ASA's 37th National Conference on Autism Spectrum Disorders (July 13-15, 2006)

• Audio
• Recorded Presentation

Clinical Approach: Professor, Robert Hendren, Director of the UCD MIND, recently stated it is time to stop thinking of autism, and time to think about autisms. I agree. To accomplish this however, each child must be individually assessed by a careful history and physical examination. Based on the insights gained during the interview and exam, appropriate diagnostic testing can be obtained to target specific problem areas.

1)Abnormal Methylation-transulfation: Cysteine a simple sulfur-containing amino acid appears to be deficient in the vast majority of autistic children. Jill James at UAMS and we at ICDRC see a prevalence of cysteine deficiency along the order of 90%. This amino acid is critical to the production of glutathione; the bodies most important intracellular antioxidant. Cysteine can be measured in the blood through inexpensive testing at commercial laboratories. Once it is determined the level is low, steps to enhance this can be undertaken. Dr James published her findings showing a complete correction of cysteine deficiency by diet supplementation of folinic acid, trimethylgycine (TMG) and injections of methyl B12 (the active form of B12). Phase II of the research is completing and it appears the addition of transdermal N-acetylcysteine is also of significant clinical benefit to many children with autistic symptoms. We and others have also used infusions of N-acetylcysteine and Glutathione with further gains in many children. 2)Immune Activation in the Brain and Gut: It has been known for sometime that the gastrointestinal tract is frequently affected in autism spectrum disorders. The problems range from ulcers, to reflux esophagitis to a unique form of inflammatory bowel disease. A group from Johns Hopkins recently reported significant inflammatory changes in the central nervous system as well. This presents unique challenges, but there are promising agents that seem helpful and are under investigation. 3)Heavy metal accumulation shares many of the features of autism. In particular, mercury has been the target of much controversy and promise as an agent which may model autism. Bradstreet and colleagues found significantly more mercury in children with autism and a in some children lead is in excess as well. Removal of heavy metals is complex. But effective strategies are being developed and children are showing significant gains in many areas when the metals are eliminated. 4)Hyperbaric Oxygen: Several smaller studies in the process of being published show promise for this intervention. This is the use of oxygen under pressure to improve perfusion of the body. In particular SPECT brain imaging shows significant improvement in perfusion after hyperbaric in autistic patients.