ANSWERING / [ ¢ | The Doman Method® Plan for Autism, ADD and Neurodevelopmental Delays With contributions from : DOMAN Dr. Vijay Murthy and Melissa Doman < Po"AN- SWERING AUTISM The Doman Method® Plan for Autism, ADD and Neurodevelopmental Delays by Douglas Doman & Spencer Doman Posicién 2CHAPTER 1: AUTISM AND ADD IS IN THE BRAIN We have not come easily or quickly to the Doman Method. Our work is the result of more than 70 years of interaction with more than 25,000 families from around the world. We have worked shoulder to shoulder with parents of children with autism, ADD, ADHD, and nearly every other kind of special needs. These fam- ilies love and adore their children with special needs. They have stopped at nothing to give their child the best chance of becoming well. Throughout history, there have always been children with special needs. Throughout history, it has al- ways been believed that children with autism (and other children with neu- Posicién 144 4%rodevelopmental disabilities) could not be made well. As a result, some have died. Historically, some were kept in institutions worse than prisons. Many were treated as second-class citi- zens. Of course, there have been many wonderful advances in medicine. Chil- dren who would have died 70 years ago, because of health issues and ill- nesses, now routinely survive. When Glenn Doman and his team began their work to help patients in the 1950s, they had never seen or heard of any autistic child that had ever become well. The Objective was Total Wellness: They made it their objective that children with autism, as well as other children with neurodevelopmen- tal delays, should become well just like their brothers and sisters, and other children their age. It was considered preposterous to propose that such chil- dren could become well. Some consid- ered it ridiculous and dishonest. And yet, Glenn Doman made this brave (and heroic) goal. Posicién 149 3%Ina world that believes children with special needs cannot be made well, it is not surprising that we some- times fail to achieve this goal. What is astonishing is how often we succeed. The field Glenn Doman created is the field of Child Brain Development. Child Brain Developmentalists have been demonstrating for more than a half-century that a significant number of children with autism can be made well and that the majority have a great deal more potential than the world rec- ognizes. In these pages, we will teach you how these vital discoveries have been made, and how it is possible for a child with autism, ADHD, or another special need to improve in all the sig- nificant developmental areas. We will explain how parents can learn this pro- gram and carry out a home program with their child. Witnessing What is Considered Im- possible: Many times, at Doman Interna- tional’s European campus in Pisa, Italy, I have watched a previously uncoor- Posicién 157 4%dinated, disorganized, hyperactive, and socially inappropriate child perform gymnastic activities well beyond what average children can do. This has filled my heart with joy. Elle doing gymnastics I have watched a young girl di- agnosed with autism put on a tutu and dance a beautiful ballet. But what is the common view of autism? Let’s look at the word itself. The etymology of autism, according to the Oxford English Dictionary is “early 20th century (originally with refer- ence to a condition in which fantasy dominates over reality, regarded as a symptom of schizophrenia and other disorders).” Autos comes from Greek and means “self”. Often autism is commonly re- ferred to as a disorder of “one who is Posicién 165 4%intensely interested in self.” I have to confess that this morning when I was shaving, I was “intensely interested in self.” This term appears rather unsci- entific when examined more closely, and yet, we use it so freely to describe children with a serious neurodevel- opmental disability. The definition of diagnosis is “the art or act of identify- ing a disease from its signs and symp- toms.” The confusion derives from the fact that the name “autism” comes from a symptom that these children have. Being “intensely interested in self” is a symptom of a disease. Autism is a term describing a symptom of a neurological problem. Autism is a Symptom: If one believes that a symptom is a disease, then they will attempt to treat the symptom rather than the dis- ease itself. It is not possible to treat a symptom and cure the disease. Sci- ence has known this for a very long time. Imagine if a person walked into a hospital and told the doctor, “Doctor, I have a terrible tightness in my chest, pain in my left arm, and I am dealing with shortness of breath and nausea.” Posicién 172 4%If the doctor tried to treat the symp- toms they might say, “For the pain in your arm and chest, you should take a painkiller. For nausea, take this anti- nausea medication. For the shortness of breath, go home and get some bed rest.” A good doctor would assess the situation and immediately examine the patient to see if the patient was having a heart attack. This is the great difference be- tween treating the symptoms and treating the cause of the problem. If a doctor treats only the symptoms of the patient having a heart attack as the first doctor did, the patient would likely die. However, assessing the symptoms allows the good doctor to di- agnose the cause of the problem (the heart), and then the doctor can take action to treat the heart, wherein the problem lies. For children with autism and ADD, the origin of their problems is in the brain. They have neurodevelop- mental delays — a delay in their devel- opment due to a lack of normal neuro- logical development and function. This has most recently been demonstrated with the use of func- Posicién 180 4%tional magnetic resonance imaging (fMRI), which shows that children di- agnosed with autism have a “neurode- velopmental disorder that displays brain network abnormalities”, with de- creased brain connectivity between various regions of their brain (Saleh, M.M. & Adel, A., 2019). For Too Long the World Has Failed the Children: Why is this important? For so long, the world has tried to treat chil- dren with neurological conditions by treating symptoms. They say, this child is autis- tic, so let’s prescribe speech therapy for them to talk, physical therapy so they can learn to move correctly, oc- cupational therapy to get them more independent, and behavioral therapy to teach them correct behavior. These well-intentioned professionals are try- ing to fix a problem by address- ing symptoms — in the end, unfor- tunately, parents find that their child often does not improve significantly with this approach. Posicién 189 4%If the problem for these chil- dren is in their brain and neurological function, then we have to make sure that any approach or treatment we take with them addresses the underlying neurological problem. The renaissance for children with special needs began in 1953 when Glenn Doman spoke at the Rusk Insti- tute, which is considered one of the best rehabilitation centers in the US. He was speaking to a group of profes- sionals and said: The Renaissance: “It must be considered as a basic principle, that when a lesion ex- ists, when in the confines of the brain, that treatment, to be successful, must be directed to the brain wherein lies the cause rather than to that portion of the periphery where the symptoms are reflected. Whether the symptoms exist as an almost undetectable subtlety in human communication or an over- whelming paralysis, this principle must not be violated by those who seek success with the brain-injured patient.” Posicién 196 5%From that time till now, Glenn Doman and Doman International have spent all our time and effort finding and developing methods to treat the brain itself. If one treats the cause of the problem effectively, the symptoms will disappear. If we take the example of the patient with a heart attack, addressing the underlying cause will save the pa- tient’s life, and stop the terrible symp- toms from worsening. If a doctor tried to treat the symptoms of chest tight- ness, pain in the arm, and shortness of breath, the patient would die. To fix a problem, first, we must understand what the problem is. Until we as a society grasp the fact that children with autism, ADD, and ADHD have a problem in their brain, and that it is this problem which leads to all the devastating symptoms we all see in these children, we will not find many solutions to fix the problem. Treating the Symptoms Does Not Work: It isn't possible to fix a problem. by treating the symptoms. This is pre- Posicién 204 5%cisely what the traditional treatments have done for children with autism, and this is exactly why children with autism have struggled to get better. This is why parents often ask them- selves if traditional treatments yield any significant results at all. But if par- ents are told by every professional in their life that the traditional therapies are the only option, how else are they supposed to know where to look? It is why professionals continue to believe that it is impossible for chil- dren with autism to become well, de- spite the fact that our Child Brain De- velopmentalists have been advocating for more than 70 years that children with neurodevelopmental disabilities can get significantly better, and in some cases get entirely well. A very wise person once said, “Ignorance does not consist of not know- ing. It consists of knowing so many things that are not true.” The problem is that many professionals, often with the best intentions, believe that children with autism or ADD are not able to get better. They don’t think they ever have the possibility to get better. They don’t try to address their underlying issues Posicién 212 5%which are in the brain, and instead try to treat the symptoms. We are fortunate