Integrative Autism and ADD Spectrum Disorder
by Dr. Maggie Yu, MD
There are many studies and articles in the past twenty years that have researched various areas of integrative management for Autism and ADD spectrum disorders. Although there is a growing mountain of evidence to support incorporating some of these holistic approaches, few medical providers or clinics treat these disorders integrating multiple approaches. As we discuss the approaches to consider, one can see why it can be challenging for traditional medical model to incorporate some of these alternative options to complement care.
A number of studies have pointed out that these patients have problems with their gastrointestinal systems. Studies have shown that the bacterial flora that keeps the gut health is different in these patients. Also these patients have a higher prevalence of gastrointestinal symptoms, the most common being diarrhea, about 17%. Yet there are also many less obvious symptoms like gas, bloating, and constipation. A recent study in one of the most respected medical research journals, the Lancet, concludes that food intolerance plays a key role in children with ADD. They found that if patients were put on diets that avoided the most commonly allergenic or intolerant foods, children responded better than they did to treatment with ADD medications. The authors concluded that food intolerance should be addressed in children with ADD and speculated that in fact some children may be misdiagnosed as having ADD when they’re actually struggling with food intolerance issues. However, they felt that due to lack of medical training for medical providers and the lack of providers who know how to interpret testing results, this made it difficult for these patients to get adequate care for their gut issues.
It is difficult to figure out what foods these patients are intolerant to. Add to that, food intolerance testing is very different from standard allergy testing, and most of these patients end up in their allergist office being only tested for immediate allergies with IgE testing. The problem is that food intolerance is a IgA and IgG mediated response, so the reactions are low and slow, hard to figure out and some of the testing for it isn’t so great. Because of this, gastroenterologists and allergists do not discuss or discourage food intolerance testing saying that the testing isn’t reliable and that intolerance doesn't matter much. Despite the fact that the Lancet study, the experience of many holistic providers, and our experience show that proper diagnosis and treatment of food intolerance can be more effective than treatment with ADD medication. While it is true that some intolerance tests do lack validity (especially the patient self bought home kits), there are some laboratories that do provide good testing methodology with reliable results. However, the experience of the clinician interpreting it is invaluable. Some patients with a history of severe viral infections, and family history of autoimmune disease can have very exaggerated responses. Furthermore, some patients with gut infections can also have exaggerated testing results. Medical authorities unfamiliar with intolerance testing advise against intolerance testing because they just do not have enough volume or experience with the various labs or kinds of testing to give patients good advice. We offer intolerance testing and our clinic does hundreds every year. Many of our providers have vast experience in interpreting food intolerance test results. Our practice focuses on food intolerance, food allergies, the amount of nutrition being absorbed, gut function, and gut infections as part of integrative Autism/ADD management.
We don't just stop there, we have partnered with providers that include feeding specialists, sensory integration therapists, and holistic nutritional experts to help families work through the additional facets of feeding their child.
Blood sugar is another crucial factor in any behavior illness. Most Americans eat way too much sugar and carbohydrates (SUGAR). High and low blood sugar is one of the leading factors behind behavior disturbances in children. Yet this requires a careful diet history and education to the child and parent about a low carbohydrate diet. This requires time, which most offices do not spend. We consider nutritional assessment and counseling to be the cornerstone of spectrum disorder management.
Nutritional status is a major factor. As the earlier part of the article about gastrointestinal issues discusses, spectrum kids and adults do not have normal gut function. They do not absorb food normally. As a result, they often have many nutritional deficiencies. Common deficiencies include Vitamin D, B12, Iron, and up to 20% of patients with spectrum and psychiatric disorders have a genetic condition called pyroluria. These patients genetically have their Vitamin B6 and zinc bound so it’s unusable. Yet if 20% of spectrum disorder patients have this condition, and few if any medical doctors even test or know of this condition, a potentially easily reversible cause of symptoms is just ignored. Correcting vitamin deficiencies improve sleep, behavior, mood, and fatigue and it can change lives.
Brain neurotransmitters are the natural chemicals that our brain use to communicate with each other. In patients with mood disorders, the only choice often given is antidepressants or anti-anxiety medications. Many parents do not want their children on these drugs as they can have side effects. We offer an alternative choice if desired, by measuring neurotransmitter levels, we can give advice as to what herbs or supplements can adjust various neurotransmitter abnormalities. We offer tests of many of the neurotransmitter levels in the urine.
Another condition that can be misdiagnosed as a spectrum disorder is APD, auditory processing disorder. In this condition, the path of how language and sound is processed by the brain is interrupted. Patients with APD may look like they're listening and comprehending and processing, but they do not do so properly. Because of this they can appear inattentive, easily frustrated, they act out, and they seem to have inappropriate emotional responses. If no one diagnoses or tests for this condition, this child or adult can look like they have ADD, or Autism. A careful evaluation to see rule out APD is really important as it is a treatable cause of behavioral disturbances. We work with Clear Pathways Learning in WestLinn (Janel Schicor), one of the only speech and language pathologist in the state of Oregon who tests for APD and treats with a variety of listening techniques including Integrating Listening Systems, a system which has changed lives for many of our patients. We also work with the Artz Center to further help treat APD and other hearing disorders which many kids with spectrum disorder have.
Other pieces to treatment include counseling, parenting classes, support groups, physical therapists and occupational therapists. We see ourselves as the hub for families in accessing and organizing all the myriad of approaches and services it takes to help families flourish.
Medications are necessary sometimes, that’s why we call it integrative treatment here. We offer medical treatment with medications if necessary, however we clearly set out to provide a thoughtful integrative approach which includes gastrointestinal testing, food intolerance testing, vitamin and nutritional assessments, nutritional counseling, and neurotransmitter testing if desired. Currently Jenn Lucas, Dr. Hicks & Dr. Rice focuses on the integrative management of the spectrum disorders.
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