A "Best Practices" Model for Treating Autism:

Biomedical & ABA Therapies

Put into Practice Together
Improve Optimal Outcomes

Autism One 2009 Chicago

The Hopes of a Mother, the Dreams of a Father are Real.
Our Children get Better

Chicago, IL May 20th - May 24th

Lauren W. Underwood, PhD

 What is autistic spectrum disorder?
A developmental
disability resulting from a
neurological disorder
That affects normal functioning of
the brain . . .
Autistic Spectrum Disorder
Abnormal development of
Communication skills
Social skills
Reasoning
… affecting children in a spectrum
of ways . . .
. . . . and children affected behave in
a spectrum of ways . .
The tough part about autism is that there is no
definitive “cure” or treatment
No one will tell you that this is something that will
definitely work
Today’s presentation
Treatments grounded in Applied Behavior Analysis as
well as biomedical treatments have individually
helped provide effective treatment models for autism
In recent years, evidence for successful outcomes with
biomedical treatments has also been observed
Ultimately, in developing a “Best Practices” Model,
these interventions must work together to provide
the best possibilities for optimal outcomes
 An overview of support for the
behavioral-biomedical treatment model
will be presented
Why behavioral AND biomedical?
Many children with autism also suffer from co-
morbid medical conditions
Treat the underlying medical disorders
Increase reception to behavioral interventions
Then, the synergistic effects of behavioral and
biomedical interventions result in an increase in
successful outcomes
 Synergy of biomedical and behavioral
interventions
 Therapies or interventions are designed to remedy specific
symptoms in each individual
 The best-studied therapies include a combination of
educational/behavioral, sensory and biomedical
interventions
 They may not cure autism, but they often result in
substantial improvement
My goal as an educator . . .
1st . . . The Science . . . .
Biology
Anatomy and cell biology
Immunology
Biochemistry
Then,
the reasoning behind what can go wrong with these
systems . . . explain how issues with these systems
can affect
Behavior
Behavioral intervention
Sensory intervention
 . . . to enable you to understand some of the
biological approaches currently available for
the treatment of the medical condition
described as autism,
. . . .so if you choose you can consider applying
them responsibly
Why consider biomedical
approaches for treating of autism?
There is literature in peer review journals and
other related sources that suggests that there
are several biomedical interventions that . . .
can be helpful for the treatment of the
symptoms in many autistic spectrum disorder
children
What does biomedical approach mean?
The application of the natural, biological and
physiological sciences to clinical medicine
http://talkaboutcuringautism.org/medical/supplement_help.htm
http://www.pediatrics.org/cgi/content/fu
ll/120/5/1162
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;
107/5/1221.pdf
The Science
The body is made up of specific systems,
including skeletal, circulatory, immune,
cardiovascular, nervous, digestive
Digestive system
Anatomy and function
Food allergies/food intolerances
Leaky gut/intestinal dysbiosis
Immune system function
Basic biochemistry
Digestive System
Mouth
Stomach
Small intestine-absorption
Duodenum
 Jejunum