that modern neuroscience is demonstrating what Glenn Doman declared more than half a century ago. Neuroscience has shown that the symptoms which chil- dren who are called autistic have are a result of an organic problem in the brain. Glenn Doman wrote a book in 1973 called What to Do About Your Brain-Injured Child. He wrote this book for children with autism, ADD, ADHD, developmental delay, learning difficul- ties, epilepsy, brain injury, Trisomy 21, and other genetic abnormalities. He explained a revolutionary idea at the time, that these children had problems in their neurological development. If their brain development and function could improve, then they could im- prove. Today, autism is called a neurodevelopmental disorder. Glenn Doman fought for many years to have autism and other special needs treated as a neurodevelopmental problem. He said that the injury to the brain might have occurred in utero during fetal de- Posicién 221 5%velopment, during the trauma of birth, or perhaps after birth due to an acci- dent, or environmental factors. He said that until this brain injury could be fixed, the symptoms would remain. Another very wise person once said that “Unlearning is much more diffi- cult than learning.” It is difficult for pro- fessionals to unlearn what they were taught; that autism and other special needs are not curable, or that it is not possible for a hurt or underdeveloped brain to develop or function normally. This is why the system has not adapted. or changed much to help these chil- dren in the past six decades. This is also why more and more parents (perhaps including yourself) have been driven to learn more on their own to help their children. Labels Can be Libels: Sadly, the chaos of diagnosing individuals based on symptoms per- vades the entire spectrum of children with neurodevelopmental disorders. These labels, at times, can be libels be- cause once a child is labeled with one of these terms, society can be quick to write them off and consider them Posicién 230 5%hopeless, which has created so much upset for parents and professionals: Autism Attention Deficit Disorder Cerebral Palsy Developmentally Delayed Learning Disabled Mentally Retarded Brain-Damaged Epileptic These neurodevelopmental dis- orders have been treated based on their symptoms, not the cause of the symp- toms, which is in the brain. This is why all the children with these, and other labels have not gotten well. It is com- monly believed they are hopeless. We have even seen children with Trisomy 21 and other genetic ab- normalities greatly improve in ability when we improve their brain devel- opment and function. This is because, while they have a genetic disorder, they also have a neurodevelopmental condition. Once their brain function and development improve, the nega- tive symptoms, which may be speech problems, or cognitive developmental Posicién 238 6%issues, improve. Then, physical ability and development can all improve. Sadly, there are many ways that a brain can be damaged. Our children may suffer brain damage in utero dur- ing fetal development, during birth de- livery, immediately after birth, during the early days of their development, or later. A child may have suffered from an acute illness, head trauma, or a ge- netic disorder that affected brain de- velopment. Sometimes there is no ob- vious reason why brain function was affected. Below are some of the most common causes of injury to the brain, in no particular order: Possible Causes of Brain Injury: 1. Not enough oxygen to the brain dur- ing the prenatal period or birth 2. Prematurity of the baby . Postmaturity of the baby 4. Precipitous or prolonged labor (labor that is too fast or takes too long) 5. Traumatic birth and delivery 6. Birth process delay (where birth was delayed) 7. Traumatic brain injury w Posicién 246 6%8. Automobile accident 9. Falls 10. Umbilical cord compression or wrapped around the neck 11. Drug or alcohol abuse during preg- nancy 12. Surgical complication (cardiac ar- rest while under general anesthesia) 13. Infectious disease 14. Stroke 15. Exposure to environmental chemi- cals, toxins, and heavy metals What Happens When the Brain is In- jured? While there are many possible causes of brain injury, it is very com- mon that a lack of oxygen leads to in- juring the brain. Oxygen is the princi- pal food of the brain. If it is decreased or cut off, brain cells die. When brain cells die, we call that brain injury. Every single one of us, at one point or another, has suffered some kind of brain injury. Little boys or girls fall off bicycles. Average adults will have sports injuries or inadvertently walk into a kitchen cabinet. All these incidents may cause a tiny amount of Posicién 261 6%brain injury. It is known that drinking alcohol can kill brain cells. Who is Brain-Injured? So, when Glenn Doman spoke about “brain-injured” people, who was he speaking about? He meant all of us. Most of us have likely lost brain cells in the past, whether it was in a sports- related concussion, hitting our head on a kitchen cabinet, or in a car accident. People have suffered some brain dam- age from alcohol and drug abuse. The point is that we are all brain-injured. The bigger question is, does it show? Has the brain injury each of us sus- tained stopped us from achieving our goals in life? For most adults, the answer is no. We can continue to go to work each day, survive and succeed in the things that we do. But for children with autism and ADD, or another neurodevelop- mental issue, the signs of their im- paired neurological function show. So, for those children, we must take ac- tion. Their brain injury is real, and it matters. If we can get their brains Posicién 274 6%to function and develop better, they will get better. If their brains improve enough, their symptoms will disap- pear. In conclusion, to help your child with autism and ADD, we must focus on helping brain function and brain development. That is our greatest and most important goal, and we hope that after reading this book, it is now your biggest goal. Why is an Integrative Treatment Pro- gram Needed? Over the last 60 years, we found that there are four ways to treat the brain effectively. These are non-surgi- cal treatments. All of these treatments were developed with the purpose of teaching them to parents so they could carry them out at home. These non-surgical treatments developed by Glenn Doman are the foundation for the Doman Method. Respiration: In the same way that a lack of oxygen can create brain injury and neurological problems, we have found Posicién 282 7%that supplying the brain with addi- tional oxygen is a vital solution. In ad- dition, we have found that developing the entire respiratory system is essen- tial for the child’s well-being and devel- opment, as oxygen is the brain’s food. Our Doman Method Oxygena- tion Program is one effective way of providing more oxygen to the brain. It also helps to develop the child's chest, as well as improving inhalation and exhalation. We won't go into de- tail about this significant part of the Doman Method Program as it requires one-on-one teaching from Doman In- ternational’s staff as well as clearance from our medical staff. We have devel- oped other effective ways to improve breathing. Our Physical Program is an active way we can improve aerobic ac- tivity and the child's respiration. We will go more in-depth into our Physical Programs later on in the book and why they are essential. The Physical Program: As mentioned above, physical development works hand in hand with respiratory development. Not only can an Aerobic Running Program deliver Posicién 289 7%oxygen to the vital organs and mus- cles of the body, but it can also provide more oxygen to the brain. Recent research has demon- strated various positive effects for run- ning. First of all, running makes the heart beat faster, which helps deliver more blood to the brain. Blood carries oxygen with it, which is essential as the brain requires oxygen to function at its best. It also helps drive the pro- duction of brain-derived neurotrophic factor (BDNF), which helps new neu- rons grow and thrive and helps protect brain cells from degeneration (Ferris, Williams & Shen, 2007). There are many physiological benefits to our Physical Program. It improves the body’s metabolism. It es- tablishes deep breathing, which im- proves oxygen delivery to the brain. It can help remove toxins from the body. These could be toxins from air pol- lution, water pollution, food additives, and medications. The Physical Program also can be a great award for the children, giv- ing them the opportunity to go outside and enjoy the sun and environment. Many children, especially hyperactive Posicién 297 7%children, are desperate for both more physical activity, and time in nature. In 2018, a meta-analysis of re- search published in the Journal of Science and Medicine in Sport found that regular activity for pre-adoles- cent children improved various areas of development and function, includ- ing academic performance, attention, and executive function (De Greef, et al., 2018). This review of the research shows the powerful, long-term effects regular aerobic activity can provide for children as they develop. What might surprise parents and professionals the most is how regular physical activity seems to provide the best results not just in improved health and healthy weight, but also in very important cog- nitive areas of function. Cognitive Development: Our cognitive development pro- grams are often the most loved by the children in our program. These programs are designed to be effec- tive in teaching children with special needs. The program is designed to be presented with great joy and enthusi- asm, so the child enjoys the learning Posicién 305, 7%process. Parents learn how to provide content that truly interests