Autism Spectrum Disorder (ASD) Naturopathic Protocol

Autism Spectrum Disorder (ASD) Naturopathic Protocol

This Autism Spectrum Disorder (ASD) Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations. This Autism Spectrum Disorder (ASD) Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.

HealthMasters Naturopath Kevin Tresize ND

 

Pathophysiology: Autism Spectrum Disorder (ASD)

  • Autism spectrum disorder (ASD) is an early-onset neurodevelopmental disorder affecting approximately 1/59 children,[1] characterised by impairment in social communication and social interaction, accompanied by restricted and repetitive behaviours, interests, and/or activities.[2]
  • These characteristics have been linked to physiological differences, including decreased brain blood flow affecting neuronal firing and metabolic activity, altered neural connectivity within certain brain regions (e.g. frontal cortex), sensory processing difficulties, impaired executive function, reduced brain neurotransmitters (e.g. gamma-aminobutyric acid (GABA) and serotonin) and neuroinflammation,[3],[4],[5] resulting in a wide range of functional imbalances (e.g. communication difficulties and sleep disturbances).
  • ASD patients display several biochemical differences, including a two-fold increase in lipid oxidation and oxidative stress compared to healthy controls, alongside lower levels of plasma antioxidant enzymes[6]; thereby putting ASD individuals at a greater susceptibility to cellular damage.
  • Cellular damage may spark increased cytokine production, promoting blood-brain barrier (BBB) permeability, apoptosis, neurodegeneration and demyelination.[7]
  • Abnormalities in the intestinal mucosa have been observed, which have been associated with increased production of inflammatory mediators, malabsorption and nutritional deficiencies, alongside functional abdominal pain and discomfort.[8],[9]
  • Sensory overload is a common feature in ASD, which may lead to patient distress in clinical situations featuring harsh lighting, busy environments, and high levels of background traffic noise, in addition to the general situational unfamiliarity, which may result in patient distress.

 

Consultation Overview: Autism Spectrum Disorder (ASD)

Identify Risk Factors

In Clinic Investigations - Refer to Key Drivers and the Clinical Investigation and Pathology sections below for further guidelines:

  • Review family history, developmental history, and symptomatic manifestations.
  • Administer validated, age-appropriate screening tool. See Additional Resources.
  • Assess dietary intake and quality, and identify whether macronutrients and micronutrient intakes are sufficient (i.e. protein intake, omega-3: omega 6 fat ratio, fibre deficiency, adequate hydration, iron deficiency etc.)
  • Assess sleep history, onset, maintenance, regularity, quality, quantity, and environmental factors.
  • Identify co-occurring conditions or comorbidities (e.g. anxiety, depression, or digestive issues).
  • Establish if patient has had significant exposure to environmental toxicants via the Metagenics Detoxification Questionnaire.
  • Support caregiver health and wellbeing,[10] and determine if additional support is required for parents or carers of ASD children to support a healthy stress response.

Pathology Investigations- Refer to Key Drivers and the Clinical Investigation and Pathology sections below for guidelines:

  • Conduct physical examination, record body mass index (BMI), height, and head circumference.
  • Test nutritional status: Refer patient for external laboratory testing or to a General Practitioner for assessment of iron studies, serum folate, vitamin B12, homocysteine, zinc: copper ratios and vitamin D.
  • Screen for inflammatory markers if indicated: erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hs-CRP).
  • Assess other clinical drivers, including coeliac serology, hair tissue mineral analysis (HTMA), and methylenetetrahydrofolate reductase (MTHFR) genetic polymorphism.
  • Consider screening OmegaQuant®Omega-3 Index and microbiome health with MetaBiome™ Microbiome Sampling Kit.

 

Identify Signs of ASD

  • Deficits in social communication and interaction (e.g. difficulty in developing, maintaining, and understanding social relationships)[11]
  • Delayed developmental milestones[12]:
- Lack of babbling by 9 to 12 months
- Lack of hand waving by 12 months
- No single words by 16 months
- Lack of symbolic or pretend play at age 18 months
- Use of fewer than 10 words by 24 months
- Abnormal delivery, regression or loss of speech, in addition to very literal use and interpretation of language.[13]
  • Reduced and/or infrequent use of language for communication, with trouble expressing needs using typical words and motions[14]
  • Deficits in coordination, movement preparation and planning, praxis, gait, and balance[15]
  • Extremes of emotional reactivity to change, new situations or sensory stimuli (textures, sounds, smells, tastes)[16]
  • Repetitive movements and behaviour (e.g. flapping, rocking, spinning, jumping, opening and closing doors, lining up of objects, turning switches on and off, watching same portion of video repeatedly)[17]
  • Inability to identify and describe emotions experienced by one's self or others (i.e. alexithymia).[18]
  • Limited responsiveness to smiling, facial expressions or feelings[19]
  • Reduced or absent awareness of personal boundaries, reduced social interest or lack of imitation of others’ actions[20]
  • Superior or special skills in one or more area of functioning (e.g. calculations, memory, music, or visual art)[21]

 

Key Drivers: Autism Spectrum Disorder (ASD)