 Ileum

Large intestine/Colon
Rectum
Liver
Pancreas-secretes enzymes and hormones
Digestion-digestive tract function
Digests food
Absorbs nutrients
Carries vitamins and nutrients into
bloodstream
Chemical detoxification
Excretion
How do you get nutrients from foods?
Protein
Foods are made up of proteins
When foods are eaten and properly digested,
proteins are broken down by enzymes into
peptides
Peptides are then further broken down into amino
acids
Amino acids are the building
blocks of life
What can go wrong with the GI?
1. Leaky gut
2. Intestinal dysbiosis
a. Constipation
b. Diarrhea
c. Enterocolitis
3. Allergy
1. What is “leaky-gut”?
Definition: an abnormal or unfavorable increase
in intestinal permeability
 Epithelia are either 'tight' or 'leaky' depending
on the ability of the tight junctions to prevent
water and solute movement
 The intestinal lining is supposed to be the
protective barrier between the gut and the
bloodstream
 If the intestinal lining becomes damaged-it is
possible for incompletely digested proteins
and/or other by-products to “leak” through the
intestinal lining
 They can be recognized as foreign by the
immune system, and/or “leak” into
bloodstream
2. Dysbiosis
Intestinal flora (yeast and bacteria) are a normal
part of digestive track
Intestinal dysbiosis occurs when there is an
overgrowth/imbalance of intestinal flora(s)
Dysbiosis results from
Increased use of antibiotics, steroids, etc.
Poor diet
Diets high in sugar
Stress
Immune system dysregulation
a. Constipation/ b. Diarrhea
a. Constipation-having a bowel
movement fewer than three times per
week
 Stools are usually hard, dry, small in size,
and difficult to eliminate.
 Can be painful to have a bowel movement
and
 often experience straining, bloating, and the
sensation of a full bowel
b. Diarrhea-frequent loose or liquid
bowel movements (often associated
with infection, allergy and food
intolerances)
c. Enterocolitis
Inflammation [itis](due to infection or irritation)
that affects part or all of the intestines (the small
[entero]and/or large [col] intestines)
Hyperplasia-general term for an increase in the number
of the cells of an organ or tissue causing it to increase in
size
Endoscopy-looking inside, the human body for medical
reasons, by inserting a small scope in the body
Ileonodular Normal Terminal
Hyperplasia Ileum
Consequences of intestinal dysbiosis
or “leaky gut”-if left untreated
Nutrients and vitamins aren’t absorbed
properly---vitamin deficiencies
Intestinal distress
Food allergies are created
Detoxification is compromised
Bacteria and yeast can be mobilized
Formation of antibodies you might not want---
because of immune dysregulation
3. Allergy
The most obvious place for an allergic reaction to food
to take place is in the GI track
Reactions can range from acute to chronic
A large part of the immune system is located in or near
the intestinal tract-to helps prevent microorganisms in
the intestine from entering into the rest of the body
 1st line of defense against pathogens 
 Defects in the immune system can lead to gastrointestinal
problems
Food allergies vs. food sensitivies
Food allergies
An immune system response . . . to foods
Body mistakes a protein in food as harmful, and
creates a defense against it (antibody)
Allergy symptoms appear within minutes to an hour
or so after eating the suspected food-body is battling
invading food
Symptoms include eczema, an itchy red rash most common
in the elbow creases or behind the knees hives, nausea,
swelling, difficulty breathing and/or anaphylactic shock
Food sensitivities/food intolerances

Digestive system response to foods

Not an immune system response
Something in food irritates digestive system or
person is unable to breakdown/digest food
Can include metabolic food disorders such as
lactose intolerance (missing enzyme)
Symptoms include crapping, gas, nausea, and
stomach pain
Overview of the immune system

White blood cells

associated with
acquired immune
system are called
lymphocytes
T Cells
B Cells
Normally, there is a balance
between infection and immunity

infection immunity
Immune system function
The immune response is how your body recognizes and
defends itself against bacteria, viruses, and substances
that appear foreign and harmful to the body
Normal immune system function, depends upon proper
immune system responses
1. Protects and defends against foreign cells
2. Memory-gets smarter
3. Responds appropriately
4. Do no harm
Things can go wrong with the
immune system . . .
Hypersensitivity
Autoimmunity
Inflammation
Immune system dysregulation
 Immune system dysregulation
Immune system dysregulation causes an abnormal
immune response
there is a “ shift or skewing” – lack of balance
The immune system looses the ability to respond
appropriately. . . and when this happens, it is
possible that the body develops abnormal
responses to things it might not normally react
to . . .
like foods
What happens if the immune system is
compromised
Immune dysregulation
Abnormal balance and communication between immune
cells
Chronic Inflammation
An abnormal, persistent activation of immune cells in the
tissues
Autoimmune reactions
Antibodies targeting and causing injury to normal body
tissues
The immune system is closely connected to virtually every
other system of the body
Disorders in the immune system can cause disease
The liver & detoxification
Designed to remove toxic matter from the bloodstream
Produces bile
Metabolizes proteins and fats
What happens if liver function is
compromised?
If detoxification systems are overloaded,
destruction of nutrients necessary for proper
detoxification occurs
If detoxification pathways are overloaded,
build up of toxins can occur
If transsulfuration is disrupted,
there is less antioxidant production, and
oxidative stress can occur
The Vicious Circle •heavy metal exposure
Of Chronic Toxic •environmental toxins
Liver •foreign proteins-
Overload Overload incompletely broken-
down
food
Candida Intestinal
Detoxification
Problems
permeability
Dysbiosis

