. ) - hand held computer games (produce frontal lobe abnormalities) - media and video games (affects behaviour, violence and suicide) 13

Social and environmental changes influencing health and development • Social structure - absence of fathers - babies separated from parents for sleep and travel - breast feeding reduced from 3 -7 yrs to 3 -6 months - bottle feeding doubles risk of ADHD - deficiency of DHA (Broadhurst et. al. ; Stordy; Levine; Oski) 14

• “Long chain polyunsaturated fatty acid deficiency at any stage of foetal and/or infant development can result in irreversible failure to accomplish specific components of brain growth - optimal brain development requires DHA and AA provided by breast milk”. (Broadhurst et. al. British Journal of Nutrition 1998) 15

• ……. . “For every year of delay, more than 2 million formula-fed, full-term babies born annually in the United States may experience a disadvantage of 3 -6 IQ points compared with breast-fed full-term babies…… the difference is even greater for infants with low weight at birth”. • Because formula-fed babies “are deprived of this essential building block (DHA/AA) there are incalculable quality of life issues”…… Frank Oski M. D. , former chairman of pediatrics John Hopkins University School of Medicine. Nutrition 1997 16

• Pregnancy - more mothers smoking (27%) -caffeine (low birth rate and breathing problems) -alcohol (> 50% - even 1 glass/week increases the risk of delinquent behaviour) -amalgam fillings (Bernard et. al. 2000) -maternal stress - causes decreased blood flow and low birth weight -8 x higher rate of antibiotic use in mothers of autistic children - ill and producing cytokines (Waring, MOA 2002) 17

Blood brain barrier 18

Biology of behaviour…. . . 19

The interactive factors…. . . Immune System AUTISM Gut 20 Brain From Gupta - MOA 2002

1 in 5 children will develop learning difficulties and/or pervasive developmental disorders. What can be done? . . . • Individual researchers and clinicians around the world are beginning to realise that intensive multi-modal intervention designed around the individual’s unique neurobiochemical, metabolic and genetic makeup can make a difference to outcomes. 21

• Diverse strategies are currently in place and continually being developed for effective early intervention as our shared knowledge base of these disorders grows. • The complexity of ASD requires the integration of research findings so that fundamental cellular dysfunction is systematically addressed through multi modal interventions. 22

The Pyramid of Learning, Development & Wellbeing by Rosemary Boon 1996 (Adapted From Shiel & Dyson) “All learning has an emotional base” -Plato, 347 B. C. LIFE STYLE Self Actualisation COACHING TEACHING DEVELOPMENTAL, VISION & SPEECH THERAPY EEG & EMG BIOFEEDBACK COUNSELLING & FAMILY SUPPORT 23 NUTRITION & SUPPLEMENTS COMMUNITY CONTRIBUTION LIFE SKILLS Stress mgt, Anger mgt, Philosophy, Self Reliance & Spirituality ACADEMIC Literacy & Numeracy Training, Thinking Skills, Learning Styles MENTORING SUPPORT PSYCHOLOGY PERSONAL DEVELOPMENTAL & PRE ACADEMIC Developmental Auditory & Visual Skills, Language, Vision, Spatial, Eye-hand, Sequencing Skills PRE-ACADEMIC PROGRAMMES FUNCTIONAL Neuronal Function, Vestibular, Occulomotor, Auditory & Visual Processing, Motor Coordination, Balance, Primitive & Postural Reflexes, Emotional Distress GENETIC, STRUCTURAL, METABOLIC & NEUROPHYSIOLOGICAL Musculoskeletal, Illness, Injury/Trauma, Toxicity, Environmental/Food, Allergens, Disorders, Eyesight, Hearing, Diet & Nutrition GUT & IMMUNE SYSTEM HEALTH & MEDICAL PRACTITIONERS ENVIRONMENTAL CONSULTANT SENSORY MOTOR INTEGRATION SOUND THERAPY FLEXYX NEUROTHERAPY CHIRO, OSTEO, CRANIO, BOWEN

Formal Assessment……. . 1. History, including environmental and familial history, pre/neonatal development. 2. Physical examination - skin, nails, hair, eyes, ENT etc. 3. Biomedical evaluations (e. g. , as needed, EEG, metabolic work-up, genetic studies, and nutrition) 4. Checklists including - DSM IV criteria, ATEC (ARI), PDD Screening Tests I & II (Seigal) The Australian Asperger’s Scale (Garnett and Attwood). 24

Screening and diagnosis of autism ……. . (From the Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society - 2000) 25 • First concerns of parents need to be checked into…….