  • Nutritional deficiencies: Deficiencies in long-chain polyunsaturated fatty acids,[22]  vitamin B6, folate, vitamin B12[23] and vitamin D[24] have been shown to worsen ASD symptoms. These nutrients play functional roles in supporting brain development, neurotransmitter synthesis and healthy immune function. ASD patients have been shown to be at higher risk of iron deficiency.[25] Supplementation of these specific nutrients has been shown to improve ASD outcomes.[26],[27],[28]
  • Gastrointestinal dysfunction: Constipation, diarrhoea, bloating, abdominal pain, reflux, vomiting, foul smelling or unformed stools, flatulence are four times more prevalent in ASD, and correlates with symptom severity.[29],[30],[31],[32],[33],[34]
  • Dysbiosis: can impair the integrity of intestinal epithelia, resulting in the movement of inflammatory toxins such as bacterial lipopolysaccharide (LPS) into the bloodstream. Systemic inflammation caused by LPS is associated with increased BBB permeability and behavioural impairments. Human studies have shown that disturbances in the microbiome during early childhood may contribute to the onset of ASD.[35]
  • Allergy: Approximately 52% of children with ASD have at least one allergic condition (e.g. asthma, eczema or angioedema).[36] The incidence of GIT symptoms has been shown to increase the chance of developing an allergy in 88% of ASD patients.[37]  Research also indicates an increased prevalence of intestinal permeability (IP) in ASD,[38] which may increase the incidence of immune reactivity against allergens, thereby magnifying the immune and thus inflammatory response.[39]
  • Food intolerances: Due to increased intestinal and BBB permeability,[40] common antigens (such as casein and gluten) may exert direct effects on the CNS and mediate behavioural changes. ASD patients may also present with coeliac disease, or non-coeliac gluten sensitivity (NCGS), which may manifest without gastrointestinal symptoms, however is associated with mucosal inflammation and immune reactivity. There is also evidence to suggest that ASD populations are more sensitive to food additives. For example, monosodium glutamate (MSG) may raise blood glutamate, an excitatory neurotransmitter, by 20 to 45 times in the brain. In children, the brain is estimated to be four times more sensitive to glutamate excitotoxicity than adult brains.[41] Food additives may therefore contribute to ASD symptomology, such as hyperactivity or behavioural issues.
  • Circadian rhythm/sleep disruption: Bedtime resistance, delayed sleep onset, decreased sleep duration, night awakenings, and greater disturbed circadian rhythms are prevalent in ASD.[42] These effects are associated with impaired GABA receptor expression and reduced melatonin synthesis.[43] Sleep disruption may also be influenced by comorbidities, such as internalised anxiety, allergies, epilepsy, vision difficulties,[44] obstructive sleep apnoea,[45]  and external environmental factors, such as psychological stimulation based on media content, blue light emitted from devices, and electromagnetic field (EMF) exposure.[46]Further, sleep deprivation is a physiological stressor often associated with increased cortisol levels,[47] which may exacerbate ASD presentations.
  • HPA axis dysfunction: Normally, elevations in cortisol occur due to an initial stress stimulus and then return to normal. However, a heightened response to stress and new/unfamiliar situations in individuals with ASD causes elevated cortisol release and therefore increased hypothalamic-pituitary-adrenal (HPA) axis reactivity,[48] leading to an increased risk of various comorbidities, such as anxiety, depression, sleep disturbances and behavioural issues.
  • Decreased methylation capacity: Reduced folate status and defects in methylation genes have been linked to impaired methylation and neurological deficits in ASD, resulting in a reduced capacity to create and synchronise neuronal networks in the brain, which is linked to pathophysiological changes in ASD.[49],[50]
  • Environmental toxin accumulation: Higher blood levels of heavy metals such as lead, aluminium, arsenic, mercury and cadmium,[51] alongside exposure to persistent organic pollutants (POPs), phthalates and glyphosate[52]  can drive neuroinflammation in ASD and exacerbate symptom severity.[53] Impaired detoxification mechanisms in ASD individuals associated with genetic mutations may lead to reduced toxin clearance and increased retention in the body.[54]
  • Immune dysregulation and chronic inflammation: Elevated levels of inflammatory cytokines have been observed in ASD and are associated with communication deficits and aberrant behaviour. Greater levels of inflammation have been linked to increased BBB permeability and cytokine-mediated neuroinflammation in the brain,[55] thereby compromising healthy brain function in ASD.
  • Oxidative stress: ASD patients are highly susceptible to the damaging effects of oxidative stress due to decreased glutathione (GSH) capacity associated with genetic defects and nutrient deficiencies, resulting in an imbalanced redox/antioxidant state.[56] Increased levels of oxidative stress have been shown to worsen childhood autism rating scores.[57]
  • Mitochondrial dysfunction (MD): MD has been observed in ASD, and may be associated with other key drivers of ASD, such as gastrointestinal dysfunction and dysbiosis, environmental toxicity and oxidative stress. MD is associated with immune dysfunction, cerebral folate deficiency and abnormal brain development in ASD, and its treatment has been shown to exert positive benefits for ASD-related behaviours.[58]

 

Treatment Priorities: Autism Spectrum Disorder (ASD)

  • Enhance nutritional status of key nutrients via supplementation (i.e. omega-3s, vitamin D, protein, B vitamins, and essential minerals) to manage and prevent deficiency, support healthy brain function, enhance neurotransmission and promote anti-inflammatory pathways.
  • Promote dietary inclusion to improve the patient’s nutritional intake, microbiome health, and support general wellbeing.
  • Promote digestive health with gut healing agents to improve nutrient metabolism, reduce IP, support healthy detoxification and provide symptomatic support for digestive pain and symptoms, such as constipation.
  • Improve microbiome diversity and reduce dysbiosis to improve gastrointestinal symptoms and regulate overactive immune activity contributing to inflammation and ASD symptoms.
  • Support sleep quality and a healthy stress response by promoting GABA-ergic neurotransmission to reduce cortisol levels and help regulate circadian rhythm, thereby protecting healthy HPA axis function and reducing mood symptoms in ASD (such as anxiety and depression).
  • Manage and limit exposure to environmental toxins and promote detoxification pathways in order to reduce inflammation and oxidative stress as a driver of ASD.
  • After the implementation of foundational strategies (Figure 1) to manage key drivers, consider dietary elimination to minimise ASD symptoms if indicated. Consider re-introducing eliminated food periodically to reassess reactivity.
  • Encourage an active lifestyle to promote metabolic wellbeing, enhance mood, and develop physical health and self-esteem.
  • Manage and monitor for co-occurring conditions and comorbidities (e.g. prescribe anxiolytic support and monitor with Moods and Feelings (MFQ) and Mood and Stress (MSQ) questionnaires).
  • Consider dietary elimination to remove triggers of immune activation and inflammation.
  • Provide support and resources for families (e.g. community support groups). See Additional Resources.
  • ASD requires a multidisciplinary approach, in addition to good communication between therapists. Specialist care indicated in ASD includes paediatricians, speech therapists, occupational therapists, physiotherapists, psychologist and psychiatrists in addition to complementary health care practitioners.

 

Figure 1 Hierarchy of intervention and treatment priorities in ASD.

Figure 1: Hierarchy of intervention and treatment priorities in ASD.

