BIOMEDICAL

Mary Megson, MD is a developmental pediatrician who She is board certified by the American Board of Pediatrics,
has worked in the field of pediatrics for more than twenty a Fellow of the American Academy of Pediatrics and a
years. As a developmental specialist in pediatrics, she Member of the Society of Developmental Pediatrics.
devotes her career to children with developmental issues,
which include ADHD, ADD, autistic spectrum disorder, Dr. Megson travels all over the world speaking at
Asperger’s syndrome, and developmental delays. international conferences.

Developmental Needs
in Children Growing up with Autism
BY Mary Megson, MD

A
s a developmental pediatrician
in practice for twenty-five years,
I have watched a generation of
young children with autism grow up. The
oldest children, now adults, were treated
for symptoms with speech therapy,
occupational therapy, special education
intervention, and medications when
called for.
Younger patients have benefitted
from our growing knowledge of
the biochemistry of autism and
have been treated with multiple
biomedical interventions based on the
child’s individual genetic profile and
environmental challenges. To simplify
this, Dr. Sidney Baker says, “we take
away what they have too much of,
and add back what they need more
of” to correct the individual child’s
biochemistry.
Other therapies include early
intervention with one-on-one teaching,
such as applied behavior analysis (ABA),
and therapies like auditory integration
training (AIT) and vision therapy. With
these interventions, more and more
children are improving. Some even
lose the diagnosis. These children still
have long-term, perhaps more subtle
developmental, educational, and medical
needs. Autistic children remain vulnerable
due to their genetic profile and
subsequent environmental exposures.
As the children grow, they are often
expected to get more vaccines with less
thimerosal but with aluminum and other
preservatives in them. The children need
protection against infectious disease
without further harm. It is important to
determine which vaccines the child had a
poor response to. I look at family history
to see if there is a multi-generational
history of metal sensitivity, (e.g., can the
mother wear inexpensive earrings or do
they itch?). Avoiding further injection
with metals, preservatives, and/or living
viruses may be helpful.
In elementary school, the children
often have speech and language
disorders. Language re-emerges in a
predictable fashion when receptive
understanding improves, and before
expressive language emerges. During
this stage, the children face greater
frustration and tantrums increase. The
child should have a safe, quite place to
regroup when this happens. A bean bag
chair in the corner of the classroom, with
books available nearby, works nicely for
this.
Many children have abnormal sensory
modulation that waxes and wanes. These
children should be taken away to a quiet
These children should not
be punished because of
sensory issues.
place, and they need to be warned in
advance of fire drills. If the cafeteria
is too noisy, they should be allowed a
quiet place to eat their lunch. If sensory
issues intensify, the parent should take
the child to a practitioner knowledgeable
about biomedical management in autism.
Often a yeast or Clostridia infection will
exacerbate sound sensitivity because
fungi and clostridia make proteins that
block modulation of senses at the cellular
level. One adolescent patient described
loud sounds as feeling like a knife was
being poked into her ear. These children
should not be punished because of
sensory issues. Giving the child sensory
breaks with sensory integration therapy
(spinning, running, jumping, etc.) or
deep pressure on the skin and joint
compressions all stimulate the release of
acetylcholine, the “sit back, relax, focus,
digest your food” neurotransmitter that
takes the child out of “fight-or-flight”
and allows them to regroup and focus.
Learning disabilities often appear as
the child moves through elementary
school
Three types of reading disorders are
prominent: hyperlexia, dyslexia, and
ADHD reading. The hyperlexic child reads
beyond their level of comprehension,
especially, if the topic is somewhat
abstract. Reading comprehension goals
should be included in the Individualized

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Education Plan (IEP) and a learning
specialist should be consulted to help
the child. Dyslexic children often have
millisecond delays in auditory processing
and/or rod dysfunction.