Assessment continued…. . . 5. Assessment of current challenges and functioning, including: developmental capacity (attention, engagement and thinking) processing capacity (auditory & visual, motor planning and sequencing, visual-spatial skills and sensory-motor integration) at home with caregivers and siblings, with peers in educational and social settings 6. Observation 26 At least two 45 minute sessions with the caregiver or clinician to provide the basis forming a hypothesis about the child’s functional capacities

Formal Assessment continued………. . 7. Speech and language evaluation including articulation, syntax, pragmatics, semantics, receptive and expressive languages 8. Evaluation of cognitive functions, including neuro-psychological and educational assessments 9. Mental health evaluations of family members, family patterns, and family needs 10. Family and caregiver functioning 27

Laboratory Investigations……. • Stool Analysis • Organic Acid Test • Urinary Peptide Test • Food Allergy Testing • Intestinal Permeability Studies • Gluten Antibody Studies (Gliadin endomesial and reticulin) • Secretory Ig. A (Saliva or stool) • Immunilogical testing (Immune markers, immunolglobulins, activated T Cell subsets (NK cells) • Sulphation studies 28

From “Fed Up” by Sue Dengate, 1999 Food Allergies……. . 29

Gastrointestinal factors…… • Malabsorption (J. Autism/Childhood Scizo, 1971 1(1): 48 -62) -freq. Reports acholic stools, undigested fibers, proteins, positive Sudans. • 85% of autistics meet criteria for malabsorption (B. Walsh, 500 patients) • Maldigestion - elevated urinary peptides (P. Shattock, Brain Dysfunct 1990, 338 -45 & 1991, 4: 323 -4; KL Reicheldt, Develop Brain Dys 1994, 7: 71 -85, and others; Z Sun and Cade Autism 1999, 3: 67 -83) • Abnormal Intestinal Permeability (P. D’Eufemia Acta Pediatr 1995, 85: 1076 -9) 30

Gastrointestinal factors continued…. . . • G. I. Symptoms reported by parents - diarrhoea, constipation, gas, belching, probing, visibly undigested food and need for rubs • Microbial Overgrowth - fungal, bacterial and viral (William Shaw, Biological Basis of Autism and PDD, 1997) - Clostridium - high wheat content in diet (E. Bolte Med Hypoth, 1998, 51: 133 -144) - Aerobic Lactobacillus - high rice in diet (J. Child Neurology, 15: 429 -435; P. Shattock & A. Broughton, JAG elevations; Andre Wakefield, Lancet, 1998, 351: 637; T. J. Borody, Centre for Digestive Diseases, NSW, Australia) 31

Gastrointestinal factors continued…. . . • Fecal and urine samples from 36 patients revealed significantly lower aerobic flora (56. 3%) compared to healthy controls (70 -95%). By contrast lactic acid bacteria Enterococcus/Streptococcus was significantly higher in autistic subjects (40. 1%) than in healthy subjects (5%). • The excretion of C 18 fatty acids was positively correlated with lactic acid bacteria. Alteration of fecal lipids significantly associated with intermediaries of the Krebs and Urea cycles, suggesting that fecal microflora may affect multi system homeostasis. 32 (Bioscreen Pty Ltd Collaborative Pain Research Unit, University of Newcastle, Australia, 2002)

Factors affecting gut flora……. Levels of endogenous and exogenous nutrients (Mucin, gut proteins, biliary secretions, sloughed cells, gluten and casein - zinc, glutathione and metallathione) Bile Acids Antibiotics Vaccinations Gut Flora Bacterial Interactions p. H Bacterial Interactions (SCFA, Bactereocins) Disease 33 Age Drugs Redox Potential (From Autism and the Human Gut Microflora - Max Bingham - University of Reading) Leaky Gut