 

Red Flags: Autism Spectrum Disorder (ASD)

  • Behavioural problems/Sensory overload: Behavioural issues in ASD are often linked to sensory processing disorders (SPD), which affect the brain’s ability to process sensory messages.[59] In ASD, the brain may lack the ability to filter information (i.e. noise, bright lights, food textures, rough clothing etc.) due to hyperacute sensory perception, triggering sensory overload.[60] This can create stress for an individual, who will often try to escape an overwhelming situation, resulting in disruptive behaviour in order to manage a challenging situation.[61] Unmanaged sensory overload may over-activate the stress response, increasing daily cortisol levels.[62] Elevated cortisol levels may contribute to the enlargement of the amygdala and shrinkage of the hippocampus,[63] which in turn may escalate perceived stress, reinforcing SPD symptoms, as well as increasing the risk of anxiety and depression as a result of stress-induced neuronal remodelling.[64],[65] Refer to occupational therapist to manage SPD, and explore additional strategies to manage sensory overload (e.g. soft lighting, sound-dampening furniture and decor, decluttering the home etc.)
  • Anxiety:  ASD patients have a higher prevalence of anxiety disorders,[66] which may arise due to patient sensitivity to new and challenging situations, and exacerbate difficulties with communication and adaptive behaviour. Anxious behaviour is associated with excess cortisol activity, resulting in with chronic amygdala activation leading to lasting structural changes, perpetuating anxious behaviour.[67] Use the MFQ for children aged 7 to 18 or the Depression Anxiety Stress Scales (DASS) for children 14 years and over, alongside the MSQ to assess the patient’s mental wellbeing. Refer to General Practitioner/Psychologist where indicated.
  • Depression and Suicide: Individuals with ASD have an increased risk of suicidality associated with higher levels of autistic traits (such as alexithymia) and depression.[68] This may be associated with chronic stress and persistent HPA axis activation, which has linked to the development of depression in ASD.[69] This causes excess levels of cortisol binding to hippocampal receptors,stimulating glutamate release from presynaptic neurons via N-methyl-D-aspartate (NMDA) receptor signalling, resulting in neurotoxicity-induced structural and functional changes with the  hippocampus and the prefrontal cortex, which is associated with low moods.[70],[71],[72],[73] Use the MFQ for children aged 7 to 18 or the DASS for children 14 years and over, alongside and the Mood and Stress Questionnaire to assess the patient’s mental wellbeing and refer to a General Practitioner where indicated. If patient is deemed at risk of self-harm or harm to others, seek immediate guidance from a Crisis Assessment and Treatment Team (CATT).
  • Developmental delays: In children with ASD, findings of physical examination are often normal,[74] however developmental awareness is key to determining risk of underdevelopment or failure to thrive. At each appointment, monitor BMI, head circumference and growth and assess for nutritional intake, and encourage parents to be familiar with key age-dependant developmental milestones. If abnormalities or developmental delay is identified within physical exam, refer patient onto paediatrician or General Practitioner for comprehensive evaluation. See Additional Resources for growth reference charts.
  • Pregnancy: Several factors influencing in utero development may increase the risk of ASD diagnosis, which may be related to immune activation and increased oxidative stress.[75]There is insufficient evidence to implicate any one prenatal factor in ASD aetiology; however exposure to these factors may increase the risk of autism.[76]  These may include: advanced parental age (mothers >35 years and fathers >40 years),[77]birth order (being first, third or later),[78] maternal anaemia ≤30 weeks of pregnancy,[79] maternal allergies, prenatal stress or depression, gestational diabetes,[80] and maternal use of medications such as acetaminophen,[81] valproic acid and selective serotonin reuptake inhibitors.[82] To assist in the prevention of ASD diagnosis in future offspring, parents of who wish to conceive again may reduce future risk by mitigating specific risk factors where possible, in addition utilising the Metagenics Pregnancy (General) Protocol to promote preconception and perinatal wellbeing. See Treatment Recommendations for specific interventions.

Treatment Recommendations: Autism Spectrum Disorder (ASD)

Core Recommendations

Children’s Gut, Liver and Detoxification Support

Dosage:

Children 1 to 4 years: 1 level scoop (5.0g) daily mixed in 50 mL of water. Children 5 to 12 years: 2 scoops (10 g) twice daily mixed in 100 mL of water.

To soothe gastrointestinal tract: Take once daily.

For detoxification: Take twice daily.

A comprehensive formula designed to reduce IP caused by heightened mucosal inflammation; support detoxification pathways and enhance the body’s resistance to ubiquitous toxins; and enhance microbiome health and function. These three mechanisms provide fundamental support for several key drivers in pathophysiology of ASD.[83],[84],[85],[86]

Mechanism of Action/Clinical Research:

  • Curcumin inhibits a myriad of inflammatory mediators including phospholipase, lipoxygenase (LOX), cyclooxygenase-2 (COX-2),[87]  leukotrienes, thromboxane, prostaglandins, collagenase, elastase, hyaluronidase, tissue necrosis factor-alpha TNF-α, and interleukin(IL)12.[88] These broad-spectrum anti-inflammatory actions are fundamental to reducing gastrointestinal inflammation, and inflammation associated with toxicity.
  • Curcumin increases the expression of several detoxification enzymes, impacting phase I and phase II detoxification pathways; as well as glutathione S-transferases (GST) and NAD(P)H dehydrogenase (quinone) 1 (NQO1), by activating nuclear factor erythroid 2-related factor 2 (Nrf2).[89]
  • Larch arabinogalactans and pectin are complex polysaccharides shown to increase the production of short-chain fatty acids (SCFAs) [particularly butyrate, acetate, and propionate], which promote the health and diversity of the gut microbiome.
  • Silymarin from milk thistle supports phase I pathways, and provides significant protective activity against oxidative stress induced by toxin exposure, including that derived from environmental contaminants.[90]     
  • Liquorice also exerts anti-inflammatory effects via inhibition of nitric oxide (NO), IL-6 and prostaglandin E2 (PGE2) in LPS-induced macrophage cells.[91]
  • Tight junctions (TJs) within intestinal epithelial cells depend on transmembrane proteins, claudin and occludin.[92] Glutamine deprivation is linked to decreases in claudin levels in the TJ, and restoration of epithelial glutamine increases claudin levels,[93] as it is required for the growth of enterocytes.[94]
  • Zinc promotes TJ organisation and function by attenuating the pro-inflammatory mediators tumour necrosis factor alpha (TNF-α), interleukin-1b (IL-1b), nuclear factor kappa B (NFĸB) and oxidative stress, which drive IP.[95] 
In an open label trial, 10/12 patients with persistent IP receiving 75 mg/d elemental zinc over eight weeks achieved normal IP (p<0.0028).[96]
  • Zinc is integral for metallothionein (MT) function (important cysteine-rich metal-binding proteins) and antioxidant compounds. MTs promote homoeostasis of essential metal ions as well as detoxify heavy metals (e.g. cadmium, mercury) due to their exceptional metal-binding capabilities.[97]    
  • Marshmallow and slippery elm are used traditionally in Western herbal medicine to soothe the gastrointestinal tract.[98]
  • Selenium and cysteine support the synthesis of GSH enzymes involved in phase II detoxification.[99],[100]

 

Children’s Lipid Complex for Brain Support

Dosage:

Children aged 0 to 2 years: Take ½ teaspoon (2.5 mL) daily.

