A brighter future awaits autistic children, as clinicians learn how to apply the tools of neurotransmitter assessment, detoxification protocols, and nutritional therapies to this increasingly common problem.
Autism and the spectrum of related disorders will always be a challenge for physicians, parents, educators and the patients themselves. But the evolving sciences of neurobiology, environmental medicine, and clinical nutrition are converging in a way that opens up important new therapeutic options.
Physicians no longer need to stab in the dark, trying drugs that historically have had little impact other than to control the most violent or self-destructive behaviors. Neurotransmitter assessment opens a direct window into the nervous systems of these kids. It reveals that autism is a constant state of sympathetic nervous system overdrive, a chronic internal fight-or-flight state in which ordinary sensory input becomes nearly intolerable. Fortunately, this is reversible, once you understand the underlying neurobiology.
Neurotransmitter Testing: A Window on the CNS
One of the most important clinical advances in recent years is the development of reliable methods to assess neurotransmitters in urine. Pioneered by Gottfried Kellermann, PhD, a population geneticist who several decades ago became interested in the causes of mental illness, these methods lay a foundation for more rational treatment of neurobehavioral and stress-related disorders.
All of the major neurotransmitters are excreted in urine, and the relative levels in urine samples reflect rates of neurotransmitter turnover. Properly interpreted, this gives great insight into a patient's neurobiology. Dr. Kellermann's company, NeuroScience Inc., established reference standards for all key neurotransmitters, and systematic testing methods with an eye toward guiding amino acid therapies.
In general, neurotransmitters fall into two general categories: Excitatory and Inhibitory, roughly reflecting the division of the autonomic nervous system. The major excitatory neurotransmitters are: epinephrine, norepinephrine, glutamate, phenylethyl amine (PEA), and histamine. Key inhibitory neurotransmitters are: serotonin, GABA, glycine, taurine and agmatine. Dopamine is one of a few that can be both inhibitory and excitatory. (For more information on the NeuroScience approach, visit www.NeuroRelief.com, and read "Neurotransmitter Assessment Brings Light to Management of Psychiatric Problems," on our website.)
Excitotoxicity: The Neurotransmitter Profile of Autism
Dr. Kellermann described the neurotransmitter patterns seen in autistic kids by the term "excitotoxicity." Typically, they show markedly increased levels of epinephrine, norepinephrine, aspartic acid, and dopamine (i.e., excitatory neurotransmitters), and very low levels of serotonin and GABA. Basically, their nervous systems are on fire. Call it sympathetic overdrive to the extreme.
Jared Skowron, ND, a naturopathic primary care physician in New Hampshire, who works with many families of autistic/ADHD kids, said that despite differing behavioral patterns, the neurotransmitter profiles are highly consistent. "There's a certain neurophysiology of autism, characterized by very low levels of the inhibitory neurotransmitters and high levels of norepinephrine, dopamine and epinephrine." Serotonin is usually extremely low, and since it is required for the synthesis of melatonin, this too is usually low, which contributes to the significant sleep disturbances seen in many autistic kids.
Annette Cartaxo, MD, a pediatrician in Kinnelon, NJ, who specializes in the holistic treatment of developmental and behavioral problems, said that in practice, the neurotransmitter testing goes a long way in helping her understand her patients. "The majority of these kids cannot make eye contact, because they're too engaged in an internal fight/flight response. They can't be bothered by you, and your need to communicate. Picture it like someone who's drowning and struggling not to go under."
Toxicity is not too strong a word for it. Dr. Kellermann explained that the breakdown of excitatory neurotransmitters by monoamine oxidase and other enzymes can produce highly neurotoxic substances. For example, dopamine is broken down into DOPAL (3-4-dihydroxyphenylethanol) and DOPEGAL, both of which are neurotoxic and can lead to Parkinson's-like symptoms, and cognitive impairment (Eisenhofer G, et al. Ann NY Acad Sci. 2004; 1018: 224–230). Normally, this is not a problem; the body quickly clears the toxic metabolites (Burke WJ, et al. Brain Res. 2003; 989(2): 205–213).
But in states like autism, where norepinephrine levels are on average 27% higher than in non-autistic kids, and dopamine levels are often up to 60% higher for extended periods of time, this becomes highly problematic. Many of these kids have deficiencies in hepatic detoxification to begin with.
Toxicity & Neurologic Stress
Dr. Skowron and others in the field believe exposure to toxins, especially heavy metals, is at the root of the autism spectrum disorders. Environmental mercury, lead, and other metals all play a role. Children are exposed beginning in utero. "In 9 out of every 10 patients I see, the mother has a mouth full of mercury amalgam fillings. Add metal exposures from the air, from seafood, and other sources, and intrauterine exposure can be very high." For kids with deficient detoxification capacity, this quickly becomes problematic.
