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Autism Spectrum Disorder and Modality of Treatments

Autism Spectrum Disorder and Modality of Treatments

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Autism Spectrum Disorder and Modality of Treatments

For the past few decades, the healthcare sector and the public has given increasing amount of attention to Autism Spectrum Disorder (ASD). ASD is a lifelong neurodevelopmental disorder that affects individuals differently. According to the Centres for Disease Control and Prevention (CDC) (2016), the prevalence rate of ASD has increased significantly since 2000 (1 in 150) to 1 in 68 in over a 12-year period. ASD is reported to be more prevalent among boys than in girls, with a 4.5 times more commonly seen in boys than girls. While much research and studies have been done in ASD, there is still no known cause to this disorder. Yet, it is suggested that genetic predisposition and environment may play a role in the development of ASD.

Through twin studies and sibling studies, it is suggested that certain genes in a child inherited from their parents may make them more vulnerable to developing ASD. The gene has not yet been identified, but it is suggested that it shares similarity in some form of rare genes such as those seen in Fragile X Syndrome, Williams Syndrome, and Angelman Syndrome (NHS, 2016). As a result, individuals with such predisposed genes are more likely to developed ASD when exposed to specific environments, such as prematurely born, alcohol toxicity in the womb, and medication (NHS, 2016).

ASD is a spectrum disorder that would affect an individual in different ways and in different level of severity. Reported by several literatures, the areas that are commonly affected are such as intellectual functioning, communication and comprehension, adaptive functioning, imitation, attention, social interaction and engagement (Eapen, Crncec, & Walter, 2016).

Modality of Treatments

There are several different modality of treatments available for ASD through medicinal, behavioural, and educational practice. More recently, it has been conceptualized that the environment has an impact on ASD, thus suggesting Complementary and Alternative Medicine (CAM) treatments for individuals with ASD. Studies have showed a high rate (28%-95%) of families with children with ASD adopting CAM as a treatment modality for the ASD symptoms such as attention, hyperactivity, irritability, moodiness, gastrointestinal symptoms, seizures, sleep, and tactile sensitivity. It has been reported that the use of CAM has been employed for a more comprehensive treatment in addition to the conventional treatments, and also to overcome the negative side effects of conventional treatments (Levy & Hyman, 2015).

The article will briefly introduce some of the conventional treatments, as well as commonly used CAM treatments for individuals with ASD.

Conventional Treatments

Behavioural Interventions

Behavioural intervention not only teaches a child new rules and learning new skills, but also modify unwanted or inappropriate behaviours by using established behavioural principles such as reinforcement, shaping, prompting, fading, and generalization. The Applied Behaviour Analysis (ABA) is one of the most evident technique used during behavioural intervention. It is recommended that ABA and other behavioural interventions to be included in the treatment of children with ASD. Behavioural intervention programs should also include parental involvement so that the trained behaviours may be implemented even at home on a daily basis. While behavioural interventions are promising, they can be costly and time consuming on the family members. Parents and guardians would need a strong and positive commitment throughout the program for positive outcomes (Coben, Linden, & Myers, 2010).

Pharmacological Treatments

Pharmacological treatments have been widely used among individuals with ASD. The use of medication such as anti-psychotics (risperidone and aripiprazole) has its pros and cons. While such medications treat specific symptoms such as irritability and aggressiveness, they may lead to inconclusive results and have adverse effects, such as rebound aggressive behaviour and weight gain (Brondino, Fusar-Poli, Rocchetti, Provenzani, Barale, & Politi, 2015). In addition, multiple medications are usually needed to treat the core symptoms. While positive outcomes are seen, it has also been reported that not all individuals respond well to such medications. It is not to dispute the effect of pharmacological medication as reports had indicated their beneficial at managing some behavioural disturbances (Coben et al., 2010), it is important to take note of whether the benefits do outweigh the side effects.

Complementary and Alternative Medicine Treatments (CAM)

Diet Treatments

Research on nutrients and dietary suggested that individuals with ASD may not have proper functioning of the metabolism, especially in casein (dairy) and gluten (wheat and grains). The result of such poor metabolism may give an opioid effect on the brain when dairy and gluten products are being consumed. Other possible metabolic anomalies are such as a poor digestive system to fully metabolize casein and gluten into amino acids; and leaky gut syndrome including bloating, gas, cramps, food sensitivities, aches and pains (Reichelt, 2001). Studies have shown that following a gluten-free, casein-free (GFCF) diet, children with ASD experienced an 81% improvement in various areas such as cognitive functioning, language, and social skills. While little side effects have been reported, some researchers have criticized that GFCF diet may induce nutritional imbalances. The limited food intake may increase the risk of overweight or obesity, and parents are often burden with the type of food to restrict (Coben et al., 2010).