Children aged 1 to 4 years: Take 1 teaspoon (5.0 mL) daily.

Children aged 5 to12 years: Take 1 teaspoon (5.0 mL) twice daily.

A high-quality fish oil enriched in eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), phosphatidylserine and vitamin D3 to support healthy brain development and cognition in children.

Mechanism of Action/Clinical Research:

  • Phospholipids enriched with EPA and DHA are crucial to normal neurological function, with phospholipid deficiencies resulting in neuronal impairment and decreased adenosine triphosphate (ATP) production.[101]
  • DHA may help to support cognitive development, membrane flexibility and healthy synaptic function.[102] DHA is an integral component of neural membrane phospholipids and helps modulate functional activity in cortical attention networks of the brain.[103]
  • In a clinical study in 25 autistic children aged 3 to 15 years, phosphatidylserine was significantly lower compared to the healthy controls. This may be correlated with increased oxidative stress and inflammatory responses.[104]
  • Several studies have shown children with ASD have a reduced vitamin D status (25-OH-D3), often significantly lower than healthy controls.[105],[106],[107]
  • In a randomised placebo-controlled trial, EPA, DHA and vitamin D have been shown to reduce irritability and hyperactivity in ASD. Positive outcomes in this study were attributed to the protective role of vitamin D in supporting neuronal differentiation and connectivity; alongside the effects of EPA, DHA and vitamin D supporting neurotransmission systems involved in mood regulation; and the anti-inflammatory effects of these nutrients in mitigating inflammation and oxidative stress in ASD.[108]

 

Children’s Multivitamin and Mineral

Dosage:

Children aged 1 to 3 years: Take ½ teaspoon (2.0 g) daily mixed in 50 mL of water.

Children aged 4 to 12 years:  Take 1 teaspoon (4.0 g) daily mixed in 100 ml of water.

A nutritional formula delivering therapeutic levels of micronutrients to support healthy development, immune resistance, nutritional intake (particularly in cases of food sensitivity or aversion), and general wellbeing.[109]

Mechanism of Action/Clinical Research:

  • ASD patients have been shown to be at higher risk of iron deficiency,[110] alongside suboptimal levels vitamin B6, folate and vitamin B12.[111]
  • To produce energy for nervous tissue function, vitamin B1 is required. In addition, vitamins B6 and B12 are directly involved in the synthesis of neurotransmitters, such as GABA, dopamine and serotonin.[112]
  • Neuronal synapses contain the second highest concentration of vitamin C in the human body (after the adrenal glands), whilst vitamin E is directly involved in the protection of neural membranes.[113]
  • Iodine is a trace element primarily required for thyroid hormones triiodothyronine (T3) and thyroxine. A lack of iodine can result in hypothyroidism, however it is also associated with impaired brain development and suboptimal intelligence in children.29
  • In ASD children aged between three to eight years old, supplementation of a multivitamin containing beta-carotene, vitamin C, vitamin D, vitamin B1, B2, B3, B5, B6, B12, folic acid, biotin, calcium, magnesium, zinc amongst other nutrients over three months was shown to significantly improve gastrointestinal symptoms and sleep (p<0.03).[114] Enhancing intake of deficient nutrients (particularly vitamin C and B6), supports their functional role in supporting antioxidant activity and neurotransmitter synthesis respectively.

 

Gluten-free and casein-free (GFCF) diet

GFCF diet may take 6 to 12 months to show full benefits. Patients may experience significant withdrawal symptoms in the early stages of elimination.

Mechanism of Action/Clinical Research:

  • In a controlled, single-blind Scandinavian trial improvements in core autistic behaviours were found when using a GFCF diet over an 8 to 12 month period, with improvements in communication, social functioning, attention, concentration and hyperactivity. Improvements in social interaction and repetitive behaviours were also noted after 24 months.[115]
  • Research indicates that a key factor in the adherence and success of a GFCF diet is the provision of appropriate food substitutes for gluten-containing foods.[116] This information can be found on the GFCF dietary resource, alongside and a comprehensive food/ symptom diary under Additional Resources.

 

Additional Considerations: Autism Spectrum Disorder (ASD)

If presenting with anxiety:

Children’s Stress And Anxiety Relief

Dosage:

Children aged 1 to 4 years: Mix ½ metric teaspoon (1.75 g) into 50 mL of milk or juice.

Children aged 5 to12 years: Mix 1 metric teaspoon (3.5 g) into 100 mL of milk or juice.

For symptoms of stress: Take once daily.

To support sleep: Take once in the afternoon and a second dose before bed.

An effective combination of passionflower, German chamomile, magnesium (Meta Mag®) and alpha-casozepine enriched hydrolysed milk protein (LactiumPURE™) to soothe stress and nervous tension and support sleep onset in ASD.

Mechanism of Action/Clinical Research:

  • Passionflower has been found to modulate the GABA system, demonstrating an affinity for both GABAα and GABAβ receptors, increasing its inhibitory effects.[117]
In a clinical trial, 154 adults with prolonged nervous tension were treated with 1,020 mg/d of passionflower for 12 weeks. Passionflower significantly improved stress-associated symptoms including restlessness, sleep disturbances, exhaustion, anxiety and poor concentration.[118]
  • Chamomile contains the flavonoid, apigenin, which has modulatory actions on GABAα receptors,[119] responsible for its calming and anxiolytic effects.[120]
  • Magnesium improves resistance to neuropsychological stressors, such as glutamate excitotoxicity, through its actions as a voltage-gated antagonist at the glutamate, NMDA receptor site.[121] The reduction of glutamate activity has been shown to increase the actions of the GABAergic systems.[122]
  • Alpha-casozepine enriched hydrolysed milk protein supplemented over 30 days was shown to reduce stress-related symptoms in healthy female volunteers, with significant improvement within digestive symptoms, and emotional and social problems.[123]

 

If presenting with circadian rhythm/sleep disruptions:

Magnesium with Lutein and Zeaxanthin for Sleep Pattern Support

Dosage:

Children aged 1 to 2 years: Take 1/8 scoop once daily in the evening. 

Children aged 3 to 4 years: Take ¼ scoop once daily in the evening.

Children aged 5 to 8 years: Take 1/3 scoop once daily in the evening.

Children aged 9 to 12 years: Take ½ scoop once daily in the evening.