the child and sparks a joy of learning. Having a Cognitive Program designed by parents who know the child's interests better than anyone else, is a vital key to the success of this program. The human cortex is the part of the brain responsible for cognitive de- velopment. Our program works to de- velop the visual and auditory pathways into the brain. By improving a child’s sensory ability, the child is better able to experience the environment around them and learn about the world. As we can only learn from the world around us using our sensory abilities, like see- ing, hearing, and feeling — improving these important functions will im- prove a child’s ability to comprehend and understand. By increasing cogni- tive development and comprehension, we can improve speech. Both the Respi- ratory and Physical Programs, working together with cognitive development, help to improve language as well. For these reasons, an integrative approach is important to get the finest results. Nutrition and Health: Posicién 314 7%Adelle Davis, the famous bio- chemist, played an instrumental role in the development of our Nutrition Program. Adelle is the mother of modern American nutrition. Her best- selling books have been read by mil- lions. Over the years, our Nutritional Program has continued to develop due to researchers, nutritionists, and col- leagues around the world who work to continue developing nutritional pro- grams to benefit children with special needs. Now, it is common for parents to cut sugar, additives, and processed foods out of the diets of their children with special needs. We have been doing this for decades as we have clearly seen positive changes with children when we do so. There are four primary ways to change the brain — through physical activity, cognitive development, and stimulation, improving respiration, and enhancing health and nutrition. All our Child Brain Developmentalists specialize in one of these four areas (physical, cognitive, respiration, or nu- trition and health). Posicién 322 8%CHAPTER 2: NEUROPLAS- TICITY OR “THE BRAIN GROWS BY USE” In this chapter, we will be re- viewing several important principles of brain development, which are fun- damental to the creation and applica- tion of the Doman Method with chil- dren with special needs. Understand- ing these principles is essential for par- ents to grasp why and how this method is effective. Principle 1: Function Determines Structure Function determines structure is an important biological principle. This is a principle that applies to the Posicién 330 8%physical growth of any child. This is also alaw of many other fields of study. Our function, what we do, deter- mines our physical and neurological structure. This is easy to understand if we consider it from a physical stand- point. Let’s imagine there are two peo- ple of identical height and size, and we are going to have them both lift a weight. If one person picks up a 10-pound weight to do a bicep curl and continues to lift it over and over, his bicep will obviously become big- ger and stronger. If the second person picks up a 20-pound weight and lifts it an equal number of times as the first person, the second person will have a bigger and stronger bicep. Professional bodybuilders have huge muscles because they lift weights all day. Their greatly increased func- tion (of lifting heavy weights) has given them the astounding physiques they have. They were not born with huge, rippled muscles — the function that they performed produced the re- sult. Function determines structure is a law of biology. Throughout nature, there are many fine examples of this. Posicién 334 8%For example, in Ecuador, there is a bird called the sword-billed hummingbird. In the photo, you can see the extraordi- nary length of its beak. To survive and overcome the competition from other hummingbirds, over generations and generations, it developed along beak to get into flowers that other humming- birds can't feed on because of their short beaks. Their extraordinary func- tion has given them an extraordinary structure. Sword-billed hummingbird Most importantly, function de- termines structure is an essential prin- ciple of brain growth and develop- ment. The more your child with spe- cial needs uses his or her brain, the more the brain will function better and develop. More physical function, more cognitive function, and more social Posicién 343 8%function will improve and develop the brain. There is a corollary law that states that a lack of function deter- mines a lack of structure. If the sword- billed hummingbird was moved to an environment where all flowers were shallow and the incredibly long bill was no longer an advantage (and in fact was a disadvantage), the lack of function would change its structure over time, and its long beak would change. Understanding that function determines structure, and that alack of function creates a lack of structure, is very important for children with spe- cial needs. Imagine if we take two chil- dren with autism, two children with ADD, and two children with another neurodevelopmental disability (like developmental delay, cerebral palsy, Trisomy 21, etc.). Imagine if we sep- arated these children into two groups, and in one group we placed children into an environment where there was great stimulation and opportunity — the children could run, play with oth- ers, play sports, interact with others, and be taught and stimulated with in- Posicién 349 8%teresting information. The other group we placed into an environment like an institution that lacked any physical ac- tivity, intellectual stimulation, or so- cial interaction with others. One does not need to be a sci- entist to know that the children in the first group would do much better than the children in the second group. The children in the first group would likely be much healthier, much stronger and more fit, happier, capable, and con- fident. This greater function would make them fitter, stronger, and health- ier people. The children in the unstim- ulating environment, which lacked op- portunity, would most likely be more ill, weaker, less interactive, bright, etc. This lack of function would affect them. It is easy to think that only someone cruel would place people into such a terrible institutional environ- ment, but keep in mind that the lat- ter environment is the one that the professional world historically created for children with special needs. Glenn Doman and other pioneers fought the system to make sure that children with special needs could receive the stimu- Posicién 356 8%lation and opportunities they deserve, but in some parts of the world, this still isn’t available to kids with special needs. We know from history that de- privation hurts and inhibits brain de- velopment. We occasionally see heart- breaking stories in the press about chil- dren having been locked up in a room by a psychotic adult. It’s a miracle that children can even survive such terrible circumstances, and fortunately, it hap- pens very rarely. But when the child is evaluated by professionals, it is found that the child lacks the ability to com- prehend, speak, or communicate like other people. This is not because the child is unintelligent, it’s because the child lacked the natural visual, audi- tory, tactile, and social stimulation, as well as the physical opportunities that other children get naturally. What do these extreme situa- tions teach us? That we must give all children, but ESPECIALLY chil- dren with special needs, extraordinary stimulation, and opportunities. Their increased function will help them in every way. Posicién 364 9%A lack of function determin- ing a lack of structure is the reason why many children with special needs are small compared to their aver- age peers. Doman International's inte- grated physical, nutritional, and respi- ratory programs are designed to help the special needs child catch up to the height, breadth, and weight of their av- erage peers. Let’s again consider the func- tion of bodybuilders and weightlifters for a second. Do you know body- builders start out with a similar num- ber of muscle fibers that you and I have? Because of their increased func- tion, the structure and size of each of their muscle fibers is bigger than yours and mine. It’s not that they were ge- netically endowed with more muscle fibers, it’s that their muscle fibers have had a great deal more function than ours. One of the ways the human brain grows and develops is that brain cells (neurons) can change in size and in connectivity with other neurons de- pending on the function of the per- son. With enhanced stimulation and function, the structure of the brain’s Posicién 372 9%neurons, and neural connectivity can change. So, we've got to give a child in- creased function to change the struc- ture of the brain. Principle 2: Understanding the Difference Between Physiology and Pathology Understanding the difference between physiology and pathology is an important principle of the Doman Method. Pathology is the study of ab- normal conditions of the body. Neu- ropathology would be the study of the diseases of the brain. For hundreds of years, the parents of children with spe- cial needs have been told by “experts” that when a brain cell is dead, itis dead. They have been told there is nothing that can be done about a hurt brain. This is the reason children with special needs have been considered hopeless. It’s true that a child with autism, cerebral palsy, ADD, or another special need may have lost millions of brain cells in the process that led to them having a neurodevelopmen- tal condition. We even see profoundly brain-injured children who may have lost as many as a billion brain cells Posicién 379 9%in the process of being hurt. By view- ing children with special needs from a pathological viewpoint, it is easy to be negative