The disorder that we call ASD is treatable by various means, so is it preventable? For the time being, the most accurate answer appears to be, “It’s complicated. Maybe. Sometimes. But, it’s not how you think.” At the beginning of an epidemic, doctors are mostly looking at the trees, and the bigger picture is elusive.
A major stumbling block to better understanding ways to diffuse the epidemic is the abundance and predominance of research about genetic influence on the disorder. So, if it’s largely genetic, as has ofttimes and generally been believed, then prevention is less likely, because our genes are, sort of, fixed.
However, if occasional-to-frequent, previously unrecognized, minor genetic variations have led to downstream abnormalities due to unforeseen environmental influences, that would be a situation that deserves further investigation. And finally, if what-we-call ASD is mostly not genetic, then the there exists an even greater possibility of preventability.
Can breast feeding reduce autism? One report of infants who received either breast milk or formula with similar supplements indicated a reduced incidence of ASD. Even if this finding is verified, correct formulation merely highlights that it’s the nutrition that matters, not the breast milk, per se. First, for most of the second half of the 20th century, when there wasn’t an autism epidemic, the vast majority of moms (in the US, at least) did not breast feed. Second, I treat many patients with autism whose moms are STILL breast feeding at 3 and 4+ years! (Yes, teeth and everything). Third, while there are many studies advancing the healthy consequences, there aren’t ones that target reduction of autism with breast feeding.
Don’t get me wrong. I am a neonatologist and I firmly believe that human milk directly from the breast is the preferred method of feeding infants. It reduces allergies, otitis media and other respiratory infections, and some studies claim improvement in IQ. But, I want to assure any guilty moms that personal and scientific evidence indicates that THIS was NOT the reason that their child suffers from ASD. Many of the affected but as-yet-unrecognized newborns have colic, GERD, hypotonia and feeding intolerances in the first place, making breastfeeding impossible or impractical.
Would alteration of the present vaccination schedule have an effect on the incidence of autism? The answer from most experts, including a recent report from the IOM, is a resounding “No”. I have serious concerns about the plethora of childhood vaccinations and I am skeptical because of the dearth of prospective, randomized double-blind research assuring us that the present schedule is always safe for everyone. Furthermore, 5% of my parents report an absolute proximate association between vaccinations and autistic regression.
However, I do treat many patients whose were never vaccinated and appear with autism. My biggest concerns are the overuse of antibiotics, and when pediatricians give vaccinations while a child is sick, even if the child had negative reactions to previous vaccinations, give extra ‘shots’ to make up the schedule, or do not take other comorbidities (such as diarrhea, asthma or eczema) into account. This is one area where we might see a reduction – if the experts would just listen to the parents.
The more recognition that the immune system triggers markers of ASD, the more we should be able to target and diminish that inflammatory reaction.The discovery about patients diagnosed with autistic symptoms who have antibodies to folic acid, which is an important prenatal vitamin for the prevention of other CNS abnormalities, may help identify the risk of the disorder and provide clues to treatment and prevention.
Autoimmunity seems to play an important part in this disorder, as reported last summer in the New York Times. Dr. Judy Van Der Water has discovered another type of auto-antibody, specific to fetal brain proteins, a finding which could lead to a prenatal test for some types of ASD. She has recommended that women get the flu shot BEFORE they consider getting pregnant, and particular attention to cleanliness and avoiding inflammation. Additionally, she emphasizes the need for pregnant moms to reduce the risk of infection and illness during pregnancy.
Dr. David Berger, a pediatric colleague who practices in a similar fashion and has assisted many families, offers his experience regarding the issue of prevention in this publication.
Obviously, research is lacking. For the present, treatment focuses on patients who already exhibit symptoms. As we identify and appropriately address the younger siblings or others with newly-identified high-risk behaviors, it appears that we can prevent the diagnosis from fully-developing in such patients. If intervention begins at the earliest red flag – before an ‘official’ diagnosis – and leads to improvement in hypotonia, G-I issues, or poor health and the child never develops further evidence of ‘traditional’ autism, that is good start.
Addendum: A recent study in the Journal of the American Medical Association reported an association between the intake of folic acid and decreased risk of ASD in the offspring of mothers who started taking the supplement at least 4 weeks prior to conception. It has been known for years that this was an important nutrient for preventing certain CNS malformations, and this lends even more credence to a healthy maternal state influencing an optimal outcome. My advice on this supplement is that the recommended dose is 400 micrograms per day – more is not necessarily better (and could be worse).