Conference Coverage

Viewing childhood autism as a whole body disorder

Intestinal inflammation, oxidative stress, immune problems affect subsets of patients.


 

EXPERT ANALYSIS FROM NPA 2019

– When parents of children with autism ask their primary physicians about complementary and integrative medical treatments, they often get stonewalled, according to Robert L. Hendren, DO.

Dr. Robert L. Hendren, University of California, San Francisco Doug Brunk/MDedge News

Dr. Robert L. Hendren

“They find [clinicians] usually say, ‘Don’t try that stuff. It doesn’t work,’” Dr. Hendren said at an annual psychopharmacology update held by the Nevada Psychiatric Association.

“Parents then go to two different sets of providers,” he said. One provider “tells them about complementary and integrative medicine, but is likely not a traditional physician who’s treating their autism. It’s somebody who knows about these biomedical interventions but when parents tell them that they’re using traditional interventions ... that person also says, ‘Don’t use that. That’s doesn’t work.’ Then they go see their traditional provider who might be thinking about traditional medications. But they’ve learned that they don’t want to tell them, ‘I’m considering using omega 3s or zinc.’ Regrettably, most times physicians don’t say, ‘Let’s examine that. Let’s look at the literature and see if that’s the right decision for you.’ By shutting a family down saying, ‘I don’t want to hear about that,’ it often leads the family to think: ‘How do I make a decision about this? How do I know what to do?’ ”

Dr. Hendren said clinicians are beginning to embrace the notion that autism is not just a brain disorder, but rather a whole body disorder. For example, he noted that significant subsets of people with autism have intestinal inflammation, digestive enzyme abnormalities, metabolic impairments, oxidative stress, mitochondrial dysfunction, and immunity problems that range from immune deficiency to hypersensitivity to autoimmunity. “In many cases, improvement of autistic symptoms is achieved by a combination of nutritional recommendations, prescription medications, and addressing the underlying medical conditions seen in these individuals,” said Dr. Hendren, professor of child and adolescent psychiatry at the University of California, San Francisco. “I hope that by thinking about making the body healthier, we can help kids have the very best outcomes.”

Several biomedical treatments have adequate evidence to use for many patients, he said, including melatonin, probiotics, omega 3s, and possibly vitamin D3, methyl B12, oxytocin, restrictive diets, digestive enzymes, and choline. “There are strong anecdotal reports of gluten-free diet benefits,” said Dr. Hendren, who also directs the UCSF Program for Research on Neurodevelopmental and Translational Outcomes. “Some parents I greatly respect tell me it’s the single most important thing they’ve done in their child’s health, that their GI symptoms have improved, and their overall health has improved.”

In a multisite trial called aViation, researchers are evaluating the effects of an investigational vasopressin antagonist in autistic patients aged 5-17 years. The drug works by blocking a brain receptor of the vasopressin receptor that is associated with control of stress, anxiety, affection, and aggression. “The first trial in adults showed potential benefit,” Dr. Hendren said.

No robust studies exist to suggest that medical marijuana makes a difference for patients with autism, he said, but he has several patients whose parents give their affected child medical marijuana or cannabidiol. “I have a number of families who say it’s really made a big difference for their children and for how they’re doing,” he said.

In Marin County, Calif., the Oak Hill School serves a heterogeneous population of children, adolescents, and young adults, all of whom have autism spectrum disorder (ASD) or other neurologically based disorders of relating and communicating. Students receive special education instruction and customized on-site clinical programs that might include speech/language pathology, occupational therapy, and group and individual psychotherapy. Some of the students have received recent functional behavior analyses from Dr. Hendren and his colleagues, with school staff implementing positive behavior intervention programs.

The researchers also are using metabolomics as a biomarker of outcome. “We’re using metabolomics from the urine, where we can look at these processes in different clusters and see whether our interventions make a difference or not,” said Dr. Hendren, who is a past president of the American Academy of Child and Adolescent Psychiatry. “We did one trial with sulforaphane, which is a concentrated broccoli sprout extract that helps with oxidative stress. It was initially developed to treat oxidative stress in cancer,” he said. Upcoming trials in this cohort include the use of folinic acid and CM-AT, a pancreatic digestive enzyme intended to increase levels of chymotrypsin.

“I think of autism as being a disorder where you have this person and there’s a veil of autism that comes over the top of them,” he said. “That veil is not the kid, although the kid becomes more and more expressed through that. If we can do something to lift that veil, we can do more and more to pull that child out.”

Dr. Hendren disclosed that he has received grants from Curemark, Roche, Shire, and Sunovion. He is a member of the advisory boards for Curemark, BioMarin, Janssen, and Axial Biotherapeutics.

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