Teresa Binstock
Researcher in Developmental & Behavioral Neuroanatomy (9)
PO Box 1788
Estes Park CO 80517
usa
© December 19, 2005 (c)
During November and December, 2005, I visited several autism families in their homes. These visits lasted from one to several days. The home environment allowed each child to display a range of behaviors and gestures that might not be apparent in an interview situation or from other perspectives such as a camp for ASD children and their families (ASD Gathering, Ojai,Calif, 2004, 2005).
Two general categories distinguish the children. Some were early in the stages
of biomedical therapeutics and other therapeutics, and others had been following biomedical
and other therapeutics for several years (1-5).
For many children treated biomedically in accord with a DAN! approach and the
closely related strategy summarized in the book Children with Starving Brains (1), cognitive and behavioral
improvements important to the child and to his or her family have occurred.
However, as months turn into years, then into more years, some such children
retain a negative trait (or several) and/or fail to develop a positive trait
that naturally occurs among neurotypical peers of a certain age. In other
words, a plateau of healing becomes apparent for some children who have been
making improvements via biomedical therapeutics for a long time. In
some instances, an affected child who had been accepted by non-affected,
similarly aged peers begins to be rejected as the peers realize that their pal
is different.
Playing “catch” provided insights. Two soccer balls were available. The younger, unaffected sibling (4yo) understood the concept of “playing catch”, whereas the older, affected-child (7yo) did not grasp the concept of playing catch and threw the ball aggressively without regard to the person who – in a game of catch – ought to have been the recipient. When that affected child was younger – after a year or several of biomedical interventions and other therapies that have been very healing, very helpful – that child’s not comprehending the rules of playing catch may have been overlooked by his peers, but as the affected child and the other children advance in age (eg, as they become 7 or 8 or 9), the affected child’s inability to play catch becomes a significant impairment of sociality – as his peers begin to notice his “otherness”. Concurrently, his parents have come to sense the peers’ reactions to the affected child.
Another lad (aged 12) has made significant improvements via DAN!-associated biomedical and other therapies. Yet he too has remaining traits that are beginning to set him apart from peers, some of whom has been playmates until recently. This lad had biomedical issues delineated by lab data, medical history, and observation, thus he may yet heal in ways that minimize his increasing distance from peers. However, regardless of improvements that may occur in the future, as months turn into years, circa 2005 he is learning about social rejections and about other quirks in his cognition.
In contrast, several affected children who had only recently begun biomedical interventions were amidst wonderful progress and had not been biomedically treated long enough for parents and others to sense if and where each child’s adverse traits would plateau.
Among the children and families visited this fall, an affected child who is nearly five seems to be the closest to achieving neurotypical. In contrast, a somewhat older, still severely affected child has been making major gains via several biomedical and other therapies. Nonetheless, while amidst these ongoing improvements, he continues to be a very affected child. How much progress towards neurotypical each child shall make remains to be determined, as does the nature of each child’s plateau in healing.
The concept “plateau” is not cast in stone. What seems like an enduring set of negative traits (or absence of certain positive traits) may ameliorate with further treatment, perhaps and especially if additional “breakthrough” therapies are developed.
In the absence of new treatments, an important question arises: Does a specific child’s plateau reflect persistent, deeply embedded neurologic and gastrointestinal damage from toxins and suboptimal nutrients? Two ramifications follow.
A. The plateau achieved by long-term biomedical therapeutics may represent the core of what social, environmental, and medical policies have done to injure the child (eg, the allowing of a wide range of toxic exposures).
B. The characteristics of a specific child's plateau become a more precise foundation for physical and cognitive therapies as the child ages, especially for children who have healed to a functional level of self-awareness, social awareness, receptive language, and cognition.
The biomedically oriented book Children with Starving Brains delineated general categories (levels) of improvement in response to parental investments in biomedical evaluations and interventions (1). When considering hundreds or thousands of ASD children, the results of biomedical therapy range from no gains, to some gains, to neurotypical. In most families, biomedical interventions are accompanied by other therapies (eg, ABA).
A baseball analogy is useful. Some
parents "strike out" pursuant to not inexpensive biomedical
therapeutics, others hit a single and get to first base, others get to
second base, while still others hit a triple and get to third, and a size-unknown
subgroup of parents hits a home run and their child heals to the point of becoming virtually
(and in some cases perhaps actually) neurotypical.