Adults: Add 1 scoop (5.7 g) in 200 mL of water once daily in the evening.

A combination of Meta Mag® magnesium bisglycinate, ornithine, ashwagandha, lutein and zeaxanthin to address disrupted sleep cycle patterns, potentiate non-rapid eye movement (NREM) sleep and slow wave asleep (SWS), improve sleep quality and enhance melatonin, and reduce cortisol that negatively impacts sleep.

Mechanism of Action/Clinical Research:

  • Magnesium has been shown to significantly decrease serum cortisol levels within hours of sleep initiation, resulting in increased in SWS (p<0.01).[124]

500 mg/d of elemental magnesium over eight weeks was shown to significantly increase sleep time and sleep efficiency, while improving sleep onset latency (p<0.03).[125] Patient serum cortisol levels was shown to decrease (p<0.008) in correspondence with increased in melatonin (p<0.007), indicative magnesium’s effect on improving sleep quality.[126]

  • Ornithine also improves sleep quality, as well as reducing stress markers through the regulation of cortisol and dehydroepiandrosterone sulfate (DHEAS) production.[127]

In a double-blind, randomised, placebo-controlled trial, 52 participants who received 400 mg of L-ornithine for eight weeks reported improved sleep quality, including enhanced sleep initiation and maintenance.[128] L-ornithine was shown to reduce serum cortisol and improve cortisol/DHEAS ratio indicative of its beneficial effects on HPA function.[129]

  • Withania somnifera has been shown simultaneously improve sleep quality to moderate cortisol levels, which may counteract stress-induced HPA overactivity in insomnia.

In a study conducted in 60 healthy individuals receiving either 250 mg/d and 600mg/d of withania over eight weeks, Participants showed significant improvement in perceived stress scores, reductions in morning cortisol and enhanced sleep quality in both treatment groups (p<0.05).[130]

  • Lutein and zeaxanthin may assist sleep regulation by enhancing ocular MPOD levels, which is involved in filtering blue light. This in turn supports the production and release melatonin.[131],[132] These carotenoids have been shown to reduce the effects of excessive screen time (i.e. six hours of screen time daily for six months), and improve sleep onset and maintenance.[133]

Supplementation of 20 mg/d of lutein and 4 mg/d of zeaxanthin in 48 healthy adults was shown to improve the incidence of sleep disturbances over six months, reduce the need for sleep-enhancing medications, and improve Pittsburgh Sleep Quality Index scores(p<0.05).[134]

 

If presenting with abdominal pain, constipation or poor microbiome health:

PHGG and 299v for Functional GI Disorders, Including Constipation

Dosage:

Children aged 3 to 4 years: Take 3/4 teaspoon (1.2 g) daily mixed in 50 ml of water.

Children aged 5 to 8 years: Take 1 teaspoon (1.6 g) daily mixed in 50 ml of water.

Children aged 9 to 12 years: Take 1.5 teaspoon (2.5 g) daily mixed in 100 mL of water.

Adults: Add 3 metric teaspoons (5 g) to 200 mL of water and stir until dissolved. Take once daily.

A unique prebiotic and probiotic combination for functional gut disorders prevalent in ASD populations,[135] targeting IP and resistant functional gastrointestinal symptoms with a focus on reducing constipation, bloating, abdominal pain and flatulence.

Mechanism of Action/Clinical Research:

  • Lactobacillus plantarum 299v has been shown to improve functionality of the intestinal barrier through protection of intestinal cell morphology and permeability, as well as expression of tight junction proteins.[136] This probiotic strain has also been shown to reduce increased IP in animal[137] and in vitro studies.[138]
  • L.plantarum 299v has been shown to support the production of SCFAs, including acetate, propionate and butyrate,[139],[140]as confirmed by stool testing, helping to support microbial diversity and a healthy microbiota.[141]
  • PHGG is a selective prebiotic, used as a fuel by butyrate-producing bacteria.[142]

A meta-analysis of seven randomised trials of PHGG found a reduction in chronic constipation,[143] while several randomised trials[144],[145] found a significant decrease in irritable bowel syndrome (IBS) symptoms.

 

If presenting with low digestive function/low stomach acid:

Gastric Acid Support

Dosage:

Children aged 5 to12 years: Take ½ tablet three times daily after meals, crushed or intact.

Adults: Take 1 tablet daily after a meal.

A digestive stimulant to support gastric acid production, complete digestion of proteins and modulate an over-active immune response in ASD associated with undigested proteins.

Mechanism of Action/Clinical Research:

  • Hypochlorhydria, a deficiency of stomach acid, can lead to a variety of symptoms. The chief effect of this condition is inadequate digestion and absorption of food, particularly proteins. Betaine hydrochloride acts as a source of hydrochloric acid when dissolved; pepsin is itself a digestive enzyme, whilst gentian has long traditional use for indigestion.[146]
  • Metagest enhances gastric stimulus for the whole digestive sequence by providing adequate amounts of the main constituents of gastric acid, pepsin and hydrochloric acid to assist protein digestion.[147]

 

If presenting with nutritional deficiencies:

Vegan Choline for Healthy Pregnancy, Brain Function and Liver Health

Dosage:

Children aged 5 to 8 years: Take 1 capsule daily.

Children aged 8 to 12 years: Take 2 capsules daily.

Adults: Take 3 capsules daily.

Choline is a key nutrient involved in methylation, a process important for healthy cell function, gene expression and detoxification.[148] Reduced methylation is a core symptom driver in ASD.[149],[150]

Mechanism of Action/Clinical Research:

  • Approximately 60% to 93% of ASD children consume an insufficient amount of dietary choline,[151] which is required for the synthesis of phosphatidylcholine (PC), betaine, and acetylcholine (Ach). These compounds are important for a range of neurological functions, including adequate DNA methylation. Betaine provides 60% of the body’s methyl groups, thereby facilitating a significant portion of methylation activity.[152] As such, choline deficiency can compromise methylation enzyme activity, which is a key driver of ASD pathophysiology.[153],[154]
  • Choline supplementation has been shown to support individuals with various genetic single-nucleotide polymorphisms (SNPs) associated with impaired methylation, including MTHFR mutations,[155] which can impede healthy methylation in conjunction with folate deficiency in ASD populations. For example, in adults, a total intake of 930 mg/d of choline compensates for several methylation-limiting SNPs, thereby restoring functional methylation.[156]

 

Vitamin D3 1000IU

Dosage:

Children aged 1 to 12 years: Take 1 to 3 capsules daily OR 0.25 ml to 0.75ml daily.