Gastrointestinal factors continued………………. . 34 From Autism and the Human Gut Microflora - Max Bingham - University of Reading

Who want’s to party? ? ? ……… (From Autism and the Human Gut Microflora - Max Bingham - University of Reading) 35

The digestive system…. . . 36

What is Leaky Gut Syndrome? ……. . • Leaky gut or LGS is a poorly recognised but extremely common problem. It is rarely tested for. Essentially, it represents a hyperpermeable intestinal lining. • Large spaces develop between the cells of the gut wall, and bacteria, toxins and food leak in to where they shouldn’t. • If the gut is not healthy, neither is the rest of the body. It is the point of fuel and nutrient entry. 37

Leaky Gut Syndrome 38

Detoxification Weakness • Glutathione Conjugation low in 14 of 17 (mean 0. 55 vs 1. 4 -2. 9) • Metallothionine suppression • Peroxisomal Malfunction (P Kane, J of Orthomolec Med 1997; 12 -4: 207 -218 and 1999; 14 -2: 103 -109; Anne Moser) • Phase II Depression (S. Edelson, DAN Conference Sept, 1997, and Toxicology and Industrial Health 14 (4): 553 -563 1998) 39

Detoxification pathways of the liver……. Environmental toxins Non-end product Bowel metabolite toxins PHASE I Cytochrome P 450 Immune Bacteria Complexes Kupffer cells Activated Intermediaries Destroyed PHASE II Sulphation Conjugation Glucuronidation 40 EXCRETION FILTERING

Detoxification continued……. . • Sulphation Deficit in 15 of 17 (mean 5 vs. nl 10 -18) (Biol Psych 1; 46(3): 420 -4, 1999; Waring, 2000) • Glucuronidation low in 17 of 17 (mean 9. 6 vs. 26. 046. 0) • Glycine Conjugation low in 12 of 17 (15. 4 vs. 30. 053. 0) • Increased Heavy Metal Burden • Sulphydrate affinity for heavy metals 41

Permeability and Gastrointestinal Support…. The 4 R approach to gut rehabilitation • Remove - pathogens, xenobiotics, allergens • Replace - digestive enzymes, Factors, HCl • Reinoculate - Pre & probiotics, FOS, inulin • Repair - low irritant diet, nutrients to support growth & repair 42

Immunological Factors………. . Recurrent Infections (Euro Child/Adolesc Psych, 1993: 2(2): 79 -90 J Autism Dev Disord 1987; 17(4): 585 -94) T-cell Deficiency (J Autism Child Schizo 7: 49 -55 1977) - There is a shift from TH 1 to TH 2 cells in autism which impairs cell mediated immunity. (Gupta University of CA, MOA 2002) Reduced NK Cell Activity (J Ann Acad Chil Psyc 26: 333 -35 '87) Low or absent Ig. A (Autism Develop Dis 16: 189 -197 1986) 43

Immunological Factors continued………. . Low C 4 B levels (Clin Exp Immunol 83: 438 -440 1991) • There is a lack of inflammation - i. e. cell death without the normal immune response (Gupta University of CA, MOA 2002) • There antibodies to neurological tissue proteins (Gupta University of CA, MOA 2002) 44

Prevention is better than cure. Nutrition is the cornerstone of health and wellbeing……. . • Research indicates that a deficiency in any or many essential nutrients on the part of parents can contribute to L. D. and P. D. D. s • Many foods today are subject to genetic modification, pesticide sprays and industrial processing, --- what are the potentials to health? 45

Nutritional Factors…. . • Lower serum Magnesium than controls (Mary Coleman, The Biology of Autistic Syndromes 197 -205, 1976) Lower RBC Magnesium than controls (J. Hayek, Brain Dysfunction, 1991) • Low activated B 6 (P 5 P) in 42%. • B 6 and Magnesium therapeutic efficacy --multiple positive studies (Am J Psych 1978; 135: 472 -5) • B 12 deficiency suggested by elevated urinary methylmalonic acid (Lancet 1998; 351: 637 -41) • Low Methionine levels not uncommon (Observation by J. Pangborn) 46

