Clinic Notes: Autism and Gluten

Several years ago a pediatrician contacted me regarding her two-year old child who had just been diagnosed with autism. She worked in a large university hospital and took her child to the Neurology Department for an evaluation and they told her that autism was a neurological disorder. The followed up with an appointment with the Immunology Department and they told her that autism was an immune disorder. Similarly, in the Gastroenterology Department she was told that autism was a gastric disorder. In desperation she contacted me and asked what kind of disorder was autism. I told her in the end autism is a neurological disorder although gastric and immune factors may be involved in the etiology of autism. Previous studies have found a link between autoimmune disorders such as type 1 diabetes, rheumatoid arthritis and celiac disease. Celiac disease is a gastric disorder, which is treated by a gluten free diet. Gluten is found in wheat products and is in a variety of foods. Many parents have reported improvement in behavior in their children with autism on a gluten free diet. Unfortunately, this claim has not been confirmed in a double-blind study. In a double blind study the person giving the substance, in this case gluten or the absence of gluten, and the person receiving the substance do not know which they are giving or receiving. This is the standard for controlling placebo effects. I would like to see this study done, but I would like to see children in the study restricted to children with autism who also have gastric problems. This still wouldn't be a perfectly controlled study because the children not receiving gluten may simply feel better and therefore act better.

Clinic Notes: Recovering From Autism with ABA

We have been telling parents for years that ABA is the best treatment for autism. But then we quickly add that there is no cure for autism and it is a life long condition. Well, maybe we were wrong. We have had data for some time suggesting that it may be possible to prevent autism in high-risk toddlers by using intensive ABA (See www.aba4autism.com). Now a recent study finds that one in ten children given intense ABA at an early age recover from autism. (See WebMD Health News for details). The results of this study do not surprise me. Many of the kids who started ABA early in my clinic seem to be "normal" by age six or seven. I think the problem now is finding affordable and competent ABA for all of the kids with autism who are out there.

Clinic Notes: The Window to the Mind of Children with Autism

According to poets the eyes are the windows to the soul. I don't know if that is the case, but I do know that for many nonverbal children with autism speech augmentative devices are the windows to the mind. I am still amazed at the cognitive ability that is locked away in many nonverbal children with autism. This cognitive ability becomes unbridled when they learn to push the buttons on a speech augmentative device and generate electronic words. The autism literature says that anywhere from 75 to 90% of children with autism are mentally retarded, but I don't believe it. I am convinced that many children with autism who tested as mentally retarded would loose their mentally retarded diagnosis if they were proficient with a speech augmentative device. But with a 5 to 7 thousand-dollar price tag that won't happen anytime soon.

Clinic Notes: Asperger's and Social Networking

I was surprised to learn that some of the Asperger's kids who come to my clinic have Facebook pages. Their parents have set them up for them and closely monitor their activity. The Asperger's kids post pictures they have taken and post comments. Often, their posts are edited by their parent for content, grammar and punctuation. I doubt that anyone reading their post would guess that they have Asperger's. Writing and socialization is hard for kids with Asperger's and I think that social networking is a great idea. With the parents permission I plan on getting all of the Asperger's kids who come to my clinic a Facebook page.

Clinic Notes: Asperger's and Bullies

All of the children with an Asperger's diagnosis that I see in my clinic are mainstreamed. And that's good until Middle School when testosterone kicks in at puberty and bullying starts. It's like kids with Asperger's have a target on their back that says bully me. Of course other kids besides Asperger's kids are bullied, but for kids with Asperger's it is especially bad because they don't understand social behavior much less anti social behavior. I was especially glad to see that the American Academy of Pediatrics is publishing a policy statement on bullying and recommending a prevention model developed in Norway by Dan Olweus. The Olweus program focuses on the bystanders rather than the bully or the victim. The bystanders are taught that the bully has an anger management problem and they can protect the victim. Hopefully schools will adopt this model and provide training to stop bullying of children with Asperger's as well as the other ¼ surveyed who say they have at times been bullied.

Clinic Notes: Autism in Adults

In a recent article in "Time Magazine" the brother of a man with severe autism describes the life of his autistic brother and the ordeal his parent and now him are dealing with. Noah, who cannot speak or care for himself, bangs his head and pinches himself, and grabs people, spent 15 years in a state facility. His "therapy" has mainly been drugs, which unsuccessfully managed his symptoms. The article was taken from Karl Taro Greenfield's book, Boy Alone: A Brother's Memoir.
Greenfield notes that his parents were exhausted after years of caring for Noah at home and had no choice but to place him in an institution for children with developmental disabilities. They visited weekly and the family served as Noah's support group until he was moved to an assisted living facility. Greenfield notes, as I did in a previous blog, that we are not prepared for the explosion of adults with autism that will be here in a few years. All of the money now is being spent on services and research for children who are growing up.

Clinic Notes: Terrorists Recruiting Asperger's Suicide Bombers?

Apparently, terrorists using the internet helped a British citizen with Asperger's plant a bomb in a restaurant. The bomb went off prematurely injuring the man with Asperger's and causing a stampede in the restaurant. Sentenced in the Old Bailey Court to 18 years in prison the suspect is now undergoing test in a mental hospital. Many of the children with Asperger's that I treat in my clinic have problems with social concepts so I'm not surprised that the terrorists were successful. I suppose this is an isolated incident?