Autism and Autism Spectrum Disorder
Autism is a neurodevelopmental disability which results when the normal development of the brain goes off course. Some key neuroanatomical abnormalities have emerged across the spectrum of Autism. Approximately 20% of individuals show enlarged cerebral cortex, representing either brain overgrowth or the failure of normal developmental pruning. Many individuals show abnormally small cerebellums with disorganization of the cellular layers. Studies of functional connectivity show that there is increased local interconnectivity, but the connections between different parts of the brain or long-range connections are decreased in number. Inflammation is often found in the brains of people with autism. Inflammation is most prevalent in the hippocampus and the cerebellum.
Treatment of ASD
There is no FDA-approved medication for the treatment of ASD. Risperidone (Risperdal) is often cited, but it is FDA-approved for the treatment of aggression in autism. The treatment of autism has to be targeted to the symptoms that are creating difficulties for the patient. Thus, a variety of medications have been repurposed to treat ASD. This includes the SSRI antidepressants for low mood and obsessive or perseverative thinking, buspirone for anxiety, donepezil for cognitive difficulties, cardiac medications for agitation and PTSD, mood stabilizers, and…yes…antipsychotics. Many of these medications can be beneficial and can be safely used over long periods of time. However, the tendency in Medicine is to reach for the antipsychotics first. Antipsychotics carry serious long-term risks and those risks must be carefully considered before starting a prescription for a child with ASD.
A Non-Pharmacological Alternative
Neuro-Luminance and others have researched the benefit of infrared light therapy for ASD. The results have been very promising. We have seen improvement in cognitive function, increases in social interactions, and reduction in anxiety and depression among the patients we have treated. Using our LUMIT (Laser Unattenuated Multi-watt Infrared Therapy) protocols, infrared light directly reaches the brain and the mitochondria within brain cells. As you will read below, mitochondria appear to play a key role in the neurophysiology of ASD. Numerous clinical and animal model studies now support the potential benefit of infrared light therapy as a unique treatment modality for ASD [Hamilton C, Liebert A, Pang V, Magistretti P, Mitrofanis Lights on for Autism: Exploring Photobiomodulation as an Effective Therapeutic Option. J. Neurol Int. 2022 Oct 27;14(4):884-893]
Research Supporting the Use of Infrared Light to Treat ASD
Leisman and colleagues studied the benefits of infrared light treatment in a larger group of children in a sham-controlled study. Among 40 children aged 5-17 years, 19 received sham treatment, while 21 received low-power infrared light treatment of 635 nm at 15 mW for 5 minutes twice a week for four (4) weeks. This very low-powered light was applied to the base of the skull and temporal regions with a headband containing LEDs. This study from Israel, used the Aberrant Behavior Checklist and showed that irritability score was reduced by 15.17 points in the low-level infrared therapy group. [Leisman G, Machado C, Machado Y, Chinchilla-Acosta M. Effects of Low-Level Laser Therapy in Autism Spectrum Disorder. Adv Exp Med Biol. 2018;1116:111-130]
A small subset of these subjects was followed 6 and 12 months after the end of treatment. They demonstrated a persistent reduction in irritability based on the Aberrant Behavior Checklist. [Machado C., Machado Y., Chinchilla M., Machado Y. Twelve Months Follow-up Comparison between the Autistic Children vs. Initial Placebo (Treated) Groups. Internet J. Neurol. 2019;21:2]
Recently, Ceranoglu and colleagues studied a small group of adults with ASD. Among ten (10) adults with ASD who received 850 nm infrared light delivered via LEDs within a headband. Treatments were applied twice a week for eight (8) weeks (total of 16 treatments). Participants showed a reduction in the Social Responsiveness Scale by 30 points and improvements in the Global Assessment of Functioning score by 13 points. This small study at Harvard/Massachusetts General was an open-label trial with no follow-up. However, the clinical improvements were short-lived. [Ceranoglu TA, Cassano P, Hoskova B, Green A, Dallenbach N, DiSalvo M, Biederman J, Joshi G. Transcranial Photobiomodulation in Adults with High-Functioning Autism Spectrum Disorder: Positive Findings from a Proof-of-Concept Study. Photobiomodul Photomed Laser Surg. 2022 Jan;40(1):4-12]
Sverdlov and colleagues recently presented new data on the use of an infrared LED headband that delivered unspecified amount of energy at an unspecified wavelength. In an 8-week trial with treatments twice per week (total 16 treatments) involving 22 subjects, a reduction in delta waves was demonstrated by qEEG. Also, a reduction in score on the Childhood Autism Rating Scale (CARS) of 5 points was demonstrated (mean 35 to 30 point). Only a portion of the participants saw persisting benefit; most returned to baseline after the treatment period. [Transcranial Photobiomodulation for Treatment of Pediatric Autism: Results of a Sham-Controlled Human Clinical Trial, Frontiers in Optics meeting 2023]
One exciting finding in an animal model of ASD, demonstrated that infrared light therapy for the pregnant mother may be preventative. Using a model of ASD based on the adverse effects of the anticonvulsant, valproate, on neurological development, a group in South Korea made this remarkable finding. Kim and colleagues have shown that autistic behavior can be induced in the offspring of mice injected with valproate during pregnancy. Treating the pregnant mice with 830 nm light (70 mW for 10 min – E13, E15, E17) resulted in reduced repetitive behaviors, reduced hyperactivity, improved social preference index scores, and improved cognitive function in the offspring. Neuroinflammation was also reduced. [Kim UJ, Hong N, Ahn JC. Photobiomodulation Attenuated Cognitive Dysfunction and Neuroinflammation in a Prenatal Valproic Acid-Induced Autism Spectrum Disorder Mouse Model. Int J Mol Sci. 2022 Dec 17;23(24):16099]
While much of this work has focused on the use of low-level infrared devices which can easily be worn over prolonged periods by individuals with ASD, a notable feature is that the benefits with low-level infrared light tend to be short-lived. Often the symptoms return to baseline levels of severity when the treatment is stopped. Here is where Neuro-Luminance’s LUMIT protocols shine bright. LUMIT penetrates the scalp and skull to safely and effectively reach the neurons of the brain. Thus, LUMIT directly aids the functioning of the mitochondria, activate growth factors, and reduces inflammation. As a result, the changes we see in our patients are long-lasting and life-changing.
