The document discusses recent advances in treatments for autistic spectrum disorders. It outlines typical developmental milestones from 7 months to 2 years and associated "red flags". It then discusses the emergence of a new model for autism that sees it as environmentally triggered and influenced by genetics, involving both brain and body abnormalities. Topics covered include autism being a medical rather than mental disorder, and treatments including educational and developmental therapies, behaviorally-based treatments, medical/biological treatments, and mind-body medicine. Common complementary and alternative treatments are also outlined, including their hypothesized mechanisms and safety. The role of heavy metals, yeast overgrowth, leaky gut, methylation, methylcobalamin supplementation, and chelation therapy in

1. Recent Advances in the
treatment of Autistic
Spectrum Disorders

2. By the end of 7 months
Smile back at another person
Respond to sound with sounds
Enjoy social play
Red Flags
• No big smiles or other warm, joyful
expressions by six months or thereafter
• No back-and-forth sharing of sounds,
smiles, or other facial expressions by nine
months or thereafter

3. By the end of 12 months
Use simple gestures
Imitate actions in their play
Respond when told “no”
Red Flags
• No back-and-forth gestures, such as
pointing, showing, reaching, or waving bye
• Not answering to one’s name when called
• No babbling – mama, dada, baba

4. By the end of 18 months
Do simple pretend play
Point to interesting objects
Use several single words unprompted
Red Flags
• No single words by 18 months
• No simple pretend play

5. By the end of 2 years
(24 months)
Use 2- to 4-word phrases
Follow simple instructions
Become more interested in other children
Point to object or picture when named
Red Flags
• No two-word meaningful phrases (without
imitating or repeating)
• Lack of interest in other children

6. Red Flag: Any loss of speech or
babbling or social skills
Regression at any age is cause for
immediate referral

7. The emergence of a
new autism model
Older model
• Genetically determined
• Brain based
• Hard-wired
• Treatable but not curable
Is autism a BRAIN
DISORDER?
Newer model
• Environmentally triggered
• Genetically influenced
• Both brain and body
• Metabolic abnormalities play big
role
• Treatable and recovery possible
OR is it
A DISORDER THAT
AFFECTS THE BRAIN?

8. Topics
AUTISM is A Medical condition .
It is not a mental Disorder
As such it is preventable
Treatable .
8

9. Treatment
Goals
 Minimize core features and associated deficits
 Maximize functional independence and QOL
 Alleviate family stress
Educational intervention
Developmental Therapies
 Communication
 Sensory, fine motor, gross motor
Behaviorally Based treatments
 Core and associated symptoms
 Social skills
Medical or biologic treatments
Support family in home and community

10. ABA (Applied Behavioral Analysis)
General behavioral teaching approach involves reinforcement
and consequences to shape behavior
All of our parents used it!
Involves the A, B, C’s
Not airway, breathing circulation
Antecedent
Behavior
Consequence

11. Speech/Language Therapy
Behaviorally based/ intensive structured teaching
 E.g., Verbal Behavior
Augmentative strategies
 Sign language
 PECS
 Aided augmentative/ alternative system(s)
Decrease non-communicative language
Developmental-pragmatic approaches
 appropriate use of language in social situations
 e.g., SCERTS
 Social skills training

12. Adjunct to educational,
developmental & behavioral
treatments
So far no evidence of impact
on core symptoms
Evidence supporting is
variable
Toolkit – handouts for MD &
families
Treat target symptoms
 Stereotypies
 Withdrawal
 Obsessions
 Irritability
 Hyperactivity
 attention span
 self-injurious behavior
 Aggression
 sleep

13. Mind-body Medicine
Yoga
Music Therapy
Manipulative and Bodybased
Chiropractic
Massage/Therapeutic Touch
Auditory Integration
Energy Medicine
Transcranial & magnetic
stimulation
Biologically Based
Most commonly used
~ 50% - biologically based
30% - mind body
25% - manipulation/ body
based
** Most use > 1 modality

14. Immune
Supplements
B6/Magnesium, B12
DMG/ TMG
Vitamin A, Vitamin C
Folate
Omega 3 Fatty Acids
Elimination Diets
Casein/ gluten free
Off-label medications
Secretin
 Antifungal therapy
 Immunotherapy, steroids
 Antibiotics/Antivirals
 Stem cell transplantation
Immunization-
related
 With-hold immunization
 Chelation
Hyperbaric oxygen
therapy (HBOT)
Always others coming along…

15. One of most commonly used CAM treatments
Hypothesis :
Exogenous opiate-like peptides = false neurotransmitters
Evidence – most non-blinded; few RCT emerging, no differences
Requires
elimination of ALL dairy products (not “GFCF except for ice
cream…”) & elimination of barley, rye, oats & wheat products
Potential deficiencies
Inherently deficient in calcium, vitamin D
B vits, Iodine, others may be lower in substitute products
Weight typically adequate, monitor Fe status