The role of thimerosal in the etiology of autism remains controversial. Dr. Skowron said vaccines may be a problem for some kids, but not for most. "I would say only one-third of these kids have vaccine issues, and adverse responses to vaccines were pretty immediate. For the other two-thirds, intrauterine heavy metals and other toxins are much more of an issue."
"We're seeing more and more kids being born with damaged neurotransmitter systems. It is not genetic, it is epigenetic and environmental," said Dr. Kellermann.
He explained that the CNS responds to stress, be it due to emotional upset, physical trauma, infection, or toxin exposure by cranking out excitatory neurotransmitters, but this is quickly balanced by the inhibitory side. When stresses persist and compound, the inhibitory side eventually burns out, and the excitatory side runs rampant until it, too, burns out.
Autistic kids are overwhelmed by multiple stressors, from environmental toxins to the emotional wounds caused by social rejection and familial frustrations. It is all compounded by lack of sleep, poor nutritional status, food allergies (gluten and casein are common) and severe GI problems.
Detoxification is essential in the overall management strategy, said Dr. Skowron. A number of methods will work, depending on the child. Some physicians use chelation with DMSA or EDTA, but Dr. Skowron believes this is too dangerous for most kids. DMSA should only be used if there is clear evidence of lead exposure. There are many good botanical detoxification kits now available. One he recommended was the PureKids protocol from Integrative Therapeutics.
But he said he sees the best effects from homeopathic detoxification. "If you use relatively low potency (12×) homeopathic gold or lead, it somehow increases the movement of intracellular metals into the blood, so they can be excreted in urine." He also uses cuprum (copper) for kids with aversions to being touched or those who can't sit still, and Stramonium (Thornapple) for those with night terrors.
Targeted Amino Acid Therapy
The primary objective of the new approach to autism therapy is to rebuild the inhibitory neurotransmitters an autistic child lacks. This is done through provision of amino acid precursors, the primary building blocks for neurotransmitters.
"Nothing makes neurotransmitters except a natural and steady supply of the proper amino acid precursors," explained Dr. Kellermann. "Unless you address the neurologic stress, the kids don't really improve. Neurologic stress is a major stumbling block for everything else you're trying to do. To treat them properly, you really need to know specifically which neurotransmitters are out of balance."
NeuroScience's Targeted Amino Acid Therapies provide patients with amino acid supplements specifically formulated to rebuild the depleted inhibitory transmitters, while simultaneously supporting healthier levels of excitatory neurotransmitters, to help the kids pay attention and improve their cognitive, speech and social skills.
Over the years, Dr. Skowron found that many families were having trouble complying with the targeted amino acid protocols, which typically involve getting kids to take many tablets at different times of the day. "The cost was high and the compliance was pretty low. I had some Moms tell me that they were starting to feel like pharmacists."
This prompted Dr. Skowron to explore the possibility of an all-in-one formula that would provide amino acid precursors as well as B vitamins, omega-3 fatty acids, zinc, magnesium and other ingredients known to downregulate sympathetic activity, support hepatic detoxification, and improve cognitive function. The result is Spectrum Awakening, a once-daily powder formulation manufactured by Metabolic Maintenance (www.metabolicmaintenance.com), one of the nation's leading practitioner-only nutraceutical brands.
Spectrum Awakening is formulated to be as flavorless and odorless as possible, given how sensitive many autistic kids are to taste and smell. Parents can mix the powder with apple sauce, puddings, yogurt, or whatever their child will eat. "I have some parents add it into Jell-o mix, and then pour it into ice trays, to make daily Jell-o Pops, which most kids love." He typically has the parents start the nutritional therapy at the same time as the detoxification.
Dr. Skowron acknowledged that his formula represents something of a shotgun approach, and it is something of a departure from Dr. Kellermann's insistence on individually tailored amino acid treatment. On the other hand, a therapy is only as good as a patient's willingness to take it. "The truth is, these kids show very similar neurotransmitter patterns. Spectrum Awakening gives you a really good base to work from. You can always modulate it, changing the daily dose, or adding other things that an individual child might need."
Turning Young Lives Around
Detoxification and neurotransmitter replenishment are only part of the therapeutic picture. These kids are still going to need special education, speech therapy and other forms of therapy, but if you can detox them, clean up their GI problems and rebalance the neurotransmitters, you'll start to see marked improvements. "Getting them out of constant neurological stress mode is the key. It will improve all of your other medical efforts with these kids," said Dr. Cartaxo.
According to Dr. Skowron, it is not a question of whether a child will improve, the issue is how much, and how long it will take." Generally, younger kids respond faster than older ones. "Under age 7, improvement is the fastest. Over age 21 it is a lot slower." The 'tweens and teens are somewhere in the middle.
He noted that sleep is the first domain to improve, "which is a big relief for the parents." In many cases, a child will start to sleep better within one week of detoxification and nutritional therapy, especially if you also eliminate allergenic foods. Hypersensitivity and sociability are usually next to improve. "The last things to improve are speech and potty training. It can sometimes take 6 to 7 months or even longer to see improvement there."
