Module 13 Autism ADHD Sleeep and Behavioural Disorders Flashcards
Autism Spectrum Disorder.
What is it?
Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention.
Have an understanding about the diagnostic criteria of ASD
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history
Severity is based on social communication impairments and restricted repetitive patterns of behavior
Specify if:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
The most notable symptoms of and signs of Autism are:
- Non-developed or poorly developed verbal and nonverbal communication skills
- Abnormalities in speech patterns, impaired ability to sustain a conversation
- Abnormal social play
- Lack of empathy
- Inability to make friends
- Stereotypical body movements
- Marked need for sameness
- Very narrow interests
- Preoccupation with parts of the body
10.Withdrawn and often spends hours in solitary play
11.Ritualistic behavior prevails
12.Tantrum-like rages may accompany disruptions of routine
13.Eye contact is minimal or absent.
14.Visual scanning of hand and finger movements, mouthing of objects, and rubbing of surfaces may indicate a heightened awareness and sensitivity to some stimuli
15.Diminished responses to pain and lack of startle responses to sudden loud noises reflect lowered sensitivity to other stimuli.
16.If speech is present, echolalia, nonsense rhyming, and other idiosyncratic language forms may predominate.
EARLY DETECTION OF AUTSIM
Infant Toddler Checklist 9months- 18 months of age)
What are some early detection ideas- it may affect the outcome.
Ie General retrospective parental reports
First year
Second year
* Excessive brain growth (head circumference) between months 1-2 and 6-14 should raise suspicion of autism
General retrospective parental reports:
- isolation from others
- failure to play like other children - apparent deafness
- empty gaze
- failure to attract attention
- lack of smiling
- poor imitation of movements
- concerns over delayed speech
-restlessness and hyperactivity.
First year:
1. lack of social smile
2. lack of appropriate facial expression 3. hypotonia
4. poor attention.
Second year:
1. preference for aloneness
2. lack of eye contact
3. lack of appropriate gestures
4. lack of emotional expression.
5. less likely to show an object or point to objects, 6. less likely to orient to their name
7. abnormalities in orientation to visual stimuli
8. aversion to touch
What are some early motor impairments
- By 12 months of age:
hypotonia and unusual posturing;
atypical behaviors, such as hand flapping, finger flicking, shaking head and rolling eyes
delayed onset of independent sitting and walking;
postural instability
head lag;
impairment of fine motor skills. - By 18 months of age:
lower fine motor skills, perhaps also lower gross motor skills reduced motor control
postural instability. - At 2 years:
unusual postures,
hypoactivity, and hypotonia
lower gross and/or fine motor skills increased repetitive behaviors.
What are the sensory subtypes in autism?
- Sensory Adaptive
-seeks sensations that are unlikely to be functionally limiting - Taste smell sensitive
-Characterised by extreme taste and smell sensitivity along side moderate- level concerns in auditory filtering and under responsive/ seeks sensation. - Postural inattentive
-characterised by extreme difficulties in postural processing alongside moderate level concerns in auditory filtering and under responsive/ seeks sensation. - Generalised sensory difference: experiences significant difficulties across all areas of sensory difference.
Sensory type
1. research has linked sensory hyper-reactivity with increased anxiety, GI disturbances and repetitive behaviour in children with ASD.
2. Postural inattentive and generalised sensory difference may experience difficulties in attention and motor skills.
Sensory hyperactivity display behaviours consistent with intolerance and sensitivity to specific sensory stressors.
Children were reported to exhibit heightened response to
1. Select taste and smells
2. Movement, tactile, visual, and auditory stimuli
List 14 Subtypes of Autism
- ADHD
- Allergies
- Food intolerance
- Fragile X syndrome
- Gastrointestinal symptoms
- Hyperactivity
- Methylation deficiency
- Mitochondrial dysfunction
- PANDAS*
- 1Phenol intolerance
- PTEN* mutations, macrocephaly
- Rett syndrome
- Seizures
- Tuberous sclerosis
*Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections
List 21 Risk factors for Autism
- Identical twin of sibling with autism
- Allergies
- Asthma
- Presence of brain autoantibodies
- Caesarean section with general anaesthesia
- Environmental toxin exposure
- Exposure to heavy metals
- Exposure to mould
- Haemorrhage
- High fever
- Infection
- Low birth weight
- Low APGAR score
- Obesity
- Oxytocin, prolonged use for labor induction
- Preeclampsia
- Prematurity
- Psoriasis
- Psychotropic medication use 20. Sexual abuse
- Stress
What are some Environmental insults to be aware off?