Nutritional factors continued…………. . • Dietary analysis revealed below-RDA intakes in Zinc (12 of 12 subjects), Calcium (8 of 12), Vitamin D (9 of 12), Vitamin E (6 of 12) and Vitamin A (6 of 12) (G. Kotsanis, DAN Conf. , Sept, 1996) • Higher in serum copper. (Nutr. and Beh 2: 9 -17, 1984) Higher Copper/Zinc ratios in autistic children. (J. Applied Nutrition 48: 110 -118, 1997) • Low Derivative Omega-6 RBC Membrane Levels 50 of 50 autistics assayed through Kennedy Krieger had GLA and DGLA below mean. Low Omega-3 less common (may even be elevated) (J Orthomolecular Medicine Vol 12, No. 4, 1997) 47

Nutritional factors continued…………. . • Lowered glutamine (14 of 14), high glutamate (8 of 14) (Invest Clin 1996 June; 37(2): 112 -28) • Reduced sulphate conjugation & lower plasma sulphate. (Dev. Brain Dysfunct 1997; 10: 40 -43) • Hypocalcinurics Improve with Calcium Supplementation - Lower Hair Calcium in Autistics Reported (Dev Brain Dysfunct 1994; 7: 63 -70) 48

Nutritional Assessment & Protocol…. . Nutritional/Biochemical work-up • Full blood count • Metabolic Biochemical Analysis (MBA) - Full iron studies - Thyroid function - Urine analysis - Stool Analysis - Lipid and Peroxisomal Studies (Kennedy Kreiger, Kane) - Mineral levels (Zinc/Copper, ceuroplasma ) - Vitamin levels (especially B 6 function) 49

Nutritional Protocol…. . • Start with gluten and casein elimination. • Eliminate processed foods and soft drinks with additives, preservatives, sugar, aspartame, pesticides, hormones & potential allergens • Eat as much organic food as possible - Biodynamic is even better. Build up proteins, vegetables, fruit • Clean filtered water • Big Breakfast - Low Glycemic Index Foods - High Protein, Frequent Meals 50

Nutritional Protocol continued…. . . • Gut Care Digestive enzymes (Betaine Hydrochloride - TMG & DMG), amylase, lipase, peptidases, supplements and complementary remedies - milk thistle protects the liver, cranberry, grapefruit seed, papain & bromelain. • Address EFAs First Omega 6 (Evening Primrose for GLA) then Omega 3 Cod Liver Oil (Provides Vit A and D plus EPA/DHA) Fish Oil for additional Omega 3 Other: B 12, Biotin, Taurine, MSM, Folate, DMG, Amino Acids, Mb • Address bacterial overgrowths Pre & Probiotics- Lactobacillus GG, bifidobacteria etc. 51

Nutritional Protocol continued………. . . • Enhance detoxification pathways including Epsom salts bath - sulphates better absorbed via skin than food. • Start with the following incrementally, and monitor Zinc with Manganese B 6 (and/or P-5 -P) with Magnesium Calcium Vitamins C and E • Continue monitoring and modifying as necessary to the individual’s metabolic changes. 52

ARI parent survey for therapeutic responses by autistic children: • 50% improved with Zinc (6% worsened) • 49% improved with Vitamin C • 46% improved with Magnesium and B 6 (5% worsened) • 58% improved with Calcium (Later survey 42%) • Further research is needed 53

Immediate environmental factors…… • EMF: Our environment is now filled with man-made electro magnetic radiation that did not exist 100 years ago. - Many research studies indicate that amongst other things, our immune system is depleted by continued EMF exposure. • Sick Building Syndrome: Increased use of plastics, awareness of drinking water content, toluene, cleaning fluids, carpets, paints, toiletries, ‘air conditioning’ etc. • In light of the concerns raised, it makes sense to try to limit exposure to EMF's and other household pollutants as much as possible while still enjoying all that technology has to offer. 54

