Autism, An Extreme Challenge
to Integrative Medicine
Part 1: The Knowledge Base

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   Alternative Medicine Review 2002 (Aug); 7 (4): 292–316 ~ FULL TEXT

Kidd PM

Parris Kidd, PhD (Cell Biology, University of California at Berkeley)
Contributing Editor, Alternative Medicine Review;
Health educator and biomedical consultant to the supplement industry.
847 Elm Street,
El Cerrito, CA 94530

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Autism, archetype of the autistic spectrum disorders (ASD), is a neurodevelopmental disorder characterized by socially aloof behavior and impairment of language and social interaction. Its prevalence has surged in recent years. Advanced functional brain imaging has confirmed pervasive neurologic involvement. Parent involvement in autism management has accelerated understanding and treatment. Often accompanied by epilepsy, cognitive deficits, or other neurologic impairment, autism manifests in the first three years of life and persists into adulthood. Its etiopathology is poorly defined but likely multifactorial with heritability playing a major role. Prenatal toxic exposures (teratogens) are consistent with autism spectrum symptomatology. Frequent vaccinations with live virus and toxic mercurial content (thimerosal) are a plausible etiologic factor. Autistic children frequently have abnormalities of sulfoxidation and sulfation that compromise liver detoxification, which may contribute to the high body burden of xenobiotics frequently found. Frequent copper-zinc imbalance implies metallothionein impairment that could compound the negative impact of sulfur metabolism impairments on detoxification and on intestinal lining integrity. Intestinal hyperpermeability manifests in autistic children as dysbiosis, food intolerances, and exorphin (opioid) intoxication, most frequently from casein and gluten. Immune system abnormalities encompass derangement of antibody production, skewing of T cell subsets, aberrant cytokine profiles, and other impairments consistent with chronic inflammation and autoimmunity. Coagulation abnormalities have been reported. Part 2 of this review will attempt to consolidate progress in integrative management of autism, aimed at improving independence and lifespan for people with the disorder.

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Introduction

In 1943 the psychologist Leo Kanner published case histories of a childhood developmental disorder he called autism. He defined three symptom patterns:

(1) failure to use language for communication,

(2) abnormal development of social reciprocity, and

(3) desire for sameness, as seen in repetitive rituals or intense circumscribed interests. [1]

Autistic children seem abnormally withdrawn, almost self-occupied, and out of touch with reality. As a group they score significantly lower on measures of adaptive or life skills than the general population. [2]

Individuals with autism tend to have extreme difficulty learning from experience and modifying their behavior to accommodate varying situations. [2] Coping with the unpredictability of the social world is especially demanding, even overwhelming, for adults with autism; associated anxiety exacerbates the problem. [2] Adult individuals with autism have life outcomes that range from complete dependence to (rarely) successful employment. Most are able to benefit from structured training programs with marked improvement in their quality of life. [3]

Autism has become epidemic in the industrialized societies. In the United States, autism was relatively rare until the early 1990s, after which its prevalence increased by at least double, and more likely 3-5 times. [2] Similar steep increases in prevalence have been recorded in the United Kingdom. [4] The gender ratio is 3-4:1 boys to girls. [2] Since every autistic child has a major impact on the family, school system, and community, this epidemic calls for compassion, sensitivity, and maximum assistance from society as a whole.

There is a great deal of debate in the healthcare world over the existence of an autism epidemic and the possible contributing factors. Parents, supported by progressive healthcare professionals, are on one side pointing at vaccines manufactured with known toxic ingredients. On the other side are governmental and private organizations seemingly unwilling to institute reform. The annual monetary cost of autism in the United States is estimated to be $26 billion. [5]

From the clinical-biological perspective, this disorder or spectrum of disorders, is extremely complex and multifaceted. Its expression, pathology, etiology, and management rank it among the most perplexing disorders known. Autism challenges the intellect and research skill of investigators obtaining funding support to investigate it. Yet despite all the limitations, real progress has been made within the last decade toward helping autistic people become productive members of society.

The Autism Research Institute, founded by Dr. Bernard Rimland, and its Defeat Autism Now! (DAN!) initiative, have successfully advanced medical management of autism to the degree that some children largely recover and can have somewhat normal lives. [6, 7]Within the broader medical community, diagnosis and assessment have also markedly improved, as have the pace and intensity of research. This review (Part 1 of 2) seeks to define the features of the disorder and its core abnormalities. Part 2 will address the variety of approaches to its medical management, along with priorities for future research.

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