Integrative Family Medicine

Leigh Ann Chapman ND

Leigh Ann Chapman ND

1567 SE Tacoma Street Portland OR 97202

ph 5032338113

wwwSellwoodFamilyMedicinecom

ABSTRACT

The CDC has announced that autism is the fastest growing developmental disability in the United States

With this staggering increase in diagnoses all primary care providers must be poised to evaluate and treat

children and adults with autism spectrum disorders This presentation will review the most up to date diagnostic

criteria research and treatments for patients with autism spectrum disorders

CDC reports autism is 1 in 88

1 in 88 translates to 1 in 54 boys and 1 in 252 girls

23 increase compared to 2006 (1 in 110)

78 increase compared to 2002 (1 in 150)

2008 surveillance year covered a total population of 337093 children aged 8 years

What about state by state statistics

MMWR Surveill Summ 2012 Mar 3061(3)1-19

ABSTRACT

The CDC has announced that autism is the fastest growing developmental disability in the United States

With this staggering increase in diagnoses all primary care providers must be poised to evaluate and treat

children and adults with autism spectrum disorders This presentation will review the most up to date diagnostic

criteria research and treatments for patients with autism spectrum disorders

CDC reports autism is 1 in 88

1 in 88 translates to 1 in 54 boys and 1 in 252 girls

23 increase compared to 2006 (1 in 110)

78 increase compared to 2002 (1 in 150)

2008 surveillance year covered a total population of 337093 children aged 8 years

What about state by state statistics

MMWR Surveill Summ 2012 Mar 3061(3)1-19

CDC reports autism is 1 in 88

1 in 88 translates to 1 in 54 boys and 1 in 252 girls

23 increase compared to 2006 (1 in 110)

78 increase compared to 2002 (1 in 150)

2008 surveillance year covered a total population of 337093 children aged 8 years

What about state by state statistics

MMWR Surveill Summ 2012 Mar 3061(3)1-19

South Korea- 1 in 38 Prevalence of autism spectrum disorders in a total

population sample Kim YS Leventhal BL Koh YJ Fombonne

E Laska E Lim EC Cheon KA Kim SJ Kim YK Lee H Song DH Grinker

RR Am J Psychiatry 2011 Sep168(9)904-12

Population screening and direct assessment

264 of children in a South Korean community in 2006 have and ASD

What does this mean

Risk Factors and Characteristics- endorsed by the CDC Identical twins if one child has an ASD then the other will be affected

about 36-95 of the time Parents who have a child with an ASD have a 2ndash18 chance of having

a second child who is also affected ASDs tend to occur more often in people who have certain genetic or

chromosomal conditions About 10 of children with autism are also identified as having Down syndrome fragile X syndrome tuberous sclerosis and other genetic and chromosomal disorders

The majority (62) of children with ASDs did not have intellectual disability

Children born to older parents are at a higher risk for ASDs A small percentage of children who are born prematurely or with low

birth weight are at greater risk for having ASDs ASD commonly co-occurs with other developmental psychiatric

neurologic chromosomal and genetic diagnoses

Autism Diagnostic criteria New and improved as of May 2013

The DSM-5 manual is the only location for diagnostic criteria for Autism

This is a psychiatric manual and does not account for the evolution of biological whole systems medicine

DSM 5 - Change 1 Elimination of subcategories of

Asperger syndrome

PDD-NOS

childhood disintegrative disorder

autistic disorder

All of these subcategories are folded into the broad term autism spectrum disorder (ASD)

DSM-5 change 2 DSM-4- three domains of impairment

social impairment

languagecommunication impairment

repetitiverestricted behaviors

DSM-5- Two categories social communication impairment

restricted interestsrepetitive behaviors

New symptom will be included hyper- or hypo-reactivity to sensory input or unusual

interests in sensory aspects of the environment

Sensory Processing

ldquoIt is obvioushellipthat sensory processing abnormalities in ASD are distributed rather than localized sensory abnormalities in ASD obviously span multiple dimensions of latency adaptation magnitude and behavior abnormalities with both enhanced and impaired behavior associated with aberrant cortical responses Given this diversity in findings the heterogeneity of ASD and broad variability seen over and over again in the ASD groups almost irrespective of the study it is hard to imagine that one single theory could account for all of these observationshellip It is therefore probable that several mechanisms and neuronal abnormalities most likely at multiple levels (from single neurons through to inter-area connections) all contribute to varying degrees to the abnormal sensory processing observed in ASD It is also likely that no single mechanism is unique to one sensory modality which is why we see such a widely distributed range of abnormalities across modalitiesrdquo Kenet T 2011 Sensory functions in ASD In The Neuropsychology of Autism edited by D Fein New York Oxford University Press

DSM 5 change 3 Each person evaluated will also be described in terms

of any known genetic cause (eg fragile X syndrome Rett syndrome) level of language and intellectual disability and presence of medical conditions such as seizures anxiety depression andor gastrointestinal (GI) problems

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

Risk Factors and Characteristics- endorsed by the CDC Identical twins if one child has an ASD then the other will be affected

about 36-95 of the time Parents who have a child with an ASD have a 2ndash18 chance of having

a second child who is also affected ASDs tend to occur more often in people who have certain genetic or

chromosomal conditions About 10 of children with autism are also identified as having Down syndrome fragile X syndrome tuberous sclerosis and other genetic and chromosomal disorders

The majority (62) of children with ASDs did not have intellectual disability

Children born to older parents are at a higher risk for ASDs A small percentage of children who are born prematurely or with low

birth weight are at greater risk for having ASDs ASD commonly co-occurs with other developmental psychiatric

neurologic chromosomal and genetic diagnoses

Autism Diagnostic criteria New and improved as of May 2013

The DSM-5 manual is the only location for diagnostic criteria for Autism

This is a psychiatric manual and does not account for the evolution of biological whole systems medicine

DSM 5 - Change 1 Elimination of subcategories of

Asperger syndrome

PDD-NOS

childhood disintegrative disorder

autistic disorder

All of these subcategories are folded into the broad term autism spectrum disorder (ASD)

DSM-5 change 2 DSM-4- three domains of impairment

social impairment

languagecommunication impairment

repetitiverestricted behaviors

DSM-5- Two categories social communication impairment

restricted interestsrepetitive behaviors

New symptom will be included hyper- or hypo-reactivity to sensory input or unusual

interests in sensory aspects of the environment

Sensory Processing

ldquoIt is obvioushellipthat sensory processing abnormalities in ASD are distributed rather than localized sensory abnormalities in ASD obviously span multiple dimensions of latency adaptation magnitude and behavior abnormalities with both enhanced and impaired behavior associated with aberrant cortical responses Given this diversity in findings the heterogeneity of ASD and broad variability seen over and over again in the ASD groups almost irrespective of the study it is hard to imagine that one single theory could account for all of these observationshellip It is therefore probable that several mechanisms and neuronal abnormalities most likely at multiple levels (from single neurons through to inter-area connections) all contribute to varying degrees to the abnormal sensory processing observed in ASD It is also likely that no single mechanism is unique to one sensory modality which is why we see such a widely distributed range of abnormalities across modalitiesrdquo Kenet T 2011 Sensory functions in ASD In The Neuropsychology of Autism edited by D Fein New York Oxford University Press

DSM 5 change 3 Each person evaluated will also be described in terms

of any known genetic cause (eg fragile X syndrome Rett syndrome) level of language and intellectual disability and presence of medical conditions such as seizures anxiety depression andor gastrointestinal (GI) problems

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

Autism Diagnostic criteria New and improved as of May 2013

The DSM-5 manual is the only location for diagnostic criteria for Autism

This is a psychiatric manual and does not account for the evolution of biological whole systems medicine

DSM 5 - Change 1 Elimination of subcategories of

Asperger syndrome

PDD-NOS

childhood disintegrative disorder

autistic disorder

All of these subcategories are folded into the broad term autism spectrum disorder (ASD)

DSM-5 change 2 DSM-4- three domains of impairment

social impairment

languagecommunication impairment

repetitiverestricted behaviors

DSM-5- Two categories social communication impairment

restricted interestsrepetitive behaviors

New symptom will be included hyper- or hypo-reactivity to sensory input or unusual

interests in sensory aspects of the environment

Sensory Processing

ldquoIt is obvioushellipthat sensory processing abnormalities in ASD are distributed rather than localized sensory abnormalities in ASD obviously span multiple dimensions of latency adaptation magnitude and behavior abnormalities with both enhanced and impaired behavior associated with aberrant cortical responses Given this diversity in findings the heterogeneity of ASD and broad variability seen over and over again in the ASD groups almost irrespective of the study it is hard to imagine that one single theory could account for all of these observationshellip It is therefore probable that several mechanisms and neuronal abnormalities most likely at multiple levels (from single neurons through to inter-area connections) all contribute to varying degrees to the abnormal sensory processing observed in ASD It is also likely that no single mechanism is unique to one sensory modality which is why we see such a widely distributed range of abnormalities across modalitiesrdquo Kenet T 2011 Sensory functions in ASD In The Neuropsychology of Autism edited by D Fein New York Oxford University Press

DSM 5 change 3 Each person evaluated will also be described in terms

of any known genetic cause (eg fragile X syndrome Rett syndrome) level of language and intellectual disability and presence of medical conditions such as seizures anxiety depression andor gastrointestinal (GI) problems

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

DSM 5 - Change 1 Elimination of subcategories of

Asperger syndrome

PDD-NOS

childhood disintegrative disorder

autistic disorder

All of these subcategories are folded into the broad term autism spectrum disorder (ASD)