Structural and Somatic Work……. The value and benefit of human touch is beyond question, but in autism, it may require a considerable period of desensitisation before such therapies may be of value. The issues of comfort zone and development of trust can be major obstacles initially. While traditional chiropractic and osteopathic moves may be of benefit in cases requiring such adjustment and manipulation, in autism, subtle and gentle therapies such as the following have been used with some success. • Aromatherapy Massage • Craniosacral Therapy • Bowen Therapy 55

Aromatherapy Massage……. . . • Teaching parents basic massage techniques in combination with gentle blends of oil calming or stimulatory depending upon need - can help develop bonding and attachment where previously there was little or none. • Many children respond well to this technique, and will voluntarily initiate contact where previously, no recognition was present. 56

The Autonomic Nervous System……. . . 57

Craniosacral Therapy………. . . John Upledger in conjunction with the Autism Research Institute, developed craniosacral techniques which can be used successfully with a number of autistic children. Restrictions in the dural tube of the spinal cord and brain can impede the flow of CSF which nourishes the brain and nervous system. Children with classical autism were found to have similar restrictions in the craniosacral motion. In the hands of skilled and experienced practitioners this gentle and subtle, hands-on technique applied with just a slight amount of pressure (about 5 grams) encourages body systems (particularly musculoskeletal and the ANS) toward homeostasis. 58 - Upledger Institute - Milne Institute

Bowen Therapy………. . . • Bowen was developed in Geelong, Australia by the late Tom Bowen in the 1950’s and is now in use worldwide. • Bowen Therapy is a gentle muscle and connective tissue technique which addresses the whole body response by utilising precise moves across particular sites of the body in which the golgi tendon organ and neurovascular bundles are concentrated. • With an experienced practitioner addressing such sites, an impulse is sent to the central nervous system, (think of the reset button on your computer) allowing balance in the autonomic nervous system (homeostasis). • The moves are light and can be done through light clothing. 59

Golgi continued…. . . (From Tortora & Grabowski - 2000) 60 SITES OF CONCENTRATION OF THE GOLGI TENDON ORGAN

Counselling & Family Support……. . • Explanation of the difficulties and the criteria for diagnosis affords family members a better understanding of the child’s disorder. • Be specific about strengths and weaknesses. • Outline medical and complementary strategies available, including nutritional advice and the likely prognosis. • Explanation of the value of genetic testing. • Support groups 61 • Practitioner network and continuing education of all educational/health care personnel who work with children, esp. neonates.

Brain Section 62

Sagittal of skull and brain 63

Neurological factors…………. . . • Decreased cerebral blood flow • EEG abnormalities (frontal, temporal, parietal lobes and insular cortices; auditory ERPs at P 50, P 300) • Altered neurotransmitters (serotonin, dopamine) • Poor communication between cortical areas (angular gyrus, inferior frontal extrastiate occipital) 64

Autism and the brain……. From “The Brain In The News”, The Dana Foundation, 2002 65

Neurological factors continued……………. • Seizures are found in approximately 35 -45% of all cases - 70% temporal lobe. (Olsson, Steffenberg & Gillberg, 1988) • Structural imaging studies reveal: - Cerebral atrophy (Courchesene et. al. 1988) - Ventricular Dilation (Gaffney & Tsai, 1987) - Abnormal ventral temporal cortical activity during face discrimination among individuals with autism and Asperger’s Syndrome (Shultz et. al. Arch Gen Psychiatry. 2000; 57: 331 -340) • - Various abnormalities of cellular migration (Piven et. al. 1990) 66

Neurological factors continued……………. • Anterior and medial temporal lobe abnormalities (Bauman& Kemper, 1985; Bolton & Griffiths, 1997; Chugani et. al. 1996; Maurer & Damasio, 1982; Bachevalier 1994) • Decreased neuronal size and increased cell packing density has been observed in the hippocampus, entorhinal cortex and amygdala suggesting cells are fixed at an earlier stage of brain maturation. (Miller et. al. 1999) 67

