I came upon an article in the Huffington Post about Dr Mark Hyman's account of a child who seemed to have been "cured" of his childhood autism: "Autism Research: Breakthrough Discovery on the Causes of Autism". (December 11, 2010 11:37 AM). Dr Hyman attributed the child's "cure" to intense nutritional intervention aimed at correcting gut flora and metabolic functions concerning absorption. In making this connection, he referred to this exploratory research by Dr Cecilia Giulivi and colleagues of University of California, Davis.
I note that it is titled by the authors as a "Preliminary Communication" only and was not meant to be the final answer to any specific problem.
The paper is about "Mitochondrial Dysfunction in Autism", which means it's about how the cells of the body process energy or nutrients which are absorbed from the blood, after they enter the body via the gut. Dr Giulivi and colleagues did a laboratory experiment with some white blood cells belonging to autistic and normally developing children- they didn't use their brain cells. In autism research the processes that happen in white blood cells are used as an analog or model of how brain cells work. So their research is NOT on autistic children who are present in the lab, and is only about cells, not the whole living, breathing child. You should note that none of the authors work in a clinic or school for autistic children, so they are certainly not claiming they have even the beginnings of a cure. Their basic research conclusion is "In this exploratory study, children with autism were more likely to have mitochondrial dysfunction, mtDNA overreplication, and mtDNA deletions than typically developing children."
Please, dear readers and parents, don't put too much hope on this piece of research. There has been 50 years or more research on possible metabolic influences on autism- I was involved in some myself on serotonin/dopamine metabolism.
My own conclusion from the research is firstly that I am not very confident white blood cell metabolism is a very good representative of the areas of the brain I believe may be damaged pre-natally in autism spectrum disorders. Also, I imagine that the damage to the developing brain occurs to varying degrees and reaches different projections of nerve pathways in each child's brain, interacting with the rest of their potential for brain development, making it very unlikely that any one "treatment" or combination of strategies could ameliorate autistic thought and behaviour.
The appealing little boy featured in Dr Hyman's video seems rather normal and delightful and he also resembles several children I have interacted with who were similarly autistic when they were toddlers. As several people commented on the Hyman post, brain development reaches a certain level of maturity around 6 years old and kids become able to learn in class groups rather than alone or one-to-one. After this time lots of connections are possible between areas of the brain, but hardly any more new cortical cells develop or migrate. I think this little guy was rather bright originally and was able to benefit from his brain maturation plus good therapy.
Some high-functioning autistic children learn the rules, or how to simulate the rules, of normal social interactions and communication during the early school years, particularly if they have had attentional training and helpful parents. I remember a youngster whom I used to collect from his home to travel to the Flinders Medical Centre laboratory where we asked him to do some attention-grabbing tasks while recording his EEG/brain waves. He was a nice, quiet young boy (around 10 to 11 years old) and would talk during our journey if I spoke to him. He had very few twitchy movements or strange habits and could have been taken for "normal" by anyone we met. However, until he was about 8 he was the weirdest kid his parents had ever met! His habits, noises, bizarre reactions to people and situations had held the household to ransom since he was about 8 months old and became mobile! He had received a lot of individual speech, cognitive training and behavioural therapy so he could attend a mainstream school, because he could read and count at age level. His brain activity during the tasks was very similar to the other autistic people we tested, and was unlike that of the "normal" kids we had matched to them on several criteria. I'm sure Dr Hyman would have considered him "cured" given his everyday behaviour, just as his teachers did; his mum could still see his little quirks.
If you're interested in the idea of pre-natal brain development problems as an explanation for different degrees of autism, have a look at some early work from 1982 and some much more recent work in Italy which recaps the same theme, but with greater detail.
I love the work done by Simon Baron-Cohen on "theory of mind" and autism. While I agree with it up to a point as I can see that most autistic people behave as though they have no idea how the world appears from my point of view. However, my own pet theory is that the brains of autistic people are damaged sufficiently to leave them with a deficit in understanding what is important to attend to in the world, in order to function and survive. I call this a problem with "salience"- I think there is something wrong with the connections amongst the parts of their brains responsible for visualising movements and relating what they can see others doing, to their own body in motion. To me they seem as though they don't get the idea that speech is for communicating and that there is a lot of information in other people's faces that they should be using to decipher what happens. It's as though a basic biological connectedness is missing or damaged, so that they don't really "get it" the same way as ordinary people. They experience the world in different ways to the rest of us- it is quite difficult for us to explain to anyone how WE experience the world (we take it for granted; it's natural)- so how can we expect them to convey to us how THEY experience it? A super BIG ASK! All we can do is try to teach them to behave and reason about things like the rest of us so they and their families can have a calmer time.
There is a lot of research and therapy development at the Autism Research Centre in London, UK, which has a whole website devoted to it.
NB. It might be a little hard to include this as a "public health" post, but to me it is important that we balance the spending of health dollars amongst things which are likely to have an effect on a lot of people versus on special programs we might ration amongst only those likely to derive maximum benefit. It can be a cruel reality for parents when their autistic child is rated as "too impaired" to enter a special social skills or language program. For higher functioning kids, this sort of program might enable them to eventually live independent lives in the community whereas there is little hope of this for the children with the worst symptoms.
