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Martha Herbert, MD, PhD marthaherbert TRANSCEND Research Program Pediatric Neurology

Martha Herbert, MD, PhD www.marthaherbert.com TRANSCEND Research Program Pediatric Neurology Martinos Center for Biomedical Imaging Massachusetts General Hospital Harvard Medical School www.transcendresearch.org www.AutismRevolution.org.

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Martha Herbert, MD, PhD marthaherbert TRANSCEND Research Program Pediatric Neurology

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  1. Martha Herbert, MD, PhD www.marthaherbert.com TRANSCEND Research Program Pediatric Neurology Martinos Center for Biomedical Imaging Massachusetts General Hospital Harvard Medical School www.transcendresearch.org www.AutismRevolution.org THE AUTISM REVOLUTION1. THE SCIENCE:How Total Load Creates Autism Every Day:Chronic, Persistent and Changeable Features www.AutismRevolution.org www.autismWHYandHOW.org

  2. Autism: A Behaviorally Defined SyndromeBiology is not part of the definition(and neither is prognosis) DSM-IV Criteria for Autistic Disorder (299.0) • Impaired social interaction • Impaired social communication • Markedly restricted repertoire of activities and interests Secondary Features of Autism Seizures (~30%+), cognitive deficits, sensorimotor abnormalities, savant skills, immune impairments, GI distress(50-75%), food allergies (~50+%) No biological markers exist to identify autism at this time Autism is presumably Heterogeneous biologically But autism is biological

  3. Whole Body Model: Vicious circles in brain and body Psycho-Social Environment Physical environment Genetics Cellular Dysfunction: Energy, Signaling, Metabolism Brain Body Communication Social interaction Restricted behavior Sensory Sleep Seizures Gastro Immune Hormones etc. Frustration More easily OVERWHELMED Pain, Poor function Sickness Overload! STRESS!

  4. New model – an Autism Revolution: From genetic brain impairment to environmental, medical obstruction of brain function Not just genetic: • Hundreds of genes, most modest impact • Numbers going up • Evidence for environmental factors Not just brain: • Systemic features – Whole Body • Environmentally vulnerable physiology Not just brain modules: • Whole brain involvement • Brain tissue changes Not necessarily hardwired: • Plasticity and recovery

  5. Intrusion of an experiencefor you and for many others 1200% increase in reported cases Gene expression impacted by environment

  6. The Autism Spectrum, the Tip of the Iceberg, and the Canary in the Coal Mine

  7. Brain cells in inflammation • Excitatory chemicals created by activated glial cells • Normal housekeeping functions of glial cells get neglected • Chronic inflammation is irritating and promotes excitotoxicity • Chronic inflammation can cause damage Inflammation and Its Discontents: The Role of Cytokines in the Pathophysiology of Major Depression. Miller et al., BIOL PSYCHIATRY 2009;65:732–741

  8. A FINAL COMMON PATHWAY?Model of autism: Increased ratio of excitation / inhibition in key neural systemsRubenstein & Merzenich, Genes, Brain and Behavior (2003) 2: 255-267 Loss of informational complexity and organization Reduced signal to noise ratio Too Much Excitation More: irritability, hypersensitivity, overload = Not Enough Inhibition

  9. Reduce Total Load of Stressors to getBetter Health, that will give Brains more “Bandwidth” Lots of Bandwidth: Good Reception Poor Bandwidth: Limited Reception Better Reception Allows Better Discernment of Differences and More Spontaneous Learning

  10. Autism is a Whole-Body, Whole-System Condition • Seizures (~30%+) • Cognitive deficits • Sensorimotor abnormalities • Disordered sleep • Immune impairments • GI distress • Food allergies • Systemic metabolic disturbances

  11. TheEvery Day of Some Autisms What we need: Clinical labs that will detect and report pertinent gut pathogens

  12. Autism is Complex:Levels that are all involved AT THE SAME TIME Creativity Social interaction Learning Behavior Brain as information system Brain as wet physical organ Organs Cells Chemistry Genes and environment

  13. Autism is a process, not a thing • Definition of Reification: • Treating processes as things • Treating abstractions and concepts as if they were alive • Application to autism • Treating autism as if it were a unified entity • Example: Doctor saying, “There is nothing we can do about your child’s diarrhea because it is part of the autism.”

