A "Best Practices" Model for Treating Autism:

Biomedical & ABA Therapies

Put into Practice Together
Improve Optimal Outcomes

Autism One 2009 Chicago

The Hopes of a Mother, the Dreams of a Father
are Real.
Our Children get Better

Chicago, IL May 20th - May 24th

Lauren W. Underwood, PhD

 What is autistic spectrum
disorder?
A developmental
disability resulting from
a neurological disorder
That affects normal
functioning of the brain . . .
Autistic Spectrum Disorder
Abnormal development of
Communication skills
Social skills
Reasoning
… affecting children in a
spectrum of ways . . .
. . . . and children affected
behave in a spectrum of
ways . .
The tough part about autism is that
there is no definitive “cure” or
treatment
No one will tell you that this is something
that will definitely work
Today’s presentation
Treatments grounded in Applied Behavior
Analysis as well as biomedical treatments
have individually helped provide effective
treatment models for autism
In recent years, evidence for successful
outcomes with biomedical treatments has
also been observed
Ultimately, in developing a “Best Practices”
Model, these interventions must work
together to provide the best
possibilities for optimal outcomes
An overview of support for the
behavioral-biomedical
treatment model will be
presented
Why behavioral AND
biomedical?
Many children with autism also suffer
from co-morbid medical conditions
Treat the underlying medical disorders
Increase reception to behavioral
interventions
Then, the synergistic effects of
behavioral and biomedical interventions
result in an increase in successful
outcomes
 Synergy of biomedical and
behavioral interventions
 Therapies or interventions are designed to
remedy specific symptoms in each individual
 The best-studied therapies include a
combination of educational/behavioral,
sensory and biomedical interventions
 They may not cure autism, but they often
result in substantial improvement
My goal as an educator . . .
1st . . . The Science . . . .
Biology
Anatomy and cell biology
Immunology
Biochemistry
Then,
the reasoning behind what can go wrong
with these systems . . . explain how
issues with these systems can affect
Behavior
Behavioral intervention
Sensory intervention
 . . . to enable you to understand some of the
biological approaches currently available for
the treatment of the medical condition
described as autism,
. . . .so if you choose you can consider applying
them responsibly
Why consider biomedical
approaches for treating of autism?
There is literature in peer review journals and
other related sources that suggests that there
are several biomedical interventions that . . .
can be helpful for the treatment of the
symptoms in many autistic spectrum disorder
children
What does biomedical approach
mean?
The application of the natural, biological
and physiological sciences to clinical
medicine
http://talkaboutcuringautism.org/medical/supplement_help.htm
http://www.pediatrics.org/cgi/content/full/120/5/1162
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/5/1221.pdf
The Science
The body is made up of specific
systems, including skeletal, circulatory,
immune, cardiovascular, nervous,
digestive
Digestive system
Anatomy and function
Food allergies/food intolerances
Leaky gut/intestinal dysbiosis
Immune system function
Basic biochemistry
Digestive System
Mouth
Stomach
Small intestine-absorption
 Duodenum
 Jejunum