DSM-5 change 2 DSM-4- three domains of impairment

social impairment

languagecommunication impairment

repetitiverestricted behaviors

DSM-5- Two categories social communication impairment

restricted interestsrepetitive behaviors

New symptom will be included hyper- or hypo-reactivity to sensory input or unusual

interests in sensory aspects of the environment

Sensory Processing

ldquoIt is obvioushellipthat sensory processing abnormalities in ASD are distributed rather than localized sensory abnormalities in ASD obviously span multiple dimensions of latency adaptation magnitude and behavior abnormalities with both enhanced and impaired behavior associated with aberrant cortical responses Given this diversity in findings the heterogeneity of ASD and broad variability seen over and over again in the ASD groups almost irrespective of the study it is hard to imagine that one single theory could account for all of these observationshellip It is therefore probable that several mechanisms and neuronal abnormalities most likely at multiple levels (from single neurons through to inter-area connections) all contribute to varying degrees to the abnormal sensory processing observed in ASD It is also likely that no single mechanism is unique to one sensory modality which is why we see such a widely distributed range of abnormalities across modalitiesrdquo Kenet T 2011 Sensory functions in ASD In The Neuropsychology of Autism edited by D Fein New York Oxford University Press

DSM 5 change 3 Each person evaluated will also be described in terms

of any known genetic cause (eg fragile X syndrome Rett syndrome) level of language and intellectual disability and presence of medical conditions such as seizures anxiety depression andor gastrointestinal (GI) problems

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

DSM-5 change 2 DSM-4- three domains of impairment

social impairment

languagecommunication impairment

repetitiverestricted behaviors

DSM-5- Two categories social communication impairment

restricted interestsrepetitive behaviors

New symptom will be included hyper- or hypo-reactivity to sensory input or unusual

interests in sensory aspects of the environment

Sensory Processing

ldquoIt is obvioushellipthat sensory processing abnormalities in ASD are distributed rather than localized sensory abnormalities in ASD obviously span multiple dimensions of latency adaptation magnitude and behavior abnormalities with both enhanced and impaired behavior associated with aberrant cortical responses Given this diversity in findings the heterogeneity of ASD and broad variability seen over and over again in the ASD groups almost irrespective of the study it is hard to imagine that one single theory could account for all of these observationshellip It is therefore probable that several mechanisms and neuronal abnormalities most likely at multiple levels (from single neurons through to inter-area connections) all contribute to varying degrees to the abnormal sensory processing observed in ASD It is also likely that no single mechanism is unique to one sensory modality which is why we see such a widely distributed range of abnormalities across modalitiesrdquo Kenet T 2011 Sensory functions in ASD In The Neuropsychology of Autism edited by D Fein New York Oxford University Press

DSM 5 change 3 Each person evaluated will also be described in terms

of any known genetic cause (eg fragile X syndrome Rett syndrome) level of language and intellectual disability and presence of medical conditions such as seizures anxiety depression andor gastrointestinal (GI) problems

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

Sensory Processing

ldquoIt is obvioushellipthat sensory processing abnormalities in ASD are distributed rather than localized sensory abnormalities in ASD obviously span multiple dimensions of latency adaptation magnitude and behavior abnormalities with both enhanced and impaired behavior associated with aberrant cortical responses Given this diversity in findings the heterogeneity of ASD and broad variability seen over and over again in the ASD groups almost irrespective of the study it is hard to imagine that one single theory could account for all of these observationshellip It is therefore probable that several mechanisms and neuronal abnormalities most likely at multiple levels (from single neurons through to inter-area connections) all contribute to varying degrees to the abnormal sensory processing observed in ASD It is also likely that no single mechanism is unique to one sensory modality which is why we see such a widely distributed range of abnormalities across modalitiesrdquo Kenet T 2011 Sensory functions in ASD In The Neuropsychology of Autism edited by D Fein New York Oxford University Press

DSM 5 change 3 Each person evaluated will also be described in terms

of any known genetic cause (eg fragile X syndrome Rett syndrome) level of language and intellectual disability and presence of medical conditions such as seizures anxiety depression andor gastrointestinal (GI) problems

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

DSM 5 change 3 Each person evaluated will also be described in terms

of any known genetic cause (eg fragile X syndrome Rett syndrome) level of language and intellectual disability and presence of medical conditions such as seizures anxiety depression andor gastrointestinal (GI) problems

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

Currently or by history must meet criteria A B C and D

A Persistent deficits in social communication and social interaction

across contexts not accounted for by general developmental delays and

manifest by all 3 of the following

1 Deficits in social-emotional reciprocity

2 Deficits in nonverbal communicative behaviors used for social

interaction

3 Deficits in developing and maintaining relationships

B Restricted repetitive patterns of behavior interests or activities as

manifested by at least two of the following

1 Stereotyped or repetitive speech motor movements or use of objects

2 Excessive adherence to routines ritualized patterns of verbal or

nonverbal behavior or excessive resistance to change

3 Highly restricted fixated interests that are abnormal in intensity or

focus

4 Hyper-or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

CSymptoms must be present in early childhood (but may not become

fully manifest until social demands exceed limited capacities)

DSymptoms together limit and impair everyday functioning

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

DSM-5 Change 4 Fourth the work group added a new category called

Social Communication Disorder This will allow for a diagnosis of disability in social communication without the presence of repetitive behavior

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

Naturopathic medicine and the autism community

Naturopathic physicians are poised to provide exemplary primary care of children and adults with autism and developmental disorders

Be mindful of person centered language

Advocate and support vs defeat and recover

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

Does this child have a problem Tools to identify a struggle need for a referral

Parent Reported- Ages and Stages Questionaire

ASQ- wwwasqoregoncom

Developmental Milestones checklist (Bright Futures)

Practitioner delivered assessment

MCHAT- Modified checklist for autism in toddlers

18 and 24 months wwwM-chatorg

MCHAT wwwM-CHATorg

2 Does your child take an interest in other children Yes No

5 Does your child ever pretend for example to talk on the phone or take

care of dolls or pretend other things Y N

7 Does your child ever use hisher index finger to point to indicate interest in something Yes No

9 Does your child ever bring objects over to you (parent) to show you

something Yes No

14 Does your child respond to hisher name when you call Yes No

15 If you point at a toy across the room does your child look at it Yes No

20 Have you ever wondered if your child is deaf Yes No

RITVO (RAADS-R)- Scale for adults Diagnostic scale for adults

64 or less indicates that it is highly unlikely that a patient has autism

A score of 77 or higher indicates a high probablility of ASD

Riva Ariella Ritvoet al The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults An International Validation Study Journal of Autism and Developmental Disorders August 2011 Volume 41 Issue 8 pp 1076-1089

RITVO (RAADS-R)- Scale for adults Diagnostic scale for adults

64 or less indicates that it is highly unlikely that a patient has autism

A score of 77 or higher indicates a high probablility of ASD

Riva Ariella Ritvoet al The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults An International Validation Study Journal of Autism and Developmental Disorders August 2011 Volume 41 Issue 8 pp 1076-1089

This patient needs a referral Who should you refer to

Psychologist

Educational Assessment Early Intervention

Behavioral Pediatrician

Neurologist- if you suspect seizure activity order a sleep deprived EEG and refer

The Culture of Autism With the rising population of ASDs- it is critical that

we begin

Supporting listening and advocating

Including individuals with ASD into our society

Accepting differences

Moving beyond the imposition of our cultural norms onto the culture of autism

Karlarsquos ASD Blog on Facebook

ASAN- httpautisticadvocacyorg

Rethinking Autism

Brain-based or Systemic

Correlation does not imply mechanism- how but not why

wwwautismwhyandhoworg

Genes Inherited and acquired mutations Gene expression

Environment Too much bad not enough good Different levels of environment Physical biological social emotional

Physiology Molecules ndash different molecules different molecular interactions Biochemistry and metabolism ndash some pathways working harder other pathways stuck Organ systems ndash gastrointestinal immune endocrinehormone

Brain Brain modules under- or over-active Brain networks and connections differently mapped or differently active Brain cells and tissue affected by physiological problems like inflammation and oxidative stress Too much or not enough of brain chemicals like neurotransmitters or neuropeptides Electrophysiology

Total load allostatic load cumulative stress Cumulative impact of genetic vulnerabilities environmental stressors lack of environmental

supports all shift the functioning of the system

Global crisis

Research Advances in 2013

Deeper Understanding of Link between Chemical Pollutants and Autism

Hundreds of Tiny Mutations Linked to Autism

Insights into Immune Changes amp Autism

Autism and our planet

Autism may be a development reflecting environmental change

Environmental pollutants continue to be implicated neurodevelopmental issues

Beyond physical toxicants- EMF

Disconnect from Nature and GAIA

EPA Builds List of Potentially Dangerous Chemicals

As the rates of learning disabilities and neurodevelopmental conditions rise the Environmental Protection Agency has released a roster of the pollutants likely to contribute to these or other neurological disorders

httpwwwepagovaceace3draftdraft_pdfsACE3NeurodevelopmentalDisordersReviewPackage3-02-11pdf

The Culture of Autism With the rising population of ASDs- it is critical that

we begin

Supporting listening and advocating

Including individuals with ASD into our society

Accepting differences

Moving beyond the imposition of our cultural norms onto the culture of autism

Karlarsquos ASD Blog on Facebook

ASAN- httpautisticadvocacyorg

Rethinking Autism

Brain-based or Systemic

Correlation does not imply mechanism- how but not why

wwwautismwhyandhoworg

Genes Inherited and acquired mutations Gene expression

Environment Too much bad not enough good Different levels of environment Physical biological social emotional

Physiology Molecules ndash different molecules different molecular interactions Biochemistry and metabolism ndash some pathways working harder other pathways stuck Organ systems ndash gastrointestinal immune endocrinehormone

Brain Brain modules under- or over-active Brain networks and connections differently mapped or differently active Brain cells and tissue affected by physiological problems like inflammation and oxidative stress Too much or not enough of brain chemicals like neurotransmitters or neuropeptides Electrophysiology