Causes of ASD
While a single cause for Autism was sought for many years, research now shows that there are multiple causes of Autism. Some individuals show a genetic difference; however, there appear to be multiple genetic abnormalities which can lead to the symptoms of Autism. To date no single genetic mutation has been shown to account for more than 2% of all cases. There is some evidence for certain viruses that can contribute to the progression of autistic symptoms. There is also evidence that certain chemicals, given early in life, which can contribute to the progression of autistic symptoms. Ultimately, it appears that Autism is a final common pathway of amplified symptoms, which result from multiple causes.
As with many neuropsychiatric disorders, there is evidence of mitochondrial dysfunction in autism. Mitochondria are organelles within our cells responsible for energy production, but they also serve many other functions. Mitochondria release reactive oxygen species, generate a variety of second messengers, communicate freely with the chromosomal DNA, and have a pivotal role in the body’s intrinsic immune system. Furthermore, some viruses have been shown to interfere with the mitochondria’s ability to produce intrinsic proteins required for proper function. Mitochondria modulate the neuron’s response to inflammation and stress, regulate reactive oxygen species, send signal proteins, and activate growth factor production.
Speaking of growth factors, there is a fascinating finding in animal models of Autism which link the health of the gut microbiome to the production of growth factors in the brain, in particular brain-derived neurotrophic factor (BDNF). BDNF has a major role in neuroplasticity in the adult brain, but also has a pivotal role in the developing brain. The brain in fetal life has far more neurons than the adult brain. The highly complex organization of the brain is achieved in large part by a “sculpting out” or selective death of neurons. This selective death is regulated by growth factors, including BDNF. Recall that some individuals with Autism have extra neurons in the cerebral cortex. Notably, increased levels of BDNF have been found in animal models of Autism and in the blood of individuals with Autism. It is possible that abnormalities in the gut microbiome might disrupt this normal restriction of BDNF and other growth factors, resulting in the aforementioned overgrowth and confused circuitry of the cerebral cortex. Extensive evidence exists for abnormalities in the gut microbiome in those with Autism.
Diagnostic Strategy for ASD
Level 1 or mild ASD – is considered “high functioning” ASD and includes those who would have previously been diagnosed with Asperger’s Syndrome. Individuals with Level 1 ASD may struggle with social relationships and understanding subtle forms of communication, particularly nonverbal cues. Nonetheless, these individuals can be successful in school and work. Patients with Level 1 ASD may tend to be very verbal, often orating like “Little Professors” on topics that interest them. Yet, nonverbal communication and the emotional qualities of speech can be a mystery to them. They may have some social reciprocity (you smile at them and they will smile back), but social reciprocity can be very limited. Children may lack social imitative play and engage in parallel play only. Adults with Level 1 ASD may appear aloof and indifferent to others, while internally they struggle with how to “fit in” socially. They may be upset by changes in routines, but generally are able to adapt.
Level 2 ASD – the individuals with this diagnosis have much greater difficulty with language and social interactions. Their speech may be repetitive, or they may perseverate on one topic. Speech development is typically delayed. The nuances of intonation, emotional speech, and nonverbal communication are often absent or markedly impaired. Individuals with Level 2 ASD struggle to initiate conversations and to sustain them. These individuals generally prefer to talk about a limited range of topics which are of interest to them. Individuals with Level 2 ASD have much greater difficulty developing friendships and peer relationships. They tend to have poor social reciprocity, limited eye contact, and struggle to understand the emotions of others. Behavioral rigidity and stereotomies are much more common among those with the diagnosis of Level 2 ASD. Hand-flapping, spinning of objects, rigid routines of behavior, and emotional outbursts in response to change are often seen. Those with Level 2 ASD can function in school or work environments with support.
Level 3 ASD – Individuals with Level 3 ASD are severely impaired and will often be nonverbal or have quite limited use of language or communication. Individuals with Level 3 ASD have very limited social reciprocity and generally do not initiate social interactions. These individuals also struggle with understanding social responsibilities involved in school or work. They often cannot learn fundamentals of self-care, such has cooking, cleaning, laundry, and handling money. Individuals with Level 3 ASD generally exhibit marked inflexibility of behavior and react poorly to change. These individuals generally require tremendous levels of support throughout their lives.
- An infant does not imitate other children and/or does not reach out to the parents.
- Becomes stiff when held, does not like to be touched, or is ‘floppy’ and has low muscle tone.
- Delays is speech development.
- A child does not develop age-appropriate peer relationships and has difficulty mixing with others.
- Little or no eye contact, aloof manner, appears detached, lacks spontaneous sharing of interests with others.
- Inappropriate attachment to objects
- Obsessive, odd play (for example, lining up or spinning toys).
- Resists changes in routine more than typically expected for a child his/her age.
- Eats only certain foods or insists on a preferred texture of clothing.
- Repetitive motor movements and/or demonstrates uneven fine and gross motor skills development.
- Does not develop speech or has speech and then loses it; does not point or gesture.
- Repeats words or phrases over and over again; talks only about narrowly defined topics.
- Difficulty in discussing abstract concepts, takes everything literally or has impaired language skills.