Entorhinal cortex…. Subic. CA 1 FORNIX CA 3 Dentate Gyrus ENTORHINAL CORTEX Perirhinal Cortex 68 Parahippocampal Cortex Unimodal and polymodal Association Areas Other Cortex

Neural networks in autism……. . (Zimmerman & Gordon 2001) Prefrontal Cortex Dysfunctional Plasticity Caudate Nucleus Anterior Cingulate Nucleus Accumbens Limbic System Autism? 69 Thalamus Functional Plasticity Globus Pallidus Cerebellum Autonomic Centres Inferior Parietal Lobe Autism? =Disconnection Syndrome

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FLEXYX® Neurotherapy • An advanced form of EEG biofeedback. • It is non-invasive and painless, and requires only sitting in a comfortable chair and wearing dark glasses that generate feedback via transducers. • This is not a conscious learning task and attentional capabilities are not necessary. • Reduces the electrical "noise" in the brain (EEG slowing). These changes are the equivalent of greater neurological and behavioural "flexibility". • When EEG slowing is reduced, symptoms can decrease and even disappear. 71

Neurofeedback……. . . • Is a learning strategy that works to improve the brain's ability to produce certain brainwaves. It can be considered “aerobics for the brain”. • Sensors are placed on the scalp and ears and brainwave activity is amplified and monitored by a computer. The computer feeds back the signal in the form of a game. • When information about a person's own brainwave characteristics is made available to him/her, they can learn to change them. • Specific protocols are designed according to QEEG analysis. • 100 -200 sessions (approximately 30 minutes a session) of neurofeedback are required for the autistic child. 72

Functional Improvements observed with Neurofeedback…. . . • Medications often reduced. • Previous "memorised" speech replaced by some original thought; expression of own ideas and questioning. • Speech and language begin to develop/improve. • Attention improves. • Initiates touch; less sensitive to light, sound, and textures. • Interacts more and able to do some group work at school. • Responds more appropriately to parental directions. • Improved balance and gross motor control. • Decrease in hyperactivity and impulsivity. • More aware of feelings, emotions, and humour. • Less resistant to change. • Less mood swings/depression/anxiety 73

The sense of hearing…. . . 74

SOUND THERAPY cont’d………. . Hearing - external canal, drum (Tympanogram), otic bones and cochlear, the auditory nerve and the auditory cortex. -No timing, sequencing or Central Auditory Processing (CAP) involved. -It is the volume needed to hear each frequency (audiogram) 75

Sound therapy continued…. . Listening - requires good hearing plus the ability to efficiently sequence and process the sounds (40 -60 msec) Sounds are processed and linked to auditory memory for meaning ie central auditory processing. When listening ability is reduced resultant problems with decoding, blending, reading, spelling, auditory memory, visual input, visual memory and compliance occur. Reading - normal reading requires a complex mixture of processes to occur. 76

SOUND THERAPY………. 77

Reading cont’d………. . “Poor auditory processing abilities were recorded in poor readers; particular difficulties were posed by tasks requiring spectral distinctions, the simplest form of which was pure tone frequency discrimination. In absolute terms, the greatest deficits were recorded in tasks in which stimuli were presented in brief forms and in rapid succession……. Psychoacoustic difficulties are largely retained throughout adulthood and may be the source of retained reading difficulties”. (Ahassar et. al. -2000 Proc. Natl. Acad. Sci. USA. ) 78

Reading cont’d………. . This means ……. . The ability to understand verbally presented language requires fast processing of the sequence of sounds (vowels and consonants) and accurate identification of those individual sounds. If accurate identification is due to the ability to detect small differences in frequency (spectral differences), then the ability to sequence these sounds is due to the ability to detect the time gap between the spectral peaks (temporal processing). 79

