Question 6-Last posting: What are 4 key take home treatment strategies that SLPs and OTs can apply given the literature and discussion you provided on your blog? What is the rationale for each of these take home strategies?

1) Being educated. We need to arm ourselves with knowledge. Often a parent may be reluctant to discuss CAMs with their doctor but more inclined to ask their therapist since therapy is a non-invasive approach. Be aware of the many choices that are out there but do not recommend any particular one. Some CAMs do have serious side effects and parents need to make their own decision.  CAMs have not been scientifically proven. So if parent chose to use a particular CAM they should be aware of the risks. Encourage them to research the CAM’s for themselves.
2) Know the side effects. Especially if you plan to recommend a particular CAM to a family, know the side effects. It is also important to know side effects so you can recognize them in a child that you are working with and report the side effect back to the team and the parents.
3) Communication. Without communication with families, we are working in a vacuum. I have found that a child may exhibit a side effect in one therapy but does not exhibit the same side effect in the classroom or with another therapy. It could be something that is happening in that particular setting and not an actual side effect. Also, a child spends so much of their day in school and away from parents that they need to know exactly what is going on so that they can determine if a CAM is working or needs some modifications or needs to be discontinued.
4) Know the CAMs in your area. It’s one thing to tell someone about CAMs and it another if you point them in a direction. In my area of NJ, the best place to send someone with autism is the Hackettstown Regional Medical Center.

Question 5-What is valued in current practice? What is under-considered, and may be valuable, to current practice paradigms?

The CAM that is most valued in current practice is diet; specifically gluten and casein free diets. As with most new ideas regarding CAM’s, putting your autistic child on a gluten/casein free diet was controversial just a decade ago. Now, we can find gluten/casein free foods in our regular supermarkets. Families used to have to go to specialty stores to get the food for their autistic child.
Proponents of the gluten-free diet say that many children with autism have gastrointestinal difficulties that make it hard for them to digest certain grains properly. The most studied theory is that eating gluten leads to high levels of protein by-products in some children with autism. These by-products may then affect behavior like a drug would. Specifically, these children could reduce their desire for social interaction, block pain messages, and increase confusion. If gluten is taken out of the diet, the idea is that this will reduce the level of protein by-products and behavior will improve as a result (2-4).
These by-products are much more common in the urine of children with autism than in children without autism. Some scientists have concluded that they are leaking from the intestines into the blood of these children (2, 5). Many research studies report that children with autism often have gastrointestinal problems, including intestinal leakage (5). The argument is that, if gluteomorphine (the protein by-products) is being absorbed into the general circulation in children with autism, then it could affect behavior (2-5). There have been many studies on autism and gluten free and casein free diets and there are conflicting results. The current thinking is that there is at least some evidence showing that a gluten-free diet, when combined with a casein-free diet, can help improve the behavior of some children with autism. Although the casein-free diet combined with a gluten-free diet is popular, there is little evidence to support or refute this intervention and reviewers have determined that meaningful conclusions cannot be drawn from the existing literature (3, 4).
References:

1) Murch, S. 2005. "Diet, Immunity, and Autistic Spectrum Disorders." J Pediatr. 146(5):582-584.
2) Reichelt, K.L., and A.M. Knivsberg. 2003. "Can the Pathophysiology of Autism be Explained by the Nature of the Discovered Urine Peptides?" Nutr.Neurosci. 6(1):19-28.
3) Christison, G.W., and K. Ivany. 2006. "Elimination Diets in Autism Spectrum Disorders: Any Wheat Amidst the Chaff?" J Dev Behav Pediatr. 27(2 Suppl):S162-S171.
4) Millward, C., et al. 2004. "Gluten- and Casein-Free Diets for Autistic Spectrum Disorder." Cochrane.Database.Syst.Rev. (2):CD003498.
5) Horvath K, P.J. 2002. "Autism and Gastrointestinal Symptoms." Curr Gastroenterol Rep. 4(3):251-258.
6) Elchaar, G.M., et al. 2006. "Efficacy and Safety of Naltrexone Use in Pediatric Patients with Autistic Disorder." Ann.Pharmacother. 40(6):1086-1095.

