Changing the Course of Autism II
Bill Long 4/14/08
A "Wholistic" Approach to Autism
We do best to begin with the basic thesis of this book--that autism is a disease, not a disability. It isn't simply a behavioral disorder or a problem in processing information, but is a disease affecting many bodily systems. As Jepson and Johnson ("J & J") say:
"Currently the definition of autism is a collection of behavioral symptoms, and it's classified as a developmental disability or disorder. This oversimplificaiton does not account for the many differences in the neurological presentation of children within the autism spectrum, and certainly doesn't account for the symptoms in the other organ systems. Whatever the root cause, autism affets a fundamental and critical part of metabolism. Calling it a develpmental disorder is like calling a brain tumor a headache. 'Autism' is merely one symptom of an underlying disease process that affects the immunological system, the gastrointestinal system, and the toxicologial system, as well as the neurological system," 44.
They then state their thesis more succinctly:
"The most likely scenario for the develpment of this disease involves a series of negative responses to the environment in a baby who is at risk genetically," 45.
If you understand these global methodological statements, you are in for a real treat, for J & J then go on to describe the bodily systems affected by this "environment" around us. They do not spend any time at all describing this chemically-laden, richly-reeking environment in which we all live; their focus will be on the bodily systems more likely than not to be compromised by exposure to our "modern" environment. Thus, chapter 6 teaches us the basics of the immune system; chapter 9 leads us into an understanding of gastroenterology; chapter 10 focuses on toxicology issues in the body; chapter 13 describes autism and the brain. Interspersed in these chapters is significant discussion of the raging controversy regarding thimerosal, mercury content in vaccines (the MMR especially) and whether mercury overdose can "cause" autism. Then, after presenting the basics of the science of these bodily system, the authors proceed to go, one system at a time, through the various treatments that have been suggested and studied for their effectiveness with people with autism.
Causes/Triggers of Autism
But before I mention a little about the treatments, I would like to pause on their conclusions in chapter 14--on the likely etiology and characteristics of autism. They propose three possibilities:
"The first possibility is that the disease is primarily neurological, with secondary effects on other organ systems. In this hypothesis there is a disruption of normal neuronal development resulting in disordered cellular structure in several brain areas...The abnormal brain develpment creates dysregulation of neurotransmitters, neurotrophins, and neurokines-neurochemical aberrations that will have adverse effects on the developing immune system....The neurological disruption in the brain affects the GI tract (i.e., the "gut")...Gut inflammation leads to 'leaky gut' syndrome...the overburdened detoxification system results in oxidative stress and tissue damage," 177.
Though this is one possibility, they don't see this as the most likely course of the disease.
"A second possible sequence begins in the gastrointestinal tract. Subtle GI abnormalities can begin shortly after birth; the baby has difficulty processing food proteins, leading to colic, reflux, constipation, or loose stools, and the gut sustains further injury with the introduction of solid foods and cow's milk....," Ibid.
With this system compromised, others, including the brain, are affected.
"A third possible course of events stems from early and repeated damage from toxic substances in our environment. Because of a genetically weak detoxification system, babies who develop autism are more susceptible to toxins, even at low doses. The developing fetus is exposed to mercury through maternal amalgams, fish consumption, or thimerosal-containing injections.
J & J then conclude:
"All three scenarios are easily defended by the medical literature, but the third, implicating environmental toxins as the underlying cause of autism, is the most logical in light of the epidemic rise in the numbers of autistic children," 179.
Where Does This Leave Us?
With this new approach to autism, we see that the focus must be on treatment. Research, of course, is necessary in order to try to be more precise in defining which systems are compromised in which way and which treatments might be more helpful than others. But the focus should now be on developing modes of treatment that show promise of being able to improve the condition of children, as well as adults, suffering from autism spectrum disorders. In the last 60 or so pages of the book, J & J go through the major bodily systems one by one (ch. 16 deals with nutritional deficiencies; ch. 17 with treating the gut; ch. 18 with detoxification; ch. 19 with treating the immune system; and ch. 20 with treating the brain) and review studies that have been performed, gaps in the studies and possible new leads for future research.
Future essays on this site may deal with the ever-changing research scenario on autism and the various bodily systems, or various treatments for autistic individuals. Suffice it to say at this juncture that J & J have opened up new vistas for those who really are sympathetic to reconceptualizing their understanding of this most perplexing disease.
One final note. J & J, in their salutary zeal to emphasize the "disease-like character" of autism, stress that it is a "disease" and not a "disability," 44. Though this might be a helpful emphasis in medicine, it might not work in law. Because of additional protections accorded to people who are disabled in our society, chiefly through the Americans with Disabilities Act of 1990, a finding of disability actually would help an autistic person get access to work and demand reasonable accommodations for his/her condition at work. So, I will not yet throw out the word "disability" with respect to autism....