 Ileum

Large intestine/Colon
Rectum
Liver
Pancreas-secretes enzymes and
hormones
Digestion-digestive tract
function
Digests food
Absorbs nutrients
Carries vitamins and nutrients
into bloodstream
Chemical detoxification
Excretion
How do you get nutrients from
foods? Protein
Foods are made up of proteins
When foods are eaten and properly
digested, proteins are broken down by
enzymes into peptides
Peptides are then further broken down
into amino acids
Amino acids are the building
blocks of life
What can go wrong with the
GI?
1. Leaky gut
2. Intestinal dysbiosis
a. Constipation
b. Diarrhea
c. Enterocolitis
3. Allergy
1. What is “leaky-gut”?
Definition: an abnormal or unfavorable
increase in intestinal permeability
 Epithelia are either 'tight' or 'leaky'
depending on the ability of the tight
junctions to prevent water and solute
movement
 The intestinal lining is supposed to
be the protective barrier between
the gut and the bloodstream
 If the intestinal lining becomes
damaged-it is possible for
incompletely digested proteins
and/or other by-products to “leak”
through the intestinal lining
 They can be recognized as foreign by
the immune system, and/or “leak”
into bloodstream
2. Dysbiosis
Intestinal flora (yeast and bacteria) are
a normal part of digestive track
Intestinal dysbiosis occurs when there is
an overgrowth/imbalance of intestinal
flora(s)
Dysbiosis results from
Increased use of antibiotics, steroids, etc.
Poor diet
Diets high in sugar
Stress
Immune system dysregulation
a. Constipation/ b. Diarrhea
Constipation-having a bowel
movement fewer than three
times per week
 Stools are usually hard, dry, small
in size, and difficult to eliminate.
 Can be painful to have a bowel
movement and
 often experience straining,
bloating, and the sensation of a full
bowel
Diarrhea-frequent loose or
liquid bowel movements
(often associated with
infection, allergy and food
c. Enterocolitis
Inflammation [itis](due to infection or
irritation) that affects part or all of the
intestines (the small [entero]and/or
large [col] intestines)
Hyperplasia-general term for an increase in
the number of the cells of an organ or tissue
causing it to increase in size
Endoscopy-looking inside, the human body
for medical reasons, by inserting a small
scope in the body
Ileonodular Normal Terminal
Hyperplasia Ileum
Consequences of intestinal dysbiosis
or “leaky gut”-if left untreated
Nutrients and vitamins aren’t absorbed
properly---vitamin deficiencies
Intestinal distress
Food allergies are created
Detoxification is compromised
Bacteria and yeast can be mobilized
Formation of antibodies you might not want---
because of immune dysregulation
3. Allergy
The most obvious place for an allergic
reaction to food to take place is in the GI
track
Reactions can range from acute to chronic
A large part of the immune system is
located in or near the intestinal tract-to
helps prevent microorganisms in the
intestine from entering into the rest of the
body
 1st line of defense against pathogens 
 Defects in the immune system can lead to
gastrointestinal problems
Food allergies vs. food sensitivies
Food allergies
An immune system response . . . to foods
Body mistakes a protein in food as
harmful, and creates a defense against it
(antibody)
Allergy symptoms appear within minutes
to an hour or so after eating the suspected
food-body is battling invading food
Symptoms include eczema, an itchy red rash
most common in the elbow creases or behind
the knees hives, nausea, swelling, difficulty
breathing and/or anaphylactic shock
Food sensitivities/food
intolerances

Digestive system response to foods

Not an immune system response
Something in food irritates digestive
system or person is unable to
breakdown/digest food
Can include metabolic food disorders
such as lactose intolerance (missing
enzyme)
Symptoms include crapping, gas,
nausea, and stomach pain
Overview of the immune
system

White blood cells

associated with
acquired immune
system are called
lymphocytes
T Cells
B Cells
Normally, there is a balance
between infection and immunity

infection immunity
Immune system function
The immune response is how your body
recognizes and defends itself against
bacteria, viruses, and substances that
appear foreign and harmful to the body
Normal immune system function, depends
upon proper immune system responses
3.Protects and defends against foreign cells
4.Memory-gets smarter
5.Responds appropriately
6.Do no harm
Things can go wrong with the
immune system . . .
Hypersensitivity
Autoimmunity
Inflammation
Immune system dysregulation
Immune system
dysregulation
Immune system dysregulation causes
an abnormal immune response
there is a “ shift or skewing” – lack of
balance
The immune system looses the ability to
respond appropriately. . . and when this
happens, it is possible that the body
develops abnormal responses to things
it might not normally react to . . .
like foods
What happens if the immune
system is compromised
Immune dysregulation
Abnormal balance and communication
between immune cells
Chronic Inflammation
An abnormal, persistent activation of
immune cells in the tissues
Autoimmune reactions
Antibodies targeting and causing injury to
normal body tissues
The immune system is closely connected to
virtually every other system of the body
Disorders in the immune system can cause
disease
The liver & detoxification
Designed to remove toxic matter from the
bloodstream
Produces bile
Metabolizes proteins and fats
What happens if liver function is
compromised?
If detoxification systems are overloaded,
destruction of nutrients necessary for
proper detoxification occurs
If detoxification pathways are overloaded,
build up of toxins can occur
If transsulfuration is disrupted,
there is less antioxidant production,
and oxidative stress can occur
The Vicious Circle •heavy metal exposure
Of Chronic Toxic •environmental toxins
Liver •foreign proteins-
Overload Overload incompletely broken-
down
food
Candida Intestinal
Detoxification
permeability
Problems
Dysbiosis