Total load allostatic load cumulative stress Cumulative impact of genetic vulnerabilities environmental stressors lack of environmental

supports all shift the functioning of the system

Global crisis

Research Advances in 2013

Deeper Understanding of Link between Chemical Pollutants and Autism

Hundreds of Tiny Mutations Linked to Autism

Insights into Immune Changes amp Autism

Autism and our planet

Autism may be a development reflecting environmental change

Environmental pollutants continue to be implicated neurodevelopmental issues

Beyond physical toxicants- EMF

Disconnect from Nature and GAIA

EPA Builds List of Potentially Dangerous Chemicals

As the rates of learning disabilities and neurodevelopmental conditions rise the Environmental Protection Agency has released a roster of the pollutants likely to contribute to these or other neurological disorders

httpwwwepagovaceace3draftdraft_pdfsACE3NeurodevelopmentalDisordersReviewPackage3-02-11pdf

Rethinking Autism

Brain-based or Systemic

Correlation does not imply mechanism- how but not why

wwwautismwhyandhoworg

Genes Inherited and acquired mutations Gene expression

Environment Too much bad not enough good Different levels of environment Physical biological social emotional

Physiology Molecules ndash different molecules different molecular interactions Biochemistry and metabolism ndash some pathways working harder other pathways stuck Organ systems ndash gastrointestinal immune endocrinehormone

Brain Brain modules under- or over-active Brain networks and connections differently mapped or differently active Brain cells and tissue affected by physiological problems like inflammation and oxidative stress Too much or not enough of brain chemicals like neurotransmitters or neuropeptides Electrophysiology

Total load allostatic load cumulative stress Cumulative impact of genetic vulnerabilities environmental stressors lack of environmental

supports all shift the functioning of the system

Global crisis

Research Advances in 2013

Deeper Understanding of Link between Chemical Pollutants and Autism

Hundreds of Tiny Mutations Linked to Autism

Insights into Immune Changes amp Autism

Autism and our planet

Autism may be a development reflecting environmental change

Environmental pollutants continue to be implicated neurodevelopmental issues

Beyond physical toxicants- EMF

Disconnect from Nature and GAIA

EPA Builds List of Potentially Dangerous Chemicals

As the rates of learning disabilities and neurodevelopmental conditions rise the Environmental Protection Agency has released a roster of the pollutants likely to contribute to these or other neurological disorders

httpwwwepagovaceace3draftdraft_pdfsACE3NeurodevelopmentalDisordersReviewPackage3-02-11pdf

Correlation does not imply mechanism- how but not why

wwwautismwhyandhoworg

Genes Inherited and acquired mutations Gene expression

Environment Too much bad not enough good Different levels of environment Physical biological social emotional

Physiology Molecules ndash different molecules different molecular interactions Biochemistry and metabolism ndash some pathways working harder other pathways stuck Organ systems ndash gastrointestinal immune endocrinehormone

Brain Brain modules under- or over-active Brain networks and connections differently mapped or differently active Brain cells and tissue affected by physiological problems like inflammation and oxidative stress Too much or not enough of brain chemicals like neurotransmitters or neuropeptides Electrophysiology

Total load allostatic load cumulative stress Cumulative impact of genetic vulnerabilities environmental stressors lack of environmental

supports all shift the functioning of the system

Global crisis

Research Advances in 2013

Deeper Understanding of Link between Chemical Pollutants and Autism

Hundreds of Tiny Mutations Linked to Autism

Insights into Immune Changes amp Autism

Autism and our planet

Autism may be a development reflecting environmental change

Environmental pollutants continue to be implicated neurodevelopmental issues

Beyond physical toxicants- EMF

Disconnect from Nature and GAIA

EPA Builds List of Potentially Dangerous Chemicals

As the rates of learning disabilities and neurodevelopmental conditions rise the Environmental Protection Agency has released a roster of the pollutants likely to contribute to these or other neurological disorders

httpwwwepagovaceace3draftdraft_pdfsACE3NeurodevelopmentalDisordersReviewPackage3-02-11pdf

Research Advances in 2013

Deeper Understanding of Link between Chemical Pollutants and Autism

Hundreds of Tiny Mutations Linked to Autism

Insights into Immune Changes amp Autism

Autism and our planet

Autism may be a development reflecting environmental change

Environmental pollutants continue to be implicated neurodevelopmental issues

Beyond physical toxicants- EMF

Disconnect from Nature and GAIA

EPA Builds List of Potentially Dangerous Chemicals

As the rates of learning disabilities and neurodevelopmental conditions rise the Environmental Protection Agency has released a roster of the pollutants likely to contribute to these or other neurological disorders

httpwwwepagovaceace3draftdraft_pdfsACE3NeurodevelopmentalDisordersReviewPackage3-02-11pdf

Autism and our planet

Autism may be a development reflecting environmental change

Environmental pollutants continue to be implicated neurodevelopmental issues

Beyond physical toxicants- EMF

Disconnect from Nature and GAIA

EPA Builds List of Potentially Dangerous Chemicals

As the rates of learning disabilities and neurodevelopmental conditions rise the Environmental Protection Agency has released a roster of the pollutants likely to contribute to these or other neurological disorders

httpwwwepagovaceace3draftdraft_pdfsACE3NeurodevelopmentalDisordersReviewPackage3-02-11pdf

EPA Builds List of Potentially Dangerous Chemicals

As the rates of learning disabilities and neurodevelopmental conditions rise the Environmental Protection Agency has released a roster of the pollutants likely to contribute to these or other neurological disorders

httpwwwepagovaceace3draftdraft_pdfsACE3NeurodevelopmentalDisordersReviewPackage3-02-11pdf

List of Implicated Toxicants 2-ethoxyethyl Acetate ndash a solvent used as a coating for wood metal and other materials sometimes found in

cosmetics Acibenzolar-S methyl -- a fungicide Acrylamide ndash a chemical that is produced naturally in certain foods when they are cooked at high temperatures It is

also manufactured industrially for use in the production of polyacrylamide gels which are used for various purposes including the treatment of drinking water and wastewater and found in cigarette smoke

Aldicarb ndash a pesticide Allethrin ndash a pesticide Aluminum (lactate) -- used in lotions to treat very dry skin Aminopterin ndash chemical originally developed for use in cancer treatment Arsenic -- a semi-metal element which enters drinking water supplies from natural deposits in the Earth or from

agricultural and industrial practices Aspartame ndash an artificial sweetener Benomyl ndash a fungicide Benzene ndash a volatile organic chemical formed through natural processes such as volcanoes and forest fires It is also

formed from industrial processes and is used to make plastics rubber resins and synthetic fabrics like nylon and polyester Benzene is also a natural part of crude oil gasoline and cigarette smoke

Bioallethrin (s-bioallethrin) ndash a pesticide Bis(tri-n-butyltin)oxide ndash a biocide Bisphenol A ndash This chemical is the main ingredient in polycarbonate plastic used to make water bottles baby bottles

and food storage and heating trays and epoxy resin which is used in the lining of most food and beverage cans Butylated Hydroxy Anisole ndash a food additive better known as BHA

Butylated hydroxytoluene ndash a toluene-based ingredient used as a preservative in food and personal care products

Cadmium ndash a natural element in the Earths crust It is found in food and people can be exposed from smoking cigarettes or breathing cigarette smoke or from water or industrial facilities which release it into the air

Carbaryl -- insecticide

Carbon monoxide -- an odorless and colorless toxic gas

Chlordecone ndash an insecticide

Chlorine dioxide ndash a chemical mostly used to disinfect water

Chlorpyrifos -- insecticide

Cypermethrin --insecticide

DEET ndash a common ingredient in insect repellents

Deltamethrin -- insecticide

Diazinon ndash a pesticide

Dieldrin ndash an insecticide no longer produced in the US but still found in the environment

Ethanol ndash grain alcohol produced from crops such as corn used as a fuel additive solvent and for other purposes

Ethylene thiourea ndash an industrial chemical mostly used to make rubber products but also in the manufacture of fungicides and rodenticides

Fluazinam ndash a fungicide

Heptachlor ndash a non-agricultural insecticide whose use is now very limited

Hexachlorobenzene ndash can be formed as a byproduct during the manufacture of chemicals used as solvents other chlorine-containing compounds and pesticides Small amounts of hexachlorobenzene can also be produced during combustion processes such as burning of city wastes Currently the substance is not used commercially in the United States

Hexachlorophene ndash a disinfectant

Lead ndash This heavy metal occurs naturally in the Earths crust It was formerly used as a gasoline additive and was also commonly added to paint Lead pipes may also contaminate drinking water Currently coal-fired power plants and other industrial uses release lead particles into the air

Lindane ndash a chemical used to treat scabies and lice Maneb ndash a fungicide Methanol ndash also known as wood alcohol an alternative fuel and other uses Methylparathion ndash a pesticide Monosodium Glutamate ndash a flavor enhancer used as a food additive Nicotine ndash the addictive drug in tobacco Methoxyethanol 2 ndash an organic compound used mainly as a solvent Methylmercury ndash- a form of mercury found in contaminated fresh water and salt water fish It gets into the air

when coal oil or wood are burned as fuel or when mercury-contaminated wastes are incinerated Ozone ndash a gas that occurs both in the Earths upper atmosphere and at ground level Paraquat ndash an herbicide Parathion (ethyl) ndash an insecticide PBDEs ndash Polybrominated diphenyl ethers called PBDEs are used as flame retardants among other purposes

Some types of PBDEs have been banned or phased out but industry has developed others to replace them PCBs (generic) ndash Polychlorinated biphenyls (PCBs) are a group of chemicals that were used as insulation in

electrical transformers and for other industrial purposes They are no longer manufactured but have persisted in the environment