Sound Therapy……. • SAMONAS® SOUND THERAPY • THE LISTENING PROGRAM® • AUDITORY INTEGRATION TRAINING® • TOMATIS® 80

How SAMONAS® Sound Therapy Works…. . The understanding of how SST works has two main bases. 1. The Brain itself i. Inherent neuroplasticity (King et. al. -2000) ii. The effect of music on the auditory cortex (Horowitz et. al. -1998) iii. The anatomical connections between auditory and other neurological systems. 2. SST i. Types of music selected (Full spectrum of the audible range) ii. The combinations of specific technical changes made to the music. A) Spectral activation - increase in multiple frequencies of the same pitch B) Temporal variation of the music C) Spatial localisation of the musical instruments D) Emphasis on the dominant ear E) CDs take advantage of the right & left side input crossover in brain F) Enhances the receptive mood of the listener G) Bone conduction applied to the mastoid bone changes sound to vibration directly affecting the vestibular system. 81

Benefits of SST • The auditory & visual sequence threshold decreases • Speech and language improves • Visual function problems improve • Motor balance and gross and fine coordination problems improve • Behaviour & sleep problems improve • General learning ability & classroom performance improve • Hypersensitivity to sound decreases 82 • Reduced levels of anxiety

Sensory Motor Integration…. . . the motor act is the cradle of the mind. - C. S. Sherrington…. . Problems with sensory integration in autism present as: - • Tactile sensitivity • Proprioception • Vestibular perception • Gross & Fine Motor difficulties • Visual motor difficulties • CAPD (central auditory processing disorders) 83 Interventions that address these difficulties include sensory-motor integration, primitive reflexes, auditory training/sound therapy, neurofeedback, facilitated communication, speech and occupational therapy.

Primitive reflexes…. • Are survival reflexes occurring sequentially in the first few weeks of foetal development • automatic, stereotyped movements, directed by a very primitive part of the brain (brain stem). • executed without involvement of higher levels of the brain (the cortex). • ideally short lived and as each fulfils its function is replaced by more sophisticated structures (Postural Reflexes) which are controlled by the cortex • retained if they do not fulfil their function 84 • considered aberrant and evidence of an immaturity within the CNS if present beyond their time.

Retained reflexes continued………. . . • A Reflex inhibition program: • is based on theory of replication ie. it is possible to replicate specific stages of development through the repetition of movement patterns based upon early development • gives the brain a "second chance" to pass through the stages which were omitted or incomplete in the first year of life 85

Retained reflexes continued………. . . • establishes neural connections and sets the "neural clock" to the "correct time". • consists of specific physical, stereotyped movements practiced for approximately 5 to 10 minutes per day over a period of nine to twelve months. • once begun should not be abandoned mid stream • should only be given under careful and qualified supervision. 86

Retained reflexes continued………. . . • Detection of primitive reflexes can help isolate the causes of a child's problem so that remedial training can be targeted more effectively. Craniosacral correction may also be necessary to re-establish central nervous system functioning. • Aberrant reflex activity needs to be addressed in order to facilitate normal development and eliminate many of the physical, academic and emotional problems their presence caused. 87

Developmental Vision & Speech Therapy……. . • 70% of information the brain receives for processing is through the eyes. • Distortions, stress related to lights, colours, patterns, high contrast or movement will affect the other senses and a child’s ability to interact with the environment. • Essential fatty acids, behavioural optometry and The Irlen Method® can help address peripheral vision issues and scotopic sensitivity in many instances. 88

Wenicke-Gershwind Model 89

Vision & speech therapy continued……. . • Lindamood-Bell®, Spalding® etc. • Speech therapy is most beneficial after CAP issues have been addressed and. . . • when applied intensively and consistently in all settings throughout the course of the child’s day. A 20 minute session of speech therapy 3 times per week is simply not enough. 90

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Pre-academic Programmes…. . . • ABA • TEACCH • PECS • DIR/“Floor Time” • INCLUSION • SOCIAL STORIES • The Miller Method 92

Teaching…………. • The acquisition of literacy and numeracy skills can only begin once the areas of affect, attention and sensory motor issues have addressed. • Remedial interventions which target the appropriate developmental level will be necessary for continued learning & development. (eg. IEP, teacher’s aides, inclusion strategies etc. ). 93

Psychology & Personal Development……. • Encouragement toward self esteem • Functional independence • Goals and goal setting Coaching (parents, teachers, peers etc. ) Mentoring (workplace) 94