Oxidative May treat with

Stress Rx/drugs
•antibiotics
Health •antifungals
Free Radical •steroids
Problems
Production
•gastrointestinal distress
•allergy
•autoimmune problems
•infections
Detoxification biochemistry
Methylation and sulfation
A healthy body’s way to rid itself of toxic
substances
Methylation-transferring a methyl group
Transsulfation-responsible for production of
glutathione-the body’s number one
antioxidant

Children with autistic spectrum disorders

often need supplements to provide them
with the raw materials their bodies need to
efficiently carry out methylation and
sulfation
49 Lauren W. Underwood, PhD
 Transsulfuration
Methionine/Glutathione pathway

Transsulfuration Pathway
Methionine
Remethylation
pathway SAM
THFolate TMG

Methionine DMG
Synthase SAH
Methylene
THFolate Homocysteine
Methyl
B12
Methyl B6
THF B12
MTHFR
Cysteine

Glutathione (GSH)
Critical to the body’s ability
to remove toxins!
Methionine/glutathione
transsulfuration pathway in
autistic children
How do you treats
biomedically?
Look for a physician or other healthcare
practitioner who considers an integrative
approach to treatment
combining mainstream medical therapies
and CAM (Complementary and Alternative
Medicine) therapies
No single treatment works for every child. 
What works for one child may not work for
another, and a successful course of
treatment often includes a combination of
approaches
Expected key benefits of
biomedical treatment for autism
Improvements in immune function,
resulting in healthier children who seem
to be very resistant to coughs, colds,
runny noses, ear infections and who
seem to get over  viral infections quicker
than the rest of the family.
Improvements in digestive function,
resulting in more normal stool frequency
and consistency; reduction or
elimination of lower abdominal pain or
discomfort; reduction or elimination of
Children seem to
loose stools or diarrhea.
thrive
Expected key benefits of
biomedical treatment for autism
Improved appetite and a wider variety
of foods tried and consumed, increased
nutrition
THEN . . .
Better socialization and initiation of
communication with family and peers;
Increase in more normal social
interactions and social play
Improved vocabulary and sentence
structure;
Improved cognitive function
Improved higher order functions
Some basic biomedical
interventions
Diet
Healthier diet
Specialized diet
Gluten-Free Casein-Free Diet (GFCF)
Rotation Diets, others
Nutritional Supplementation
Detoxification
Some
complementary/alternative
biomedical interventions
HBOT
Chelation
Healthier Diet
Read labels . . . .
Are special diets so “special”
and which one do I choose?
Many autistic children suffer from
inflammatory response/immune system
dysregulation
Many autistic children don’t/can’t digest
their foods efficiently
diet options: GF/CF, SCD, BED, LOD,
Pick one that works best for you and your
family
regardless of diet choice, it is important
to ensure proper nutrition
Diet: Gluten-free Casein-free
Diet
A restrictive diet that removes all food
items that contain both
gluten and casein
The are two main theories currently
present in scientific literature that
explain why some people with autism
and PDD respond positively to a GFCF
diet
 improperly broken down dietary
peptides
 immune system dysregulation
Improperly broken down dietary
peptides
 Some people with ASD cannot properly digest
gluten and casein, which break down into
substances that act like opiates in their bodies
 According to this theory, these "drug-like"
substance alters the person's behavior,
perceptions, and responses to his environment
Casein/casomorphin and
gluten/gliadorphin
 Casein is a protein found in milk and products
containing milk
 Casomorphin (or caseomorhin) is a peptide
derived from the milk protein casein

 Gluten and gluten-like proteins are found in

wheat and other grains
 Gliadorphin (or gluteomorphin) is a peptide
derived from the wheat protein gluten
Immune system
dysregulation
Immune system loses it’s ability to
respond properly
Body develops abnormal responses to
things it might not normally react to
An abnormal immune response can
result in
Autoimmunity
Inflammation
Hypersensitivity
Allergy
 Other dieting options
SCD diet
Rotation diet
Soy and corn-free diet
White diet
Sarah’s diet
“But bread and
cheese are all
my child eats!”
If I take away
those foods, . . .
they’ll starve!”
Consider this . . . .