16. Another approach to therapy
Dealing with the yeast overgrowth.
Dealing with the leaky gut.
Heavy metals and their effects.
Chelation.
Methylcobalamin.
16

17. with before dealing with
the heavy metal issue
There are 3 main issues common to all autistic Children
1. Yeast Overgrowth
2. Leaky gut
3. Heavy Metal Accumulation
17

18. Yeast Overgrowth
Yeast overgrowth leads to poor absorption of
necessary vitamins, minerals & esssential nutrients.
It is normal to have a small amount of yeast in the GI
tract. Autistic children however have abnormal
amounts, usually leading to poor absorption of
essential nutrients and the leakage of toxic substances
into the bloodstream which should not be absorbed.
18

19. How do we treat the Yeast
overgrowth & Leaky gut
syndrome
 Nutrition/Antioxidants in food and metabolised in
the body
 Vitamins A, B Complex, C, E, B12 , B6, Folic Acid, Niacin
 Essential Fatty Acids These are extremely important.
They are a most powerful anti-inflammatory agent.
 Co-Enzyme Q10,DMG
 Trace elements – Magnesium, Selenium, Chromium, Zinc
 Probiotics
 Reduced L glutathione,N Acetyl cysteine, Alpha-Lipoic
Acid
 Anti-fungals medications.
 Herbal Products,
19

20. and where do they come
from
Lead – petrol, paint, batteries, certain water mains
Mercury – fillings in teeth, fish, paint, numerous
appliances such as mercury thermometers, nasal
sprays and eye drops, certain vaccines.
Cadmium – Cigarettes, tyres, metal platings
Arsenic – Pesticides, chicken feeds, rice, treated
wood
20

21. and where do they come
from
Aluminum – Cooking wares, aluminum
foil, antacids, certain vaccines, canned
drinks/foods
Antimony – Carpets, flame retardant
clothes
Iron
Copper
21

22. Heavy Metals – how are we protected
against these free radicals
 Diet /nutrition– “let food be your medicine






and let medicine be your food”- Hippocrates
Supplementation
Skin release
Good kidney eliminations
Good bowel eliminations
Exercise
Healthy lifestyle
22

23. What are the effects of these toxic metals
overload
They are oxidised to form free radicals resulting in
the destruction of cells,
They affect organs ,interfere with enzyme systems,
inhibit prostaglandin formation. Weaken the immune
system, inhibit the proper functioning of cells,
contribute to gastrointestinal problems, and are
carcinogenic.
23

24. What Chelation agents are there
1.
EDTA-Ethylene diamine tetra acetic acid
2.
DMSA(dimercocaptosuccinic acid)
3.
DMPS(dimercaptopropanesulfonic acid)
4.
TTFD Transdermal Allithiamine
24

25. How are they used
EDTA is effective only intravenously.It is used in
adults in the form of MG EDTA for Heart
Disease,Circulatory disorders,neurological disorders,
and the chronic degenerative diseases.
DMSA (dimercocaptosuccinic acid)
DMPS(Dimercaptopropanesulfonic acid)
TTFD/allathiamine (active form of B1)
25

26. EDTA and its safety
Given according to ACAM protocol millions of
chelations in past 30 years no recorded death.
Doctors licensed in western Canada since 1997 No
serious ADRS
NIH conducting $30 million clinical trial on 2,300
patients no serious adrs
NIH 800,000 I.V EDTA chelations in U.S. alone no
serious ADRS
Not suitable for ASD children 3 hour i.v. inneffective
in chelating mercury
Powerful chelator of all other toxic heavy metals
26

27. Metal Dertoxification in Auistic children
DMSA is the most widely used , convenient, safe , and
given orally. It is a good chelator of Mercury, Lead
and Cadmium.
Dmps May be given intravenously. A good chelator of
mercury,often used as a provovative agent, usually
given in oral form
27

28. Chelating With the oral chelators
 DMSA is given orally according to the Dan protocol 10mg/kg body
weight/3times daily for three days on and 11 days off.
 Repeat Full Blood Count and Blood chemistry tests at 3 to 4 month
intervals.
 Mobilization and excretion of the heavy metals produces a shift in the
equilibrium between the various compartments of the body. This
exerts an almost magnetic effect on metals in depots which are not
directly accessible to the chelating agent. The body attempts to
restore an equilibrium between the depots again. The heavy metals
will then migrate partially into compartmenst where it is accessible to
the chelating agent.
28