about their prognosis and to be ignorant of their great potential. The Doman Method is based upon understanding physiology. Phys- iology is the study of normal func- tion. Neurophysiology is the study of the normal function of growth and development in the brain. Our chil- dren with special needs, like average children, have billions and billions of healthy brain cells. The average per- son has around 100 billion neurons and many other billions of glial cells in their brain. Damage to the brain may kill many of these cells, but in com- parison to the many billions of cells left, it is not necessarily a great deal. Instead of thinking “The damage has been done, and there’s nothing that can be done about it”, we can view our chil- dren in another way, “Let’s work with what we have and build upon it!” These viewpoints are very different — one is focused on the problem and one is fo- cused on solutions. If one is only fo- cused on the problem, they don’t even look for solutions. Posicién 387 9%Let’s look at this from a finan- cial standpoint. If you had 100 billion dollars, and through a misfortune, lost a billion dollars, would you be terri- bly upset? A physiological viewpoint means considering the billions of good neurons that are still in the brain, waiting to be stimulated. Rather than lamenting the loss of those cells from a pathological standpoint, we celebrate the remaining healthy billions of neu- rons just waiting for the opportunity to grow and develop. Application of this vital principle for children with special needs means considering them and their potential with optimism. Principle 3: Neuroplasticity (The Brain Grows by Use) Since the 1950s, Glenn Doman taught every parent of a child with spe- cial needs who came to learn about the Doman Method the most important of all the principles of brain develop- ment. The vital principle Glenn Doman began to teach was "the brain grows by use." The underlying pur- pose of the Doman Method program is to provide extraordinary daily stim- Posicién 396 9%ulation, and opportunity for the child with special needs to use their brain. We do our best, and our parents do their best, to continue this process throughout the day until the child is ready to go to bed. This principle guides the Doman Method Program that we de- sign for children. It was considered a revolutionary and radical idea so many decades ago and is now established in scientific literature — the idea that the human brain could change during a person’s lifetime. The ability of the brain to change and adapt based on ac- tivity and environment is called “neu- roplasticity”. Neuroplasticity is now a famous and well-understood neurolog- ical concept. Now, all neurophysiologists know that the brain grows by use. This is one of the most exciting areas of study for neurophysiologists. Many of the top neurophysiologists in the world continue to dedicate their laboratories to this research. Sadly, for children with spe- cial needs, many professionals who work with these children do not study neurophysiology. Their viewpoint is Posicién 404 10%pathological rather than physiological. If they understood that the brain can change with activity and environmen- tal enhancement, they would look at these children very differently. Glenn Doman was attacked early on for his radical idea that the in- jured brain could change and improve, although research since the 1930s has shown that the brain does, in fact, respond to environmental changes. It took decades for the professional world to start to catch on. In a May 2006 edition of Time magazine, it was written that neuroplasticity, “the ca- pability of the brain to develop and change throughout life, something western science once thought impos- sible” (Time Magazine, 2006). For hundreds of years, children with special needs have paid an enor- mous price for the ignorance of so- called experts responsible for their well-being. It is hardly excusable when one considers that the first neurophys- iological studies demonstrating that the brain grows by use were published nearly a century ago. As early as the 1930s, neuro- physiologists were demonstrating that Posicién 411 10%the brains and neural networks of ani- mals could be changed by environmen- tal changes. The brain grows by use. These are the five most important words for the successful treatment of children with neurodevelopmental disabilities, whether they have been diagnosed with autism, ADD, cerebral palsy, de- velopmental delay, or another kind of neurological condition. Conclusion: How the Doman Method Works Understanding that autism, ADD, and other forms of neurodevelop- mental delays are a result of an injury to the brain (which may have occurred before, during, or after birth) is es- sential. This is important because we know the brain can change and can im- prove. Understanding that the child’s real problem is in the brain, and not due to some mystic incurable disease, is essential. Glenn Doman said, “The world has looked at the brain and brain growth and development as if this process was a predestined and unchangeable fact. Posicién 420 10%Brain growth and development is a dy- namic and ever-changing process. This is a process which can be stopped, as in the case of profound brain injury. It is a process which can be slowed as in the case of mild brain injury. Most sig- nificantly, it is a process that can be speeded.” Understanding how to speed brain development is what we're all about. Understanding Brain Physiology: The research demonstrating neuroplasticity, which is the brain’s ability to change and adapt from en- vironmental stimuli and activity, is overwhelming. It has been studied for many decades and gives support to Glenn Doman’s claim that “the brain grows by use.” Neuroplasticity has be- come a popular area of study, and an understood phenomenon, but when Glenn Doman proposed in the 1950s that the brain could change, he was at- tacked viciously for those claims. Now, these same statements are established science taught in schools. While neu- roplasticity is well understood as a phenomenon and a concept, most pro- Posicién 429 10%fessionals don’t know how to use this information practically to help people with special needs. To better understand how a child with autism and ADD can de- velop with an integrated treatment program, it is good to comprehend some basic brain physiology. The brain contains about 100 billion neurons (Herculano-Houzel, S. 2009). Neurons are brain cells and are responsible for our brain function. They are responsi- ble for receiving stimuli from the ex- ternal world — for our ability to see, hear, feel, taste, and smell. They allow us to experience the world around us. As you read this page, neurons are transmitting messages from your eye to your brain so that you can compre- hend what you are reading. Neurons also send motor commands to your muscles. Neurons send messages to your eye muscles to move as your eyes scan these pages, and to your hands when you flip pages. Neurons are able to do these amazing things because they send electrical signals from neuron to neu- ron. Take a second, look around your immediate environment, and take in Posicién 440 10%for a second what you can see, hear, and feel. The amazing thing is that neurons are transmitting messages to your brain about everything around you. When those messages arrive in your brain, your brain interprets them. It’s absolutely phenomenal that when we look at a beautiful sunset, or smell a bouquet of roses, or hear a beautiful sonata by Beethoven, that those expe- riences are entirely caused by the elec- trical signals being sent to our brain from the body and sensory organs. Neurons exist throughout our body — even the digestion system con- tains 500 million neurons from the esophagus to the colon. These neurons relay messages when we feel hungry, when we feel full, when we have stom- ach discomfort, etc. It is important to note this, as these many millions of neurons in the gut help explain why proper nutrition is so important for children with autism, ADD, and other neurodevelopmental conditions. Gut function can impact neurons, which are responsible for our sensory and motor abilities. We will focus on nutri- tion intently in this book and urge you Posicién 448 11%to take some important steps for your child. Why is this important for your child? Because if we want to im- prove your child’s ability to function, we must improve neuronal function. Your child’s brain has been affected, and that is why your child exhibits abnormal function — this poor func- tion could be poor vision, hearing, un- derstanding, abnormal behavior, poor coordination or balance, poor speech, lack of fine motor skills, and a host of other symptoms of neurological dys- function. We need to improve the function of neurons, and therefore the brain, to get your child to improve in function, and see these symptoms re- duce. In addition to our approxi- mately 100 billion neurons, they are billions of glial cells, which are other brain cells that provide insulation and protection of neurons. They hold neu- rons in place, as well as transfer nu- trients to neurons, and remove waste from them. We will talk about glial cells again when we review studies that have demonstrated that environ- Posicién 455 11%mental changes can lead to very real changes in the brain. Let’s better understand neurons —neurons have three important parts. First, there is the cell body, which is like the command center of the cell. The second part of the neuron are den- drites, which are tree-like extensions that receive electrical impulses from other neurons. Third, there are axons, which are nerve fibers that branch out from the cell body that signals out to other neurons. So, when an electrical impulse arrives at the dendrite of a cell, it is sent to the cell body (command