Autism and autism spectrum disorders create an enormous burden on both the individual and their families. The aetiology of autism spectrum disorder involves many genetic and environmental contributions and implicates several brain systems, in particular the gamma-aminobutyric acid (GABA), serotonergic and glutamatergic systems. Many symptoms can occur, with sleep disorders, anxiety, depression, attention deficit/hyperactivity disorder, irritability, and multiple gastro-intestinal disturbances.⁽¹⁾

Initial Consultation

An 8-year-old Bangladeshi boy presented with a diagnosis of Autism - Level 2 on DSM-V 1-3 scale. (‘Expressive and receptive language disorder, Sensory processing disorder, Mental self-regulation problem’). Early childhood development had been good up until the age of two. Previously he had been reaching his age-appropriate milestones in spelling, reading and numeracy development but then deteriorated to total loss of speech by three years of age. He had become fearful, lost co-ordination, and unable to understand others (except his mum). He had been receiving occupational speech therapy and three years of behavioral therapy through a behavioural paediatrician, with little improvement.

A case history revealed:

• Speech problems – does not make eye contact, does not engage in conversation, limited use of words and simple in structure e.g. ‘I want milk.’
• Intellectual understanding of a 3 year old (at 8 years of age).
• Will not listen, only able to follow one instruction at a time.
• Hyperactive, unable to sit quietly (fidgets constantly), stay seated or concentrate and focus at school.
• Lack of smell sensitivity (agnosmia), though sense of taste fine.
• Some light and noise sensitivity.
• Anxious, cries regularly, prone to tantrums, nail biting, chewing nonfood objects.
• Anxiety when activities are interrupted or if electronic devices taken away (device focused).
• Good spelling and reading skills.
• Energy 9/10 though weight in the 10th percentile.
• Sleep recently deteriorated, previously went to bed at 9 pm, but now 11 pm, and waking now at 9 am. Takes a half hour to ‘get going.’
• Three febrile episodes treated with antibiotics in Bangladesh.
• Two years of recurrent upper respiratory tract infections (URTIs), dry cough (after arriving in Adelaide).
• Nose often blocked.
• Born via C-section after healthy gestation, breastfed two years.
• Marked change in diet on arrival in Australia. Traditional diet had been replaced by highly refined carbohydrate foods (pasta, bread, weet-bix, chicken nuggets), with little fruit.
• Mum had recently made changes to re-introduce more traditional foods – lentils, beans and vegetables.
• No pathology tests were provided, however, low vitamin D levels had previously been found.

Initial Prescription

• Magnesium amino acid chelate powder (150 mg elemental Mag) plus glutamine, taurine, selenium, and vitamins C, B2, B3, B6, and B12. Dosage: One scoop, twice daily for neurological energy and anxiety.
• N-acetylcysteine powder. Dosage: 600 mg twice daily for neuroinflammation, immune protection, glutamate regulation, and glutathione enhancement.
• Vitamin D spray. Dosage: 4000 IU once daily for neuroinflammation and immune support.
• Omega-3. Dosage: 4000 mg for neuroinflammation.
• Other non-disclosed sleep remedy.

Dietary advice

• Remove milk and gluten. Replace wheat-based foods with rice.
• Add fruit to his diet (to increase vitamin C and polyphenol content), continue to increase lentils, dahl and beans, vegetables.
• Include good fats and oils (ghee, tahini, avocado, coconut, oily fish).

4-Week Follow-Up

Now going to sleep by 9 pm and waking at 7 am. Found melatonin worked best at 8 pm. Tiredness had reduced by 50%.

• Speaking clearly to mum, responding 80% of time compared to 20% previously.
• Able to understand complex instructions (3 or 4 separate instructions at once) and speak complex sentences to himself.
• No tantrums, no anxiety in general.
• Started initiating conversation and asking for needs, speaking in complex sentences.
• Able to sit with occupational therapist (OT) for 25 minutes, and sit without electronic devices without causing anxiety or tantrums.
• Blocked nose had disappeared.

The initial supplementation was continued with no changes.

8-Week Follow-Up

• Sitting for extended periods at school and 45 minutes with his OT. No longer fidgeting with mum or OT.
• No anxiety.
• Some speaking at school, as previously there was very little speech.
• Now able to complete 2-digit additions in maths.
• Good attention and responsive, able to maintain eye contact, and continued improvement in initiating speech and answering.
• No tantrums.

His prescription was adjusted accordingly:

• Magnesium nutrient powder changed to magnesium citrate, Bacopa monniera (Bacopa) 4.5 g, Crocus sativus (Saffron) 15 mg , Acetyl L-Carnitine 1 g, Tyrosine 1 g, zinc 5 mg, and activated B vitamins (higher B dose than previous formula). Dosage: 1/3 scoop twice a day for neuroinflammation and neurotransmitter modulation
• Include more vitamin A and carotenoid rich foods in his diet to reduce bowel and neuroinflammation.

16-Week Follow-Up

• Attention continued to improve.
• Now a happy boy singing, no anxiety, crying or tantrums.
• Engaging in two-way conversation in both English and some Bengali.
• Able to follow instructions at school and sitting for extended periods of time.
• OT assessment ‘could not recognise him’ and ‘remarkable progress’. Medically assessed as no longer having “behavioural problems.”

His prescription was adjusted accordingly:

• Omega-3 blend (per 5 ml: EPA 346 mg, DHA 1.15 g, Soy Lecithin 1.7 g (Phosphatidyl choline 575 mg and phosphatidylserine-enriched), plus Vitamin D 800 IU. Dosage: 4 ml once daily (replaced original omega-3 capsules) for neuroinflammation and enhancing new neural connections (neural structure and function).
• Reduce Vitamin D spray to 3000 IU once daily.
• Within six months, he had continued to make further improvements, initiating his own activities with substantial academic progress.
• Muscle tone significantly improved.
• No sensory issues, no nail biting or chewing of objects.
• Significant improvements seen and maintained in all aspects of learning, communication and socialisation, with his “personality now coming through.”
• Medically assessed as only having developmental delay.

Clinical Take Home

Autism and associated disorders can be complex conditions to treat. However, massive positive changes can occur with even basic, but targeted supplementation. Prescribing usually involves dosage adjustment and addressing different aspects over time. These positive changes can be maintained and life changing.

References

1. Bruchhage MMK, Bucci MP et al. Cerebellar involvement in autism and ADHD. Handb Clin Neurol. 2018;155:61-72. doi: 10.1016/B978-0-444-64189-2.00004-4. PMID: 29891077.