Permethrin ndash an insecticide Phthalate di-(2-ethylhexyl) ndash This phthalate commonly referred to as DEHP is found in many plastic

products Tebuconazole ndash a fungicide Toluene ndash a common solvent found in many consumer goods including floor polish moisturizing cream

lubricating oils paint thinners Tributyltin chloride ndash Manmade organic substances containing the metal tin They are used as pesticides and

biocides in marine antifouling paints and in wood preservatives Trichlorfon ndash an insecticide Trichloroethylene ndash used as a solvent to clean metal parts and for other industrial processes often found as a

water contaminant

In Utero Exposures and Autism The only in prenatal exposure well documented in autism is Valproic

acid Bromley RL Mawer G Baker GA Autism spectrum disorders following in utero exposure to

antiepileptic drugs Neurodevelopment GroupNeurology 2008 Dec 2 71(23)1923-4

All contaminants are not equal

Organohalogens higher in mom than baby PCBs higher in baby than mom Mercury is high uniform in all matrices

Larry L Needhamdagger Philippe GrandjeanDaggersect Birger Heinzow Poul J Joslashrgensenpara Flemming NielsenDagger

Donald G Patterson Jrdagger Andreas Sjdindagger Wayman E Turnerdagger and Pal Weihe Partition of Environmental Chemicals between Maternal and Fetal Blood and Tissues Environ Sci Technol Article ASAP Publication Date (Web) December 17 2010

National Childrenrsquos Study wwwnationalchildrensstudygov

PDBEs Halt Flames and Neurodevelopment

Cord Blood PDBE levels have neurodevelopmental consequences

bull Samples taken from 329 mothers and children in Manhattan who delivered in proximity to the 9112001 attack

Julie B Herbstman Andreas Sjoumldin Matthew Kurzon Sally A Lederman Richard S Jones Virginia Rauh Larry L Needham Deliang Tang Megan Niedzwiecki Richard Y Wang and Frederica Perera Prenatal Exposure to PBDEs and Neurodevelopment Environmental Health Perspectives 2010118(5)712-719

Indoor environment counts Increased risk of developing an ASD if living

in a house with PVC flooring Larsson M B Weiss S Janson J Sundell and CG Bornehag 2009 Associations

between indoor environmental factors and parental-reported autistic spectrum disorders in children 6-8 years of age Neurotoxicology 30 (5)822-31

Increased risk of ASD if living near a freeway Kalkbrenner AE Daniels JL Chen JC Poole C Emch M Morrissey J Perinatal

exposure to hazardous air pollutants and autism spectrum disorders at age 8 Epidemiology 2010 Sep21(5)631-41

Becerra TA Wilhelm M Olsen J Cockburn M Ritz B Ambient Air Pollution and Autism in Los Angeles County California Environ Health Perspect 2013 Mar121(3)380-6 doi 101289ehp1205827 Epub 2012 Dec 17

Butylated hydroxytoluene ndash a toluene-based ingredient used as a preservative in food and personal care products

Cadmium ndash a natural element in the Earths crust It is found in food and people can be exposed from smoking cigarettes or breathing cigarette smoke or from water or industrial facilities which release it into the air

Carbaryl -- insecticide

Carbon monoxide -- an odorless and colorless toxic gas

Chlordecone ndash an insecticide

Chlorine dioxide ndash a chemical mostly used to disinfect water

Chlorpyrifos -- insecticide

Cypermethrin --insecticide

DEET ndash a common ingredient in insect repellents

Deltamethrin -- insecticide

Diazinon ndash a pesticide

Dieldrin ndash an insecticide no longer produced in the US but still found in the environment

Ethanol ndash grain alcohol produced from crops such as corn used as a fuel additive solvent and for other purposes

Ethylene thiourea ndash an industrial chemical mostly used to make rubber products but also in the manufacture of fungicides and rodenticides

Fluazinam ndash a fungicide

Heptachlor ndash a non-agricultural insecticide whose use is now very limited

Hexachlorobenzene ndash can be formed as a byproduct during the manufacture of chemicals used as solvents other chlorine-containing compounds and pesticides Small amounts of hexachlorobenzene can also be produced during combustion processes such as burning of city wastes Currently the substance is not used commercially in the United States

Hexachlorophene ndash a disinfectant

Lead ndash This heavy metal occurs naturally in the Earths crust It was formerly used as a gasoline additive and was also commonly added to paint Lead pipes may also contaminate drinking water Currently coal-fired power plants and other industrial uses release lead particles into the air

Lindane ndash a chemical used to treat scabies and lice Maneb ndash a fungicide Methanol ndash also known as wood alcohol an alternative fuel and other uses Methylparathion ndash a pesticide Monosodium Glutamate ndash a flavor enhancer used as a food additive Nicotine ndash the addictive drug in tobacco Methoxyethanol 2 ndash an organic compound used mainly as a solvent Methylmercury ndash- a form of mercury found in contaminated fresh water and salt water fish It gets into the air

when coal oil or wood are burned as fuel or when mercury-contaminated wastes are incinerated Ozone ndash a gas that occurs both in the Earths upper atmosphere and at ground level Paraquat ndash an herbicide Parathion (ethyl) ndash an insecticide PBDEs ndash Polybrominated diphenyl ethers called PBDEs are used as flame retardants among other purposes

Some types of PBDEs have been banned or phased out but industry has developed others to replace them PCBs (generic) ndash Polychlorinated biphenyls (PCBs) are a group of chemicals that were used as insulation in

electrical transformers and for other industrial purposes They are no longer manufactured but have persisted in the environment

Permethrin ndash an insecticide Phthalate di-(2-ethylhexyl) ndash This phthalate commonly referred to as DEHP is found in many plastic

products Tebuconazole ndash a fungicide Toluene ndash a common solvent found in many consumer goods including floor polish moisturizing cream

lubricating oils paint thinners Tributyltin chloride ndash Manmade organic substances containing the metal tin They are used as pesticides and

biocides in marine antifouling paints and in wood preservatives Trichlorfon ndash an insecticide Trichloroethylene ndash used as a solvent to clean metal parts and for other industrial processes often found as a

water contaminant

In Utero Exposures and Autism The only in prenatal exposure well documented in autism is Valproic

acid Bromley RL Mawer G Baker GA Autism spectrum disorders following in utero exposure to

antiepileptic drugs Neurodevelopment GroupNeurology 2008 Dec 2 71(23)1923-4

All contaminants are not equal

Organohalogens higher in mom than baby PCBs higher in baby than mom Mercury is high uniform in all matrices

Larry L Needhamdagger Philippe GrandjeanDaggersect Birger Heinzow Poul J Joslashrgensenpara Flemming NielsenDagger

Donald G Patterson Jrdagger Andreas Sjdindagger Wayman E Turnerdagger and Pal Weihe Partition of Environmental Chemicals between Maternal and Fetal Blood and Tissues Environ Sci Technol Article ASAP Publication Date (Web) December 17 2010

National Childrenrsquos Study wwwnationalchildrensstudygov

PDBEs Halt Flames and Neurodevelopment

Cord Blood PDBE levels have neurodevelopmental consequences

bull Samples taken from 329 mothers and children in Manhattan who delivered in proximity to the 9112001 attack

Julie B Herbstman Andreas Sjoumldin Matthew Kurzon Sally A Lederman Richard S Jones Virginia Rauh Larry L Needham Deliang Tang Megan Niedzwiecki Richard Y Wang and Frederica Perera Prenatal Exposure to PBDEs and Neurodevelopment Environmental Health Perspectives 2010118(5)712-719

Indoor environment counts Increased risk of developing an ASD if living

in a house with PVC flooring Larsson M B Weiss S Janson J Sundell and CG Bornehag 2009 Associations

between indoor environmental factors and parental-reported autistic spectrum disorders in children 6-8 years of age Neurotoxicology 30 (5)822-31

Increased risk of ASD if living near a freeway Kalkbrenner AE Daniels JL Chen JC Poole C Emch M Morrissey J Perinatal

exposure to hazardous air pollutants and autism spectrum disorders at age 8 Epidemiology 2010 Sep21(5)631-41

Becerra TA Wilhelm M Olsen J Cockburn M Ritz B Ambient Air Pollution and Autism in Los Angeles County California Environ Health Perspect 2013 Mar121(3)380-6 doi 101289ehp1205827 Epub 2012 Dec 17

Lindane ndash a chemical used to treat scabies and lice Maneb ndash a fungicide Methanol ndash also known as wood alcohol an alternative fuel and other uses Methylparathion ndash a pesticide Monosodium Glutamate ndash a flavor enhancer used as a food additive Nicotine ndash the addictive drug in tobacco Methoxyethanol 2 ndash an organic compound used mainly as a solvent Methylmercury ndash- a form of mercury found in contaminated fresh water and salt water fish It gets into the air

when coal oil or wood are burned as fuel or when mercury-contaminated wastes are incinerated Ozone ndash a gas that occurs both in the Earths upper atmosphere and at ground level Paraquat ndash an herbicide Parathion (ethyl) ndash an insecticide PBDEs ndash Polybrominated diphenyl ethers called PBDEs are used as flame retardants among other purposes

Some types of PBDEs have been banned or phased out but industry has developed others to replace them PCBs (generic) ndash Polychlorinated biphenyls (PCBs) are a group of chemicals that were used as insulation in

electrical transformers and for other industrial purposes They are no longer manufactured but have persisted in the environment

