Osteopathic Medicine and Autism.

Introduction

Autism has increased in both incidence and prevalence by between
10 and 50 fold for the past ten to twenty years. This is cause for
grave concern as such a sudden increase suggests that it is not due
to genetic influences but rather environmental influences of one sort
or another. As child neurology residents twenty years ago, we rarely
saw cases of autism. Today I have almost 30 cases in my own
practice with other colleagues reporting as many as 200 cases in
theirs. In 1984 it was calculated that by the time a clinician becomes
aware of a causal association between exposure and disease or
becomes aware of an increase in incidence, the odds ratio is already
at least ten.? Within the past twenty years we have had a dramatic
increase in the introduction of multiple vaccines, multiple toxins,
multiple allergic syndromes, as well as shift geared toward fairly
aggressive interventionist obstetrics.

With the advent of the MMR vaccine there has been a significant
concurrent jump in incidence and prevalence of autism.?-? There has
also been an additional increase in incidence following the
administration of the hepatitis B vaccine in the perinatal period, which
is strongly suggestive of a cohort effect.4 We have seen a marked
increase in the familial incidence and prevalence of autism as well.
Many studies have attempted to discover a genetic etiology;
however, for a genetic influence to create an epidemic would be
against the basic laws of nature. A familial cause on the other hand,
ie. a shared risk factor from the environment, has tremendous
biologic coherence.5 A recent case report of a twin pair discordant for
autism in which one twin was subjected to the standard vaccine
schedule while the other did not receive vaccines until later, should
shed strong light on this issue as one twin is autistic, the other is
not.43 There are reports within the Osteopathic literature dating
back to the 1930s, of cranial distortion contributing to altered
cerebral function and osteopathic treatment restoring children to
normal or to markedly improved level of function.6-17 While these
reports have largely been ignored by mainstream medical practice,
many of these issues have, in fact, been discussed in books on
Osteopathic Medicine and especially in books on Cranial
Osteopathy.18-19

Within the alternative medicine environment there are additional
issues which bear directly upon Autistic Spectrum Disorders. Large
numbers of children have been studied following aggressive allergy
elimination treatment (NAET) with quite remarkable success.20
Additionally children have been treated homeopathically using both
isopathy to reverse and ameliorate vaccine side effects, as well as
with the more classical approach of a constitutional remedy. Multiple
studies have addressed themselves to rehabilitative efforts including
L.E.A.P., Lovaas, P.A.C.E., T.E.A.C.H., The Princeton Early Autism
Program and similar A.B.A. programs.21-22 Many of these programs
have demonstrated considerable success given certain circumstances.
One of the several common threads running through all of these
reports is that the earlier intervention is initiated with these children,
the better the chance for improvement and possible recovery.

Until now no one has systematically investigated the presence or
absence of cranial distortions and cranial and intra-cranial strain
patterns and their possible relationship to autism. In this paper I
report on twenty-five children who have been studied and treated
osteopathically. The majority of children in this study have been
exposed to highly integrated forms of treatment and rehabilitation
utilizing some or all of the following: cranial osteopathic techniques,
homeopathy, vitamin and herbal supplementation, lipid
metabolism,44 allergy elimination, behavior modification, auditory
integration, sensory integration, and extensive OT, PT and speech
rehabilitation. In no case was a single intervention by itself ("a
magic bullet") found to have had a significant level.

Methods:

Charts were reviewed from 25 consecutive children seen with a
diagnosis on the Autistic Spectrum meeting current DSM4
classification and diagnostic requirements (Table 1). There was one
case of Asperger's and three children who demonstrated autistic
characteristics but did not meet the requirement for diagnosis. There
were 8 girls and 17 boys. The ratio was approximately 2 boys for 1
girl. The mean age at first visit was 4.4 years. The median age at
first visit was 3 years. 15/25 of the children were ages 3 years or
less. Three of the children were siblings or twin pairs. 24/25 had
received Hep B vaccine; 23/25 had received the DPT/OPV/MMR. 1/24
with a clear onset within two weeks of MMR (ie. from typically
developing to autistic).