center). The electrical impulse then passes out through the axons, which are nerve fibers that branch out from the cell body, and on to other neurons. \ _swanse euton 3 Neuron and its parts (Photo Credit: Niyati Patel) Posicién 463 1%Dendrites and axons branch out and look like branches from trees. These branches allow the dendrites to accept signals from other neurons, and the axons to send these signals. In very simplistic terms, the dendrites receive the message, the cell body understands it, and then the axons send the message on to the next neuron. The amazing thing is that a tiny little space exists called the synapse, which is the area between the axons of one neuron and the dendrites of another. The electrical impulses ‘jump the gap” to travel from one neu- ron to another. As you read at this moment, there are likely thousands of electrical signals traveling from your eyes to your brain, and these messages are effortlessly traveling from neuron to neuron, going from axon to den- drite, jumping that tiny little gap of the synapse. The reason why it is impor- tant for you to grasp this concept is that children with autism, ADD, and other neurodevelopmental conditions often have issues with both sensory and motor abilities, which means their brains and neurons are not relaying Posicién 470 11%signals properly. Often, brain injury acts as a barrier to the brain receiving information. This makes it more diffi- cult for the individual to see, hear, and feel normally, and comprehend the in- formation from their environment. For a person with autism, ADD, or any other neurodevelopmental con- dition, their neurological issues will act as a barrier to receiving stimuli and information, so we will need to work hard to provide excellent and consis- tent stimulation that will arrive to the brain and help improve the function of the brain. What principles can we use to help achieve this goal? Glenn Doman came across this realization many decades ago, when recalling the words of his neurology professor when he was a student. His professor told the class: “There are three ways of ensur- ing the transmission of central nervous system stimuli. You must increase the stimuli in frequency, intensity, and dura- tion.” Frequency Intensity Duration Posicién 477 11%These are three of the most im- portant words for children with neu- rodevelopmental conditions. If we can increase the frequency, intensity, and duration of stimulation, we can help that stimuli reach the brain more quickly, and more effectively. Every- thing we discuss in this book and rec- ommend to you, we will always state the frequency, intensity, and duration that it should be done. Some of the programs we will teach you in this book are well known around the world as being good, but they are not in practice with the chil- dren who need them. Why? Because people don’t know the correct fre- quency, intensity, and duration to do them. Let’s look at some practical real- life examples of frequency, intensity, and duration to gain a better under- standing of these three principles. Let’s imagine I am at a dinner party with my wife, and she wants to get my attention because she is ready to leave... she will try to get my at- tention. Let’s say that I am engrossed in a conversation with a person across Posicién 486 11%from me, and she wants to get my at- tention discreetly. First, she might try to put her hand on my arm to see if that works. However, perhaps I am enjoying my conversation so much I don’t take any notice (the stimuli didn’t reach my brain). To get my attention, my wife might try to use frequency, intensity, and duration. First, she will try touching my arm multiple times to see if that gets my attention (she increases fre- quency). If that doesn’t work, she will touch my arm, and keep her hand there for some time to see if that gets the de- sired result (increases duration). Lastly, if I’m still not getting the message, she will resort to applying in- creasing pressure on my arm until I get it (increasing intensity). Finally, I realize that she is working to get my attention and I “get the message.” She has successfully em- ployed the use of frequency, intensity, and duration to get her message across. Frequency, intensity, and dura- tion is a concept that is understood by masters of their craft all around the Posicién 494 12%world. For example, everyone knows that exercise is important. Everyone knows that aerobic activity and condi- tioning are great for health. So why do so many people go to fitness experts to design workout plans for them? Be- cause those experts understand the best frequency, intensity, and duration to achieve fitness goals, that’s why. Why are bodybuilders like Arnold Schwarzenegger able to build ridiculous amounts of muscle com- pared to the rest of us? I lift weights at times — why don’t I look like them? Simply because of frequency, intensity, and duration. They lift weights more (frequency), they lift heavier weights (intensity), and for longer periods of time (duration). Your child needs stimulation at a higher frequency, intensity, and du- ration to help the message of the stim- uli to reach the brain. We will cover this in detail for each activity we teach in this book, but it is important you understand this underlying principle about why it’s important to consis- tently provide the stimulation. A Quick History of Neuroplasticity: Posicién 503 12%The concept that the brain can change due to stimulation and activ- ity is not a new concept. As early as 1793, an anatomist from Italy named Michele Vicenzo Malacarne found that the cerebellums of trained animals were larger than those of untrained animals (Rosenzweig, 1996). However, significant research into neuroplastic- ity did not occur until the 20th cen- tury, and it was not until the 1960s that the evidence for brain plasticity started to become overwhelming. De- spite these findings, Glenn Doman, and early researchers into neuroplasticity came under fire for proposing such a concept — that the brain could change over time. Glenn was certain that brain plasticity was a phenomenon that could take place with humans, as he was seeing the evidence of neurolog- ical rehabilitation with his patients. Many of the patients he had seen had suffered serious strokes and brain damage, and yet were recovering when given the right kind of stimulation and activity. Glenn assumed the brain must be changing and recovering due to brain plasticity. Posicién 512 12%He knew two leading neuro- physiologists of his time, Dr. David Krech from Berkeley, and Dr. Boris Klosovskii, the chief of neurosurgery at the Academy of Medical Sciences of the USSR in Moscow. Both of them had contributed significantly to research showing that brain plastic- ity was occurring in mammals. Krech had shown at Berkeley that rats that were exposed to significant stimula- tion and activity had larger brains than rats who were not. Krech, along with anatomist Marian Diamond, contrib- uted a great deal of the early significant research into neuroplasticity. Glenn formed friendships with Krech and Diamond, which lasted many years, where they shared their findings with one another. Dr. Klosovskii in Mos- cow in the 1930s had discovered that kittens and puppies that were raised on a revolving turntable, which slowly revolved as these baby cats and dogs were raised, had larger vestibular areas of the brain than other control ani- mals. The researchers found that “the experimental group had 22.8 to 35 per- cent more growth in vestibular areas Posicién 519 12%of the brain than did the control ani- mals” (Doman, 2005). Glenn Doman saw the great value in this research, as he could see what the researchers were finding with animal subjects, and apply this infor- mation to patients who had sustained neurological damage. Neuroscientists researched brain plasticity with animals, as doing it with humans was out of the ques- tion, because it requires killing the subject, and opening up their heads to observe brain anatomy changes. These scientists studied brain changes by raising animals, usually rats, in three different kinds of environments: 1. Individual Condition —a condi- tion where the animal is alone, without special stimulation. 2. Social Condition — an environ- ment where the animal has other animals in the cage, so they have social stimulation, but nothing else provided. 3. Enriched Condition —a condition where the animals not only have other animals in their cage but changing envi- ronmental stimuli (changing Posicién 526 12%of sights and sounds in their cage), as well as different phys- ical activities and equipment to engage with. This created an “enriched environment” full of stimulation and opportunity. After raising the animals in these different environments, the brains of these different animals were examined to see if their housing condi- tion changed their brain function and chemistry. The research was designed to see if environmental conditions could affect brain function, develop- ment, and physiology. Krech and Diamond's research was only the beginning. In 1972, re- search done by Drs. Greenough and Volkmar showed that rats in enriched conditions have greater dendritic fields than rats in other conditions (Volkmar & Greenough, 1972). Remember that dendrites are the part of the neuron that accepts signals from other neu- rons. This research showed that the dendrites literally had more branches in rats with enriched environmen- tal stimulation. It could be interpreted that rats in enriched environments were better at taking in information. Posicién 536 13%Dr. William T. Greenough, one of the foremost researchers of neu- roplasticity, went on to make other significant findings. In 1985, he dis- covered that rats in enriched environ- ments had more synapses per neuron — indicating that a better environment could result in better