• “In inflammatory bowel diseases, chronic GI inflammation, caused by autoimmune conditions, is often associated with behavioral symptoms as well as impaired cognitive activity. Interestingly, it was reported that in 35 ASD children with language regression, there was a positive association with both GI symptoms and family history of autoimmune diseases.”  

  • “The current study confirmed these suspicions, and found that children with autism had significantly fewer types of gut bacteria, probably making them more vulnerable to pathogenic bacteria. Autistic subjects also had significantly lower amounts of three critical bacteria, Prevotella, Coprococcus, and Veillonellaceae.”   

  • “Some children are aggressive, and some have even been described as animalistic. It [Autism] is a devastating disease for the children and their families……some patients have responded to several courses of vancomycin and relapsed each time it was discontinued. The issue can be raised as to whether the effectiveness of vancomycin might be related to some unknown property of the drug aside from its antimicrobial activity (e.g., an effect on the CNS). Because vancomycin is only minimally absorbed when given orally, it is much more likely that the effect is mediated through its activity on intestinal bacteria.” 

  • “The studies reported herein should be interpreted in light of the following considerations: (1) there may be ≥1 key organisms other than clostridia and ruminococci, (2) uncultivatable clostridia or other organisms may be present, (3) the key organism(s) may be present in small numbers (considering that autism is a low-grade, chronic process) and cannot be detected without the use of a selective medium or the availability of some special marker, (4) the organisms involved in autism may be mucosa-associated and therefore not cultivatable by the methods we used, (5) the key organisms may be farther down in the small bowel than we are able to sample, (6) the organisms of concern may be cell wall—deficient and therefore unable to grow on conventional media (although the response to vancomycin, a cell wall—active drug, indicates otherwise), and (7) different types of autism and/or different degrees of severity of the process may be different in terms of whether there is an abnormal flora either in the colon (reflected in the feces) or in the small bowel……”  

  •  “Studies have also shown alterations to the profile of the gut microbiome — the full range of commensal bacteria that live in the digestive tract — in children with the disorder. And studies in mice suggest that gut bacteria can actually influence behavior”

   • “Twelve of the children with autism had Alcaligenaceae, all of which was from the Genus Sutterella, the study found. No evidence of Alcaligenaceae was detected by PCR in the controls. …..Researchers have isolated Sutterella from infections, such as appendicitis, and from individuals with Crohn’s disease, an autoimmune disorder that leads to inflammation of the GI tract……Eleven of the children with autism and one control also carry antibodies that cross-react with Sutterella, an indication of infection and inflammation.”  

   •  “And now, scientists think there may be a link between what's in your gut and what's in your head, suggesting that bacteria may play a role in disorders such as anxiety, schizophrenia and autism. In some patients, the strep bacterium has been linked to OCD in a condition known as PANDAS.” 

  •  “…exposure to pathogens prenatally and postnatally, and findings of antibrain antibodies is common in disorders as diverse as schizophrenia, obsessive-compulsive disorder and autism, and suggests that differences in exposure timing and genetic vulnerability toward autoimmunity are important determinants of neuropsychiatric outcomes.” 

Are There Research and Treatment Strategies for the True Causes of Pain and Aggression In Autism?

Research is showing that the microbiome in many of those who have an autism diagnosis is the origin of pain, agitation, aggression, OCD and quite possibly -- autism itself -- that is, the myriad behaviors that manifest.  Looking through research then is imperative for clues and treatments to help:

  •  “Future metagenomic research is also likely to center on the complex relationships of the gut microbiome with the hundreds of other species of gut fungi, viruses, yeasts and parasites so that in time their true importance to human health will also be better understood.”

  •  “A study published in Nutritional Neuroscience from The Great Plains Laboratory, has shown that HPHPA levels are much higher in the urine of autistic children. Those treated with antibiotics effective against the bacteria clostridia show a decrease in symptoms….. "I don't know why this test isn't done on every psychiatric patient," he said. 'I question that every day."  

  •  “Caltech researchers found that mice with autism-like symptoms have a different mix of gut microbes than normal mice do. Those microbes make chemicals that leak from the intestines into the bloodstream (and perhaps the brain), producing behavioral changes. Treating the mice with the beneficial bacterium Bacteroides fragilis improved some symptoms, suggesting that altering the microbial mix might help some children with autism.” 

 •  “Microbes, both pathogenic and commensal, can induce autoantibodies that bind to brain and affect behavior in susceptible hosts. Interventions that correct the microbial balance or diminish autoantibody binding may be effective in diverse neuropsychiatric conditions mediated by autoimmunity.” 

  •  “…the American Association of Pediatrics (AAP) which states that, “Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders.” (Buie et al., 2010). Behaviours in the ASD population are often physical in origin, identifiable through investigation, and treatable or manageable through appropriate medical care.” 

  •  “If the gastrointestinal disorder is recognized and medical treatment is effective, the problem behaviours may diminish. When abdominal pain or discomfort is a setting event, psychotropic medications are likely to be ineffective and may even aggravate the problem if they have adverse gastrointestinal effects.”

  •  “ A joint clinical trial currently being undertaken by Massachusetts General Hospital and Second University of Naples is focusing on identifying a clinical diagnostic biomarker for non-celiac gluten sensitivity. It should be noted that Carrocio and colleagues (2013) found that the main histological characteristic of non-celiac wheat sensitivity was mucosal eosinophil infiltration. Histological findings of prominent mucosal eosinophil infiltration have been observed in a high percentage of children with autism, and have been found to be significantly lower in children following a gluten-free diet (Ashwood et al., 2003; Chen et al., 2010)”

  •  “ Animal models show clear connections between anxiety, abnormal social behaviours and levels of proinflammatory cytokines. Correcting immune abnormalities in post-exposure experiment animals with immune-modulatory treatments results in normalisation of immune function, and more importantly, improvements in cognitive function and complete and lasting reversal of abnormal autism-related behaviours.” 