Although at the beginning the diet may

seem difficult, it maybe infinitely easier
to try the diet, and end up having a
happier healthier higher functioning
autistic child, than living with a
bad/poorly functioning one!!!
Nutritional supplementation
Why nutritional
supplementation?
1. Nutritional deficiency
involves a lack of one or more nutrients
obtained from food essential for normal cell
and body function
occur due to
 Mal-absorption/poor absorption in the small intestine
 Unhealthy eating, or
 Self-imposed/imposed dietary restrictions
 Poor utilization of nutrients because of genetic or
environmental factors
2. Oxidative Stress
There are nutritional deficiencies
associated with disease
Rickets-vitamin D
deficiency
Scurvy-vitamin C
deficiency
Beriberi-thiamine
deficiency
Pellagra-niacin
deficiency
Goiter-iodine deficiency
Signs and symptoms
associated with nutritional
deficiency
Neurological symptoms
Memory loss
Psychosis
How can a
Bruising
child attend,
Confusion
focus, and learn?
Impaired learning
Growth retardation
Loss of appetite
Poor immune function
Commonly deficient nutrients
Vitamin B12
Vitamin B6
Folate or folic acid
Vitamin A
Vitamin C
Vitamin D
Zinc
Magnesium
Omega 3 fatty acids
Nutritional Supplementation
Supplementation
Enzymes
Methyl b12
Antioxidants
TMG/DMG
Essential fatty
acids
Glutathione
Folic acid
Melatonin
Nutritional supplementation
to combat oxidative stress
Vitamin E Calcium
Vitamin C Selenium
Zinc
Vitamin B6 or
its activated form,
pyridoxal-5-phosphate (P5P)
with Magnesium
Why detoxification?
 To prevent injury to the cells
and ultimately cell death
 Cell injury and cell death is
bad
 In autism, toxins may be a
cause of the neurological and
immune dysfunction
 Detoxification may help the
cells to recover which will
enable for healing
 If toxins accumulate too
rapidly, without being
safely eliminated, they
can cause damaging
effects upon cells and
How does your body
detoxify?
Designed to remove/eliminate toxic
substances from the body
Primary function of liver and kidney
Glutathione
Once toxins are bound they are
eliminated via bile and urine
Can also be achieved via artificial
(chelation) or supplementary (sauna)
means or through hyperbaric oxygen
therapy (HBOT) . . .
Complementary
interventions:
 HBOT
Effective way to get more oxygen into the body at
the cellular level by using pressurized air
chambers
healing the gut and brain inflammation (two that
may be separate issues or experienced
simultaneously)
blood flow to key areas of the brain
dealing with gut parasites, yeast or bacteria
or if it helps all four areas