neural networks and communication between neurons (Turner & Greenough, 1985). In 1987, Greenough and other researchers found that enriched con- ditions led to 80% better capillary volume in the brain (Black, Sirevaag & Greenough, 1987). Capillaries are blood vessels, so this research showed that blood transport to the brain im- proved with environmental stimula- tion and physical activity. For those of us who worked with children with spe- cial needs, this was an important find- ing. We knew that improving blood de- livery to the brain meant an increase in oxygen delivery to the brain. Oxygen is the primary food of the brain, and oxy- gen helps our brain function. We knew that improving blood, and therefore oxygen delivery to the brain, could help the brain function of our patients. Posicién 544 13%Glenn Doman realized the im- portance of oxygen delivery to the brain. We have found that if we can improve breathing in brain-injured pa- tients, their brain function improves, and symptoms decrease. Finding that environmental enrichment led to im- proved blood and oxygen delivery to the brain was a significant part of this discovery. Research has since found that axons can become thicker with en- vironmental stimulation (Juraska and Kopcik, 1988) and later Greenough found that rats placed in enriched conditions led to them having more synapses between neurons and glial cells (Jones and Greenough, 1996). After decades of research, William T. Greenough summarized his findings of the brain: “These results present a very dy- namic view of the brain. Essentially all cellular components appear to adjust to the demands placed on the brain by the organism's interactions with its environ- ment. It is clear that the anatomy and physiology of the brain varies with the housing environment” (Benefiel & Gree- nough, 1998). Posicién 553 13%Simply, Greenough said that brain anatomy changes based on the environment that the individual is raised in. We knew this from our chil- dren with special needs — if we gave them increased stimulation and in- creased activity, they improved! If you are a parent or loved one of a child with special needs, you re- alize that there are so many things that cannot be controlled. However, one thing we can control is the envi- ronment they are raised in. If we can provide stimulation with increased frequency, intensity, and duration, and maximum opportunity to develop their abilities through optimal activity, we can greatly help these individuals. Posicién 561 13%CHAPTER 3: UNDERSTAND- ING INTELLIGENCE AND NEURODEVEL- OPMENTAL DISABILITY If I asked you, what is some- thing that Albert Einstein, Alexander Graham Bell, and Thomas Edison had in common, you would most likely answer that the three of them were brilliant people, people who changed the history of humankind with amaz- ing discoveries. It might be surprising, then, to also note the three of them most likely had neurodevelopmental disorders. It is now believed by many Posicién 567 14%15:43 GN @ NBS le that Albert Einstein would have been diagnosed with autism if he were born today. He had delayed speech develop- ment and did not speak his first words until 3 years of age. He faced great diffi- culty early on in school and was very rigid in his schedule and need for rou- tine. Alexander Graham Bell dealt with reading difficulties in childhood, and most likely would have been di- agnosed with dyslexia today. Thomas Edison was sent home from school by a teacher who claimed he had “scram- bled brains." In fact, Edison was largely educated by his mother at home. Today, he would most likely be diag- nosed with “learning difficulties”. Ob- viously, at the time when these great thinkers lived, there were no formal diagnoses given. It has even been pro- posed, although it cannot be proved, that certain great scientists like Nikola Tesla and Isaac Newton may have been diagnosed with autism or ADD had they been born today based on per- sonal traits they exhibited. While we will never know for sure, it is highly likely many great minds had neurode- velopmental disabilities. This did not Ht O <stop any of them from being intelli- gent. Glenn Doman noticed that indi- viduals with neurodevelopmental con- ditions could also be brilliant. He real- ized that the societal assumption that these children were stupid was wrong. Often in the 1950s, he found that doc- tors were diagnosing these children as “{diots,” “imbeciles,” and “morons.” He knew this was disgustingly unscien- tific, but even further, he noticed that many of the children he saw were of av- erage intelligence. Some were more in- telligent than their average peers. This led him to say, “There is no correlation between brain injury and intelligence, however, there is a huge correlation between brain injury and the ability to express intelligence.” He stated that for most individuals with brain injury, their faculties for learning and under- standing had not been interrupted, it was their ability to express their intel- ligence by speaking, using their hands and their body that had been affected. There is a great difference be- tween being unintelligent and being intelligent but not being able to ex- press it. There is a phenomenal book Posicién 578 14%called The Diving Bell and the Butterfly, written by Jean-Dominique Bauby, who suffered a massive stroke. His stroke led to something called “Locked- in Syndrome,” where Bauby was aware of everything in his environment but was completely paralyzed, unable to move or speak. He wrote an entire memoir of his experience by blinking one of his eyes (he only had control of one eyelid) as his secretary read letters of the alphabet aloud to him. He would. blink when the correct letter was read aloud, and his secretary would note it down to spell out words. He had com- plete intelligence but could only ex- press himself through the blinking of an eye. The brilliant astrophysicist Stephen Hawking was completely well until he was diagnosed with motor neuron disease, which is a degenera- tive disorder that destroys the function of the motor areas of the brain. Hawk- ing lost all ability to speak, and nearly all ability to move. Fortunately, he had amazing software provided to him that allowed him to communicate his needs by twitching his cheek to form let- ters and words. His intelligence was Posicién 586 14%not impacted by his neurodegenerative condition, but his ability to express himself was. No one questions that Stephen Hawking was brilliant — but he was fortunate enough to have sophisticated software made for him to communi- cate his needs. Imagine if this software did not exist? Perhaps people would have assumed he had lost all of his in- telligence with his motor ability. Our intelligence is determined by our sensory abilities. Everything we learn, we learn from the world through our five senses — we can see, hear, feel, taste, and smell. Everything you have learned, your child learns, and every- thing Albert Einstein ever learned was learned through those five pathways. We can call these our “intelligence” pathways. However, we express our intelli- gence through our motor abilities. Our motor abilities include our speech, our ability to use our hands, and our ability to move our bodies. If lasked you to an- swer a question but told you that you were not allowed to answer the ques- tion by speaking, using your hands, or moving your body, you'd most likely Posicién 594 14%have great difficulty doing so. It would not be fair, then, for me to assume you were stupid. Children with neurodevel- opmental disabilities often have prob- lems with the motor abilities — let’s call them our “expression” pathways. It’s hard to express intelligence if you cannot speak well, cannot move well, or use your hands well. This is why Glenn Doman made it clear that it can- not be assumed a person with a neuro- logical condition is unintelligent, just because their brain makes it difficult for them to express that intelligence. For this reason, at Doman In- ternational, we assume that all chil- dren are highly intelligent. We stimu- late them, we engage them, we respect them, and we set high goals for them. We use sophisticated language when speaking to them, we explain things to them throughout the day, we read to them, and we educate them. Assuming a child is unintelligent is dangerous because it is a self-fulfilling prophecy. If we think a child is unintelligent be- cause they are diagnosed with autism or another special need, then we will speak to them, and interact with them differently. We will not expect them to Posicién 602 14%understand concepts, so we won’t ex- plain things to them. Instead of speak- ing to them with a large and sophisti- cated vocabulary, we will interact with them with a small vocabulary. Instead of expecting them to be mature, we will expect them to be immature. By treating them as unintelligent and im- mature, they become more unintelli- gent and immature. This is how people would have treated Stephen Hawking had he been born with the neurological issues he had later in life. Kids with autism, ADD, or other neurodevelopmental conditions are not stupid. Don’t allow anyone to con- vince you that they are. If anyone tells you that a child with these conditions is hopeless, all it tells you is that they are outdated in their thinking, and it's time for you to find the right profes- sional you can trust with your child's future. Our Conclusions About Brain Devel- opment and Parents: As you have learned, the brain is an amazing organ. Posicién 609 14%In the past, “experts” insisted that when a brain cell was dead, it was dead, and nothing could be done. This was used as an excuse to do lit- tle or nothing for children with special needs. Glenn Doman realized from ex- perience that neuroplasticity existed, that the brain could change due to en- vironment and