  •  “Such findings offer the tantalizing possibility of using beneficial, or probiotic, bacteria to treat mood and anxiety disorders—either by administering beneficial microbes themselves or by developing drugs that mimic their metabolic functions. The new research also hints at new ways of managing chronic gastrointestinal (GI) disorders that are commonly accompanied by anxiety and depression, and that also appear to involve abnormal gut microbiota. 

One only needs to read all of this current research to ascertain that we are seeing more and more studies aimed at helping those with an autism diagnosis who have distressing symptoms of OCD, anxiety, pain and aggression.  Yet there are still those who appear to not want this paradigm shift to take place.

Psychiatric, Inpatient Care for Autism - What Exactly Does That Mean?

There seems to be a movement happening to open more autism-specific psychiatric units, NOT medical units.  Based on the enormous amounts of research showing the lengthening list of GI, bacterial, viral, infectious, diet, and immune system abnormalities in autism, it would appear curious:

Rapid Growth in US Inpatient Autism Units 

“The growth in specialized inpatient psychiatry units for children with developmental disorders parallels the growing number of children identified within the last decade with autism, researchers say….. "The genesis of these specialized hospital psychiatry units for children with autism is heartening news," Joseph Horrigan, MD, assistant vice president and head of medical research for Autism Speaks, told Medscape Medical News…. "These units address a significant unmet medical need that, up until this point, has caused great duress for families and their loved ones with ASD [autism spectrum disorder], especially when severe, disruptive behaviors are present and when there is an uncertain contribution of medical, psychological, social, and educational factors," Dr. Horrigan commented….. Matthew Siegel, MD, medical director, Developmental Disorders Program, Spring Harbor Hospital, Westbrook, Maine, spearheaded the survey…… "In general," Dr. Siegel said, "children and adolescents with autism have been shown to have rates of mental illness that are 3 to 4 times higher than kids in the general population, so it stands that the need for psychiatric hospitalization is going to be significantly greater."

Could it be that Dr. Siegel and Dr. Horrigan have not seen any of this research above and much more showing clear GI and immune connections to the behaviors that they list and autism?  I went looking to see if these units were doing any medical testing on these children coming in for aggression and self-injurious behavior.  Were they being misdiagnosed as “mentally ill” when they instead had medical reasons for their behaviors?

I found this which filled in some more information: 

“The researchers hope to enroll at least 500 participants. They are especially interested in discovering how best to treat aggression and self-injury. Siegel estimates that about 85 percent of children with autism who are admitted to special psychiatric units are brought in because of these behaviors. …Siegel and his colleagues are also seeking better ways of evaluating autism severity and measuring the intensity of conditions such as depression and anxiety that often co-occur with autism. More than 80 percent of children in the units also have intellectual disability, and 50 percent of inpatients with autism have little or no speech…… The new collaborative aims to collect genetic material from children with autism and their families, about whom little is known. The researchers say they would like to begin to answer questions as basic as whether severe autism has different genetic roots than milder cases do — and whether the difference between the conditions is one of type or degree.”

Really?  Gathering “genetic material” is a game-changer for autism?  Realistically, that does not sound innovative or even remotely associated with helping children in an acute situation.

But then I saw this -

“We have over 1,400 children with autism admitted to our Collaborative of specialized hospital units a year,” Sigel stated. “This offers a powerful platform to perform clinical trials and develop diagnostic tools to advance the treatments available for this severely affected population.”

….” The Collaborative will also consider becoming a medicine development network for autism by creating an efficient platform for the rapid study of novel compounds. This strategy could decrease the risks and barriers faced by pharmaceutical companies when they attempt to recruit patients to outpatient trials.”

None of this---“clinical trials,” “medicine development,”” rapid study of novel compounds,” and how about this - “risks and barriers faced by pharmaceutical companies when they attempt to recruit patients to outpatient trials,” sounds like it is patient- centered or looking at the very probable medical reasons that are causing pain and aggression.

Interestingly, Dr. Horrigan was gone from Autism Speaks.  It seems that he now works for a pharmaceutical company involved in autism and Fragile X medication trials. 

Connections?  I am not sure but the connection we do know for sure is that it is clear that children with an autism diagnosis are now being seen as very sick individuals and I don’t mean mentally.  Getting them the proper medical care continues to be challenging as we see here.  Parents need to demand proper medical testing and know what is actually happening with their children based on real medical tests:

“All of the discussed medical comorbidities and consecutive pathological processes can negatively impact behaviour, socialisation, communication,function and sensory processing of individuals with autism. It is also becoming increasingly clear that the medical abnormalities that underlie autism are not stagnant or transient, but tend to be chronic and in many cases if left unrecognised and untreated, progressive. Accurate diagnosis and treatment often results in improved level of functioning and decreased severity of symptoms.

In 1972, Dr. Leo Kanner, wrote his, “Follow-Up Study of Eleven Autistic Children Originally Reported in 1943,”   in which he had this to say:

“….no one as yet has succeeded in finding a therapeutic setting, drug, method, or technique that has yielded the same or similar ameliorative and lasting results for all children subjected to it. What is it that explains all these differences? Are there any conceivable clues for their eventual predictability?”

I do believe, Dr. Kanner that we are getting closer and closer to the true roots to autism for far too many -- a gut and immune system unable to fight pathogens.  Something is happening to these children and the research and treatments are not in genetics nor are they in psychiatry.  The clues are here yet there are those who will continue to deny the truth.

Teresa Conrick is Contributing Editor for Age of Autism.