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.