The early years of biomedical therapy are years of hope:
Many and perhaps most children respond to biomedical therapeutics with various improvements (reductions of adverse traits, increases in positive traits). For instance, finally to have potty trained an 8yo is hugely important for a family (1). Generally, biomedical therapeutics receive higher ratings from parents than do pharmaceutical interventions (6). However, as years go by, some parents begin to notice negative traits which are persisting despite continuations of biomedical therapies.
Are these persisting traits actually a plateau for a given
child? In practical terms and in real situations, the answer may be Yes.
However, in discussing the ‘plateau’ concept with Bernie Rimland, Ph.D.,
founder and director of the Autism Research Institute (ARI), he cautioned against
conceptual limits, because new biomedical therapies and better individual
profiling may be on the horizon.
Peer relationships and time:
As children age, peer relationships are expected
to change. For some families, the child’s advance in years provides
yet another indication of ways that the child is different from peers. In some instances,
(despite years of improvements via biomedical and other
therapeutics) the affected child begins to be perceived as different by children who had been
peers, even friends. As these
perceptions occur, the parents notice and may wonder about the next biomedical advance
that may elevate or even eliminate the child's recovery-plateau. Additionally,
some affected children are sufficiently aware and sensitive so as to be hurt
when peers and friends begin to act in ways whereby the affected child's
otherness (different-from-ness) is made clear.
Biomedical interventions, related improvements, social awareness, and plateaus occur
on a timeline:
Generally (according to many physicians and parents active
in the ARI-affiliated DAN! movement; 7), the younger the child when biomedical
interventions are begun, the more the child will shed negative traits and
acquire positive traits that had been blocked by his or her underlying
physiological problems. An additional aspect of time is that as the
biomedically improving young child progresses toward middle-school ages, the child's
atypical awareness of games and sociality will become a more significant factor as the child interacts with neurotypical
children. Sadly but realistically, some parents will observe neurotypical
children who ay begin to commit acts of rejection of the affected child who had
been a virtual peer to the neurotypical children.
Hope versus limits:
Several parents who have been autism list participants for nearly a decade have had their affected child become violent during puberty and have had the violence persist. Aggression joins with impulse-control difficulties and combines with the pubertal and post-pubertal child’s increasing strength. In some cases, parents have been injured by the child who is now full grown and very strong. Changes such as these prompt some parents to accept the need to place their child in a group home or other facility. Recently, a 16 year-old Asperger’s lad fired a gun repeatedly in a home, police intervened, and the child is now encumbered by justice-system participation. More generally, among inmates of penal institutions, Asperger's individuals are present in a percentage far exceeding the rate of Asperger's in the general population (8)
A bottom line:
As years pass, a given child’s plateau amidst healing may bring increasing “apartness” (ostracism) and may, in some cases, lead to unacceptable moments of violence or other challenges rooted in atypical impulsivity. Thus, there is a persisting reality to the concept plateau in biomedical healing of autistic children, even when combined with other therapeutics. For several children I visited in California, years of biomedical intervention have induced significant improvements in their health, behavior, and cognition, but circa 2005, each of these long-treated children has arrived at a plateau wherein adverse traits persist seemingly unresponsive to currently available biomedical therapeutics. Perhaps additional, perhaps new biomedical therapies will elevate each child’s plateau, but – when considering all children who have improved via biomedical and other therapeutics – most such children and their families are likely to have achieved something less than a “home run”. And the distance from the “home run” may – in many such individuals – reflect an underlying neuronal, synaptic, or gastrointestinal pathology that will remain very difficult to repair.
Thus, circa 2005, the plateau concept has validity and can be useful in guiding additional therapies.
Autism is treatable
In a letter to the FDA (November 19, 2003), Bernard Rimland, PhD,
declared that “autism is treatable” and summarizes the basis for that
statement (10). Is the concept “autism is treatable” valid? In my opinion, the answer is a resounding Yes.
Despite the fact that at least some autistic children reach a seeming
plateau in their improvements via biomedical and other therapies, many
and perhaps most autistic children treated biomedically make important
improvements, either via the reduction of adverse traits and/or via the
acquisition of positive traits – along with an improvement in their
overall health.
