Over the past 30 years, Autism Spectrum Disorder (ASD) has gone from a rare and obscure medical curiosity to a common developmental disorder affecting millions of American children. Conventional medical and psychiatric treatments are limited to therapy and a handful of minimally effective drugs. But decades of research and clinical practice from a small group of dedicated practitioners has shown that autism is, in fact, treatable.
ASD affects 1 in 59 children and now comprises 1 percent of the whole population of the United States. Lifetime cost over the entire lifespan of each autistic individual is estimated at nearly $2 million per person. Thirty-five percent of young adults with ASD are unable to work and are dependent on family or public services for survival. Prevalence is projected to increase 15-25 percent in the coming decade, making all these figures even worse. The average American gives this problem very little attention until it enters their lives through an affected family member. At this rate, a larger and larger proportion of Americans will be thinking about it soon.
ASD is a behavioral and neurodevelopmental disorder characterized clinically by delays and qualitative differences in communication and social interactions as well as repetitive behaviors and restricted interests. Currently, it is characterized by the vast majority of healthcare practitioners as a subjective psychiatric diagnosis based on behaviors exhibited in the child rather than an objective medical diagnosis based on measurable core clinical imbalances resulting in their abnormal behaviors. This subtle but powerful difference in diagnosing patients with autism has resulted in profound effects on medical trials. Many of these trials have been plagued with inconsistent results because patients are being selected based on the subjective behaviors they exhibit rather than the objective clinical imbalances they possess that cause or contribute to the behaviors. This effectively reduces the power of the study and dilutes the therapeutic potential of the therapeutic agent being studied.
There is no single cause of autism. Instead, the causes are as varied and diverse as the individuals who are affected. This is the primary reason why the pharmaceutical industry has failed to produce any effective treatments beyond simple symptom control (such as antipsychotics for agitation or stimulants for inattention).
I want to be clear on which ASD individuals I am not referring to. There is a growing number of very high functioning ASD adolescents and adults who can be seen writing long, eloquent social media posts outlining their support for neurodiversity and see no need to change anything in themselves. I commend these individuals for their bravery and the level of function they have achieved.
I am referring to ASD children who are unable to engage in a simple conversation with loved ones and cannot communicate their needs. These children may spend the majority of their day engaged in repetitive, self-stimulatory activities and are frequently unable to go on a simple shopping trip or even sit in a restaurant with their parents without one severe melt-down after another. These are the children who have a very low level of function and without intervention will likely be dependent on others for their survival well into adulthood.
Conventional medicine practitioners have very little to offer these children because they have been trained that there is no treatment or cure for autism and the child’s symptoms and behaviors are a result of their autism. In the current diagnostic paradigm, the diagnosis of autism in the child is made subjectively, based on the symptoms and behaviors they exhibit. This reasoning dictates that the symptoms define the disease (behaviors, therefore, autism) and the disease causes the symptoms (autism, therefore, behaviors). This is a logical fallacy called circular cause and consequence. With this illogical thinking, it is no wonder conventional medicine has little to offer these children beyond an applied behavior analysis (ABA) therapy referral and possibly a symptom-suppressing medication. Autism is not an entity that infects your child and then causes disease, it is just a convenient name to place individuals exhibiting similar behaviors stemming from a multitude of different physiological insults and imbalances. Language may guide thought, but names do not cause disease.
The Role of Genetics
Over the past decade, conventional medicine has directed much of its research efforts and funding toward identifying the genes responsible for autism. Billions of dollars have been spent with no substantial changes in the proportion of patients identified with a clear-cut genetic cause. This misdirection of research resources has resulted in a grave disservice to children with autism. Future generations of children with autism may possibly benefit from this research but the current generation is being marginalized by resource allocation decisions of our current conventional medical model. Effective treatments are available for these children today and with the availability of adequate research dollars, these treatments could be refined and improved at a much quicker pace than is currently happening
The Functional Medicine Treatment Approach
We start with two key questions:
- Is the body and brain getting what it needs to function optimally (i.e. vitamins, minerals, omega-3 fatty acids, healthy clean food, etc.)? Get the good stuff in.