Permethrin ndash an insecticide Phthalate di-(2-ethylhexyl) ndash This phthalate commonly referred to as DEHP is found in many plastic

products Tebuconazole ndash a fungicide Toluene ndash a common solvent found in many consumer goods including floor polish moisturizing cream

lubricating oils paint thinners Tributyltin chloride ndash Manmade organic substances containing the metal tin They are used as pesticides and

biocides in marine antifouling paints and in wood preservatives Trichlorfon ndash an insecticide Trichloroethylene ndash used as a solvent to clean metal parts and for other industrial processes often found as a

water contaminant

In Utero Exposures and Autism The only in prenatal exposure well documented in autism is Valproic

acid Bromley RL Mawer G Baker GA Autism spectrum disorders following in utero exposure to

antiepileptic drugs Neurodevelopment GroupNeurology 2008 Dec 2 71(23)1923-4

All contaminants are not equal

Organohalogens higher in mom than baby PCBs higher in baby than mom Mercury is high uniform in all matrices

Larry L Needhamdagger Philippe GrandjeanDaggersect Birger Heinzow Poul J Joslashrgensenpara Flemming NielsenDagger

Donald G Patterson Jrdagger Andreas Sjdindagger Wayman E Turnerdagger and Pal Weihe Partition of Environmental Chemicals between Maternal and Fetal Blood and Tissues Environ Sci Technol Article ASAP Publication Date (Web) December 17 2010

National Childrenrsquos Study wwwnationalchildrensstudygov

PDBEs Halt Flames and Neurodevelopment

Cord Blood PDBE levels have neurodevelopmental consequences

bull Samples taken from 329 mothers and children in Manhattan who delivered in proximity to the 9112001 attack

Julie B Herbstman Andreas Sjoumldin Matthew Kurzon Sally A Lederman Richard S Jones Virginia Rauh Larry L Needham Deliang Tang Megan Niedzwiecki Richard Y Wang and Frederica Perera Prenatal Exposure to PBDEs and Neurodevelopment Environmental Health Perspectives 2010118(5)712-719

Indoor environment counts Increased risk of developing an ASD if living

in a house with PVC flooring Larsson M B Weiss S Janson J Sundell and CG Bornehag 2009 Associations

between indoor environmental factors and parental-reported autistic spectrum disorders in children 6-8 years of age Neurotoxicology 30 (5)822-31

Increased risk of ASD if living near a freeway Kalkbrenner AE Daniels JL Chen JC Poole C Emch M Morrissey J Perinatal

exposure to hazardous air pollutants and autism spectrum disorders at age 8 Epidemiology 2010 Sep21(5)631-41

Becerra TA Wilhelm M Olsen J Cockburn M Ritz B Ambient Air Pollution and Autism in Los Angeles County California Environ Health Perspect 2013 Mar121(3)380-6 doi 101289ehp1205827 Epub 2012 Dec 17

In Utero Exposures and Autism The only in prenatal exposure well documented in autism is Valproic

acid Bromley RL Mawer G Baker GA Autism spectrum disorders following in utero exposure to

antiepileptic drugs Neurodevelopment GroupNeurology 2008 Dec 2 71(23)1923-4

All contaminants are not equal

Organohalogens higher in mom than baby PCBs higher in baby than mom Mercury is high uniform in all matrices

Larry L Needhamdagger Philippe GrandjeanDaggersect Birger Heinzow Poul J Joslashrgensenpara Flemming NielsenDagger

Donald G Patterson Jrdagger Andreas Sjdindagger Wayman E Turnerdagger and Pal Weihe Partition of Environmental Chemicals between Maternal and Fetal Blood and Tissues Environ Sci Technol Article ASAP Publication Date (Web) December 17 2010

National Childrenrsquos Study wwwnationalchildrensstudygov

PDBEs Halt Flames and Neurodevelopment

Cord Blood PDBE levels have neurodevelopmental consequences

bull Samples taken from 329 mothers and children in Manhattan who delivered in proximity to the 9112001 attack

Julie B Herbstman Andreas Sjoumldin Matthew Kurzon Sally A Lederman Richard S Jones Virginia Rauh Larry L Needham Deliang Tang Megan Niedzwiecki Richard Y Wang and Frederica Perera Prenatal Exposure to PBDEs and Neurodevelopment Environmental Health Perspectives 2010118(5)712-719

Indoor environment counts Increased risk of developing an ASD if living

in a house with PVC flooring Larsson M B Weiss S Janson J Sundell and CG Bornehag 2009 Associations

between indoor environmental factors and parental-reported autistic spectrum disorders in children 6-8 years of age Neurotoxicology 30 (5)822-31

Increased risk of ASD if living near a freeway Kalkbrenner AE Daniels JL Chen JC Poole C Emch M Morrissey J Perinatal

exposure to hazardous air pollutants and autism spectrum disorders at age 8 Epidemiology 2010 Sep21(5)631-41

Becerra TA Wilhelm M Olsen J Cockburn M Ritz B Ambient Air Pollution and Autism in Los Angeles County California Environ Health Perspect 2013 Mar121(3)380-6 doi 101289ehp1205827 Epub 2012 Dec 17

PDBEs Halt Flames and Neurodevelopment

Cord Blood PDBE levels have neurodevelopmental consequences

bull Samples taken from 329 mothers and children in Manhattan who delivered in proximity to the 9112001 attack

Julie B Herbstman Andreas Sjoumldin Matthew Kurzon Sally A Lederman Richard S Jones Virginia Rauh Larry L Needham Deliang Tang Megan Niedzwiecki Richard Y Wang and Frederica Perera Prenatal Exposure to PBDEs and Neurodevelopment Environmental Health Perspectives 2010118(5)712-719

Indoor environment counts Increased risk of developing an ASD if living

in a house with PVC flooring Larsson M B Weiss S Janson J Sundell and CG Bornehag 2009 Associations

between indoor environmental factors and parental-reported autistic spectrum disorders in children 6-8 years of age Neurotoxicology 30 (5)822-31

Increased risk of ASD if living near a freeway Kalkbrenner AE Daniels JL Chen JC Poole C Emch M Morrissey J Perinatal

exposure to hazardous air pollutants and autism spectrum disorders at age 8 Epidemiology 2010 Sep21(5)631-41

Becerra TA Wilhelm M Olsen J Cockburn M Ritz B Ambient Air Pollution and Autism in Los Angeles County California Environ Health Perspect 2013 Mar121(3)380-6 doi 101289ehp1205827 Epub 2012 Dec 17

Indoor environment counts Increased risk of developing an ASD if living

in a house with PVC flooring Larsson M B Weiss S Janson J Sundell and CG Bornehag 2009 Associations

between indoor environmental factors and parental-reported autistic spectrum disorders in children 6-8 years of age Neurotoxicology 30 (5)822-31

Increased risk of ASD if living near a freeway Kalkbrenner AE Daniels JL Chen JC Poole C Emch M Morrissey J Perinatal

exposure to hazardous air pollutants and autism spectrum disorders at age 8 Epidemiology 2010 Sep21(5)631-41

Becerra TA Wilhelm M Olsen J Cockburn M Ritz B Ambient Air Pollution and Autism in Los Angeles County California Environ Health Perspect 2013 Mar121(3)380-6 doi 101289ehp1205827 Epub 2012 Dec 17

Autism and Heavy Metals Children with ASD have high amounts metals Adams JB M Baral E Geis J Mitchell J Ingram A Hensley I Zappia S

Newmark E Gehn RA Rubin K Mitchell J Bradstreet and JM El-Dahr 2009 The severity of autism is associated with toxic metal body burden and red blood cell glutathioine levels Journal of Toxicology doi1011552009532640

Children with ASD have Normal amounts of metals

Albizzati A Moregrave L Di Candia D Saccani M Lenti CNormal concentrations of heavy metals in autistic spectrum disorders Minerva Pediatr 2012 Feb64(1)27-31

Why heavy metals in Autism Direct Exposure- lead mercury aluminum or

arsenic can sometimes be implicated Faulty Genetics- Epigenetic differences can lead

to sluggish biotransforamationdetoxification and metabolic storage

Walsh WJ Usman A and Tarpey J Disordered Metal Metabolism In a Large

Autism Population Proceedings of the Amer Psych Assn New Research Abstract NR109 New Orleans May 2001

Rose S Melnyk S et al The frequency of polymorphisms affecting lead and mercury toxicity among children with autism Am J Biochem Biotechnol 2008 4(2) 85-94

The ldquoVrdquo Word wwwvaccinesafetyeducomponentshtm CDC 2001 Except for influenza thimerosal is removed from or

reduced in all vaccines routinely recommended for children 6 years of age and under manufactured for the US market

Main Preservative 2-phenoxyethanol Aluminum used as an adjuvant

Bishop N J Morley R Day J P Lucas A (1997) Aluminum

neurotoxicity in preterm infants receiving intravenous-feeding solutions The New England journal of medicine 336(22)1557-61

Aluminum exposure in the first six months of life 4mg from vaccines 10mg from breast milk 40mg from dairy infant formula 125 mg from soy based infant formula wwwvaccinechopedu

Too much too soon Destefano F Price CS Weintraub ES Increasing

Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of AutismJ Pediatr 2013 Mar 29

256 ASD and 752 controls

summation analysis of the content of Antibody-Stimulating Proteins and Polysaccharides which consisted of a summation of the antigen content of each vaccine received

Exposure to antibody-stimulating proteins and polysaccharides in vaccines during the first 2 years of life was not related to the risk of developing an ASD

Why heavy metals in Autism Direct Exposure- lead mercury aluminum or

arsenic can sometimes be implicated Faulty Genetics- Epigenetic differences can lead

to sluggish biotransforamationdetoxification and metabolic storage

Walsh WJ Usman A and Tarpey J Disordered Metal Metabolism In a Large

Autism Population Proceedings of the Amer Psych Assn New Research Abstract NR109 New Orleans May 2001

Rose S Melnyk S et al The frequency of polymorphisms affecting lead and mercury toxicity among children with autism Am J Biochem Biotechnol 2008 4(2) 85-94

The ldquoVrdquo Word wwwvaccinesafetyeducomponentshtm CDC 2001 Except for influenza thimerosal is removed from or

reduced in all vaccines routinely recommended for children 6 years of age and under manufactured for the US market