Oxidative May treat with

Stress Rx/drugs
•antibiotics
Health •antifungals
Free Radical •steroids
Problems
Production
•gastrointestinal distress
•allergy
•autoimmune problems
•infections
Detoxification biochemistry
Methylation and sulfation
A healthy body’s way to rid itself of toxic substances
Methylation-transferring a methyl group
Transsulfation-responsible for production of glutathione-
the body’s number one antioxidant

Children with autistic spectrum disorders often need

supplements to provide them with the raw materials
their bodies need to efficiently carry out methylation
and sulfation
49 Lauren W. Underwood, PhD
 Transsulfuration
Methionine/Glutathione pathway

Transsulfuration Pathway
Methionine
Remethylation
pathway SAM
THFolate TMG

Methionine DMG
Synthase SAH
Methylene
THFolate Homocysteine
Methyl
B12
Methyl B6
THF B12
MTHFR
Cysteine

Glutathione (GSH)
Critical to the body’s ability
to remove toxins!
Methionine/glutathione transsulfuration
pathway in autistic children
How do you treats biomedically?
Look for a physician or other healthcare practitioner
who considers an integrative approach to treatment
combining mainstream medical therapies and CAM
(Complementary and Alternative Medicine) therapies
No single treatment works for every child. 
What works for one child may not work for another,
and a successful course of treatment often includes a
combination of approaches
Expected key benefits of biomedical
treatment for autism
Improvements in immune function, resulting in
healthier children who seem to be very resistant to
coughs, colds, runny noses, ear infections and who
seem to get over  viral infections quicker than the
rest of the family.
Improvements in digestive function, resulting in
more normal stool frequency and consistency;
reduction or elimination of lower abdominal pain
or discomfort; reduction or elimination of loose
stools or diarrhea.
Children seem to thrive
Expected key benefits of biomedical
treatment for autism
Improved appetite and a wider variety of foods
tried and consumed, increased nutrition
THEN . . .
Better socialization and initiation of
communication with family and peers;
Increase in more normal social interactions and
social play
Improved vocabulary and sentence structure;
Improved cognitive function
Improved higher order functions
Some basic biomedical interventions
Diet
Healthier diet
Specialized diet
Gluten-Free Casein-Free Diet (GFCF)
Rotation Diets, others
Nutritional Supplementation
Detoxification

Some complementary/alternative
biomedical interventions
HBOT
Chelation
Healthier Diet
Read labels . . . .
Are special diets so “special”
and which one do I choose?
Many autistic children suffer from
inflammatory response/immune system
dysregulation
Many autistic children don’t/can’t digest
their foods efficiently
diet options: GF/CF, SCD, BED, LOD,
Pick one that works best for you and your
family
regardless of diet choice, it is important
to ensure proper nutrition
Diet: Gluten-free Casein-free Diet
A restrictive diet that removes all food items that
contain both
gluten and casein
The are two main theories currently present in
scientific literature that explain why some people
with autism and PDD respond positively to a
GFCF diet
 improperly broken down dietary peptides
 immune system dysregulation
Improperly broken down dietary peptides
 Some people with ASD cannot properly digest gluten and
casein, which break down into substances that act like
opiates in their bodies
 According to this theory, these "drug-like" substance alters
the person's behavior, perceptions, and responses to his
environment
Casein/casomorphin and
gluten/gliadorphin
 Casein is a protein found in milk and products containing
milk
 Casomorphin (or caseomorhin) is a peptide derived from
the milk protein casein

 Gluten and gluten-like proteins are found in wheat and

other grains
 Gliadorphin (or gluteomorphin) is a peptide derived from
the wheat protein gluten
Immune system dysregulation
Immune system loses it’s ability to respond
properly
Body develops abnormal responses to things it
might not normally react to
An abnormal immune response can result in
Autoimmunity
Inflammation
Hypersensitivity
Allergy
 Other dieting options
SCD diet
Rotation diet
Soy and corn-free diet
White diet
Sarah’s diet
“But bread and cheese
are all my child
eats!”
If I take away those
foods, . . .
they’ll starve!”
Consider this . . . .