It is difficult to say what is underused and may be valuable to current practice paradigms since all CAMs have not been scientifically proven to improve children with autism. In my opinion, CAMs such as traditional Chinese medicine have been underused. Practices that unblock the Qi (energy) such as acupressure and shiatsu should be considered more. They all have minimal or mild side effects and they all promote the flow of energy for the body to heal itself. I believe that Chinese medicine coupled with the correct diet will enhance the traditional treatments of education and ABA.

Question 4-Describe the implications of CAMS for families and the role of therapists working with families with respect to CAMS

The etiology of autism is unknown and because of this it is very difficult to find a cure. As of now, there is no cure of autism. There are some mainstream methods and common CAM treatments but there is no one treatment that has been shown to cure all peoples diagnosed with autism. There are some drug therapies that only alleviate some of the symptoms, and sometimes cause undesirable side effects. Behavioral therapies are promising, but even the most established methods do not work well for some patients. At the same time, autism specialists and literature emphasize intensive, early intervention to achieve the best outcomes. Parents of young or newly diagnosed children with autism often feel there is no time to wait for the science to prove the effectiveness of a particular treatment. They are racing the clock to take advantage of early childhood neuroplasticity, and are willing to try CAM treatments, especially those that are non-invasive and without harmful side effects.
Whether a family chooses to use pharmaceuticals, herbs, minerals, vitamins, homeopathy, diet change, etc. the caregivers that are working with the child need to be aware of the treatments and the side effects. The therapist and teachers are an integral part of the child’s life and can assist with assessing if a treatment is helpful or harmful or if there is no change at all.  There needs to be an open communication between the families and the therapists. Therapists need to be aware of the side affects of medications and treatments. For example if a child underwent a shiatsu treatment the day before you are working with them and the child complains of neck soreness, then you would understand that this is a natural side effect and not be alarmed. If you were not aware that the child underwent a shiatsu treatment the day before, you might be sending the child to the nurse; you might be suspecting a virus such as meningitis or you might be wondering if the child felt and injured his/her head.

Question3- Summarize a minimum of 3 articles on CAMs for children with autism.

i. Summarize a minimum of 3 articles on CAMs for children with autism.

CAM 3 articles

Article 1
Patterns of Complementary and Alternative (CAM) Medicine Therapy Use in Children Diagnosed with Autism Spectrum Disorders by Helen H. L. Wong, and Ronald G. Smith Published in The Journal of Autism and Developmental Disorders (2006) 36:901-909

This study looked at fifty children that were diagnosed with autism and fifty children that were not diagnosed with autism (the control group). Of the fifty children that were diagnosed with autism, fifty two percent of the families reported using or had used at least one CAM therapy for their child as compared to twenty eight percent of the control group. Seventy percent of the therapies used in the ASD group were biologically based, comprised of special diets or supplements, and parents felt that seventy-five percent of the therapies used were beneficial.

Article 2
Use of Complementary and Alternative Medicine among
Children Diagnosed with Autism Spectrum Disorder by
Ellen Hanson, Leslie A. Kalish, Emily Bunce ,Christine Curtis, Samuel McDaniel, Janice Ware, Judith Petry published J Autism Dev Disord (2007) 37:628–636



This study looked at the prevalence of the use of different types of conventional, complementary and alternative therapies by children diagnosed with an autism spectrum disorder (ASD). Of 112 families surveyed, seventy four percent were using complementary and alternative medicine (CAM) for their child with ASD. Most CAM was reported by families to be either helpful or without effect, but not harmful. The main reasons for choosing CAM were related to concerns with the safety and side effects of prescribed medications.


