I’ve written about integrative therapies, the medical home, and autism before, but one of my biggest New Year’s wishes is that we’ll finally accept a new paradigm for treating autism in 2007.
2006 witnessed the passing of the Combating Autism Act, recently signed into law by the President. Whether or not the funds will be appropriated to truly address the causes of autism and much needed treatments is a hotly-debated point. We must do a better job looking at environmental issues and at considering integrative approaches to autism spectrum disorders. What follows below is a summary I wrote for the Deirdre Imus Environmental Center.
Autism: A Public Health Crisis
Autism and related neurodevelopmental disorders are now believed to affect one
in six American children. The reasons for the meteoric rise in autism
spectrum disorder (ASD) diagnoses are hotly debated, but it is clear
that we are in the midst of a unique public health crisis. We are
seeing tremendous effects on health care and educational resource
utilization. In a recent article I wrote for the journal Alternative & Complementary Therapies
(October 2006) titled “Autism Spectrum Disorder: A New Paradigm for
Integrative Management,” I emphasized the need for a new model of care
for children with ASD. This paradigm shift acknowledges the
overwhelming evidence that ASD is a complex, multisystemic medical
disorder, and it supports a holistic approach integrating conventional
and complementary/alternative (CAM) therapies.
“The Medical Home” is one such model proposed to better serve the
needs of children with special health care needs, including autism. A
medical home is defined by the American Academy of Pediatrics (AAP) as
primary care that is accessible, continuous, comprehensive, family
centered, coordinated, compassionate, and culturally effective. It is
my belief that pediatric integrative medicine is ideally suited as a
model of care to support this medical home concept. Integrative
pediatricians emphasize family centered and culturally effective care,
focusing on the whole child – the child is not an island unto
themselves but exists within a context of family and community. We
value wellness and believe optimal health is not simply the absence of
disease, but a presence of healthy mind, body and spirit. We advocate
individualizing therapies, knowing that a “one-size-fits-all” approach
does not adequately address the diversity of clinical and biochemical
issues noted in children with ASD. Integrative pediatricians take into
account the effect of the environment on health, and the impact of
human living on the environment. Both the environment and social
interactions are seen as potential allies for healing. In fact, the
relationship between primary care provider and family is seen as part
of the healing process. Respectful collaboration is the model for the
doctor – patient relationship, and for that matter, for the
relationship between all healthcare providers. This model allows
families to work comfortably with CAM providers while their primary
care provider assists in coordinating care; this is the medical home
concept in a nutshell.
Families often incorporate use of CAM therapies (92% in a study I
co-authored in the Journal of Developmental and Behavioral Pediatrics)
in part because they believe conventional medicine does not address
both root causes and clinical symptoms particularly well. One of these
strongly held beliefs is that there are environmental factors
responsible for the epidemic of autism. Medical establishment
historically has been slow to accept such claims, focusing
predominantly on genetic etiologies. But, as author Richard Lathe
notes in his book, “Autism, Brain, and Environment” (Jessica Kingsley,
2006), it is plausible that children with a genetic predisposition are
more likely to express autistic clinical symptoms under certain
environmental conditions. The environmental stressors may include
infectious agents (viruses), nutritional contaminants and allergens,
and toxic exposures including heavy metals. A recent landmark paper by
Drs. Grandjean and Landrigan published in the well-respected journal
Lancet (Early Online Publication at DOI:10.1016/S0140-6736(06)69665-7) details
the important role industrial chemical pollution plays in developmental
neurotoxicity. We can no longer ignore the impact that changes in our
environment have had on our children’s health. The human cost is too
AAP Committee on Children with Disabilities: Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics 107: 598-601, 2001.
AAP Medical Home Initiatives for Children With Special Needs Project Advisory Committee: The medical home. Pediatrics 110: 184-186, 2002.
Centers for Disease Control and Prevention (CDC): How common are ASD’s? http://www.cdc.gov/ncbddd/autism/asd_common.htm, accessed Aug 10, 2006.
Harrington JW, Rosen L, et al: Parental perceptions and use of complementary and alternative medicine practices for children with autistic spectrum disorders in private practice. J Dev Behav Pediatr 27: S156-161, 2006.
Herbert MR, et al: Autism and environmental genomics. Neurotoxicology 2006, in press.
Koger SM, et al: Environmental toxicants and developmental disabilities. American Psychologist 60: 243-255, 2005.
London E, Etzel R: The environment as an etiologic factor in autism: a new direction for research. Environ Health Perspect 108: S3, 2000.
Mercer L, et al: Parental perspectives on the causes of an autism spectrum disorder in their children. J Genet Couns 15: 41-50, 2006.
Nataf R, et al: Porphyrinuria in childhood autistic disorder: implications for environmental toxicity. Toxicol Appl Pharmacol 214: 99-108, 2006.
Newacheck PW, et al: Health services use and health care expenditures for children with disabilities. Pediatrics 114: 79-84, 2004.
Szpir M: Focus: New thinking on neurodevelopment. Environ Health Perspect 114: A100-107, 2006.