activity. But he also speculated about the possibility of neu- rogenesis, the concept that, perhaps, new brain cells were created during a person’s lifetime. But he only spoke about this to his family, closest friends, and confidants. He was attacked for even suggesting that neuroplasticity existed, so he knew that if he suggested that new brain cells might be created during a person’s life, it would be con- sidered heresy. In the last few decades, neuro- physiologists began to study the pos- sibility of neurogenesis. Research has demonstrated that neurogenesis oc- curs in the child's brain, the adult’s brain, and even for those in their 80s and 90s. It happens in all of our brains. To summarize, inthe most basic sense, it can be said that we teach the Posicién 617 15%parents of special needs children how to provide visual, auditory, and tac- tile stimulation with increased fre- quency, intensity, and duration, in recognition of the orderly way in which the brain grows and develops. We also teach parents to give their children extraordinary opportu- nities to use the newly provided sen- sory information in order to develop the child's mobility, speech, and man- ual ability. Finally, we teach the parents to ensure the child has the correct nutri- tion, hydration, and respiratory func- tion to provide the brain and body with the ideal environment in which to grow and function. We offer our parents a variety of different programs based on their needs and wants for their special needs child. Our Advanced Doman Program (ADP) is our most intensive program, which provides the best results. It is true this program is challenging, but we work hard to solve the problems of the children that are considered hope- less. Our parents have told us time and time again that there is something Posicién 628 15%far more difficult than our Advanced Doman Program. Our parents say it is far harder to watch their child not get better, day after day, year after year. More than sixty years ago we learned that if parents of children with special needs know how it's possible for their child to develop, that they can become the best therapists of all. To get the best results, parents can create a winning environment for their chil- dren at home. Our parents know their child better than anyone else in the world. Only they have the love to pro- vide their child with a successful and winning cognitive, physical, and social environment at home. Only our parents have the deter- mination to give their child a fighting chance to get better. Posicién 639 15%CHAPTER 4: NUTRITION FOR CHILDREN WITH SPECIAL NEEDS Author: Dr. Vijayendra Murthy, BAMS, B. Nat, MS, MPH, PhD Nutrition and Special Needs Chil- dren: We all know how important nutrition is for physical development, cognitive development, health, and overall well-being of children. Often parents find it challenging to plan an ideal nutrition regimen for their grow- Posicién 645, 15%ing child. The challenges of maintain- ing good nutrition become even more difficult when you have a child with special needs. The general knowledge of giving a child balanced amounts of carbohydrates, proteins, and fats from various food groups is no longer an easy task. In a usual situation, a child starts to explore and eat a little of what the surrounding adults eat, and devel- ops specific likes and dislikes to certain foods. However, when you havea child with special needs, there may be limi- tations to how well your child can in- teract with you to express his or her likes and dislikes towards the food you feed them. Also, it is likely that a child with special needs may have limited abilities to express his or her food preferences or even the ability to de- velop regular eating patterns like their peers. Nutritional disorders and com- promised nutritional status are very common among children with special needs. Therefore, it is important for you as a parent to understand the ba- sics of nutrition and how to plan nutri- tion which not only fulfills your child’s Posicién 650 16%nutritional requirements but improves his or her health and well-being, re- duces the symptoms, perhaps even re- verses the factors affecting the child’s brain function. This chapter will help you in overcoming exactly those challenges mentioned, and help you become con- fident in choosing the right foods and, more importantly, eliminating foods which can be harmful to your child’s brain function. Also, you will learn more about the specific roles of food in brain function. At Doman Interna- tional, we constantly train parents in becoming informed nutritionists for their children with special needs. Food, Nutrition, and Nutrients: Even before we look at the link between nutrition and brain develop- ment, it is essential to understand what nutrition is. We are all aware of the simple truth that eating food is es- sential for the blood to circulate, the muscles to move, for thinking, and to sustain life itself among trillions of biological processes that happen on a daily basis in the human body. Nutri- tion is the science that explores what Posicién 657 16%happens to the food we eat, and how it impacts health and disease. The study of nutrition includes understanding such processes as how food is di- gested, absorbed, transported through the body, and how undigested food and waste are excreted. Food is any nutritious sub- stance that can be consumed in order to maintain life and growth. A nutrient is a chemical substance found in food which contributes to health, provides energy, serves as a building block for cells and tissues, and regulates chem- ical processes in the body. These nu- trients, which are vital to the body’s growth and repair, must come mainly from food, and they perform vital bio- logical functions. Carbohydrates from foods, such as grains and vegetables, are the key energy source for the brain to function. Proteins from foods such as beans, eggs, and meat are responsible for the building and repair of tissues. Fats from foods such as nuts, oils, and avocados help in the absorp- tion of fat-soluble vitamins A, D, E, and K. Besides these biological functions, a substance can be called a nutrient if Posicién 665, 16%the removal of it can cause a deficiency affecting certain biological functions. You can now appreciate why it is im- portant for you as a parent to learn about foods rich in nutrients and why to avoid foods poor in nutrients. For ex- ample, refined sugar is empty calories and is always to be avoided. USDA Food Guide Pyramid for Young Children and MyPlate: The Food Guide Pyramid, now replaced by MyPlate, went through different changes based on scientific data over the years. The various food groups originally recommended by the USDA Food Guide Pyramid, with carbo- hydrates forming the foundation of the pyramid, meats in the middle, and fats at the top, have all been challenged by several studies. Posicién 673 16%Credit: USDA (now replaced with MyPlate) In 2011, the pyramid was replaced with MyPlate (see Figure 2). Credit: USDA There is no guarantee that such a nutritional plan can, in reality, be healthy for your child. For instance, if you give your child refined carbohy- drates, processed meat, high glycemic root vegetables, sugary fruits, and cow’s milk in the exact proportions MyPlate suggests, your child will be harmed rather than helped. This is be- cause not all carbohydrates are the same. It is not only important for you as a parent to understand the portion sizes and the macronutrients (i.e., carbohydrates, proteins, fats), but also, to know the difference between healthy macronutrients and unhealthy macronutrients. Posicién 679 16%The Six Classes of Nutrients Every Parent Must Understand: We need energy to survive and function. Most carbohydrates, pro- teins, and fats provide the energy we need. If energy were all that was nec- essary, we could live on empty calories by ingesting sugar, but that is not the case. We need nutrients which pro- mote growth and development. These are proteins, fats, carbohydrates, cer- tain vitamins (e.g., vitamin B, vitamin C, folic acid), certain minerals (e.g., zinc, magnesium), and water. These nutrients help in regulating the biolog- ical processes in the body. For example, a child who is pro- tein deficient is likely to suffer from frequent infections. It is important to carefully plan your child’s diet to in- clude all the six classes of nutrients to support his/her growth, development, and health in general. Carbohydrates, proteins, lipids, and water are required in larger amounts by the body, and as such are called macronutrients (macro meaning large). As vitamins and min- erals are needed in small quantities by the body, they are called micronutri- ents (micro meaning small). Posicién 687 16%Carbohydrates: Carbohydrates, often referred to as ‘carbs’ in everyday language, are a major source of calories providing en- ergy. For thousands of years, carbohy- drates have been an important staple in our diets across all cultures around the world. If you take a closer look at the USDA’s MyPlate (Figure 2), grains, vegetables, and fruits, which form three-quarters of the plate, mostly con- tain carbohydrates. As long as you fill the plate with the right type of car- bohydrates, you can rest assured that your child will receive the required source of energy from foods. Often, children with special needs may not eat enough, or eat the wrong type of foods. It is important to recognize that a lack of sufficient energy can affect your child’s growth, development, and mood. The real chal- lenge, however, is to avoid bad carbo- hydrates, which are dense in calories, but deficient in nutrients. The way to be confident about what you feed your childis by being able to interpret nutri- tional labels and food ingredients. Posicién 695 17%More importantly, do not be a naive consumer of false