Main Preservative 2-phenoxyethanol Aluminum used as an adjuvant

Bishop N J Morley R Day J P Lucas A (1997) Aluminum

neurotoxicity in preterm infants receiving intravenous-feeding solutions The New England journal of medicine 336(22)1557-61

Aluminum exposure in the first six months of life 4mg from vaccines 10mg from breast milk 40mg from dairy infant formula 125 mg from soy based infant formula wwwvaccinechopedu

Too much too soon Destefano F Price CS Weintraub ES Increasing

Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of AutismJ Pediatr 2013 Mar 29

256 ASD and 752 controls

summation analysis of the content of Antibody-Stimulating Proteins and Polysaccharides which consisted of a summation of the antigen content of each vaccine received

Exposure to antibody-stimulating proteins and polysaccharides in vaccines during the first 2 years of life was not related to the risk of developing an ASD

The ldquoVrdquo Word wwwvaccinesafetyeducomponentshtm CDC 2001 Except for influenza thimerosal is removed from or

reduced in all vaccines routinely recommended for children 6 years of age and under manufactured for the US market

Main Preservative 2-phenoxyethanol Aluminum used as an adjuvant

Bishop N J Morley R Day J P Lucas A (1997) Aluminum

neurotoxicity in preterm infants receiving intravenous-feeding solutions The New England journal of medicine 336(22)1557-61

Aluminum exposure in the first six months of life 4mg from vaccines 10mg from breast milk 40mg from dairy infant formula 125 mg from soy based infant formula wwwvaccinechopedu

Too much too soon Destefano F Price CS Weintraub ES Increasing

Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of AutismJ Pediatr 2013 Mar 29

256 ASD and 752 controls

summation analysis of the content of Antibody-Stimulating Proteins and Polysaccharides which consisted of a summation of the antigen content of each vaccine received

Exposure to antibody-stimulating proteins and polysaccharides in vaccines during the first 2 years of life was not related to the risk of developing an ASD

Too much too soon Destefano F Price CS Weintraub ES Increasing

Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of AutismJ Pediatr 2013 Mar 29

256 ASD and 752 controls

summation analysis of the content of Antibody-Stimulating Proteins and Polysaccharides which consisted of a summation of the antigen content of each vaccine received

Exposure to antibody-stimulating proteins and polysaccharides in vaccines during the first 2 years of life was not related to the risk of developing an ASD

Disconnect From Gaia

Environment and Genetics

Environmental toxicants interfere with faulty epigenetics and the end result is oxidative

stress and neuroinflammation

Herbert MR Contributions of the environment and environmentally vulnerable physiology to autism spectrum disordersCurr Opin Neurol 2010 Apr23(2)103-10

Deth R Muratore C Benzecry J Power-Charnitsky VA Waly M How

environmental and genetic factors combine to cause autism A redoxmethylation hypothesis Neurotoxicology 2008 Jan29(1)190-201

Herbert MR Russo JP Yang S et al Autism and environmental genomics

Neurotoxicology 2006 27(5)671-84

Genetics and ASD

Age of father will contribute to the frequency of de novo genetic mutations

Kong A Frigge ML Masson G et al Rate of de novo mutations and the importance of fathers age to disease risk Nature 2012 488(7412) 471-5

Sanders SJ Murtha MT Gupta AR et al De novo mutations revealed by whole-exome sequencing are strongly associated with autism Nature 2012 485(7397) 237-41

So what mutations are we looking at

Enzyme SNPrsquos Studied In Autism

MTHFR - Methylenetetrahydrofolate reductase Defective folate metabolism

Elevated homocysteine levels

Defective ability to methylate DNA

Global loss of methyl groups James SJ Melnyk S Jernigan S Hubanks A Rose S amp Gaylor DW (2008) Abnormal

Transmethylationtranssulfuration Metabolism and DNA Hypomethylation Among Parents of Children with Autism Journal of Autism and Devopmental Disorders Published online only July 11 2008

COMT-Catechol-O-methyltransferase Kenneth D Gadow Jasmin Roohi Carla J DeVincent Sarah KirschEli Hatchwel Association

of COMT (Val158Met) and BDNF (Val66Met) Gene Polymorphisms with Anxiety ADHD

and Tics in Children with Autism Spectrum Disorder J Autism Dev Disord (2009) 391542ndash

1551

OBrien R A Semenuk G Coleman M and Spector S (1976) Catechol-O-

methyltransferase activity in erythrocytes of children with autism Clinical and Experimental

Pharmacology and Physiology 3 9ndash14

Enzyme SNPrsquos Studied In Autism CBS - Cystathionine Beta- Synthase

Joins the methyl and sulfur pathways

This is a one-way reaction that permanently removes homocysteine from the methionine cycle and initiates the transsulfuration pathway for the synthesis of cysteine and glutathione

No research ndash only presumptive at this point

Glutathione-S-transferase

Conjugate glutathione with toxins for Phase 2 biotransformation and elimination

Williams TA Mars AE Buyske SG Stenroos ES Wang R Factura-Santiago MF Lambert GH Johnson WG Risk of autistic disorder in affected offspring of mothers with a glutathione S-transferase P1 haplotype Archives of Pediatrics amp Adolescent Medicine 161(4)356-61 2007 Apr

What should we do about it Education and Awareness

Limit Exposure

Everyday detox

Dietary intervention

Methylation support GSH

Investigate toxic levels more thoroughly

Treat more aggressively when toxicants are suspected and confirmed

Autism ldquoPhenomerdquo Project Medical evaluations An initial exam is conducted by a pediatrician with expertise in

developmental disorders Standard data on height weight and head circumference is gathered as well as blood samples Some of these samples are gathered from siblings and parents as well Parents are asked questions related to the childs exposures to environmental toxins household products and about their dietary habits

Environmental exposuresepidemiology Several lines of evidence suggest that more than just genes determine whether or not a child will have autism The drug thalidomide viruses and mercury are among the non-genetic causes that have been implicated as causes of the disorders Therefore blood of children and mothers are being examined for the presence of metals and environmental toxins

Behavior and neuropsychology These assessments consist of established diagnostic interviews tests parental questionnaires and observational schedules

Genomics This part of the study utilizes the latest in genetic profiling the microarray to assess which genes are turned on - and at what levels - in children with autism compared to children without the disorder

Brain structure MRI EEG data

Immune function -determining the kind and number of antibodies found in the blood serum of patients and look for markers of inflammation hormones and viruses

UC Davis MIND Institute- 1800 kids- WOW

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Environment and Genetics

Environmental toxicants interfere with faulty epigenetics and the end result is oxidative

stress and neuroinflammation

Herbert MR Contributions of the environment and environmentally vulnerable physiology to autism spectrum disordersCurr Opin Neurol 2010 Apr23(2)103-10

Deth R Muratore C Benzecry J Power-Charnitsky VA Waly M How

environmental and genetic factors combine to cause autism A redoxmethylation hypothesis Neurotoxicology 2008 Jan29(1)190-201

Herbert MR Russo JP Yang S et al Autism and environmental genomics

Neurotoxicology 2006 27(5)671-84

Genetics and ASD

Age of father will contribute to the frequency of de novo genetic mutations

Kong A Frigge ML Masson G et al Rate of de novo mutations and the importance of fathers age to disease risk Nature 2012 488(7412) 471-5

Sanders SJ Murtha MT Gupta AR et al De novo mutations revealed by whole-exome sequencing are strongly associated with autism Nature 2012 485(7397) 237-41

So what mutations are we looking at

Enzyme SNPrsquos Studied In Autism

MTHFR - Methylenetetrahydrofolate reductase Defective folate metabolism

Elevated homocysteine levels

Defective ability to methylate DNA

Global loss of methyl groups James SJ Melnyk S Jernigan S Hubanks A Rose S amp Gaylor DW (2008) Abnormal

Transmethylationtranssulfuration Metabolism and DNA Hypomethylation Among Parents of Children with Autism Journal of Autism and Devopmental Disorders Published online only July 11 2008

COMT-Catechol-O-methyltransferase Kenneth D Gadow Jasmin Roohi Carla J DeVincent Sarah KirschEli Hatchwel Association

of COMT (Val158Met) and BDNF (Val66Met) Gene Polymorphisms with Anxiety ADHD

and Tics in Children with Autism Spectrum Disorder J Autism Dev Disord (2009) 391542ndash

1551

OBrien R A Semenuk G Coleman M and Spector S (1976) Catechol-O-

methyltransferase activity in erythrocytes of children with autism Clinical and Experimental

Pharmacology and Physiology 3 9ndash14

Enzyme SNPrsquos Studied In Autism CBS - Cystathionine Beta- Synthase

Joins the methyl and sulfur pathways

This is a one-way reaction that permanently removes homocysteine from the methionine cycle and initiates the transsulfuration pathway for the synthesis of cysteine and glutathione

No research ndash only presumptive at this point

Glutathione-S-transferase

Conjugate glutathione with toxins for Phase 2 biotransformation and elimination

Williams TA Mars AE Buyske SG Stenroos ES Wang R Factura-Santiago MF Lambert GH Johnson WG Risk of autistic disorder in affected offspring of mothers with a glutathione S-transferase P1 haplotype Archives of Pediatrics amp Adolescent Medicine 161(4)356-61 2007 Apr

What should we do about it Education and Awareness

Limit Exposure

Everyday detox

Dietary intervention

Methylation support GSH

Investigate toxic levels more thoroughly

Treat more aggressively when toxicants are suspected and confirmed

Autism ldquoPhenomerdquo Project Medical evaluations An initial exam is conducted by a pediatrician with expertise in

developmental disorders Standard data on height weight and head circumference is gathered as well as blood samples Some of these samples are gathered from siblings and parents as well Parents are asked questions related to the childs exposures to environmental toxins household products and about their dietary habits