Although at the beginning the diet may seem

difficult, it maybe infinitely easier to try the diet,
and end up having a happier healthier higher
functioning autistic child, than living with a
bad/poorly functioning one!!!
Nutritional supplementation
Why nutritional supplementation?
1. Nutritional deficiency
involves a lack of one or more nutrients obtained from
food essential for normal cell and body function
occur due to
 Mal-absorption/poor absorption in the small intestine
 Unhealthy eating, or
 Self-imposed/imposed dietary restrictions
 Poor utilization of nutrients because of genetic or environmental
factors
2. Oxidative Stress
There are nutritional deficiencies
associated with disease
Rickets-vitamin D deficiency
Scurvy-vitamin C deficiency
Beriberi-thiamine deficiency
Pellagra-niacin deficiency
Goiter-iodine deficiency
Signs and symptoms associated with
nutritional deficiency
Neurological symptoms
Memory loss
Psychosis
How can a
Bruising
child attend,
Confusion
focus, and learn?
Impaired learning
Growth retardation
Loss of appetite
Poor immune function
Commonly deficient nutrients
Vitamin B12
Vitamin B6
Folate or folic acid
Vitamin A
Vitamin C
Vitamin D
Zinc
Magnesium
Omega 3 fatty acids
Nutritional Supplementation
Supplementation
Enzymes
Methyl b12
Antioxidants
TMG/DMG
Essential fatty acids
Glutathione
Folic acid
Melatonin
Nutritional supplementation to
combat oxidative stress
Vitamin E Calcium
Vitamin C Selenium
Zinc
Vitamin B6 or
its activated form,
pyridoxal-5-phosphate (P5P)
with Magnesium
Why detoxification?
 To prevent injury to the cells and
ultimately cell death
 Cell injury and cell death is bad
 In autism, toxins may be a cause of
the neurological and immune
dysfunction
 Detoxification may help the cells to
recover which will enable for healing
 If toxins accumulate too rapidly,
without being safely eliminated,
they can cause damaging effects
upon cells and tissues of the body
How does your body detoxify?
Designed to remove/eliminate toxic substances
from the body
Primary function of liver and kidney
Glutathione
Once toxins are bound they are eliminated via bile
and urine
Can also be achieved via artificial (chelation) or
supplementary (sauna) means or through
hyperbaric oxygen therapy (HBOT) . . .
Complementary interventions:
 HBOT
Effective way to get more oxygen into the body at the cellular
level by using pressurized air chambers
healing the gut and brain inflammation (two that may be separate
issues or experienced simultaneously)
blood flow to key areas of the brain
dealing with gut parasites, yeast or bacteria
or if it helps all four areas

 Chelation
Chemical process in which a substance is used to bind molecules, such
as heavy metals metals (arsenic, lead, mercury) and hold them tightly
so that they can be removed from the body
How do you implement a detoxification
program?
Should be done under the direction of an
experience physician or other practitioner
Support the body’s own detoxification system—
nutrients,
Methyl B12
Glutathione
DMG/TMG
Folic acid
Remove accessible toxins—chelation
Monitor closely
 Maximize metabolism;
normalize biochemical pathways
Understanding the “overlay”
of biomedical and behavioral
interventions . . .
Why consider behavioral therapy
programs?
An autism diagnosis is based upon behaviors---NOT
medically based
Generally a psychiatric/psychological diagnosis is
made at 18-24 months
Most neurological development occurs during this
time
Experienced 18 months of abnormal deviant
developmental behaviors . . . HUGE developmental
gap
You can not go back in time to go through this
developmental period
18 month old
Warning signs that might reflect
biomedical issues
Any shift in behavior
Looks for patterns of behavior change
Look for signs and sources, red flags:
Changes in sleep
Increased irritability
Rashes
Red ears
All discipline strategies can be affected by
biomedical issues/conditions
Why is there an overlap between
behavioral and biomedical interventions .
..
Remember co-morbid biomedical conditions which
can setback or slow down therapies
No single treatment works for every child--What
works for one child may not work for another, and
A successful course of treatment often includes a
combination of approaches
Be aware of any change in meds or supplements–
this can affect behavior- applies for
neurotypical as well as child with autism
 