Results:

22/25 children demonstrated a characteristic common cranial
distortion. This distortion was characterized by compression and/or
restriction of the left middle cranial fascia. In all cases there was an
over-lying hyper-flexion type of pattern at the spheno-basilar
synthesis. This resulted in tension on the falx such that the falx was
pulled down exerting compression on the corpus callosum. The
tentorium was likewise flattened causing compression and decreasing
the space available for growth of the cerebellar vermis. The left
middle cranial fossa was restricted with significant restriction through
the left frontal temporal sphenoidal articulations extending down
through the spheno-temporal articulation into the spheno-sqamous
or SS Pivot. Over-lying compression was uniformly noted to involve
the left zygoma. Additionally, bi-lateral alanto-occipital (condylar)
compression was noted in all of the children studied (25 of 25). In
all 25 children the sacrum was markedly restricted and in 22/25 a
marked sacral torsion was noted. In all cases primary diaphragmatic
dysfunction was noted and the pulmonary diaphragm was noted to
be out of phase with the other two diaphragms. Compressions
through the left and right innominate were ubiquitous.
Decreased function through left and right lumbo costal arches was
also uniformly noted. In the other three children one exhibited a
severe torsion at the spheno-basilar symphysis as well as
spheno-basilar symphysis compression. The other two children
demonstrated a severe lateral strain (parallelogram deformity) with
significant plagiocephaly.

On an energetic level additional distortions were noted in all cases
which significantly compromised the overall health and functioning of
each child. In 22/25 children the posterior anterior energy flow
through the midline of the body was diverted at the level of the sella
tursica with a deviation approximately 90 degrees to the left. In
25/25 cases the motion of the third ventricle was significantly
impaired, as was the inherent motion of the central nervous system.


In 25/25 children the ignition system through the third ventricle was
also significantly impaired. In 25/25 children the energetic notochord
was found to be foreshortened of its normal length.

Outcome to Date:

15/25 children are communicating in sentences of 4 words or more,
initiating social contact and demonstrating spontaneous imaginative
play. 1/25 is fully mainstreamed and recovered. 11/25 are in
regular preschool, kindergarten or grade school with some
assistance. 13/25 are in special school programs for autistic
children.

Homeopathy:

11/25 children were treated with isopathy using preparation of
standard vaccines.
10/11 responded markedly to treatment with hepatitis B. 11/11
responded to treatment with MMR. 6/6 responded to treatment with
DPT. It should be noted that the majority of the children required
isopathic/homeopathic treatment for multiple vaccines. Following the
most isopathic/homeopathic treatment a clear increase in cognitive
function and socialization was noted. While some of the responses
were quite impressive, in no instance did this treatment lead to a
miraculous recovery.

Discussion:

At the onset of this discussion I want to emphasize once again that
no "magic bullet", no single treatment alone was found to
significantly ameliorate or reverse the effects of autism. Instead, in
all cases an individualized, well thought out and integrated approach
was required to move these children along the road to improvement
and recovery. It appears that some interventions paved the way by
having the effect of allowing subsequent interventions to be better
tolerated and more effective.

The cranial distortions which were identified were remarkably
consistent, even in siblings and twins (ie. the same distortion
patterns were found with the sib or twin). While it is tempting to
immediately look for a genetic component, there is clearly another
possibility to be considered that is far more consistent with an
epidemic event. It has long been known that pelvic distortions in the
mother result in similar distortion in the child who passes through the
birth canal. It has also been known in osteopathic literature and
teaching that interventionist obstetrics utilizing epidural anesthesia
and pitocin with forceps and vacuum extractors often results in cranial
distortion. Unfortunately, it is also documented that these
distortions are frequently NOT self-correcting. These non-physiologic
cranial distortions create an ongoing cerebral irritability usually
diagnosed as irritable baby syndrome, colic, difficulty sleeping, etc.

