The Wall Street Journal on Treating Autism
Treating the Body vs. the Mind - More on the Autism Treatment Network

[By Rachel Zimmerman for The Wall Street Journal. Available online by
subscription only. Thanks again to Beth Noland.]

Many parents of autistic kids have long argued that something other than the disorder itself was causing some of their children's problems. Now, mainstream medicine is beginning to acknowledge that. The idea, embraced by a growing number of top specialists, is to treat medical conditions that are common in autistic children.

These problems -- which include gastrointestinal disturbances, sleep disorders and food allergies -- may be contributing to the children's behavioral difficulties. While such conditions are frequently treatable, they often go undetected due to lack of physician awareness and the children's poor language skills.
Major hospitals, from Massachusetts General to the Cleveland Clinic, have begun aggressively treating underlying medical problems in autistic children, and researching how these problems may be linked to the disorder's symptoms.

The movement got a big push this month when six hospitals joined together to form the Autism Treatment Network, aimed at coordinating an approach to a wide range of potential physical problems.

When 10-year-old Becky Sullivan began biting holes in her wrists and hitting her own face so hard that it bruised, two psychiatrists and a neurologist told her mother the outbursts were behavioral problems caused by her autism. One suggested an antipsychotic medication, but that didn't stop
the aggressive behavior.

Her mother then took Becky to Massachusetts General Hospital in Boston, where a pediatric gastroenterologist found that Becky's esophagus was severely inflamed and covered with ulcers. Her violent behavior likely resulted from frustration with her inability to communicate the excruciating
pain, the doctor concluded. Acid- reflux medicines halted the problem almost immediately. "She's a whole different kid," says Becky's mother, Jacquelyn Sullivan of Quincy, Mass.
Autism is a broad term used to describe a spectrum of developmental disorders marked by language difficulties and emotional withdrawal.

Currently, there is little agreement about what causes it, or why its incidence appears to have increased tenfold over the past decade.

Desperate parents have often stumbled through a morass of conflicting medical and behavioral advice, from intravenous supplements to swimming with dolphins.

Guidelines for an Exam The Autism Treatment Network, which recently began meeting, plans to draw up national guidelines for a thorough physical examination aimed at catching medical problems that appear todisproportionately affect autistic children. The hospitals plan to gather
data on patients and publish findings on the prevalence of different medical disorders in autistic children. Centers participating in the network include Baylor College of Medicine, Houston; Cleveland Clinic Foundation, Cleveland;
Columbia University Medical Center, New York; Massachusetts General Hospital, Boston; Oregon Health & Science University, Portland, Ore.; and the University of Washington Medical Center in Seattle.

"What we are trying to standardize is the concept that children with autism can and do have health-care issues just like typical kids and they deserve the same degree of attention, evaluation and treatment," says Margaret Bauman, a pediatric neurologist at Massachusetts General Hospital
and a member of the committee that will oversee the new consortium.

One of the first priorities of researchers will be to settle --
through clinical study -- the hotly debated question of whether certain medical conditions, such as acid reflux, diarrhea and other gastrointestinal maladies, are more common in autistic children than in other kids.

For example, sleep deprivation, which can cause irritability and social difficulties in healthy people of all ages, appears at least at first blush to be more common in autistic children. One small study found that more than 66% of autistic children suffer from insomnia or other sleep disturbances, compared with only 30% of typical children, says Kyle Johnson,
co-director of the pediatric sleep clinic at Oregon Health & Science University.

The autism network will soon begin collecting data on children and adolescents' sleep patterns. Researchers may also look for potential causes of the sleep problems, such as defects in the production of melatonin, a brain hormone that induces sleep, which preliminary work suggests may be
produced at lower levels in autistic children.
Some parents already treat their autistic children with over-the- counter supplements, but there's little proof they work.
Another area getting increased attention is food allergies.
Scientists at Massachusetts General and across the country have begun looking for the reason that many autistic people appear unable to tolerate certain foods, such as wheat and dairy. Early research suggests the children have very "permeable guts," a term that means the intestines allow certain substances to cross into the bloodstream that would normally be blocked, says Timothy Buie, the gastroenterologist who treated Becky Sullivan.

One theory of how this relates to autism is that the small proteins of wheat and milk could bind to cell receptors in the brain and alter a child's mental state.

Richard Fade, a Medina, Wash., venture capitalist and parent of an autistic child who helped organize and raise funds for the new consortium, says he eliminated wheat and dairy from son Mitch's diet four years ago. The then-6-year-old's temper tantrums and anxiety decreased dramatically, and
the unpleasant rashes on his body went away, his father says. The dietary change didn't cure his autism, diagnosed at age 2, notes Mr. Fade, but"there's a night-and-day difference in what he can do."

Another area the network will research is so-called metabolic
disorders, where the body can't properly break down important biochemicals.

One related problem that appears to affect a small percentage of autistic children is a malfunction in the mitochondria, small intra-cellular bodies that produce the energy needed to fuel the body, says Marvin Natowicz, a medical geneticist in the neurology department at the Cleveland Clinic. A
mitochondrial malfunction could be responsible for the extreme exhaustion found in some autistic children, Dr. Natowicz says. It could also be somehow causing other symptoms as disparate as seizures, significant diarrhea and
even constipation.

Supplements and Vitamins
Some physicians have tried giving high doses of certain vitamins such as B2, B1 and C, which are believed to aid aspects of mitochondrial function. Another approach is to give supplements such as antioxidants or carnitine, an amino-acid derivative, which scientists believe can neutralize the buildup of certain compounds if the mitochondria aren't working properly. The consortium plans to gather data on children with a series of tests to screen for chromosomal and metabolic disorders.

Until more is known, many doctors say parents with autistic children who are acting out should press their pediatricians to keep looking for possible medical causes -- and seek multiple opinions from specialists if necessary. "If the kid is being aggressive, self injurious, or otherwise exhibiting odd behavior or symptoms, parents should be unwilling to accept that as 'autism' behavior until proven otherwise," Dr. Buie says.