Although I am not a pediatrician, I am genuinely concerned about the dramatic rise in the prevalence of Autism and Autism Spectrum Disorders, or ASD. The latest CDC reports 1 in every 68 children in the USA may suffer ASD, but my concern turns into anguish when I see a child’s life robbed of his full potential. That is when I can no longer be a spectator, and it is important for me to bring awareness to the rise in autism. Hopefully, increased awareness will result in early detection and intervention-as well as helping mothers better prepare their bodies to create a healthy environment for conception.
Autism Spectrum Disorder, or ASD
Autism, or Autism Spectrum Disorder (ASD) is defined as a neurodevelopmental disorder characterized by poor social ability and verbal communication skills. This disorder has a broad presentation which can affect communication, behavior, and learning capacity, and usually begins in early childhood and lasts throughout life, especially if not treated. Within the ASD spectrum there are children and adults with Asperger’s that may have a normal or superior IQ. Most of the autistic children are said to have below average IQ, however that is also debatable due to the hurdles to measure IQ in autistic children.
New mothers are no experts in normal neurodevelopment- and even I had to google what to expect of my 10 months old grandbaby! There is good 20 question questionnaire for toddlers called M-CHAT-R that provides parents a checklist if you are concerned about your child’s progress. By age 2 to three it may be easy to for anyone to see that something is not quite right with the child, but the earlier problems are detected the sooner the physician can implement remedial actions. We have learned from mothers of autistic children that often the children had normal development and only after the second year did things begin to not look right, so the M-CHAT-R test may be a good way to start.
Here is a sample of the questions on the M-CHAT-R:
-Does your child make unusual finger movements near his or her eyes? (FOR EXAMPLE, does your child wiggle his or her fingers to his or her eyes?)
-Does your child point with one finger to ask for something or to get help? (FOR EXAMPLE, pointing to a snack or toy that is out of reach)
-Does your child point with one finger to show you something interesting?
-Is your child interested in other children? (FOR EXAMPLE, does your child watch other children, smile at them, or go to them?)
Multi-factorial Possible Causes of Autism
The causes of Autism are multifactorial and include genetic abnormalities that may render the child more susceptible to environmental factors than normal children. This factor may play a role since the baby’s brain is forming in utero, and if exposed to heavy metals, viruses, or bacteria that cross the placenta, in utero de novo chromosomal abnormalities and or inherited DNA changes that could render the child susceptible to developmental disorders.
After birth, exposure to toxics, virus, bacteria, parasites, and abnormal microbiomes (gut intestinal bacteria) can orchestrate the damage in the child’s brain. Studies have also shown that autistic children have low levels of oxytocin and scientists have considered this as a potential therapeutic modality.
Neurodevelopmental therapy and motor training is paramount to help the child, but at the same time we should be going to the root of the problem and implement the needed remedies.
In the near future we may have gene therapy to help the child, perhaps even in utero, but at present what we can do is alter the environment that allowed that genetic aberration to manifest or make the child more susceptible to every day toxins.
Environmental Factors and Heavy Metals
Lets review some facts. The Environmental Working Group (EWG) and collaborators did a study in 2004 of the umbilical cord blood of newborn children and they found 200 industrial toxic chemicals. In 2009, the study showed 230 chemicals and among the chemicals found were lead, mercury, and PCB, which are known neurotoxins. What are these environmental toxins doing in umbilical cord blood? What are these chemicals doing to susceptible children?
It is common for many autistic children to have allergies (even if breastfed) eczema, food intolerances (dairy, wheat), gastrointestinal issues, bloating, constipation, diarrhea, foul smelling stools (a dysbiosis alteration of microbiome).
There may be a connection of the cause and effect and the presentation of signs and symptoms that reflect brain inflammation but it is beyond the scope of this writing and more research needs to be done for possible aspects that may contribute to Autism Spectrum Disorders. The important thing is that is a multi-factorial disorder and therefore a comprehensive analysis of the child with a plan for remedy will likely result in more success stories.
The Gut Connection
We know that when children are born they still have not fully developed a brain blood barrier nor an intestinal barrier. Many toxic chemicals, bacterial pathogens, virus, and parasites can cross the placenta, including heavy metals, mercury, lead, aluminum, arsenic and cadmium. I also believe that the breastfeeding mother’s gastrointestinal issues and allergies may reflect in the child. Our intestinal macrobiota starts developing in utero and as we pass through the birth canal we get a lot of our mother’s good flora to help us colonize our intestine and develop a healthy gut. But antibiotics can wipe out the good flora and leave the field for bad bugs to take residence in the intestine. This may seem minor, but it is not.
Several authors have looked into the gut microbiome to see if it plays a role in autism. Feingold and others have examined the flora composition of Autistic children versus controls and found significant differences. One of the differences is too much of bacteria that produce short chain fatty acids. Specifically of concern is propionic acid, a well-known neurotoxin that, with a permeable intestinal epithelium, can reach the brain. Other bacteria in disproportion are the bacteria that produce the toxic gas Hydrogen sulfite, which damages the intestinal epithelium among other toxicities.
One study found that the autistic children had less bifidobacterium, enterococcus, enterobacter clocacea, and less klebsiella oxytosa, but too much of lactobacillus-mostly the ones derived from milk products, not lactobacillus derived from plants.They postulated that when children were treated with antibiotics, disrupted intestinal flora composition ensues such as overgrowth of anaerobic Clostridium species that in turn increase the production of propionic acid that reach the brain and starts a series of events of neurotoxicity including Microglia activation, disruptor of signaling and neurotransmitters.
It is noted that when children with autism were given vancomycin in order to correct the dysbiosis there was a temporary improving while on antibiotics only to reverse once the oral vancomycin was discontinued.
On reviewing the interplay of different factor that lead to autism or ASD, it is not hard to come to the conclusion that the plan of treatment starts with prevention, and once autism has been diagnosed, the treatment will be aimed at the many different factors playing a role in the symptoms. Some treatment plans may be general to all children with Autism and ASD and some may only apply to some, such as future gene therapy (e.g. what genes need to be silence or expressed in what child.)
Integrative Approach to Treat Underlying Issues in Autism
A complex disorder can not be expected to have a simple fix, and the success of treatment and reversal of autism symptoms to reach normality will likely involve a holistic approach addressing mitochondrial dysfunction, oxidative stress, detoxification, allergy elimination, normalization of nutrients and hormones, calming and resolving brain inflammation, and correcting methylation abnormalities.
Part of this approach should include prevention that begins long before conception. I would love to see future mothers checking their toxic load of heavy metals, gut flora, methylation abnormalities, possible dormant viruses and bacteria (Epstein Bar virus, Lyme bacteria) and perhaps oxytocin levels- and preparing their body for a healthy baby.
Margarita Kullick MD is a functional and anti-aging medical physician who is board certified in Internal Medicine. Her areas of interest include holistic primary care, chronic disease management and prevention (diabetes, kidney disease, chronic fatigue, osteoporosis), hormone replacement therapy, depression/anxiety, brain health and memory loss, and testing of the markers of aging. Dr. Kullick is bilingual in English and Spanish and a medical writer for a Hispanic community publication.