29. Advantages of DMSA over DMPS
 DMSA more widley used therefore greater experience with its use and
well established safety profile.
 Well established in the DAN protocol.
 No well established oral DMPS protocol.
 DMPS used more in acute poisoning with Lead, Mercury, Arsenic etc.
 DMSA is more effective in removing Mercury from the brain,
particularly when combined with Alpha Lipoic Acid.
29

30. Disadvantages of DMSA oral
therpay
 DMSA may feed into the yeast/leaky gut/Gastrointestinal problems.
 DMPS is not as severe on the gastrointestinal problems
 DMPS used by some physiciansina once weekly dosage of 100 mg per
week
 Is over 50 % absorbed
30

31. Methylcobalamin and
pharmacology
Metylathion is the process by which a single Carbon
atom is transferred from a Methyl donor to another
molecule.This process is essential to life itself.
Dr. Richard Deth of Boston believes that Thiomersail
interferes with the Metylathion process in converting
Vitamin B12 to Metylcobalamin.
In many cases Autsim can be treated effectively by
the Administration of Metyl B12 to augment the
Metylathion capacity.
31

32. Biosynthesis of Active Methylcobalamin
The low levels of Glutathione in autistic children will
adversely affect their ability to detoxify and protect
against heavy metals such as Thiomersal.
32

33. Impaired Methylation
As impaired Methylation is important in Autism, the
administration of Methylcobalamin should bring
about an improvement.
Dr. James Neubrander has found significant
improvement with injections of Methylcobalamin by
giving the Methylcobalamin every 3 days.
Improvements were noted in Attention, language
ability and social skills.
33

34. How is Methylcobalamin given?
Dosage recommendation is 65 micrograms per
Kilogram Bodyweight every 3 days.
This means that as much as 1250 micrograms is
present in 0.05ml
The needle 30 gauge 3/10 Ultrafine BD insulin. It may
be given by the parent while the child is sleeping.
It is inserted into the buttock at a 30 – 45 degree
angle just under the skin.
34

35. Adverse effects
1.
Stimming
2.
Hyperactivity
 Should these effects occur one does not necessarily
stop the treatment.
 If Adverse effects are tolerable the treatment should
continue
35

36. Concentrated Metylcobalamin by Injection
Metylcobalamin is the active Co-enzyme element of
B12
B12 is present in the brain and central nervous system
as Metylcobalamin & is Non toxic.
It is known that Metylcobalamin metabolism is
impaired in the Autistic child.
Much information on this is available for Dr.
Neubrander.
36

37. Typical Naturopathic
Treatment Plan
Heavy Metal Toxicity
Gastrointestinal Health
Wheat (gluten) and milk (casein) free diet
Candida diet (sugar, arabinose, tartaric acid)
Hypoallergic diet to prevent autoimmunity
Anti-inflammatory diet to control inflammation
Supplements including EFA, probiotics, glutamine,
MCT
Asses presence of heavy metals
Investigate heavy metal exposure
Undergo chelation therapy for removal of heavy
metals
Brain Chemisty
Evaluate levels of Glutamate/GABA,
serotonin and dopamine

38. Nutrition
Why does food matter?
Opium, gluten and milk in Autism
Breakdown of gluten and casein by secretions of the pancreas and the
intestines create peptides (small proteins) that are similar in structure
to endorphins (the body’s natural pain killer). These peptides have
opiate-like qualities.
Normally, these peptides are degraded and excreted with little effect.
In autistic patients, these peptides can lead to reduced brain electrical
activity and thus altered behavioural changes.
This activity is improved by naltrexone administration (an opioid
antagonist) therefore proving opioid action.
Much anecdotal evidence exists of significant improvement in autistic
symptoms when milk and wheat are eliminated from the diet.
A study using 15 autistic children correlated significantly increased urine
exorphin level with autistic spectrum patients. Elimination of milk
and gluten from the diet resulted in improvement of social, cognitive
and communications sills, commensurate with reduction of urinary
exorphin level. Knivsberg et al, 1990

39. Treatment
 Atypical antipsychotic, Abilify
(Aripiprazole) oral formulation
was approved November 24,
2009 by the FDA for the
treatment of irritability
associated with ASD in children
aged 6-17 years.
 Data based on two 8 week,
randomized, placebo-controlled
multicenter studies evaluating
its efficacy for improving mean
scores on the Caregiver-rated
Irritability subscale of the
Aberrant Behavior Checklist
(ABC-I).

40. Multi dimensional approach
It should be remembered that improving Methylation
capacity is only one component of the multi
dimensional approach in the treatment of Autism.
Gluten Casein free diet
Nutritional supplementation
Chelating
Behavioural therapies
Pharmacotherapy
41