- Is something present in the body and brain that is interfering with its ability to function optimally (i.e. toxins, occult infection, disrupted microbiome, free radicals, cytokines, histamine, etc.)? Get the bad stuff out.
In the context of these two questions, causes and contributing factors leading to clinical imbalances are identified and corrected.
We do not accept the conventional thinking that autism is an entity onto itself causing disease in the individual. Instead, autism is viewed only as a label for a group of individuals who share similar abnormalities in development and behaviors. By providing the body and brain with what they need and eliminating that which may be interfering, the potential exists to significantly improve brain function and improve the quality of life for these individuals.
Current Treatment for ASD
The backbone of current treatment for ASD is Applied Behavior Analysis or ABA. This is a form of therapy built upon the principles of operant conditioning and the evidence supports that this therapy is effective for children with ASD. Occupational and speech therapies can also be helpful. All these modalities should be continued as the child and their families work with an experienced practitioner to determine the causes and contributing factors driving the autism.
Autism Spectrum Disorder Causes and Contributing Factors
A large and rapidly growing body of research points toward ASD as an inflammatory disease associated with immune dysfunction activated by environmental triggers. The various permutations of these three components then become the causes and/or contributing factors that we connect to the patient’s existing psychiatric diagnosis of ASD. There are a myriad of core clinical imbalances that may directly or indirectly affect the brain function of children with autism.
Oxidative stress and chronic inflammation: Both are present in the vast majority of children on the spectrum. Addressing these two key issues is critical to treatment success.
Gastrointestinal dysbiosis with increased intestinal permeability: A pathological alteration in the gut microbiome with “leaky gut,” both of which can underlie a subsequent immune dysfunction or autoimmunity.
Mitochondrial dysfunction: This refers to the impaired function of the portion of the cell responsible for providing all the energy needs of the individual. It has been theorized that in this state mitochondria become generators of inflammation rather than energy.
Unmet nutrient needs: These are rarely a cause but commonly a contributor. These result from nutritional deficiencies, gastrointestinal malabsorption, or variations and mutations in the enzymes involved in nutrient utilization.
Food sensitivities and intolerances: This is particularly true of gluten and casein. They can produce immune dysfunction and inflammation or opiate-like byproducts in susceptible patients.
Impaired detoxification: This is typically a consequence of other imbalances and occasionally an isolated cause of disease.
Autoimmunity or immune dysfunction: This is frequently caused by persisting gut issues and a contributing factor to decreased energy production and chronic inflammation. Caution should be exercised when altering immune function.
Impaired production of hormones and neurotransmitters: This is evident in decreased levels of oxytocin (the “love hormone”), increase levels of cortisol (the “stress hormone”), as well as erratic levels of adrenaline, dopamine, and serotonin driving much of the self-stimulatory behaviors and sleep disturbances commonly present.
One or more of these factors are present in almost all individuals with autism and it is the intricate interplay of these imbalances which ultimately create the complex clinical presentation of ASD. Dozens of other, less common, imbalances have also been identified as contributors to the complex condition of ASD.
Autism is now treatable but we have to displace the out-dated psychiatric baggage it brings with it from the 20th century. The optimal approach to treating ASD in the 21st century continues to be early intervention with psychological and educational services (ABA, special education, speech, and occupational therapies) working from the “outside-in” as well as an in-depth functional medicine investigation into the causes and contributing factors working from the “inside-out”.
Armen Nikogosian, MD, practices functional and integrative medicine at Southwest Functional Medicine in Henderson, Nev. He is board-certified in internal medicine and a member of the Institute for Functional Medicine and the Medical Academy of Pediatric Special Needs. His practice focuses on the treatment of complex medical conditions with a special emphasis on autism spectrum disorder in children as well as chronic gut issues and autoimmune conditions in adults.