Environmental exposuresepidemiology Several lines of evidence suggest that more than just genes determine whether or not a child will have autism The drug thalidomide viruses and mercury are among the non-genetic causes that have been implicated as causes of the disorders Therefore blood of children and mothers are being examined for the presence of metals and environmental toxins

Behavior and neuropsychology These assessments consist of established diagnostic interviews tests parental questionnaires and observational schedules

Genomics This part of the study utilizes the latest in genetic profiling the microarray to assess which genes are turned on - and at what levels - in children with autism compared to children without the disorder

Brain structure MRI EEG data

Immune function -determining the kind and number of antibodies found in the blood serum of patients and look for markers of inflammation hormones and viruses

UC Davis MIND Institute- 1800 kids- WOW

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Genetics and ASD

Age of father will contribute to the frequency of de novo genetic mutations

Kong A Frigge ML Masson G et al Rate of de novo mutations and the importance of fathers age to disease risk Nature 2012 488(7412) 471-5

Sanders SJ Murtha MT Gupta AR et al De novo mutations revealed by whole-exome sequencing are strongly associated with autism Nature 2012 485(7397) 237-41

So what mutations are we looking at

Enzyme SNPrsquos Studied In Autism

MTHFR - Methylenetetrahydrofolate reductase Defective folate metabolism

Elevated homocysteine levels

Defective ability to methylate DNA

Global loss of methyl groups James SJ Melnyk S Jernigan S Hubanks A Rose S amp Gaylor DW (2008) Abnormal

Transmethylationtranssulfuration Metabolism and DNA Hypomethylation Among Parents of Children with Autism Journal of Autism and Devopmental Disorders Published online only July 11 2008

COMT-Catechol-O-methyltransferase Kenneth D Gadow Jasmin Roohi Carla J DeVincent Sarah KirschEli Hatchwel Association

of COMT (Val158Met) and BDNF (Val66Met) Gene Polymorphisms with Anxiety ADHD

and Tics in Children with Autism Spectrum Disorder J Autism Dev Disord (2009) 391542ndash

1551

OBrien R A Semenuk G Coleman M and Spector S (1976) Catechol-O-

methyltransferase activity in erythrocytes of children with autism Clinical and Experimental

Pharmacology and Physiology 3 9ndash14

Enzyme SNPrsquos Studied In Autism CBS - Cystathionine Beta- Synthase

Joins the methyl and sulfur pathways

This is a one-way reaction that permanently removes homocysteine from the methionine cycle and initiates the transsulfuration pathway for the synthesis of cysteine and glutathione

No research ndash only presumptive at this point

Glutathione-S-transferase

Conjugate glutathione with toxins for Phase 2 biotransformation and elimination

Williams TA Mars AE Buyske SG Stenroos ES Wang R Factura-Santiago MF Lambert GH Johnson WG Risk of autistic disorder in affected offspring of mothers with a glutathione S-transferase P1 haplotype Archives of Pediatrics amp Adolescent Medicine 161(4)356-61 2007 Apr

What should we do about it Education and Awareness

Limit Exposure

Everyday detox

Dietary intervention

Methylation support GSH

Investigate toxic levels more thoroughly

Treat more aggressively when toxicants are suspected and confirmed

Autism ldquoPhenomerdquo Project Medical evaluations An initial exam is conducted by a pediatrician with expertise in

developmental disorders Standard data on height weight and head circumference is gathered as well as blood samples Some of these samples are gathered from siblings and parents as well Parents are asked questions related to the childs exposures to environmental toxins household products and about their dietary habits

Environmental exposuresepidemiology Several lines of evidence suggest that more than just genes determine whether or not a child will have autism The drug thalidomide viruses and mercury are among the non-genetic causes that have been implicated as causes of the disorders Therefore blood of children and mothers are being examined for the presence of metals and environmental toxins

Behavior and neuropsychology These assessments consist of established diagnostic interviews tests parental questionnaires and observational schedules

Genomics This part of the study utilizes the latest in genetic profiling the microarray to assess which genes are turned on - and at what levels - in children with autism compared to children without the disorder

Brain structure MRI EEG data

Immune function -determining the kind and number of antibodies found in the blood serum of patients and look for markers of inflammation hormones and viruses

UC Davis MIND Institute- 1800 kids- WOW

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Enzyme SNPrsquos Studied In Autism

MTHFR - Methylenetetrahydrofolate reductase Defective folate metabolism

Elevated homocysteine levels

Defective ability to methylate DNA

Global loss of methyl groups James SJ Melnyk S Jernigan S Hubanks A Rose S amp Gaylor DW (2008) Abnormal

Transmethylationtranssulfuration Metabolism and DNA Hypomethylation Among Parents of Children with Autism Journal of Autism and Devopmental Disorders Published online only July 11 2008

COMT-Catechol-O-methyltransferase Kenneth D Gadow Jasmin Roohi Carla J DeVincent Sarah KirschEli Hatchwel Association

of COMT (Val158Met) and BDNF (Val66Met) Gene Polymorphisms with Anxiety ADHD

and Tics in Children with Autism Spectrum Disorder J Autism Dev Disord (2009) 391542ndash

1551

OBrien R A Semenuk G Coleman M and Spector S (1976) Catechol-O-

methyltransferase activity in erythrocytes of children with autism Clinical and Experimental

Pharmacology and Physiology 3 9ndash14

Enzyme SNPrsquos Studied In Autism CBS - Cystathionine Beta- Synthase

Joins the methyl and sulfur pathways

This is a one-way reaction that permanently removes homocysteine from the methionine cycle and initiates the transsulfuration pathway for the synthesis of cysteine and glutathione

No research ndash only presumptive at this point

Glutathione-S-transferase

Conjugate glutathione with toxins for Phase 2 biotransformation and elimination

Williams TA Mars AE Buyske SG Stenroos ES Wang R Factura-Santiago MF Lambert GH Johnson WG Risk of autistic disorder in affected offspring of mothers with a glutathione S-transferase P1 haplotype Archives of Pediatrics amp Adolescent Medicine 161(4)356-61 2007 Apr

What should we do about it Education and Awareness

Limit Exposure

Everyday detox

Dietary intervention

Methylation support GSH

Investigate toxic levels more thoroughly

Treat more aggressively when toxicants are suspected and confirmed

Autism ldquoPhenomerdquo Project Medical evaluations An initial exam is conducted by a pediatrician with expertise in

developmental disorders Standard data on height weight and head circumference is gathered as well as blood samples Some of these samples are gathered from siblings and parents as well Parents are asked questions related to the childs exposures to environmental toxins household products and about their dietary habits

Environmental exposuresepidemiology Several lines of evidence suggest that more than just genes determine whether or not a child will have autism The drug thalidomide viruses and mercury are among the non-genetic causes that have been implicated as causes of the disorders Therefore blood of children and mothers are being examined for the presence of metals and environmental toxins

Behavior and neuropsychology These assessments consist of established diagnostic interviews tests parental questionnaires and observational schedules

Genomics This part of the study utilizes the latest in genetic profiling the microarray to assess which genes are turned on - and at what levels - in children with autism compared to children without the disorder

Brain structure MRI EEG data

Immune function -determining the kind and number of antibodies found in the blood serum of patients and look for markers of inflammation hormones and viruses

UC Davis MIND Institute- 1800 kids- WOW

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Enzyme SNPrsquos Studied In Autism CBS - Cystathionine Beta- Synthase

Joins the methyl and sulfur pathways

This is a one-way reaction that permanently removes homocysteine from the methionine cycle and initiates the transsulfuration pathway for the synthesis of cysteine and glutathione

No research ndash only presumptive at this point

Glutathione-S-transferase

Conjugate glutathione with toxins for Phase 2 biotransformation and elimination

Williams TA Mars AE Buyske SG Stenroos ES Wang R Factura-Santiago MF Lambert GH Johnson WG Risk of autistic disorder in affected offspring of mothers with a glutathione S-transferase P1 haplotype Archives of Pediatrics amp Adolescent Medicine 161(4)356-61 2007 Apr

What should we do about it Education and Awareness

Limit Exposure

Everyday detox

Dietary intervention

Methylation support GSH

Investigate toxic levels more thoroughly

Treat more aggressively when toxicants are suspected and confirmed

Autism ldquoPhenomerdquo Project Medical evaluations An initial exam is conducted by a pediatrician with expertise in

developmental disorders Standard data on height weight and head circumference is gathered as well as blood samples Some of these samples are gathered from siblings and parents as well Parents are asked questions related to the childs exposures to environmental toxins household products and about their dietary habits

Environmental exposuresepidemiology Several lines of evidence suggest that more than just genes determine whether or not a child will have autism The drug thalidomide viruses and mercury are among the non-genetic causes that have been implicated as causes of the disorders Therefore blood of children and mothers are being examined for the presence of metals and environmental toxins

Behavior and neuropsychology These assessments consist of established diagnostic interviews tests parental questionnaires and observational schedules

Genomics This part of the study utilizes the latest in genetic profiling the microarray to assess which genes are turned on - and at what levels - in children with autism compared to children without the disorder

Brain structure MRI EEG data

Immune function -determining the kind and number of antibodies found in the blood serum of patients and look for markers of inflammation hormones and viruses

UC Davis MIND Institute- 1800 kids- WOW

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

What should we do about it Education and Awareness

Limit Exposure

Everyday detox

Dietary intervention

Methylation support GSH

Investigate toxic levels more thoroughly

Treat more aggressively when toxicants are suspected and confirmed

Autism ldquoPhenomerdquo Project Medical evaluations An initial exam is conducted by a pediatrician with expertise in

developmental disorders Standard data on height weight and head circumference is gathered as well as blood samples Some of these samples are gathered from siblings and parents as well Parents are asked questions related to the childs exposures to environmental toxins household products and about their dietary habits