Why do behavioral and biomedical
interventions go hand in hand?
If a child suffers from allergies
Focus and concentration can be affected
If a child suffers from GI distress, like constipation,
diarrhea
Cramping, bloating will distract them
Pain may lead to self-injurious behavior
If their are immune system issues
Increased infections, inflammation can affect attention
and concentration
If biochemical pathways compromised
Neurotransmission can be under or over stimulated
Why do behavioral and biomedical
interventions go hand in hand?
If a child suffers from digestive issues
Improperly broken-down foods can have an affect upon
behavior
Not receiving essential nutrients for biochemical
pathways and maximum metabolism
If a child has detoxification problems
Build-up of toxins, increased oxidative stress, symptoms
—affect attention
 Treat underlying medical conditions
Look for signs:
Posturing
Bloated belly
Eczema
Allergy
Sound sensitivity
Look for symptoms associated with
abdominal pain…
 Crying
 Unexplained tantrums
 Night time wakening
 General irritability
 Vocalizing complaints
 Posturing
 Irritability just prior to bowel movement
 Hyperactivity and distractibility
 Self injurious behavior
Treat underlying medical conditions
Look for signs:
Sleep issues
Toileting issues
Tantruming
Irritability
Hyperactivity
Self-injurious behavior
 A happier, healthier child is
going to be more responsive to
behavioral, social and sensory
interventions
 Paradigm switch

autism is not a psychological condition –

it is a neuro-gastro-immunological disorder
resulting from an genetic susceptibility and
an environmental insult
“The abnormal metabolic profile in children with
autism is consistent with the abnormal genetic
profile and strengthens the hypothesis that may
predispose these children genetic susceptibility to
oxidative stress and reduced methylation capacity
to neurological, immunological, and
gastrointestinal dysfunction that occurs with
autism”—Dr. Jill James
Maybe there is a genetic
susceptibility . . .
and environmental factors can affect trigger
effects
A new paradigm in autism
Autism is an environmental illness with a genetic
component.
It is a complex metabolic disease, not just a
developmental disability.
Autism is treatable, but . . .
We must continue fighting for a cure!
 Understanding Autism for
Dummies
 Provides the simple breakdown of
behavioral, medical and other
intervention
 Offers practical advice on how to
educate children, as well as
insights on helping people with
autism maximize their potential

S. Shore, L. Rastelli,
T. Grandin
Take home lessons
1. There are many behavioral therapy options-pick
one that works best for you and your family
2. There are biomedical options for treatment
3. Basic immunology and biochemistry can explain
how things can go wrong in the body, and
 that many autistic children suffer from real clinic
symptoms that are treatable, and
 nutritional supplementation may be necessary to replace
necessary building blocks for proper cell function and
system functions
Take Home Lessons
4. If detoxification is not functioning properly, it
may be necessary to supplement with co-factors
to bypass deficiencies. These include methyl
B12, folic acid, B6, DMG and/or TMG
5. Most importantly, understand that biochemical
and behavioral interventions need to be
implemented together to enable more successful
treatment results and outcomes
And this is how you feel now . . .
Don’t try to do everything all at
once!!!!
Baby Girl: 12 weeks
Baby girl: 9 months
Baby girl: 12 months
Baby girl: 13 months
Baby girl: 15 months
Baby girl: 20 months
Baby girl: 24 months
Baby girl: 30 months
After interventions:
4 year old girl
Same child: Age 10 and 12
Baby boy: 12 weeks old
Baby boy:13 months old
Baby boy: 22 months old
Baby boy: 24 months old
Boy after interventions

3 years old 5 years old

More and more autistic children are
getting better every day,
and although there is no guarantee . . .

there are more reasons to be hopeful that your

child could be part of the extraordinary
journey towards recovery
Remember, . . .
Be patient
Be inspired
Have strength
Never give up hope, and
Never give up courage
Love your child!