advertising and marketing messages. Once you start to learn to interpret the scien- tific facts about food, it’s like learning a new language, and as we all know, the more languages we know, the better we can thrive in this world. The language of nutrition, therefore, is an essential skill to have when you are caring for a child with special needs. Most of us like sweet taste and children certainly do. This sweet taste of cooked rice, bread, pasta, potatoes, or sugary sweets is essentially due to the chemicals of which they are pre- dominantly made. Glucose is the ulti- mate end product of all carbohydrate- containing foods after digestion. Depending on how simple or complex the bonds between the mol- ecules forming the carbohydrates are, they are referred to as simple carbo- hydrates or complex carbohydrates. When your nutritionist advises you to give complex carbohydrates, and not simple carbohydrates, it may help to know what exactly they are talking about. Simple carbohydrates are also Posicién 703 17%called “simple sugars”. Remember that sugar is acommon name for glucose. If you picture how food gets digested, the process is one of break- ing down complex molecules to the simplest form so they can be released into the blood which then carries these molecules to the brain and other tis- sues. Now, imagine a food item such as a carrot, which is made of complex car- bohydrates, being digested. The body has to work harder and longer to break down the complex bonds, which, in re- ality, is a good thing as there will be a slow release of energy. However, eating a sweet muffin containing lots of table sugar which, as we learned, is a simple sugar, would take less time to be broken down, and therefore the energy released by simple sugars is immediate. That’s why adults may reach for a muffin when tired in the afternoon rather than a carrot. You can also experience the effects of sim- ple carbohydrates on children if you give them a piece of cake. This can result in immediate hyperactivity, as there is a sudden release of energy. So, it is better to give complex carbohydrates than simple carbohy- Posicién 712 17%drates, as a slow release of energy is better than an immediate release of en- ergy. The next time you are at the su- permarket, instead of rushing through the aisles, read and mentally compare the carbohydrate, sugar, and fiber con- tent of various foods in the aisles with vegetables, bread, and breakfast cere- als. Even though the packaging may suggest it is healthy, with no added sugars, or rich in vitamins, simple carbohydrate-containing foods such as sugars, or fruit juices given on a daily basis can be a bad idea. Giving your child complex car- bohydrates such as millet, or vegeta- bles is a good idea, as it will provide the necessary energy by slowly and constantly releasing energy for longer times. Table 1 has examples of simple carbohydrates (not good for your child) and complex carbohydrates (good for your child). Foods containing | Foods con- Simple Carbo- taining hydrates Complex Posicién 720 17%Carbohy- drates Table sugar Vegetables Cake Leafy Fruit juice greens Candy Nuts Corn syrup Beans Baked treats Whole Cookies grains Packaged break- Oats fast cereals Peas Brown rice Apples Berries Table 1: Simple and Complex Carbohydrate Foods Glycemic Index of Foods: Another useful way to look at healthy and not-so-healthy carbohy- drates is by understanding what hap- pens in the body when different types of carbs are consumed. When any carbohydrate-containing food is con- sumed, the blood sugar level rises. In response to increased glucose in the blood, a hormone called insulin is re- leased, which delivers glucose to the cells providing energy. Glucose that is not needed by the cells is stored in the liver and muscles for future use. The Posicién 727 17%more sugary food one eats, the more the body has to produce insulin to reg- ulate it. Repeatedly triggering insulin will result in cells developing insulin resistance which results in high blood glucose. An analogy would be when a liquid is spilled on the floor, you would immediately get a mop, and mop the floor dry. But if the spill is constant, and you need to keep mopping very often, the mop wears out and becomes inefficient, leaving the floor wet. In a similar way, a high intake of sug- ary carbs will stress insulin produc- tion much like an overused mop, be- sides contributing to high sugar in the blood. Glucose must arrive slowly and regularly to the brain for it to function at its best. In order to measure how quickly sugar levels are raised in the blood by consuming carbohydrates, a rating system called “Glycemic Index (GI)” is used. It ranks carbohydrate- containing foods from O to 100. The lower the number, the lesser the in- crease in blood sugar, and the higher the GI, the greater the increase in blood Posicién 740 18%sugar. Table 2 provides examples of high GI and low GI foods. It is known that high GI foods can lead to insulin resistance in the brain, affect brain function, reduce learning ability, and impair memory. Also, high GI foods negatively impact the formation of neurons and increase brain inflammation. As such, high GI foods are not good for your child. For a child with special needs, it is best to choose foods which are low GI and medium GI. High GI(70 Medium GI | Low GI(0-55) to 100) (56 to 69) ‘sugar, sugary | sweet potatoes, | raw carrots, foods, sugary | __ bananas, raw apples, soft drinks, | raisins, pineap- | peas, lentils, white rice, | ple, sweetcorn, | most veg- white bread, | porridge oats, etables, skinless wholemeal | kidney beans, bakedwhite | rye, honey, grapefruit, potato, wa- beetroot, rolled oats, termelon, mango,sul- | whole-grain cornflakes, | tanas, bananas, | pumpernickel, shredded papaya, figs broccoli, wheat, bagel, cauliflower, white French cabbage, baguette, mushrooms, glutinous lettuce, green rice, short- beans, red grain white peppers, tice, tapi- onions, brown oca, dates, rice, buck- pumpkins, wheat, barley, parsnips walnuts, Posicién 747 18%butter beans, chickpeas, yellow split peas, cher- ries, plums, peaches, apples, pears, fied apri- cots, grapes, coconut, kiwi fruit, oranges, strawberries, prunes Table 2: Examples of High, Medium and Low GI foods Glucose and the Brain: The brain needs glucose as an important fuel. We have just identified how carbohydrates are essential for en- ergy, and complex carbohydrates and low GI foods are key to supporting your child’s brain functions. Unlike some or- gans, the brain requires a steady supply of energy over 24 hours, day and night. Unfortunately, the brain only runs on glucose and oxygen as its fuel, yet there are no reserves of glucose in the brain. This makes the brain extremely vulnerable should there be a lack of glucose availability. Learning and communication can become impaired when glucose supply to the brain is poor. Therefore, a steady glucose sup- Posicién 753 18%ply to the brain is crucial for cogni- tive function in a child. In adults, the brain uses 20% of the energy gained through diet. A child’s brain consumes twice the amount of glucose that adult brains consume. The important mes- sage here is that simple sugars and high GI carbohydrates are not the an- swer to fulfilling the glucose needs of the brain. Proteins: Proteins are the building blocks of the human body. Our muscles and bones are mainly formed of proteins. Our body uses protein to repair tissues and to make enzymes and hormones. If your child is protein-deficient, it can manifest as an increased vulnerabil- ity to infections, general weakness, or loss of muscle mass. Besides acting as building blocks, proteins also provide energy as carbohydrates do. Animal proteins take longer to digest than car- bohydrates. Meat (composed largely of proteins and some fat) will not in- crease the blood glucose levels imme- diately as carbohydrates do. The end product of proteins is amino acids. Posicién 766 18%Amino acids bind together in various patterns, forming different types of proteins. Table 3 provides a list of essential amino acids and foods rich in these amino acids. It is especially important that you give your child these foods regularly, as these amino acids are necessary for the produc- tion of neurotransmitters. For exam- ple, the happiness neurotransmitter, serotonin, is formed by the conversion of tryptophan. So, giving your child tryp- tophan-rich foods can increase the chances of greater serotonin produc- tion. Serotonin improves mood, social behavior, reduces depression, anxiety, aggression, improves memory, and quality of sleep. The brain needs a con- tinuous supply of amino acids for pro- ducing neurotransmitters. However, excessive intake of proteins will eventually get converted to glucose. Eating too much protein is not safe either. Essential | Food sources | Functions of Aminoacid | rich inth the amino Posicién 774 18% amino acid acidHistidine eggs,red | Ithelps brain meat, cheese, | function, parmesan supports cheese, white | neurotrans- meat, poul- mitters, try, seafood, | helps pro- beans, duce red legumes, chia | blood cells, seeds, sesame | white blood cells, detoxi- fies the body, protects the tissues from damage by heavy metals or radiation. Isoleucine | meat, dairy, Helps in cashews, hemoglobin almonds, | production, oats, lentils, helps in brown rice, nitrogen legumes,chia | growth seeds, eggs, | (nitrogenis white fish, necessary pork, parme- | for DNA) san cheese Leucine pumpkin, | Stimulates seeds, nuts, muscle peas, tuna, strength, seafood, synthesizes beans,eggs, | more mus- whitefish, cle fibres, cheese, beef, | regulates pork, chicken, | sugar levels, parmesan | helpsim- cheese, prove brain sesame function and neurotrans- mitters. Lysine eggs, meat, Helps in whitefish, muscle poultry, repair, beans, cheese, | supports the immune sys- tem, helps__|_ Posicién 783 19%