Article 3
Complementary Medicine in Autistic Disorders: Results from the Application of a Working Hypothesis. This article was taken from autismtoday.com

In this study, they hypothesized that the cause of autism is related to the function of the gut. They were working towards restoring normal gut function, using complex homeopathic medicines and probiotics. Twenty children were diagnosed using DSM protocols in clinics in India, Pakistan, USA, UK, Egypt, UAE and Saudi Arabia.
Results from these twenty treated children showed that fifteen had Sulphite in the urine, before treatment, but after six months of treatment there was a complete absence of Sulphite in 60% and a significant fall in 13%. This was associated with positive behavioural changes including reduced hyperactivity, more referring gaze, better social interaction, faster speech acquisition, better use of computational skills, improvements in perceptive development, and improved hand eye co-ordination. Physical symptoms such as night sweats were reduced. There were fewer trips to the doctors for ENT and URTI problems. Weight and height increased reflecting improved bowel function, diarrhea and constipation resolved and continence improved.The use of complementary medicines can be helpful in the biochemical management of autistic spectrum disorders.

Question 2-Take 3 of the alternative interventions and explain each one in depth: what is the theory, what is the intervention, what is the reported outcome? Be sure to discuss “safety” considerations with each of the alternatives (ie: is there a toxicity or deficiency concern? Are there serious negative side effects possible, and if so, what are they? Etc)

Homeopathy

The third CAD (Complementary Alternative Medicine) that I have chosen to describe in depth is homeopathy.
Homeopathy, also known as homeopathic medicine, is a whole medical system that was developed in Germany more than 200 years ago and has been practiced in the United States since the early 19th century. Homeopathy is used for wellness and prevention and to treat many diseases and conditions.

The term homeopathy comes from the Greek words homeo, meaning similar, and pathos, meaning suffering or disease. Homeopathy seeks to stimulate the body's ability to heal itself by giving very small doses of highly diluted substances. German physician Samuel Christian Hahnemann developed this therapeutic method at the end of the 18th century. Hahnemann articulated two main principles:
The principle of similars (or "like cures like") states that a disease can be cured by a substance that produces similar symptoms in healthy people. This idea, which can be traced back to Hippocrates, was further developed by Hahnemann after he repeatedly ingested cinchona bark, a popular treatment for malaria, and found that he developed the symptoms of the disease. Hahnemann theorized that if a substance could cause disease symptoms in a healthy person, small amounts could cure a sick person who had similar symptoms.
The principle of dilutions (or "law of minimum dose") states that the lower the dose of the medication, the greater its effectiveness. In homeopathy, substances are diluted in a stepwise fashion and shaken vigorously between each dilution. This process, referred to as "potentization," is believed to transmit some form of information or energy from the original substance to the final diluted remedy. Most homeopathic remedies are so dilute that no molecules of the healing substance remain; however, in homeopathy, it is believed that the substance has left its imprint or "essence," which stimulates the body to heal itself (this theory is called the "memory of water").

Side Effects and Risks
Although the side effects and risks of homeopathic treatments are not well researched outside of observational studies, some general points can be made about the safety of these treatments:
A systematic review found that homeopathic remedies in high dilution, taken under the supervision of trained professionals, are generally considered safe and unlikely to cause severe adverse reactions.
Liquid homeopathic remedies may contain alcohol. The FDA allows higher levels of alcohol in these remedies than it allows in conventional drugs. However, no adverse effects from alcohol levels have been reported to the FDA.
Homeopaths expect some of their patients to experience homeopathic aggravation (a temporary worsening of existing symptoms after taking a homeopathic prescription). Researchers have not found much evidence of this reaction in clinical studies; however, research on homeopathic aggravations is scarce.
Homeopathic remedies are not known to interfere with conventional drugs; however, if you are considering using homeopathic remedies, you should discuss this with your health care provider first.

Question 2-Take 3 of the alternative interventions and explain each one in depth: what is the theory, what is the intervention, what is the reported outcome? Be sure to discuss “safety” considerations with each of the alternatives (ie: is there a toxicity or deficiency concern? Are there serious negative side effects possible, and if so, what are they? Etc)

SHIATSU

The second CAM (Complementary Alternative Medicine) that I chose to describe in greater detail to you is Shiatsu. Shiatsu is a Japanese form of bodywork. The word shiatsu means finger massage and shiatsu is sometimes described as a finger pressure massage. Like acupuncture, shiatsu is based on the holistic system of traditional Chinese medicine, where illness is thought to result from imbalances in the natural flow of energy, or qi (pronounced "chee") through the body.

