The Autism Society Event and Education Recordings Archive

Historically, the biomedical and behavioral fields have developed in parallel fashion with relatively little communication between them. Fortunately, recent developments in these two fields have created opportunities for genuine collaboration and integration of knowledge with implications for bettering the lives of people with autism and their families. In this session, a biomedical researcher (Herbert) and a behavioral researcher (Carr) will present an integrative model that highlights functional parallels and multiple treatment opportunities in both the biomedical and behavioral domains. For some time, the biomedical and behavioral fields have been developing in parallel fashion with relatively little communication between them. Differences in training, technical jargon, priorities, and publication venues have had the effect of minimizing transfer of knowledge across fields. Fortunately, recent developments in these two fields have created opportunities for a genuine collaboration and integration of knowledge that has implications for bettering the lives of people with autism and their families. In this session, a biomedical researcher (Herbert) and a behavioral researcher (Carr) will present an integrative model that highlights functional parallels and multiple treatment opportunities in both the biomedical and behavioral domains.

The essence of the model is as follows. Within the biomedical domain, upstream factors produce metabolic problems generating downstream factors at the “whole body” level that, in turn, compromise multiple aspects of functioning within the behavioral domain. Upstream factors involve the interplay between environmental stressors (e.g., heavy metals, infection, pesticides, other stressors) and genetic susceptibility (e.g., genes failing to turn “on,” genes affecting metabolic pathways related to handling environmental stressors, or genes producing biochemical aberrations) that result in an array of metabolic problems. These problems may involve oxidative stress, abnormal methylation, neuroinflammation, and mitochondropathy.  These problems affect the functioning of cells and systems within the brain, reducing the efficiency of brain signaling and coordination.  The metabolic problems also generate several classes of downstream factors such as illness (e.g., gastrointestinal issues, nutritional deficiencies), immunological challenges (e.g., allergies or vulnerability to recurrent infection), and pain. These brain and metabolic impacts cascade further downstream to impact individual functioning related to learning, problem behavior, and quality of life issues.

The model suggests multiple targets of opportunity for bettering the lives of people with autism. These targets potentially involve a wide variety of interventions reflecting exigencies at each level of the model. Consider upstream factors. The presence of environmental stressors such as heavy metals, infection, and pesticides suggests the need for changes in public health policy designed to limit toxins and promote hygiene. Consider the metabolic problems that are the negative sequelae of these upstream factors. If oxidative stress is an issue, it may be possible to mitigate its harmful effects on body tissue by providing anti-oxidant therapy. Similarly, anti-inflammatory antibiotic drugs might be administered to control neuroinflammation or systemic inflammation if that factor is salient. Consider downstream factors. Gastrointestinal disease and allergies can be ameliorated and potentially overcome through the use of elimination diets or nutritional supplementation that remove irritants and/or provide necessary substrates for bodily function that were previously present at insufficient levels. Finally, consider the destructive impact of downstream factors on individual functioning. Illness, allergies, and pain all conspire to disrupt learning, exacerbate problem behavior, and decrease quality of life. Behavioral approaches can be used to help address many of the adverse effects of downstream factors on individual functioning but are more effective when complemented by medical interventions to reduce physical challenges.

A key “bridge concept” that helps bring together the biomedical and behavioral fields is that of the “setting event.” In the present formulation, a setting event is any biological factor that alters an individual’s response to a given environmental context. In illustration, a child with autism who has symptoms of illness/pain (setting event present) may find academic tasks highly aversive but that same child may find the same tasks less aversive when illness/pain symptoms have been reduced (setting event absent).  The presence of the setting event may trigger severe problem behavior in response to academic tasks, impede learning, and upset teachers/parents (a quality of life issue). Since many illnesses are chronic and their effects wax and wane over time, it may be prudent to combine biomedical interventions that reduce the symptoms and the chronic vulnerability to illness with behavioral procedures that address any residual pain/discomfort. Thus, curriculum redesign, choice, rapport building, functional communication training, and interspersal techniques are just some of many behavioral procedures that can be used along with medical intervention to produce positive outcomes. Importantly, ongoing medical intervention for a variety of the biological factors previously described may effectively mitigate the intensity of undesirable setting events thereby helping to increase the effectiveness of common behavioral procedures in a synergistic manner that facilitates skill acquisition and reduces problem behavior. Also relevant is the fact that behavioral procedures can be used to increase patient cooperation so that critical medical diagnoses can be made. These procedures can also be used to promote adherence to medical regimens (e.g., special diets, health-promoting medications) and help address and attenuate problematic side effects associated with drug interventions.

In sum, collaboration between biomedical and behavioral professionals can result in a process of mutual education whereby multiple sources of knowledge are integrated in a manner that produces new understanding, creates additional treatment opportunities, and results in improved quality of life for people with autism and their families.

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