In Summary……. . . “ A healthy brain is fundamentally based on a healthy biochemical/nutritional, ecologic and biomagnetic environment within each and every cell of the human body”. (Brain Allergies - Philpott & Kalita - 2000). The consensus of opinion indicates that Autistic Spectrum Disorders result from neurological problems occurring during prenatal development and/or within the first years of life whilst neural connections are still being made. 95

• Early intensive, multimodal interventions that target the fundamental deficits offer the best hope of ‘recovery’ from autism. • Following the model presented, a systematic multidisciplinary approach allows clinicians the opportunity to dynamically evaluate, apply and modify a course of action according to best practice and to accommodate specific needs. 96

Robert……. . • Robert is 11 years old and could quite easily be fitted to any of the PDD criteria/checklists including autism………. 97

Mary……. . . 98 Australian Woman’s Weekly , Aug, 2002

Perhaps in the future, with continued global interdisciplinary research, collaboration and sharing, the puzzle of autism can be solved so that individuals with ASD can function and live to their full potential. 99

Laboratory Resources (as listed by Kirkman Laboratories) • AAL Reference Laboratories, Inc. Tel (800) 522 -2611 (714) 972 -9979 Fax (714) 543 -2034 1715 E. Wilshire #715 Santa Ana, CA 92705 www. aalrl. com • Doctor’s Data, Inc. Tel (800) 323 -2784 (630) 377 -8139 Fax (630) 587 -7860 P. O. Box 111 West Chicago, IL 60186 www. doctorsdata. com • Great Plains Laboratory Tel (913) 341 -8949 Fax (913) 341 -6207 11813 West 77 th Lenexa, KS 66214 www. greatplainslaboratory. com 100

• Great Smokies Diagnostic Laboratory Tel (800) 522 -4762 (828) 253 -0621 63 Zillicoa Street Asheville, NC 28801 Fax (828) 252 -9303 www. gsdl. com • Immuno Laboratories Tel (800) 231 -9197 (954) 486 -4500 Fax (954) 739 -6563 1620 West Oakland Park Boulevard Fort Lauderdale, FL 33311 www. immunolabs. com 101 • Immunosciences Lab, Inc. Tel (800) 950 -4686 (310) 657 -1077 Fax (310) 657 -1053 8693 Wilshire Boulevard Beverly Hills, CA 90211 www. immuno-sci-lab. com

• Dr. John Criticos Tel (+61 2 9560 3154) Fax (+61 2 9569 8027) 79 Silver Street, Marrickville NSW 2204, Australia Email a 8761@ozemail. com. au • Dr. Ian Brighthope Tel (+61 3 9589 6088) Fax (+61 3 9589 5158 President of The Australian Complementary Health Care Council & Director of The Australian College Of Environmental And Nutritional Medicine. 13 Hilton St Beaumaris, Victoria 3193, Australia www. acnem. org email: mail@acnem. org • Meta. Metrix Clinical Laboratory Tel (800) 221 -4640 (770) 446 -5483 Fax (770) 441 -2237 4855 Peachtree Industrial Boulevard Norcross, GA 30092 www. metametrix. com 102

• Karl Reichelt, MD, Ph. D Tel 011 -47 -23 -07 -29 -85 Director, Clinical Chemistry Department of Pediatric Research Rikshospitalet – The National Hospital N 0027 Oslo, Norway • Smith Kline Beecham Laboratories Tel (888) 825 -5249 (919) 483 -2100 P. O. Box 13398 Research Triangle Park, NC 27709 www. us. gsk. com • US Bio. Tek Laboratories Tel (206) 365 -1256 Fax (206) 363 -8790 13758 Lake City Way NE Seattle, WA 98125 www. usbiotek. com 103

For neurofeedback • www. snr-jnt. org • www. flexyx. com • www. eegspectrum. com For Samonas Sound Therapy • www. samonas. com For Craniosacral Therapy • www. upledger. com • www. milneinstitute. com For Bowen Therapy 104 • www. bowtech. com