Numerous families attest to improvements in response to biomedical
therapies (eg, 6) and are delighted with the healing their autistic
child has experienced, even as many and perhaps most such children are not yet healed to the point of "neurotypical". Importantly, many such children have healed to the point of no longer qualifying for a diagnosis as "autistic".
Furthermore, many parents report that the
autistic child’s rate of cognitive and behavioral improvement had been
from negligible to slow until his or her underlying pathologies were
identified, evaluated, and treated in accord with a biomedical
approach.
As set forth in various sources (eg, 1-5, see also 11), biomedical
treatments include but are not limited to avoidance diets, supplements,
chelation, and antivirals. More recently, methylcobalamin (mB12),
low-dose Naltrexone (LDN), and hyperbaric oxygen therapy (HBOT) are
being found to help numerous autistic children.
One widely accepted formula for biomedical therapeutics is:
Evaluate and heal the child’s gastrointestinal pathologies.
Evaluate and optimize the child’s intra-body nutritional status.
Remove toxins such as heavy metals via chelation and other detox procedures.
Treat chronic viral infections (if any, in a specific child).
Given that many and perhaps most autistic children improve via a
biomedical approach, what is the significance of the healing-plateau
which some such children and their families experience? The child’s
plateau:
A. May reflect an underlying neuronal injury that won’t be easily
healed by currently available biomedical or pharmacologic treatments.
B. May be elevated by a biomedical treatment that the family has not yet tried.
C. May be elevated or eliminated by future developments in biomedical or other therapies.
Across hundreds and thousands of affected children, more precise
physiological profiling ought enable better subgrouping in regard to
each child’s underlying pathologies and related treatments. Various
children’s responses to DMG and TMG illustrate this point (6). As
better physiological subgrouping is achieved, more accurately designed
treatments ought occur earlier in the affected child’s course of
biomedical therapeutics. Furthermore, whether from clinicians, from
researchers, or from observant parents, new biomedical therapies are
likely to be found. Thus, there is an ongoing frontier of hope in which
– for many specific autistic individuals – the “healing-plateau” will
be elevated or eliminated.
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1. Children With Starving Brains: A Medical Treatment Guide for Autism Spectrum Disorder: Books: Jaquelyn McCandless, MD. http://www.autism-rxguidebook.net/DesktopDefault.aspx
2. Special Diets for Special Kids. Lisa Lewis, PhD. http://www.autismndi.com/store/
3. Biomedical Assessment Options for Children with Autism and Related Problems. Jon Pangborn, PhD, 2002.
4. Autism: Effective Biomedical Treatments. Sidney Baker, MD, Jon Pangborn, PhD, 2005. http://www.autismwebsite.com/ari/pub/pubs.htm
5. Physicians’ Training DVDs and Syllabus, by Jaquelyn McCandless M.D., Elizabeth Mumper, M.D., Maureen McDonnell, R.N., and Teresa Binstock. http://www.autismwebsite.com/ari/pub/pubs.htm#DVD-1
6. Parent ratings of behavioral effects of biomedical interventions. http://www.autismwebsite.com/ari/treatment/form34q.pdf
7. DAN! = Defeat Autism Now!, a collaborative process coordinated by the Autism Research Institute http://www.autismwebsite.com/ari/index.htm
8. Siponmaa L, Kristiansson M, Jonson C, Nyden A, Gillberg C. Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders. J Am Acad Psychiatry Law. 2001;29(4):420-6
"Fifteen percent of the subjects had a definite diagnosis of ADHD, and another 15 percent had PDD, including 12 percent PDD not otherwise specified (NOS) and 3 percent Asperger syndrome. Autistic disorder was not found in any case. Tourette syndrome occurred in two percent of the cases."
9. Dxed with Asperger’s Disorder, by post-doc fellow Naseem Smith, M.D., UCSHC, 1997.
10. Autism is treatable. Bernard Rimland, PhD, letter to FDA, Nov 19, 2003. http://www.autismwebsite.com/ari/treatment/congressionaltestimony.pdf
11. Scientific Foundations of a DAN! Protocol, citations arranged by Teresa Binstock. http://www.autismwebsite.com/ari/dan/scientificfoundations.htm
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