Adults: Take 5 capsules or 1.25ml daily.

Vitamin D is critical to multiple roles in immune, metabolic and nervous systems, where adequate levels are required to modulate inflammation, maintain immune homeostasis, reduce microglial activation (CNS inflammation) and protect neurotransmitter activity in ASD.[157]

Mechanism of Action/Clinical Research:

  • In ASD children with low serum vitamin D levels (<30 nmol/L), supplemental vitamin D dosed from 300 IU/per kg/d up to 5,000 IU/d for 3 months was shown to significantly reduced irritability, social withdrawal, hyperactivity and stereotypical behaviour (p<0.05). Further, greater clinical improvements were observed when final 25-(OH) D levels were >100 nmol/L compared to lower levels.[158]

 

High Potency Vegetarian Iron with 5-MTHF

Dosage for iron deficiency: Children aged 1 to 3 years: take ¼ of a capsule daily. Children aged 4 to 12 years: Take ½ a capsule daily. Adults: Take 1 capsule daily with food.

Provides iron, vitamin B12, vitamin B6 and folate necessary for normal red blood cell production, which supports oxygen transport to tissues and supporting cellular energy production. Iron bisglycinate facilitates absorption through the gut mucosa and minimises the side effects common amongst other forms of iron, as it does not dissociate from its bisglycinate carriers within the digestive tract.

Mechanism of Action/Clinical Research:

  • ASD patients have been shown to be at higher risk of iron deficiency,[159] alongside suboptimal levels vitamin B6, folate and vitamin B12.[160]
  • Iron deficiency in ASD may be associated with greater intellectual disability,[161] and delayed global development of the brain.[162]
  • The maintenance of healthy RBC production requires optimal levels of iron, vitamin B12 and folate.[163]

 

High Bioavailability Zinc with Vitamin C

Dosage:

Children aged 1 to 4 years: Take 1/8 teaspoon (0.42 g) per day mixed in 50ml of water.

Children aged 4 to 8 years: ¼ teaspoon (0.95 g) daily in 50 ml of water.

Children aged 9 to 13 years: Take ¼ metric teaspoon (0.95 g) once or twice daily.

Adults: Add ½ metric teaspoon (1.9 g) to 200 mL water once daily with food.

A highly bioavailable combination of zinc and vitamin C to support nutritional status, reduce oxidative stress and promote healthy brain development and intestinal barrier function in ASD.

Mechanism of Action:

  • Downregulation of zinc-dependant ProSAP/Shank proteins that responsible for the synthesis of excitatory neural synapses have been associated with ASD. Research in animal models indicates that zinc deficiency reduces the activity of ProSAP2/Shank3 proteins, resulting in hyper responsiveness and hyperactive behaviour, impaired social behaviour and impaired vocalisation,[164] suggesting a protective role of zinc in ASD pathophysiology.
  • Vitamin C and zinc support epithelial barriers,[165] which may be compromised in ASD.[166]

 

If presenting with heavy metal toxicity:

Liquid Selenium and Zinc

Dosage:

Children aged 1 to 4 years: Take ¼ mL daily.

Children aged 5 to 12 years: Take ½ mL daily.

Adults: Take 1.0 mL daily diluted in 100 to 200 mL water or juice, with meals.

A combination of antioxidant nutrients to protect and support healthy cellular function and heavy metal detoxification in ASD.

Mechanism of Action/Clinical research:

  • Both selenium and zinc help to protect the body against toxicity induced by heavy metals, such as mercury, lead, cadmium and arsenic.[167]
  • The trace mineral selenium is incorporated into the structure of selenoproteins, which play a key role in promoting the body’s antioxidant defences. Specifically, selenium is required for GSH activation (via glutathione-peroxidase and reductase enzymes), thereby helping reduce oxidative stress caused by heavy metal exposure.[168]
  • Zinc is integral for MT function (important cysteine-rich metal-binding proteins) and antioxidant compounds. MTs promote homoeostasis of essential metal ions as well as detoxify heavy metals (e.g. cadmium, mercury) due to their exceptional metal-binding capabilities.[169]

 

If patient wants to conceive and there is a history of ASD diagnosis in offspring:

Strain Specific Probiotics for Pregnancy, Breastfeeding and Infant Health

Dosage for prevention from birth: Empty the contents of 1 capsule and mix with breast milk, formula or water, and administer to infants once daily.

Supporting adequate levels of Bifidobacterium spp. during infancy is associated with lower levels of ADHD and ASD.

Mechanism of Action/Clinical Research:

  • In expectant mothers, 10 billion CFU/d of Lactobacillus rhamnosus LGG® given in the last four weeks of pregnancy and first six months of life, in either in breast milk or direct to infant if bottle-fed. Results of the study found that at 13 years of age, ADHD or Asperger’s (a high functioning variant of ASD) was diagnosed in 17.1% in the placebo group, and 0% in the probiotic group  (p<0.008).[170]

    Supportive Programs: Autism Spectrum Disorder (ASD)

    Reducing exposure to environmental and endogenous toxins supports optimal health and may help to manage toxicant exposure in ASD patients. The Metagenics Clinical Detoxification Program* is designed to reduce toxic burden, increase resilience to toxins and improve the efficiency of waste elimination.

    * Practitioner-guided tailoring of the Detoxification program is advised to support compliance to treatment in ASD patients.

     

    Diet and Lifestyle Recommendations: Autism Spectrum Disorder (ASD)

    Diet:

    • Consider the introduction of a gluten-free and casein-free (GF-CF) diet as per core recommendations

    - If no response to GFCF, or if behaviour or symptoms worsens after certain foods, and/or food cravings, consider a Low-Allergen (Custom Elimination) diet:

    An Elimination diet, followed by food challenges, is the most effective way to identify food allergy, sensitivities and/or intolerances. When following this program over at least six weeks, patients and caregivers learn to identify the impact that food may have on their health and wellbeing.
    Complete instructions, food shopping lists are all available for free download. See Additional Resources.

      - If no response to GFCF diet and/or “Jekyll and Hyde” personality, poor sleep, perioral rash, sensitive to nutritional supplements and lower abdominal pain, consider a salicylate/amine/oxalate free diet (Custom Elimination Diet)

      Salicylates occur naturally in many fruits and vegetables, and may even be used as a natural preservative in many products. Sensitivity is a common problem, associated with localised or systemic symptoms, such as cramping and diarrhoea, headaches, hyperactivity or immunological responses such as hives, asthma or sinusitis.
      Complete instructions are available for free download. See Additional Resources.