The incidence of autism has risen 10 fold since the early 1980’s
There is underlying genetic vulnerability
-Heavy metals
-Pesticides
-Chemicals
-Food sensitivities and allergies
-Infections- chronic and acute
Prenatal influences on dopamine activity are especially well documented including:
-effects of maternal psychosocial stress
-maternal fever
-use of certain medications
-fetal hypoxia
Chronically high maternal levels of dopamine caused by the pressures of increasingly urbanised societies and by changing maternal demographics such as more working, educational achievement level, age of 1st born - can all contribute to the rise.
The dopamine link to some of the major disorders like
- ADHD
- Autism
- Bipolar disorder
- Obsessive compulsive disorder
- Parkinsons disease
- Schixophrenia
- Substance abuse
- Tourettes syndrome
Autism is more affected by prenatal insults in the first and possibly second trimesters
Autism reflects a relative over activation of the left hemisphere which is relatively deficient in social and pragmatic communicative skills.
The left hemisphere is generally regarded as superior in
The right hemisphere is superior in:
The left hemisphere is generally regarded as superior in
1. Grammer
2. Mathematics
3. Reasoning
4. Other aspects of abstract intelligence
The right hemisphere is superior in:
1. Self- awareness
2. Emotional expression
3. Judgement of speaker intent
4. Proverb interpretation
5. Various other pragmatic and social behaviours
The specific roles of the two hemispheres are paralleled by the greater concentrations of
1. DA and acetylcholine in the left hemisphere
2. Norepinephrine (NE) and serotonin (also known as 5-
hydroxytryptamine, or 5-HT) in the right
Prenatal as opposed to genetic factors appear to be paramount in the establishment of functional lateralization in humans
Excessive folate and B12 during pregnancy have been linked to a dramatic increase in autism risk in offspring, new research shows.
The replacement of folic acid > 5 methyl THF in prenatal vitamins - important
Maternal prenatal vitamin intake during 1st tri may reduce ASD recurrence in families that already have an ASD kid.
Insecticide is BAD
No screen time before 18 months
Good to know
Autism is characterised by:
- Oxidative stress
- Decreased methylation capacity
- Limited transsulfration production of cysteine and GSH
- Mitochondrial dysfunction
- Intestinal dysbiosis
- Increased toxic metal burden
- Cerebral hypofusion
- Immune dysregulation
Gut-Brain-Immune Axis
* These are the fastest developing systems in the first 3 years of life
The Mercury connection.
1 in 3 newborns have a blood mercury levels above safety limit.
The aluminium connection:
Aluminium is very high in the brain tissue of ASD kids/n
Get a shit load of aluminium and mercury In Vaccinations
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Clinical and Laboratory Findings in Autism
- Complete digestive stool analysis
- Hair mineral analysis
- Heavy metal blood and urine analysis
- Essential Fatty acid profile
- Plasma amino acid profile
- Food sensitivity panel IgG and IgE
- Pesticide residues
Management of Autism
Gluten and Casein free diet
Eliminating foods containing gluten and casein - 60-80% improvement
3 months strict exclusion (more aware, less brain fog, better eye contact, increased language and receptive and expressive, decreased pain tolerance, improved bowel function and better sleep )
Treatment with AntibioticsL
1. treatment of dysbiosis (and related gut symptoms)
2. Stabilisation of mucosal barrier (dressing leaky git) by
-increasing mucin expression.