Clinical Trials of TAAT
Neurotransmitter assessment and targeted amino acid therapy (TAAT) are in their infancy as far as clinical application in the management of neurobehavioral problems, and outcomes research is only just beginning.
Karyn Purvis, PhD, and colleagues at the Texas Christian University's Institute of Child Development, recently completed the first major clinical study of TAAT guided by NeuroScience's testing methods. They presented the findings at a recent conference on natural supplements in clinical practice, sponsored by the Scripps Center for Integrative Medicine.
In a joint project with Dr. Han Huisman of the University of Amsterdam, the TCU researchers recruited 97 adopted children from 57 families, all of whom were at significant risk for serious behavioral disorders. Roughly half of the children had already been diagnosed with one or more behavioral/psychiatric disorders at the outset of the study. The kids, with a mean age of 10, were randomized to TAAT or a delayed-treatment control group.
The TAAT subjects were asked to provide morning urine samples, which were sent to NeuroScience for analysis of eight key neurotransmitters: epinephrine, norepinephrine, dopamine, serotonin, GABA, glutamate, PEA, and histamine. While this cohort of children was not specifically autistic, they showed a general neurotransmitter turnover pattern similar to that observed in autistic children: elevated excitatory neurotransmitters, particularly glutamate and PEA, and markedly suppressed inhibitory neurotransmitters, especially serotonin and GABA). NeuroScience provided each family with a two-month amino acid supplementation program aimed at increasing GABA and serotonin.
In addition to the neurotransmitter measurements, the investigators used the Achenbach Child Behavior Checkist, a well-validated and widely used assessment instrument, to determine baseline and post-treatment behavioral patterns. The 113-item questionnaire utilizes a 3-point rating system, and was completed by parents before and after treatment. A total of 78 kids (44 in the TAAT group, 34 in the control group) completed the trial, with the drop-out rate being similar for both groups.
The amino acid supplementation gave the expected increases in inhibitory neurotransmitters. Compared with baseline values, those on active treatment showed a 148% increase in serotonin, and a 21% in GABA; those in the control group showed little change. The post-treatment tests also showed measurable changes in epinephrine and PEA levels, as the inhibitory side of the kids' nervous systems began to better regulate the excitatory side.
This translated into measurable behavioral changes. Anxiety, depression, thought problem, and attention problem scores were all significantly reduced by 20% or more in the TAAT group, reported Dr. Purvis. Control subjects showed small but insignificant improvements in these parameters.
"Taken together, these results imply that TAAT impacted serotonin and GABA levels directly, and indirectly impacted epinephrine and PEA levels. In turn, reduction in PEA levels may have played a pivotal role in the reduction of some problem behaviors," she said. "Although more research is needed, especially studies that control for placebo effects, this initial study suggests that TAAT is a promising avenue of research and development."
She added that new therapeutic options are sorely needed for children with social and emotional problems, especially in adoptive families. "Behavioral approaches can be effective but are relatively scarce. Families almost inevitably gravitate toward pharmaceutical interventions because there may be no other alternative available to them. However, drugs have limited efficacy with this population, and in some instances are contraindicated."
Clinical Pearls for Treating Autistic Children
The same general conundrum holds true for families dealing with the challenges of autism. Drug therapies are convenient but minimally effective, especially in the long term. Behavioral therapies, while more readily available for autistic spectrum problems than for the special needs of adopted children, are a long haul and by themselves may only have minimal impact.
Nutrition based therapies represent a major advance, but they should be part of a comprehensive approach that deals with multiple facets of the autistic spectrum, Dr. Skowron told Holistic Primary Care.
Over his years of working with autism spectrum kids, he's discovered a number of practical clinical pearls that can really make a difference for the children and their families. Here are a few examples:
Castor Oil for Constipation: GI problems of all sorts are very common in autistic spectrum kids, and constipation is by far the most common. In Dr. Skowron's experience, topically applied castor oil is the best quick-fix remedy you can find. "You won't believe it until you try it. Just have the parent rub a little castor oil on the child's abdomen before bed, and they'll start to have regular daily bowel movements within a day or two. It is a transdermal effect. The castor oil somehow induces peristalsis and gets things going."
Dairy Elimination Improves Violent Behavior: If you see violent behavior in a kid with autism or ADHD, it will almost always improve rapidly if you can get the family to eliminate dairy from the child's diet. "These kids always have dairy allergies. You can test for it, and the tests almost always confirm this, so at this point I just try and get the dairy out of the diet without waiting around for test results."
Lack of Focus? Get Rid of Gluten: Gluten intolerance is another very common facet of the autism/ADHD spectrum. Kids who show a lack of mental focus, constant brain fog, or other related cognitive symptoms, are almost always gluten intolerant. Though it is very difficult for many families, elimination of gluten can really help these kids, said Dr. Skowron.