Shiatsu therapists use finger and palm pressure to energetic pathways, called meridians to improve the flow of qi.

A scientific explanation is that shiatsu calms an overactive sympathetic nervous system, which improves circulation, relieves stiff muscles, and alleviates stress.
Shiatsu massage therapy and acupuncture are founded on the Chinese meridian system. Meridians are the pathways of qi (chi) and blood flow through the body. Qi flows continuously from one meridian to another. Any break in the flow is an indication of imbalance. If a person's vitality or energy is recognizably diminished it is an indication that the body's organs or tissues are functioning poorly, therefore the qi flow is inadequate. The therapist applies pressure with his/her thumbs, fingers, and palms to specific areas of the client's body that have been determined during an assessment period prior to the massage session. There are no needle pokes involved with Shiatsu. Massage techniques like tapping, squeezing, rubbing, and applied pressure are applied along the meridians to unblock energy blockages and reintroduce the optimal flow of qi.

There may be some side affects associated with Shiatu. They are mild and include:

1) Coughing and generation of mucus or symptoms of a cold: The coughing and production of mucus is due to the body being encouraged to rid itself of its surplus foods (such as sugars and fats) in this form. A cold can sometimes develop when the mucus is produced, usually when the cells of the body are not healthy.
2) A feeling of tiredness: Tiredness can occur, frequently with a person who suffers from nervous tension. After therapy has removed this stress or tension, then the body's need for sleep and rest becomes apparent.
3) A headache or other pains and aches: There are two main reasons for these, which should only last a short time. Shiatsu redresses the balance of qi in the body. Thus, blockages in the flow of energy are released and the qi can rush around the body, causing a temporary imbalance in one part and resulting in an ache or pain. It is also possible that too much time or pressure may have been applied to a particular area. The amount needed varies considerably from one person to another. If the pain or headache persists after a few days, obtain qualified medical help.
4) Feeling emotional: Emotional feelings can occur while the energy is being stimulated to flow and balance is regained. The feelings may be connected with something from the past that has been suppressed and so, when these emotions resurface, it is best for them to be expressed in a way that is beneficial, such as crying.

Question 2-Take 3 of the alternative interventions and explain each one in depth: what is the theory, what is the intervention, what is the reported outcome? Be sure to discuss “safety” considerations with each of the alternatives (ie: is there a toxicity or deficiency concern? Are there serious negative side effects possible, and if so, what are they? Etc)

Qigong -The first of three methods of alternative interventions that I have chosen to enlighten you with.

Qi (pronounced chee) means energy.
Gong (pronounced gung) means skill

Qigong is the skill of attracting vital energy. Qigong is a self-healing art that combines movement and meditation.  It includes elements of yoga as well.  It is no surprise that Qigong is viewed as effective.  Its yoga-line movement strengthens the body, and stretches and “opens” it as well.  Those who practice yoga believe that this stretching and movement forces toxins out of the organs and into the bloodstream where they may be flushed from the body.  Qigong’s deep breathing oxygenates the body, providing nourishment and vigor across the muscles, inner organs, and the mind.  Lastly, Qiqong’s mediation helps the patient to relax, and further helps the patient to focus their qi on those areas of the body that are harmed and need to be mended.  Any good doctor would tell you that a regimen that includes stretching, muscle development, breathing therapy, and mediation for calming the mind will make a person feel and be healthier.  Qigong accomplishes all of this.
The main idea in qigong practice is the control and manipulation of qi. Some elements of the qi concept can be found in popular culture “The Force” in Star Wars movies, has many qi like qualities.
The concept of qi is fundamental in Chinese Philosophy. This energy is considered to exist in all things including the air, water, food, and sunlight. In the body, qi represents the unseen vital force that sustains life. Qigong practice involves the manipulation and balance of the qi within the practitioner’s body and its interaction with the practitioner’s surroundings.
A person is considered to have been born with original amounts of qi. A person acquires qi from the food by eating, from the air by breathing and from interacting with their environment. A person becomes ill or dies when the amount or type of qi is unbalanced within the body. The practice of qigong is to regulate and control the qi within the body.
Although not proven conclusively from a Western Medical stand point, qigong is an accepted treatment option in the fields of complementary and alternative medicine. Qigong treatment is also used extensively in China as part of Traditional Chinese Medicine and has been included in the curriculum of Chinese universities. Qigong practice serves both a preventive and curative function. It is considered to be effective in improving the effects of many chronic conditions such as hypertension, diabetes, allergy, asthma, arthritis, degenerative disk disease, cancer, depression, anxiety and addiction. Qigong works by improving the practitioners’ immunity response, increasing a person’s self-healing and self-recovery capabilities and enhancing one’s self-regeneration potential.