-reducing bacterial overgrowth
-stimulating mucosal immunity
-synthesizing antioxidant substances
3. Effects on the gut related immune system
4. effects on gut- neuro connections
PROTOCOL:
- Eliminate gluten and casein
-Start with organic foods, reduce toxic load
-Whole foods, decreased processed foods
-be gentle with changing diet
Avoid food additives (colouring agents, artificial sweeteners, avoid preservatives)
Eliminate IgG, IgE and IgA positive foods (blood tested)
Reducing toxic exposures:
Arsenic- chicken, wood, rice
mercury- fish, emissions, vaccinations, corn syrup
Lead- water, soil dust
Household chemicals
Nutrients?
zinc, selenium, magnesium, iron, calcium, iodine, chromium (common mineral deficiencies)
Vit C- improved symptom severity
Zinc- vital for heavy metal removal
Essential fatty acids- omega 3- often deficient
Vit D- consistently low in ASD, neuroprotective, decreased allergic sensitisation
Treatment Protocol -Nutrients
Vitamin B6 and Mg2+
Dimethylglycine (DMG)
Trimethylglycine (TMG) (60ml per day)
Speech is m.c consistent benefit and behaviour. Transient hyperactivity will benefit from folic acid and VitB12.
Folic acid- essential to numerous metabolic pathways
-several researchers report folic acid has good effects on pts with ASD or Fragil X syndrome.
Calcium:
Nutrient supplementation for heavy metal detoxification in Autistic individuals
- A hypoallergenic multiple vitamin daily, during both chelation and non-chelation phases * A hypoallergenic multiple mineral, during the chelation off days (should exclude copper) * Alpha-Lipoic acid (ALA), preferably in combination with chelator9
- Zinc – 2 mg/kg body weight/day, maximum 50 mg/day, only during chelation off days
- Selenium – 1-4 mcg/kg/day, preferably as L-selenomethionine
- Vitamin C – 4,000 mg/day up to bowel tolerance94
- Vitamin E – 6 IU/kg/day, as mixed tocopherols. Soy sensitivity is possible * Coenzyme Q10 – 100 mg/day
- Vitamin B6 – up to 500 mg/day, or P5P – up to 100 mg/day
- B complex - including generous folate and B12
- Glycine – 150-250 mg/day
- Melatonin – up to 0.1 mg/kg at bedtime, as a sleep aid when indicated
Biomedical Management of autism
- Address the gut issues
- Nutritional supplementation & Dietary modifications
- Reduction of oxidative stress
- Detoxification
- Normalisation of immune function
- Reduce brain inflammation
- Reduce environmental exposures
And adjust their subluxations!
Chiropractic: Some possible roles in management of Autism
- Improving gut function: - constipation
- Encopresis
- bowel control
- Improvement in bladder control
- Improvement of behaviour
- Improvement of sleep
- Tensegrity and mechanotransduction
- Immune function
- Pain relief
ADHD
Attention Deficit Hyperactivity Disorder
How should we focus our examination on a child with ADHD
Identify issues with hearing and/ or vision
Examine abdomen (eg liver span) -allergies
Full neuro exam
Neuro-maturation exam
Clinical attention problem scale (questionairre)
What is the dopamine link with ADHD?
What is the cerebellar link with ADHD?
hypo function of dopamine pathways is a consistent feature of the disorder.
Cerebellar link:
cerebellum is linked with the prefrontal cortex in a functional way. We often see an asymmetry in cerebellum volume in children with ADHD.
-Cerebellum also has connections to the reticular structure of the brainstem, which is important for autonomic, emotional and motivational behaviour.
What are the Environmental Influences in ADHD? Many likely contributory factors are:
-Sensitivities to food additives
-Intolerance to foods
-Nutrient deficiencies and imbalances
-heavy metal intoxication
-Toxic pollutant burden
-abnormal thyroid responsiveness
-Perinatal environmental pollutants
Heavy metal toxicity:
children exposed acutely or chronically to lead, arsenic, aluminium, mercury, or cadmium often have attentional defects, emotional lability, and behavioural reactivity.
Lead is damaging to cognition and behaviour and can cause developmental delay and mental retardation as well.
Hypothyroidism and ADHD
Causes of Hypothyroidism:
Synthetic chemicals and pesticides and herbicides- main suspects along with industrial chemicals. Use of organic foods needs to be stressed.