One has only to look at the older generation born prior to
approximately 1940 when these obstetrical interventions were far
fewer. In this older generation, heads are regular in shape and only
very rarely distorted. One measure of cranial base distortion is
regularity of teeth. The population rarely required orthodontic
intervention to straighten their teeth, yet they have relatively straight
teeth. The teeth phenomenon is a simple one in that teeth grow
either regularly or irregularly in response to intra-cranial distortions.
When in the late 1940s there was this marked change in obstetric
practice in the United States, a change from natural delivery to
obstetric interventionist delivery of children, this change to a large
degree, resulted in a epidemic of cranial distortions. When there is a
distortion of the maternal pelvis, the perinatal head which comes
through is basically liquid or gelatinous and takes on the form of that
pelvis – much like dough coming through a cookie cutter. If
you push dough through a cookie cutter you get remarkably
reproducible cookies. The same thing happens to siblings coming
through the same birth canal. This may account, at least in part for
the familial but not genetic concordance of autism in siblings. When
one changes or alters the maternal pelvis by osteopathic treatment
geared to returning that pelvis to normal or to "neutral", the next
sibling delivered takes on a very different head shape than prior
siblings delivered through an altered pelvis.23 This is reproducible in
case after case.

All of the above studied children were treated in Cranial Osteopathy.
This treatment was not geared just to the cranio-sacral mechanism.
Cranial Osteopathic treatment addresses the entire system, not just
the membranes. In addition to the membranes, it addresses the
bones, the cartilage, the fluid, the entire dynamic of the individual.
It seeks the health within the system and to enhance that "health"
to bring about clinical improvement.24 By so doing, these cranial
restrictions can be alleviated. Once these restrictions are released
the brain has an opportunity to grow in its intended fashion.
Common observations after treatment include, "my child is calmer,
sleeps better, falls asleep easier, is less irritable, etc". It appears
that the earlier these children are treated and the restrictions
released, the better the chance for significant progress. Again
however, it must be understood that removing these restrictions does
only that: remove restrictions. In addition to the brain, the entire
system must then be rehabilitated with any number of reasonable
and appropriate interventions.

There are numerous studies that address the neuro-immunologic
aspect of brain and its effect on the system in general; this effect
includes the immunologic environment of the body.25-26 We have
known osteopathically that restoring the system to neutral, ie.
removing restrictions, has a dramatic effect upon the neuro-immune
system, as well as on allergy, infections and other aspects of
immunological function. Going through allergy elimination
treatments (to food as well) may allow these children to do much
better and be more receptive to other interventions. There are
simple non-invasive allergy elimination techniques which do not
require blood drawing, scratch testing or shots which are very
effective in dramatically reducing allergies in over 80% of children.29
When these allergies are aggressively treated the children often
gradually come off their very restricted self-induced diet and the
variety of food intake improves dramatically. This may also
significantly and positively effect cognitive function.30-31

Additionally, both isopathic and homeopathic treatment may also be
important components in ideally reversing, but at least, in markedly
decreasing the negative effects of some vaccines. In terms of
vaccine issues, we use both isopathy/homeopathy and allergy to the
specific vaccines in our office with treatment effective success. While
these children following a homeopathic or allergy treatment regime
may have a brief 2-5 day period of irritability, following this mild
aggravation these children almost uniformly demonstrate a
noticeable jump in cognitive and/or social function. Paul Herscu uses
a combination of constitutional homeopathy and osteopathic
treatment also with positive results.32 Titus Smits of the Netherlands
uses an isopathic Kentian approach to vaccine treatment.33