Two published studies reveal poor rod
function in 49% and 50% of autistic
children. Due to poor rod function, many
children have problems reading black
on white print. For some, the letters
move on the page. These children often
read more easily on the computer with
colored print. Color overlays are available
at the Irlen Institute website that help
some children. These children often lose
their place on the page and struggle
so hard to crack the code that they
miss the content. With ADHD reading,
children miss the content due to noise
in the environment or their own internal
thoughts. We have all experienced
getting to the bottom of the page and
not remembering what we read because
our mind was elsewhere.
Children with sensitive hearing often
cannot weed out noise input as they try
to read in class. Some need medications
to improve auditory processing and
focus. Many children with autism have
far better visual attention than auditory
attention. As they proceed through
elementary school, visual reinforcers
disappear by 3rd grade, and they are
expected to sit and listen most of the
day. The ADHD many autistic children
demonstrate is internal distractibility
with auditory processing problems.
Anything that is taught and reinforced
visually is easier for these children to
grasp. Some are so visually distracted
that they have to look away in order to
listen. Every child with autism should
have vision, hearing, and auditory
processing evaluations on a routine basis.
Some benefit from auditory trainers,
sound cancelling headphones, and/or
preferential seating.
Once words and sentences emerge,
the children often have a pragmatic
semantic language disorder. Typically,
speaking to adults or younger children
emerges first, then language with peers.
Outdoor interactive play (e.g., chase
games on the playground) emerges
before indoor interactive play. Social
skills training should be included in IEP
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goals. Many school counselors do “lunch
bunch” social skills training where a
group of children discuss social scenarios
over lunch. Social skills and self-esteem
improve with participation in single-
person sports and activities such as
karate, swimming, Scouts, and/or chess
club with same-age peers.
Typically, language emerges initially
with a huge noun vocabulary, with clarity
of speech before intent. Many children
have prolonged word finding problems
and pronominal reversal. They often lose
both the topic at hand and social intent
of the communication. Relationship
Development Intervention (RDI) and
social skills training is quite helpful with
these children.
At the elementary level, math problems
include difficulty with word problems.
Also, math is typically the subject most
affected by errors of inattention. Put
simply, the child “gets it” but makes
careless mistakes. In a growing child, it
is helpful to monitor math performance.
These errors of inattention in math are
often the first symptom of the medicine
for ADHD not working anymore or of
the child outgrowing the current dose.
For many children with ADHD, math
comprehension exceeds calculation.
Treating ADHD in an autistic child is
not simple. I always take a try-and-see
approach with medications. I find some
children respond well to the stimulants,
Every child with autism should have vision, hearing, and
auditory processing evaluations on a routine basis.
Strattera or clonidine. Medicines target
the presenting symptoms. If high anxiety
causes inattention, children may benefit
from an SSRI medication. All drugs have
benefits and side effects. I find zinc and
methylcobalamin also quite helpful for
attention problems. If the child needs
medication, often lower doses for weight
are more helpful without side effects.
Middle school, teen years, and
beyond
Middle school presents its own
challenges. Neurotypical (is there such
a thing as a neurotypical adolescent?)
children become increasingly aware
of “what’s cool” in dress, slang,
and projected lifestyle. Due to the
adolescent’s surge in ability to
comprehend more abstract concepts,
children with autism seem more different
for a few years in middle school.
Bullies and the social hierarchy on the
school buses are especially difficult to
navigate. Parents may need to drive
their autistic teens to school and report
to the authorities if their child is bullied.
By high school age, many maturing
teenagers become kind and interested in
other peoples’ differences. Many high-
functioning autistic spectrum disorder
teens look more like their peers again.
Although many children have improved
by this age, keeping your IEP is crucial so
that autistic innocent behaviors are not
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misinterpreted. Recently, a child I follow
was shoved to hit a girl in the chest. The
scenario that followed involved the police
with sexual battery charges filed. The
child had no IEP, so he required retesting
to document autism before charges were
dropped and social skills training was
added to his then reinstated IEP.
Out-of-school activities are helpful
at this age, including visits to a gym,
Scouting or participating on academic
teams. Ongoing exercise helps with
frustration.