Environmental exposuresepidemiology Several lines of evidence suggest that more than just genes determine whether or not a child will have autism The drug thalidomide viruses and mercury are among the non-genetic causes that have been implicated as causes of the disorders Therefore blood of children and mothers are being examined for the presence of metals and environmental toxins

Behavior and neuropsychology These assessments consist of established diagnostic interviews tests parental questionnaires and observational schedules

Genomics This part of the study utilizes the latest in genetic profiling the microarray to assess which genes are turned on - and at what levels - in children with autism compared to children without the disorder

Brain structure MRI EEG data

Immune function -determining the kind and number of antibodies found in the blood serum of patients and look for markers of inflammation hormones and viruses

UC Davis MIND Institute- 1800 kids- WOW

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Autism ldquoPhenomerdquo Project Medical evaluations An initial exam is conducted by a pediatrician with expertise in

developmental disorders Standard data on height weight and head circumference is gathered as well as blood samples Some of these samples are gathered from siblings and parents as well Parents are asked questions related to the childs exposures to environmental toxins household products and about their dietary habits

Environmental exposuresepidemiology Several lines of evidence suggest that more than just genes determine whether or not a child will have autism The drug thalidomide viruses and mercury are among the non-genetic causes that have been implicated as causes of the disorders Therefore blood of children and mothers are being examined for the presence of metals and environmental toxins

Behavior and neuropsychology These assessments consist of established diagnostic interviews tests parental questionnaires and observational schedules

Genomics This part of the study utilizes the latest in genetic profiling the microarray to assess which genes are turned on - and at what levels - in children with autism compared to children without the disorder

Brain structure MRI EEG data

Immune function -determining the kind and number of antibodies found in the blood serum of patients and look for markers of inflammation hormones and viruses

UC Davis MIND Institute- 1800 kids- WOW

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

wwwBioInitiativeorg Findings in Autism (ASD) Consistent with

Electromagnetic Fields (EMF) and Radiofrequency Radiation (RFR)

Martha Herbert MD PhD

Pediatric Neurology TRANSCEND Research Program Massachusetts General Hospital

Harvard Medical School Cindy Sage MA

For the BioInitiatve Working Group December 2012

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

EMF and RFR in Autism Electromagnetic Frequency and Radio Frequency Radiation

Exposures have outpaced precautions

ldquoThe deployment of new technologies is running ahead of any reasonable estimation of possible health impacts and estimates of probabilities let alone a solid assessment of risk However what has been missing with regard to EMF has been an acknowledgement of the risk that is demonstrated by the scientific studies There is clear evidence of risk although the magnitude of the risk is uncertain and the magnitude of doing nothing on the health effects cost to society is similarly uncertain This situation is very similar to our history of dealing with the hazards of smoking decades ago where the power of the industry to influence governments and even conflicts of interest within the public health community delayed action for more than a generation with consequent loss of life and enormous extra health care costs to societyrdquo

- Sage C and D O Carpenter 2009 Public health implications of wireless technologies

Pathophysiology 16 (2-3)233-46

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

EMF and RFR in Autism Neuropathology of ASD demonstrates striking parallels

in the physiological impacts of electromagnetic frequency and radiofrequency exposures (EMFRFR)

molecular cellular and tissue damage

cellular stress (oxidative stress the heat shock response and protein misfolding)

injury of membranes

aberrant calcium signaling

compromise of junctions and barriers

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

What to do about it Children with existing neurological problems that include cognitive learning

attention memory or behavioral problems should as much as possible be

provided with wired (not wireless) learning living and sleeping environments

Special education classrooms should aim for no wireless conditions to reduce

avoidable stressors that may impede social academic and behavioral progress

All children should reasonably be protected from the physiological stressor of

significantly elevated EMFRFR (wireless in classrooms or home environments)

School districts that are now considering all-wireless learning environments

should be strongly cautioned that wired environments are likely to provide better

learning and teaching environments and prevent possible adverse health

consequences for both students and faculty in the long-term

Monitoring of the impacts of wireless technology in learning and care

environments should be performed with sophisticated measurement and data

analysis techniques that are cognizant of the non-linear impacts of EMFRFR and

of data techniques most appropriate for discerning these impacts

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Immune Abnormalities Hsiao EY McBride SW Chow J Mazmanian SK Patterson PH Modeling an autism

risk factor in mice leads to permanent immune dysregulation Proceedings of the National Academy of Sciences 2012 109(30)

Atladoacutettir HOacute Henriksen TB Schendel DE Parner ET Autism after infection febrile episodes and antibiotic use during pregnancy an exploratory study Pediatrics 2012 Dec130(6)e1447-54 doi 101542peds2012-1107 Epub 2012 Nov 12 little evidence that various types of mild common infectious diseases or febrile episodes during

pregnancy were associated with ASDinfantile autism

maternal influenza infection was associated with a twofold increased risk of infantile autism

prolonged episodes of fever caused a threefold increased risk of infantile autism

and use of various antibiotics during pregnancy were potential risk factors for ASDinfantile autism

ldquoFuture doctors will need to correct the postmodern tendency toward immune dysregulation Evolution has provided us with a road map the original accretion pattern of the superorganism Preventive medicine will need by strange necessity to emulate the patterns from deep in our pastrdquo Moises Velasquez-Manoff

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Emerging treatments for ASD

Beyond therapy (speech behavioral QiGong and Occupational) early intervention diet nutrition homeopathy detox supporthellip now what

Novel Nutraceutical and Pharmaceutical treatments are validating themes that are important to naturopathic medicine

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Folate Autoantibodies in ASD Frye RE Sequeira JM Quadros EV James SJ Rossignol DA Mol

Psychiatry Cerebral folate receptor autoantibodies in autism spectrum disorder 2013 Mar18(3)369-81 doi 101038mp2011175 Epub 2012 Jan 10

Testing contact Department of Biochemistry BSB 7-15

SUNY Downstate Med Center

450 Clarkson Avenue

Brooklyn NY 11203 USA

Ph 718 270-4203

Fax 718 270-3316

E Mail Edwardquadrosdownstateedu

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

When to suspect CFD Low-functioning autism Mitochondrial disease or dysfunction Rett syndrome Epilepsy or seizures Abnormal electroencephalogram subclinical electrical discharges or slowing Ataxia Microcephaly Dyskinesia choreoathetosis ballismus Irritability Insomnia Frontotemporal atrophy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Folate Supplementation Start folinic acid at dose of 05 mgkgday in two divided

doses and increase to 1-4 mgkgday in two divided doses (max 50 mgday) I have been using 5-MTHF in doses of 1-5 mg but moving to Calcium Leucovorin when needing to go above those doses

Discontinue drugs that can interfere with folate metabolism

Consider cobalamin supplementation (vitamin B12) Stop folic acid supplementation Start a cowrsquos milk-free diet Monitor for changes in cognition and behavior Monitor adverse effects

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Arbaclofen Seasides drug STX209 or arbaclofen works to control an

overabundance of signaling or noise at brain synapses by reducing the amount of the neurotransmitter glutamate that is available in the brain

First studied with Fragile X

Arbaclofen = GABA agonist

GABA 250-3000 mg day

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Oxytocin Kumsta R Hummel E Chen FS Heinrichs M Epigenetic regulation of

the oxytocin receptor gene implications for behavioral neuroscience Front Neurosci 2013 May 23783

Anagnostou E Soorya L Chaplin W Bartz J Halpern D Wasserman S Wang AT Pepa L Tanel N Kushki A Hollander E Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders a randomized controlled trial Mol Autism 2012 Dec 53(1)16 doi 1011862040-2392-3-16

Found differences after six weeks of treatment- quality of life and social cognition

Stavropoulos K K M and Carver L J (2013) Research Review Social motivation and oxytocin in autism ndash implications for joint attention development and intervention Journal of Child Psychology and Psychiatry 54 603ndash618

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Oxytocin Available as a daily nasal spray or sublingual drop

No taste no smell no burn

Dose is 10 to 40 units per day

Compounded

No documented or observed negative side effects

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Decreased Tryptophan metabolism Boccuto L Chen CF Pittman AR Skinner CD

McCartney HJ Jones K Bochner BR Stevenson RE Schwartz CE Decreased tryptophan metabolism in patients with autism spectrum disorders Mol Autism 2013 Jun 34(1)16

Decreased tryptophan metabolism may alter brain development neuroimmune activity and mitochondrial function

Decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Melatonin Malow B Adkins KW McGrew SG et al Melatonin for

sleep in children with autism a controlled trial examining dose tolerability and outcomes J Autism Dev Disord 2012 Aug42(8)1729-37

Dose of 1-3 mg qhs significantly improved sleep in children with ASDs

No negative side effects were observed

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

NAC- now in phase 2 trial Hardan AY Fung LK Libove RA Obukhanych TV Nair S Herzenberg

LA Frazier TW Tirouvanziam R A randomized controlled pilot trial of oral N-acetylcysteine in children with autism Biol Psychiatry 2012 Jun 171(11)956-61

N-Acetyl Cysteine

Improvements in irritability hyperactivity and stereotypy

Dose 900 mg TID

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Qi Gong Massage

Qigong Sensory Training (QST)

wwwqstiorg

Parent delivered

May see improvements in sensory symptoms sleep and bowels

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Remember the foundation Clean up the diet and ADD Nutrition

Heal the gut mind the brain ensure sleep

Address allergies immune issues and sensitivities

Methyl B12 injections q 3d (or other methylation support)

Get outside Commune with animals and nature

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

QUESTIONS

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy

Mind in the Eyes Test httpwwwquestionwritertrackercomquiz61Z4MK

3TKBhtml

It is not as easy as you think Do you think this is an accurate reflection of social competancy