 Chelation
Chemical process in which a substance is used to bind
molecules, such as heavy metals metals (arsenic, lead,
mercury) and hold them tightly so that they can be
removed from the body
How do you implement a
detoxification program?
Should be done under the direction of an
experience physician or other
practitioner
Support the body’s own detoxification
system—nutrients,
Methyl B12
Glutathione
DMG/TMG
Folic acid
Remove accessible toxins—chelation
Monitor closely
Maximize metabolism;
normalize biochemical
pathways
Understanding the
“overlay”
of biomedical and
behavioral interventions . .
.
Why consider behavioral therapy
programs?
An autism diagnosis is based upon
behaviors---NOT medically based
Generally a psychiatric/psychological
diagnosis is made at 18-24 months
Most neurological development occurs
during this time
Experienced 18 months of abnormal
deviant developmental behaviors . . .
HUGE developmental gap
You can not go back in time to go
through this developmental period
18 month old
Warning signs that might reflect
biomedical issues
Any shift in behavior
Looks for patterns of behavior change
Look for signs and sources, red flags:
Changes in sleep
Increased irritability
Rashes
Red ears
All discipline strategies can be affected
by biomedical issues/conditions
Why is there an overlap between
behavioral and biomedical
interventions . . .
Remember co-morbid biomedical
conditions which can setback or slow
down therapies
No single treatment works for every
child--What works for one child may not
work for another, and
A successful course of treatment often
includes a combination of approaches
Be aware of any change in meds or
supplements–this can affect behavior-
Why do behavioral and
biomedical interventions go
hand in hand?
If a child suffers from allergies
Focus and concentration can be affected
If a child suffers from GI distress, like
constipation, diarrhea
Cramping, bloating will distract them
Pain may lead to self-injurious behavior
If their are immune system issues
Increased infections, inflammation can affect
attention and concentration
If biochemical pathways compromised
Neurotransmission can be under or over
stimulated
Why do behavioral and
biomedical interventions go
hand in hand?
If a child suffers from digestive issues
Improperly broken-down foods can have an
affect upon behavior
Not receiving essential nutrients for
biochemical pathways and maximum
metabolism
If a child has detoxification problems
Build-up of toxins, increased oxidative stress,
symptoms—affect attention
Treat underlying medical
conditions
Look for signs:
Posturing
Bloated belly
Eczema
Allergy
Sound sensitivity
Look for symptoms associated
with abdominal pain…
 Crying
 Unexplained tantrums
 Night time wakening
 General irritability
 Vocalizing complaints
 Posturing
 Irritability just prior to bowel movement
 Hyperactivity and distractibility
 Self injurious behavior
Treat underlying medical
conditions
Look for signs:
Sleep issues
Toileting issues
Tantruming
Irritability
Hyperactivity
Self-injurious behavior
A happier, healthier child
is going to be more
responsive to behavioral,
social and sensory
interventions
 Paradigm switch

autism is not a psychological condition –

it is a neuro-gastro-immunological disorder
resulting from an genetic susceptibility and
an environmental insult
“The abnormal metabolic profile in
children with autism is consistent with
the abnormal genetic profile and
strengthens the hypothesis that may
predispose these children genetic
susceptibility to oxidative stress
and reduced methylation capacity
to neurological, immunological, and
gastrointestinal dysfunction that
occurs with autism”—Dr. Jill James
Maybe there is a genetic
susceptibility . . .
and environmental factors can affect trigger
effects
A new paradigm in autism
Autism is an environmental illness with
a genetic component.
It is a complex metabolic disease, not
just a developmental disability.
Autism is treatable, but . . .
We must continue fighting for a
cure!
 Understanding Autism for
Dummies
 Provides the simple breakdown of
behavioral, medical and other
intervention
 Offers practical advice on how to
educate children, as well as
insights on helping people with
autism maximize their potential

S. Shore, L. Rastelli,
T. Grandin
Take home lessons
1. There are many behavioral therapy
options-pick one that works best for
you and your family
2. There are biomedical options for
treatment
3. Basic immunology and biochemistry
can explain how things can go wrong
in the body, and
 that many autistic children suffer from real
clinic symptoms that are treatable, and
 nutritional supplementation may be necessary
to replace necessary building blocks for proper
cell function and system functions
Take Home Lessons
1. If detoxification is not functioning
properly, it may be necessary to
supplement with co-factors to bypass
deficiencies. These include methyl
B12, folic acid, B6, DMG and/or TMG
2. Most importantly, understand that
biochemical and behavioral
interventions need to be implemented
together to enable more successful
treatment results and outcomes
And this is how you feel now .
..
Don’t try to do everything all at
once!!!!
Baby Girl: 12 weeks
Baby girl: 9 months
Baby girl: 12 months
Baby girl: 13 months
Baby girl: 15 months
Baby girl: 20 months
Baby girl: 24 months
Baby girl: 30 months
After interventions:
4 year old girl
Same child: Age 10 and 12
Baby boy: 12 weeks old
Baby boy:13 months old
Baby boy: 22 months old
Baby boy: 24 months old
Boy after interventions

3 years old 5 years old

More and more autistic children
are getting better every day,
and although there is no guarantee .
..

there are more reasons to be

hopeful that your child could be
part of the extraordinary journey
towards recovery
Remember, . . .
Be patient
Be inspired
Have strength
Never give up hope, and
Never give up courage
Love your child!