Wall Street Journal article/ autism link to metabolic diseases

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Thought this article might be interesting to some of you......

Treating the Body vs. the Mind

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By RACHEL ZIMMERMAN

Staff Reporter of THE WALL STREET

JOURNAL

February 15, 2005

Many parents of autistic kids have long argued that something other than the

disorder itself was causing some of their children's problems. Now, mainstream

medicine is beginning to acknowledge that.

The idea, embraced by a growing number of top specialists, is to treat medical

conditions that are common in autistic children. These problems -- which

include gastrointestinal disturbances, sleep disorders and food allergies --

may be contributing to the children's behavioral difficulties. While such

conditions are frequently treatable, they often go undetected due to lack of

physician awareness and the children's poor language skills.

Major hospitals, from Massachusetts General to the Cleveland Clinic, have begun

aggressively treating underlying medical problems in autistic children, and

researching how these problems may be linked to the disorder's symptoms. The

movement got a big push this month when six hospitals joined together to form

the Autism Treatment Network, aimed at coordinating an approach to a wide range

of potential physical problems.

When 10-year-old Becky Sullivan began biting holes in her wrists and hitting

her own face so hard that it bruised, two psychiatrists and a neurologist told

her mother the outbursts were behavioral problems caused by her autism. One

suggested an antipsychotic medication, but that didn't stop the aggressive

behavior.

Her mother then took Becky to Massachusetts General

Hospital in Boston, where a pediatric gastroenterologist

found that Becky's esophagus was severely inflamed and covered with ulcers. Her

violent behavior likely resulted from frustration with her inability to communicate

the excruciating pain, the doctor concluded. Acid-reflux medicines halted the

problem almost immediately. " She's a whole different kid, " says

Becky's mother, Jacquelyn Sullivan of Quincy,

Mass.

Autism is a broad term used to describe a spectrum of developmentaldisorders

marked by language difficulties and emotional

withdrawal. Currently, there is little agreement about what causes it, or why

its incidence appears to have increased tenfold over the past decade. Desperate

parents have often stumbled through a morass of

conflicting medical and behavioral advice, from intravenous supplements to

swimming with dolphins.

Guidelines for an Exam

The Autism Treatment Network, which recently began meeting, plans to draw up

national guidelines for a thorough physical examination aimed at catching

medical problems that appear to disproportionately affect autistic children.

The hospitals plan to gather data on patients and publish findings on the

prevalence of different medical disorders in autistic children. Centers

participating in the network include Baylor College of Medicine, Houston;

Cleveland Clinic Foundation, Cleveland; Columbia University Medical Center, New

York; Massachusetts General Hospital, Boston; Oregon Health & Science

University, Portland, Ore.; and the University of Washington Medical Center in

Seattle.

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" What we are trying to standardize is the concept that children with

autism can and do have health-care issues just like typical kids and they

deserve the same degree of attention, evaluation and treatment, " says

Margaret Bauman, a pediatric neurologist at Massachusetts General Hospital and

a member of the committee that will oversee the new consortium.

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One of the first priorities of researchers will be to settle --through clinical

study -- the hotly debated question of whether certain medical conditions, such

as acid reflux, diarrhea and other gastrointestinal maladies, are more common

in autistic children than in other kids.

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For example, sleep deprivation, which can cause irritability and social

difficulties in healthy people of all ages, appears at least at first blush to

be more common in autistic children. One small study found that more than 66%

of autistic children suffer from insomnia or other sleep disturbances, compared

with only 30% of typical children, says , co-director of the

pediatric sleep clinic at Oregon

Health & Science University.

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The autism network will soon begin collecting data on children and adolescents'

sleep patterns. Researchers may also look for potential causes of the sleep

problems, such as defects in the production of melatonin, a brain hormone that

induces sleep, which preliminary work suggests may be produced at lower levels

in autistic children. Some parents already treat their autistic children with

over-the-counter supplements, but there's little proof they work.

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Another area getting increased attention is food allergies. Scientists at

Massachusetts General and across the country have begun looking for the reason

that many autistic people appear unable to tolerate certain foods, such as

wheat and dairy. Early research suggests the children have very " permeable

guts, " a term that means the intestines allow certain substances to cross

into the bloodstream that would normally be blocked, says Buie, the

gastroenterologist who treated Becky Sullivan.

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One theory of how this relates to autism is that the small proteins of wheat

and milk could bind to cell receptors in the brain and alter a child's mental

state.

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Fade, a Medina, Wash., venture capitalist and parent of an autistic

child who helped organize and raise funds for the new consortium, says he

eliminated wheat and dairy from son Mitch's diet four years ago. The

then-6-year-old's temper tantrums and anxiety decreased dramatically, and the

unpleasant rashes on his body went away, his father says. The dietary change

didn't cure his autism, diagnosed at age 2, notes Mr. Fade, but " there's a

night-and-day difference in what he can do. "

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Another area the network will research is

so-called metabolic disorders, where the body can't properly break down

important biochemicals. One related problem that appears to affect a small

percentage of autistic children is a malfunction in the

mitochondria, small intra-cellular bodies that produce the energy needed to

fuel the body, says Marvin Natowicz, a medical geneticist in the neurology

department at the Cleveland

Clinic. A mitochondrial malfunction could be responsible for the extreme

exhaustion found in some autistic children, Dr. Natowicz says. It could also be

somehow causing other symptoms as disparate as seizures, significant diarrhea

and even constipation.

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Supplements and Vitamins

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Some physicians have tried giving high doses of certain vitamins such as B2, B1

and C, which are believed to aid aspects of mitochondrial function. Another

approach is to give supplements such as antioxidants or carnitine, an

amino-acid derivative, which scientists believe can neutralize the buildup of

certain compounds if the mitochondria aren't working properly. The consortium

plans to gather data on children with a series of tests to screen for

chromosomal and metabolic disorders.

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Until more is known, many doctors say parents with autistic children who are acting

out should press their pediatricians to keep looking for possible medical

causes -- and seek multiple opinions from specialists if necessary. " If

the kid is being aggressive, self injurious, or otherwise exhibiting odd

behavior or symptoms, parents should be unwilling to accept that as 'autism'

behavior until proven otherwise, " Dr. Buie says.

Suzanne man, AZ UMDF Chapter President