There is little controversy in the benefit of qigong when the definition of qigong is limited to a series of physical movements and a set of relaxation exercises. Conflict arises between Western views and qigong systems when the claims of qigong practice exceed the capabilities and understanding of traditional science and at an extreme make claims that border on the supernatural.
The main arguments from the view of skeptics against the correlation between qigong practices and health-related results are:
The existence of qi, or any form of vitalism, has not been independently verified in a experimental setting to the satisfaction of the general scientific community. Such a concept is not recognized in traditional biological sciences.
Demonstrations in martial arts such as breaking hard objects with strikes can be fully-explained using physics, without reference to the concept of qi.
Reported claims of supernatural abilities appear to be tricks more suited to magic shows than to any genuine scientific discipline.
Explanations that involve the supernatural or that require a spiritual element are beyond the scope of the scientific method.
Personal benefits for some qigong masters might have provided them with an incentive to exaggerate their claims
In some cases, the practice of qigong can result in mental disorders. This is known as qigong deviation and is characterized by the perception of the practitioner that there is an uncontrolled flow of qi in the body. Other complaints include localized pains, headache, insomnia and uncontrolled spontaneous movements.
When the western medical community encountered abnormal conditions presenting in patients practicing qigong, they used the term Qi-gong psychotic reaction and classified the disorder as a culture-bound syndrome in the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association. It is described as: "A term describing an acute, time-limited episode characterized by disassociative, paranoid or other psychotic or non-psychotic symptoms that may occur after participation in the Chinese folk health-enhancing practice of qigong. Especially vulnerable are individuals who become overly involved in the practice."
The DSM-IV classification has been criticized by other Western psychiatrists on the grounds that "It is not clear how the architects of the DSM-IV can logically defend labeling a syndrome as aberrant in the context of a diagnostic system while simultaneously placing that syndrome outside of conventional Western nosologic categories that serve as basis for determining whether a syndrome is or is not aberrant and therefore a disorder." In most cases in China, the psychiatrists do not use the psychosis terminology however, preferring "qigong deviation".
Within the qigong community, Qigong Deviation is believed to be caused by:
An inexperienced or unqualified instructor,
Incorrect instructions,
Impatience,
Becoming frightened, irritated, confused or suspicious during the course of qigong practice, or
Inappropriate manipulation or channeling of qi
In cases of psychosis, the Western psychiatric view is that qigong is a precipitating stressor of a latent psychotic disorder to which the patient is predisposed, rather than erroneous qigong practice; a type of reactive psychosis or the precipitation of an underlying mental illness, such as schizophrenia, bipolar disorder, or posttraumatic stress disorder. The Chinese medical literature includes a wider variety of symptoms associated with qigong deviation; the non-psychotic symptoms correspond to conversion disorder and histrionic personality disorder in Western classifications.

On a personal note, I studied Tai Chi from 1990 to 1995. Presently, my son and I are studying Tae Kwon Do. On our journey to black belt and beyond, he is a red belt and I am a green belt. He has been studying martial arts since he was 4.5 years old (he's now 10). I have been studying martial arts on and off all my adult life. I have finally found a teacher with whom I will be able to reach my potential.