The cranial osteopathic lesion, as described in the result section, has
a clear impact on cognitive and behavioral function as demonstrated
by improved clinical function. This distortion also may have a
marked impact on neurotransmitter function. Numerous reports have
appeared in the literature addressing the issue of altered
neurotransmitters and especially serotonin in autistic children.34-36
The cerebellar abnormalities involving cerebellar vermis have their
clinical correlates.37-40 In these autistic children, there is a
deficiency in rapidly orienting resources to an attended visual spatial
location. This also effects arousal and attention in addition to
coordination and retention in the acquisition of normal social
communication skills. Following release of the tentorium and
providing adequate space for growth of the cerebellar vermis, many
of these children so treated demonstrate marked improvement in
social skills, orientation, and receptivity to speech and occupational
therapy. The need is still present to be taught, re-educated and
rehabilitated in social interactions, but at least now that is physically
easier to accomplish. Reduction of pressure or release of pressure
upon the corpus callosum allows for reintegration of the two cerebral
hemispheres. Release of pressure surrounding the temporal lobe
now allows for appropriate growth of the temporal lobe and all of its
concomitant speech centers. Once this key restriction is removed,
the temporal lobe is available for aggressive speech therapy and
rehabilitation. There have been multiple reports of asymmetric brain
activity of reversed pattern of lateralization of brain activity for
language and motor imitation, as well as other priatal lobe
dysfunction.41-42 This, I believe, is in compensation for the left
sided brain compromise. Once these restrictions are relieved, these
children begin to demonstrate a sometimes dramatic and marked
increase in eye contact, initiation of social interaction and eventually
speech.



Summary

I have reported a reproducible common consistent pattern of cranial
and intra-cranial distortion in a majority of children so studied with
autism. Once these restrictions are aggressively treated
osteopathically and aggressive rehabilitative efforts are applied,
significant positive results can and do occur with these children. It is
also extremely important to note that these restrictions are treatable
manually; this is not a surgical problem. It is also clear that the
earlier these children are diagnosed and treated, the better the
possibility for a positive outcome. Ideally I like to see children under
three years of age, but we have accomplished positive results with
children entering treatment at four and five years of age. I have two
children who have responded favorably with, at least a significant and
noticeable increase in function with the initiation of treatment at age
seven. At present, I have no experience with any older children. It
should also be noted that the positive effects of the release of
cranial restrictions can be gradual and it may take several series of
treatments for noticeable changes. Unfortunately, some parents take
their children out of treatment prematurely because of temporary
worsening of behaviors (a not unusual phenomena while the
treatments are processing) or because of the unrealistic expectation
that cranial osteopathy was going to cure their child and nothing
more was needed. I cannot stress enough the need for an
integrated approach based on the needs of the individual child.

Is this osteopathic cranial strain pattern the cause of autism? Most
certainly not. From examination of photographs of siblings and
parents of these children similar strain patterns have been noted.
Most autism is, in the greatest majority of cases, of multi-factorial
causation. When there is a cranial strain pattern such as I have
described, the brain is irritable. In the presence of this increased
irritability, the brain becomes far more susceptible to outside adverse
influences such as vaccines, toxins, etc. The reports of the Missouri
cohort following hepatitis B initiation in 1991 are suggestive of a
vaccine component. The multiple reports of MMR vaccination and the
subsequent increase in autism following, and with a delay of up to 4
years, are suggestive of MMR as a possible component. The
multiple studies which have proposed or which have found new
carpets in the prenatal period to be a significant risk factor suggests
an additional component supporting adverse environmental issues.

There may be some genetic aspects which contribute to an increased
susceptibility to develop autism given certain exposures. Is genetics
the sole cause? Perhaps in very rare circumstances, but generally
that has little biological coherence. One simply does not see an
epidemic increase of any disease process solely based on genetics,
and we have a clear epidemic of autism occurring at this time. It is
important to note that with the exception of the recent California
Study, all of the other studies of epidemiology of autism examine
populations that antedate current time by approximately 10 years or
more. One would expect, given the dramatic clinical increase in
autism – PDD and related disorders that epidemiologic studies
performed over the next several years will indeed confirm this
epidemic increase.

One thing that is absolutely clear is that autism is not a behavioral or
psychiatric disorder. Autism is a neurologic, physical, chemical,
physiologic neuro-chemical disorder that results in primary cerebral
dysfunction and with secondary abnormal behavior. It is vital that, in
addition to our current treatments of these children, we aggressively
investigate the causes for this epidemic with an ultimate view to
eliminating the contributing factors. What a blessing to have even
that hope.

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