        - If no response to GFCF diet and/or with gut symptoms of bloating, pain, nausea and/or disturbed bowel habit of constipation and/or diarrhoea, consider a FODMAPs/specific carbohydrate diet

        The term FODMAPs describes a collection of common short-chain carbohydrates found in many foods. This approach is more restrictive but may be helpful in patients displaying the symptoms of IBS.
        Complete instructions are available for free download. See Additional Resources.

          - If no response to GFCF diet and/or sugar cravings, irritability, worse for fasting, worse after sugar, shaky, nervous, sweating , consider a hypoglycaemic diet

          This approach uses diet as a method of controlling blood sugar in these patients.
          Complete instructions are available for free download. See Additional Resources.
            • Outside of elimination diets, supporting parents to introduce a Mediterranean diet inclusive of a high intake of fruits and vegetables, lean protein, quality essential fatty acids, and wholegrains (limiting starchy grains and vegetables) is recommended.
            • Wholefood diets have also been found to increase hippocampal volume compared to ‘Western’ diets, which were associated with hippocampal atrophy and HPA dysfunction.[171]
            • The Metagenics Wellness Diet reflects the wholefood principles of the Mediterranean diet and also provides a simple guide to moderate portion size and the overall balance of macronutrients.
            • Choose healthy, unprocessed forms of preferred food textures, flavours and colours.
            • Offer children a choice between two foods to help provide a sense of control.
            • Introduce new foods by hiding/disguising in favourite foods.
            • Be patient, and encourage patient and siblings to enjoy new foods.
            • Avoid snacking with regular, predictable mealtimes.
            • Praise and reward trying new foods.

              Lifestyle:

              Physical activity guidelines:

              • 60+ minutes per day of moderate to vigorous physical activity.[172]
              • 20+ minutes per day in green spaces to support cognition and behaviour.[173]
              • Break up long periods of sitting as often as possible.
              • Limit sedentary recreational screen time to less than two hours per day.[174]
              • Activities such as jogging, horse-riding, martial arts, swimming, yoga/dance can result in improvements to numerous behavioural outcomes in ASD, including social-emotional functioning, cognition and attention.[175]

              Additional suggestions:

              • Educate parents on appropriate sleep requirements for children based on age: See Australian healthy sleep guidelines.
              • Limit toxin exposure:
              - Avoid chemical use around home and garden;
              - Consume organic foods OR thoroughly wash and peel conventional fruits and vegetables;
              - Keep house dust levels low as possible;
              - Keep doors and windows open as much as possible;
              - Wash stuffed toys routinely;
              - Do not use brightly colours paints in the home; and,
              - Limit consumption of fatty meat and fish.
              • Consider applied behaviour analysis (ABA): Uses behavioural learning theory to assist in modifying overt behaviours. Studies of ABA for ASD show significant improvements in IQ, language and adaptive functioning. Discuss with patient and refer to psychologist.[176]
              • Animal-assisted therapy: Animal therapy may assist children with developing communication and social interaction skills.[177]
              • Music therapy: Clinical trials and a Cochrane review show improvements in communication skills from music therapy compared to placebo.[178]
              • Acupuncture has been shown to help improve sensory problems and attention levels.[179]
              • Vision therapy: Involves wearing glasses with ambient prism lenses to help increase focus and awareness, and shown to help with autistic symptoms and motor coordination.[180]
              • Vagal nerve stimulation therapy has been shown to improve behaviour and quality of life in ASD.[181],[182]
              - TENs machine continuously for 15 minutes.
              - Pulse width - 200 µs; pulse frequency - 30 Hertz.
              - Amplitude to the level of sensory threshold (usually 2-4 mA) until ‘pin-prick’ or ‘tingling’ sensation.
              - Stimulus then turned down until borderline perceptible and comfortable.
                • Reduce excessive screen time and manage psychological stimulation based on media content with the use of Apps, such as Moment.
                • Provide additional support resources and counselling where indicated: An autistic child affects family dynamics in many ways, from dietary routines, priority over siblings and, commonly, with sleep disturbances. Refer for counselling if required. See Additional Resources.

                Clinical Investigation and Pathology: Autism Spectrum Disorder (ASD)

                Clinical Screening Rationale

                Modified Checklist for Autism in Toddlers Questionnaire (M-CHAT)

                High-Functioning Autism Spectrum Screening Questionnaire (ASSQ) [183]

                If abnormalities are identified within screening questionnaire, refer patient onto paediatrician or General Practitioner for comprehensive evaluation. If patients are non-verbal, encourage them to answer yes/no with non-verbal communication techniques, such as tapping or clapping.

                Physical Examination (General)

                Assess the patient’s physical health, measuring and recording their weight, height, head circumference and presence of physical injuries (i.e. self-harm). Observe the patient’s motor skills for signs of hypotonia (weak muscle tone), coordination deficits, gait abnormalities or toe walking, and skin abnormalities (i.e. hypopigmented lesions).

                If abnormalities or developmental delay is identified within physical exam, refer patient on to paediatrician or General Practitioner for comprehensive evaluation. See Additional Resources for growth reference charts.

                Omega-3 Index Test

                A validated test that measures red blood cell (RBC) EPA and DHA status. An Omega-3 Index in the desirable range of 8% to12% is an indicator of better overall health.*

                * Some patients may be averse to the lancet methods required to take a blood sample and may find the procedure traumatic and overwhelming, thus the test risks may outweigh the benefits.

                Zinc Taste Test

                Screen for zinc levels, important for neurotransmitter synthesis, detoxification and immune function.

                * Some patients may be adverse to the oral taste of zinc liquid and may find the procedure traumatic and overwhelming, thus the test risks may outweigh the benefits.

                 

                Pathology Testing: Autism Spectrum Disorder (ASD)

                Pathology Test Ideal reference Range Rationale

                Folate

                Normal levels in adults and children: 360-1,000 nmol/L

                 Folate is a key nutrient required for various cellular process, including cellular division, methylation, DNA synthesis and neurotransmitter production. Low levels may adversely affect ASD symptoms.

                Vitamin B12

                Normal levels in adults and children: >120 µmol/L

                 Vitamin B12 is involved in neurological development, methylation and cellular division, and may be low in ASD populations. Low levels may adversely affect ASD symptoms.