As a biomedical practitioner, I revisit
supplement routines with families of
adolescents. These need simplification
at this point. The risk of seizures
increases in adolescence. Some children
become more aggressive, especially
boys as testosterone increases. I
find using medications with an anti-
testosterone effect helpful in teens
with high testosterone (spironolactone,
azole antifungal, and/or Lupron with
precocious puberty).
In children with high anxiety, oxytocin
nasal spray can be quite helpful. Some
children thank me because it helps
them “get a friend” or “get invited
to sleepovers for the first time.” SSRI
medication and BuSpar can be helpful in
some cases of high anxiety in teenagers.
If symptoms worsen in a teenager,
I reassess the child’s gut health,
methylation support, and search for a
cause of increased oxidative stress.
Many teens rebel against special diets
and long lists of supplements. I try to
negotiate cooperation, simplify the list
of supplements, and discuss personal
environmental needs with the teenager.
I explain why they should avoid certain
foods, toxins, vaccines, dyes, and food
additives. I explain the best diet as back-
to-God food.
Parents should obtain
power of attorney for
their teenager at legal
adult age. It is important
to do this before a crisis
arises.
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All, even nonverbal, autistic adults should have a way to
communicate, a job to support their independence and
self-worth, and a safe supervised home-like environment in
which to live and feel respected and valued.
They should choose foods around
the perimeter of grocery stores, not the
prepackaged, preserved choices in the
middle. I explain the need for ongoing
basic supplements such as vitamins and
minerals, calcium, magnesium, zinc,
B-complex, and methylcobalamin, to
name a few. All children and teens need
exposure to sunlight (>20 minutes a day
with some exposed skin), exercise, and
a healthy diet. For teenagers still unable
to digest gluten and/or casein, I explain
that staying off these foods will get rid of
their feeling spacey, knowing that I get
increased cooperation with the diet and
use of enzymes.
Older teens need to be monitored
for poor endurance and/or exhaustion.
Some teens with these symptoms benefit
from Acetyl L-Carnitine 1000 mg/day
and Coenzyme Q10 150 to 300 mg/
day. I look for and treat chronic viral
infections. Hyperbaric treatments and
oxytocin nasal spray help give the “with
it” factor. Training in social skills remains
helpful at this age to teach teen slang and
innuendos.
Parents should obtain power of attorney
for their teenager at legal adult age. It is
important to do this before a crisis arises.
Recently, a patient could not be admitted
to the hospital involuntarily because he
was no longer a minor and his parents
lacked power of attorney over him.
Hopefully, by this age, the child has a
case manager with Mental Health, Mental
Retardation/Community Services Board.
Parents should take advantage of all
available benefits for the teen and adult
child such as respite funds, in-home aides,
financial support, and social/recreational
programs for adolescents and adults.
Many young adults with Asperger’s
or high functioning autism spectrum
disorder will successfully attend college
en route to a successful career. Some
students opt to live at home and attend a
community college nearby. Others want to
live on a college campus and experience
campus life. Marshall University in West
Virginia has such a model program with
a positive behavioral support program.
After being admitted to the university
and the program, each student’s needs
are assessed and appropriate academic,
social, and life skills supports initiated.
Hopefully, more such programs in the
future will aid other students at this
level. There are wonderful websites for
young adults with Asperger’s syndrome
and high functioning autism dealing with
college resources. Other websites provide
resources for dealing with adult sexuality.
Many options are being created for
alternative living arrangements for
adults with autism. In the United States,
many large institutions for adults with
disabilities have closed down, and
group homes, government-accredited
and operated facilities and/or private
facilities have opened in their place. With
the current autism epidemic, there is a
mushrooming need for adult housing.
Other options include live-in caregivers
and parent formed co-ops providing
support service for adults with disabilities.
Other communities have formed, with
groups of group homes clustered in city
and/or farm settings. Due to the enormity
of this pending crisis in housing for adults
with autism, parent groups should study
this issue carefully and prepare different
options for this population.
All, even nonverbal, autistic adults
should have a way to communicate, a
job to support their independence and
self-worth, and a safe supervised home-
like environment in which to live and
feel respected and valued. Let’s all work
together now to assure this bright future
for our affected children.
ISSUE 31 2009