  14. A Theory of How Regression Happens (see Chapter 5 of The Autism Revolution for further detail) • Demands are placed on the whole body by some combination of poor food, toxics, bugs and stress, maybe with genetic vulnerabilities in the mix. • This degrades the support system of the brain – not enough antioxidants, essential fatty acids and other nutrients. • Glial cells get distracted and overwhelmed; blood flood flow, energy metabolism and inflammation problems worsen, synaptic and network function gets weaker

  15. Problems in each area make trouble for the other areas

  16. Dialing back the problems and Moving Toward Whole Body-Brain Health

  17. A Different Model of Autism:Autism as an emergent property of a system with altered parameters Autism could be a dynamic, active consequence of challenges to cellular function throughout the body, including the brain These cellular changes may be related to environmental insults Altered cellular response could be at the root of brain and body problems This could explain the dynamic features Many cellular problems can be treated Herbert, 2009 in press, “Autism: The centrality of pathophysiology and the shift from static to dynamic encephalopathy” In Chauhan et al, Autism: Oxidative stress, inflammation and immune abnormalities

  18. If you want to read more:www.autismWHYandHOW.orga companion website to The Autism Revolution autismWHYandHOW: What it is How it works Looks at many answers to each of these three questions Looks for synergies Includes links to references • A new website, still young • A neutral presentation of many points of view • A place for civil, reflective inquiry • A repository of references and resources • Your participation is welcome

  19. Martha Herbert, MD, PhD www.marthaherbert.com TRANSCEND Research Program Pediatric Neurology Martinos Center for Biomedical Imaging Massachusetts General Hospital Harvard Medical School www.transcendresearch.org THE AUTISM REVOLUTION2. THE PRACTICE:Go for the Extraordinary Using Whole Body Strategies

  20. Autism Revolution: Ten Tips • Go for the extraordinary. • Know what you can’t control — and what you can. • Repair and support cells and cycles. • Get gut and immune systems on your side. • Build better brain health. • Calm brain chaos • Join your child’s world. • Love, rejoice, and make breakthroughs. • Lead the revolution! • Do it for yourself, your next baby, your family, and your world.

  21. RECIPE for improvement POOR BANDWIDTH, LOTS OF CHAOS • Poor food: few nutrients, many allergens • Lots of toxins and infectious issues • Lots of stress, pressure, too much too fast GOOD BANDWIDTH, RICH ORGANIZATION • Excellent food: high nutrient density, minimal allergens • Minimal toxic and infectious burden • Love, learning, respect, sensitive sensory input, savor each moment

  22. My goals for healthcare providers • That you remember and aim for the highest level of functioning and fulfillment for your patients/clients • That you support and learn more about whole-body dimensions of autism and other childhood developmental and learning issues • That you develop creative partnerships with your patients/clients to learn from each other in the service of the children/patients

  23. My goals for research • That our researchers look at the entirety of autism – whole body, whole experience – and not just genes or brain circuits • That our researchers partner with parents to get a clearer understanding of what autism is like and what would really help make life better • That our researchers learn from those who get better, as well as those who are struggling, and consider “reverse-engineering” autism from understanding what works

  24. My goals for policy makers • To understand that autism is way more than “genes and vaccines” • To go after the “low-hanging fruit” of things we can do RIGHT NOW to help the majority of people with autism have easier and more fulfilling lives • Like the Autism Revolution’s Ten Tips

  25. My goals for all of us • That autism offers us an invitation to transform ourselves so that we are • More open to difference • More aware of environmental challenges • More flexible in how we relate to others • More motivated to arrive at the best outcome • Committed to making the world a nourishing, safe and nurturing place for everyone

  26. The whole world needs anAutism Revolution www.AutismRevolution.org www.autismWHYandHOW.org

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