Vitamins Supplements and Enzymes

Various studies have demonstrated that individuals with ASD often have problematic metabolism and insufficient nutrients. Thus, vitamins and mineral supplements are widely used among individuals with ASD. Vitamins and minerals play a role as anti-oxidant, and individuals with ASD has been reported to have excessive oxidative stress, deficient methylation, and decrease glutathione in the system, suggesting that individuals with ASD have an insufficient level of vitamins and/or minerals. Studies have thus found that the consumption of vitamins such as vitamin-C, vitamin B6, and folinic acid helps to improve oxidative stress and also improve behaviour (Adams, 2015). While such nutrients may be increased through supplements, modern food fortification may cause overconsumption of certain nutrients in individuals. While vitamins and supplements intake may be beneficial, such nutrients should be consumed with caution as to not exceed the Tolerable Upper Limit for safe intake (Leahy & O’Malley, 2015). Thus, it is advisable that an individual assessment (such as Hair Tissue Mineral Analysis, HTMA) be carried out to clarify the potential deficient or excess of nutrients before consumptions of vitamins and supplements.

Hair Tissue Mineral Analysis (HTMA)

The most commonly used tissue for the examination is hair. As hair is formed, prior to extrusion from the scalp, the hair is exposed to blood, lymph, and intracellular fluids. Thus, the hair contains elements of the internal environments, not only the minerals in the body but also other substances, such as the nutritional status and toxic metal exposure. Using human hair as an effective tissue for monitoring the heavy metal toxicity has been accepted by the U.S. Environmental Protection Agency. The analysis of the hair does not determine the absolute deficiency of minerals or nutrients, but rather reveals the relative imbalances of nutrients. In addition, TMA also helps explore individual’s health status. For example, if an individual’s presenting symptoms cannot be determined through other tests, TMA may be able to direct clinician towards a specific area where certain abnormal levels of chemical is involved. Thus, Hair TMA (HTMA) is useful when interpreted properly as it provides information about individual’s metabolic and nutritional status. This allows individuals to make changes to diet, nutritional supplement, stress, and toxic metal exposure (Watts, 1995).

Chelation

One explanation to the cause of ASD is the environmental factor where researchers explained that individuals with ASD have an excessive amount of lead, mercury, and other toxic metals in their body (Adams, Baral, Geis, Mitchell, Ingram, Hensley, Zappia, Newmark, Gehn, Rubin, Mitchell, Bradstreet, & El-Dahr, 2009). It has been compared that symptoms of children with ASD and symptoms of children with poisoned mercury look alike, such as having psychiatric disturbances, speech, language, hearing difficulties, sensory impairment, and cognitive difficulties (Coben et al., 2010). Moreover, few studies have found that children with ASD have higher level of mercury in their body as compared to typical children. Also mentioned earlier that individuals with ASD tend to have higher level of oxidative stress and thiol metabolic disturbances, and since heavy metal exposure generates oxidative stress and thiol depletion, researchers have proposed the relative correlation of heavy metal and severity of ASD (Adams et al., 2009). In view of such findings, chelation treatment which involves prescribing various chemical substances to bind and to withdraw specific heavy metals from the body, is sometimes applied to individuals with ASD. Nevertheless, side effects such as fever, nausea, diarrhoea, loss of appetite, hypertension, haemorrhoid symptoms, hypotension, and cardiac arrhythmias may occur. While chelation aims to eliminate specific metals from the body and some results showed positive improvements, there is a lack of empirical evidence to support the use of chelation would ameliorate ASD symptoms (Davis, O’reilly, Kang, Lang, Rispoli, Sigafoos, Lancioni, Copeland, Attai, & Mulloy, 2013).

Neurofeedback

Studies have shown that individuals with ASD have low interhemispheric connectivity of the brain, showing either over-connectivity, under-connectivity, or dis-connectivity of the brain. In either ways, such connectivity may have contributed to the dysfunctions in individuals with ASD (Hahamy, Behrmann, & Malach, 2015). Among the many alternative treatment approaches discussed above, neurofeedback has gained attention increasingly in the past decade as a treatment for individuals with ASD (Holtmann, Steiner, Hohmann, Poustka, Banaschewski, & Bolte, 2011). Neurofeedback is designed to improve abnormal brainwaves through sophisticated computer technology. Neurofeedback or EEG Biofeedback is a form of biofeedback, that measures brainwave activities and present the signals at a conscious level. During the training via neurofeedback, individual learns to control and improve their brainwave patterns based on the operant conditioning theory. For instant, individuals play computer games during the treatment. In order to score in the game, individuals need to either inhibit or increase certain brainwaves. Excessively generated brainwaves would result in negative symptoms such as irritability, daydreaming, and anxiety while under arousal brainwaves would also produce symptoms such as cognitive impairment, learning difficulties and inattentiveness. Neurofeedback thus aims to normalize brainwaves by inhibiting excessive brainwaves and/or rewarding deficient brainwaves. Numerous studies have concluded the efficacy of neurofeedback in ASD. While neurofeedback treatment can be costly over time, parents reported improvement in communication and social interaction, and improvement in behaviour following neurofeedback training (Holtmann et al., 2011). In addition, the effect of such improvement remained stable at 2 years follow up and no adverse effects were reported.

In sum, there are many treatments available to date for individuals with ASD. The article above briefly introduced some of the commonly used conventional and contemporary treatments for individuals with ASD, including natural products, pharmacological and biomedical treatments, and behavioural treatments. While some modality of treatments is more widely used and researched than others, some treatments require further investigation on its efficacy. Families are encouraged to seek professional advice when deciding which modal of treatment to opt for.

 

 

Contributor:

Ms. Jolene Lip

Psychologist in Spectrum Of Life