                Zinc: Copper ratio

                Copper: 11.0 - 22.0 umol/L

                Ceruloplasmin: 0.18 - 0.40 g/L

                Zinc: 9.0 - 19.0 umol/L

                Zinc/Copper ratio: 0.80 - 1.00 umol/L ratio

                Copper, ceruloplasmin and zinc profiles may help determine oxidative stress levels in the ASD. The ratio of copper to zinc is clinically more important than the individual levels of each analyte. Elevated copper maybe associated with Oral Contraceptive use.

                Serum vitamin D 

                (25-OH D)

                Ideal: 100-150 nmol/L

                Normal: 40-100 nmol/L

                Deficient: 0 -40 nmol/L

                ASD patients are commonly significantly deficient in 25-OH-vitamin D.

                Homocysteine

                Ideal: <6.3 µmol/L

                Satisfactory: 6.3-9.0 µmol/L

                Normal: 9.0-13.0 µmol/L

                Raised: 13.0-15.0 µmol/L

                Significantly elevated: >15.0 µmol/L

                Elevated homocysteine levels occur in conjunction with impaired methylation and limited transulphuration pathways in ASD.

                Iron Studies

                Serum iron

                 

                10-30µg/L

                Plasma ferritin

                (6 months to 15 years)

                7- 142µg/L

                Plasma ferritin (men)

                30-300µg/L

                 Plasma ferritin (women)

                 20-200µg/L

                Total iron binding capacity

                 45-80µg/L

                Transferrin saturation

                 20%-40%

                ASD patients are at higher risk of iron deficiency due to highly selective diets or poor eating habits; this may impair neurological function.

                Coeliac serology

                Transglutaminase (tTG) IgA:*

                Gliadin Antibody IgA:*

                Gliadin Antibody IgG:*

                *Ranges vary depending on testing methods (i.e. blood spot vs. blood draw). Refer to specific ranges provided by testing laboratory.

                Serologic testing for coeliac disease consists of tissue Transglutaminase (tTG) and deamidated gliadin antibody tests. In practice, both tests have >85% sensitivity and >90% specificity. Diagnosis for coeliac disease requires affirmative small bowel tissue biopsy.

                ESR

                Children: 0 to 10 mm/hr.

                Female:17-50 years: 3 to 12 mm/hr

                Female:>50 years: 5 to 20 mm/hr

                Male:17-50 years: 1 to 10 mm/hr

                Male: >50 years: 2 to 15 mm/hr

                Raised ESR may be indicative of acute inflammation, which may adversely affect ASD symptoms.

                hs CRP

                Normal value <10 mg/L

                However, ideal is <1 mg/L

                Raised hs-CRP may be indicative of chronic inflammation, which may adversely affect ASD symptoms.

                MetaBiome Test Kit

                Refer to Metabiome Insight Report

                A simple, non-invasive sampling kit performed at home and conveniently posted in the supplied reply-paid envelope for assessment. Comprehensive, easy-to-interpret results are emailed to the Practitioner, providing a complete picture of gut microorganisms and their function.

                Hair Tissue Mineral Analysis (HTMA)

                Lead: 0.000 - 3.000 ppm

                Aluminium: 0.000 - 8.000 ppm

                Arsenic: 0.000 - 0.200 ppm

                Mercury: 0.000 - 0.600 ppm

                Cadmium: 0.000 - 0.200

                Toxic minerals associated with ASD includes  lead (Pb), aluminium (Al), arsenic (Ar), mercury (Hg) and cadmium (Cd),[184]  however, toxic minerals that exceed laboratory references ranges should also be addressed clinically.

                A functional screening for metal toxicity, which may be a driving factor in ASD.

                 

                Pharmaceutical Treatments: Autism Spectrum Disorder (ASD)

                Contact HealthMasters to ensure product recommendations are suitable for use in conjunction with pharmaceutical medications.

                • Antidepressants e.g. fluvoxamine (Luvox), fluoxetine (Prozac), clomipramine (Anafranil): Acts on cholinergic, catecholamine, serotonin and dopamine pathways, which may reduce some maladaptive behaviours.
                • Stimulants e.g. methylphenidate (Ritalin), dextroamphetamine-amphetamine mixtures (Adderall, not available in Australia): Increases release of dopamine and norepinephrine, and blocks their reuptake. Improves irritability, self-injury, aggression and tantrums.
                • Antipsychotics e.g. risperidone (Risperdal), olanzapine (Zyprexa), haloperidol (Haldol): Used to treat severe behavioural symptoms. Have shown benefit in behaviour modification.
                • Alpha2-agonist e.g. clonidine: Stimulate central (brain) alpha2-adrenergic receptors to reduce hyperarousal. May be useful in autistic children with ADHD and hyperarousal.
                • Beta-blockers e.g. propranolol: Inhibit responses to beta-adrenergic stimulation, which may be useful for treatment of aggression and self-injurious behaviour.
                • Chelation Therapy: Binds and removes free metal ions, such as mercury, which are implicated in ASD, e.g. EDTA, DMSA.
                • Anti-inflammatories e.g. pioglitozone, spironolactone, prednisolone: Brain inflammation is a recent discovery in ASD. Pioglitozone has shown reduced irritability, lethargy, stereotyping and hyperactivity in ASD.
                • Hyperbaric oxygen therapy: Counters some of the pathophysiology of ASD such as poor cerebral perfusion, oxidative stress and inflammation. Improvements in cognitive awareness, speech, social development, self-help skills and eye contact.

                 

                Additional Resources: Autism Spectrum Disorder (ASD)

                • Depression Anxiety Stress Scales (DASS): A self-report questionnaire designed to measure the three related negative emotional states of depression, anxiety and tension/stress.
                • Mindd Foundation: Providing Practitioner education and support, with a special focus on paediatric disorders, including ASD.
                • Milestone Resources based on recommendations from the World Health Organisation (WHO) and The Centre for Disease control (CDC): Growth chart resources for Practitioners to refer to and track the development of children. An in-depth checklist for Practitioners to understand what the key developmental milestones are in order to monitor child development. A parent/carer-friendly milestone checklist for parents and carers to understand what the key developmental milestones are in order to monitor child development.
                • Mood and Feelings Questionnaire (MFQ): The MFQ consists of a series of descriptive phrases regarding how the patient has been feeling or acting recently. Codings reflect whether the phrase was descriptive of the subject most of the time, sometimes, or not at all in the past two weeks. The questionnaire is appropriate for children aged between 7 and 18 years.
                • Siblings Australia: Siblings Australia provides resources and support available for siblings of children and adults with chronic conditions including disability, chronic illness and mental health issues.

                 

                References: Autism Spectrum Disorder (ASD)

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