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- “Been everywhere, done everything, nothing has really helped”
- “Falling between the cracks” of the medical specialties:
Pediatrics, Neurology, Immunology, Psychiatry, etc.
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Background & Interests
Dr. Hardy’s interest in autism and
developmental disorders dates back to his fellowship in medical ethics
sponsored by the Joseph P. Kennedy Jr. Foundation in 1976-1977. This
fellowship led to his first position with the Eunice
Kennedy Shriver
Center in Waltham, Massachusetts where
he served as a neurologist at both the Paul A.
Denver State School and the Walter
E. Fernald
State School in Massachusetts.
During this time he was exposed to a wide variety of developmental
disabilities including severe forms of mental retardation, chromosomal
disorders, metabolic disorders, as well as a wide variety of patients
with autism.
During those early years of his career
Dr. Hardy developed a subspecialty in the neuropsychopharmacology of
autism and the developmental disabilities. It was also during this time
that he worked under Dr. Raymond Adams at the Massachusetts General
Hospital and the Harvard Medical School Department of Neurology. In 1980 Dr.
Hardy moved over to the Tufts University School of Medicine, joining the
Departments of Neurology and Psychiatry, where he specialized in
treating both children and adults with developmental disabilities,
epilepsy with comorbid behavioral disorders, and persons with acquired
brain injury.
In 1992 Dr. Hardy left Tufts University
School of Medicine to form Hardy Healthcare Associates in order to
expand his clinical interests in Behavioral Neurology/Neuropsychiatry,
especially the Developmental Disabilities, for all age groups.
Defeat Autism NOW! (DAN!)
In 1997 Dr. Hardy attended his first
DAN! Conference at the urging of several mothers of children with autism
who had witnessed significant improvements in their children by placing
them on dairy-free and/or wheat-free diets. He was quite skeptical as
he flew out to the conference in San Diego, CA but it turned out to be a
practice-altering experience. Upon returning to his practice he was
truly overwhelmed by the relevance of DAN! concepts for helping to
improve the lives of children with autism.
Since that first conference, Dr. Hardy
notes he has learned more basic medicine than he had learned during his
medical school years, residency, and fellowship training. What has been
especially important has been learning to practice a truly integrative
and functional approach to healthcare, no longer considering and
treating each organ system as a separate entity. Although the DAN!
approach remains extremely controversial in the minds of many clinicians
and researchers, it has been gratifying to see how month by month, year
after year, many DAN! ideas and treatments are being accepted and
adopted by the mainstream medical community, as well as by parents who
are the final consumers in this free marketplace of ideas and meaningful
care. Dr. Hardy continues to believe that what Bernard Rimland, Ph.D.
has created will prove to be one of the most significant developments
for autism since Dr. Leo Kanner first described autism.
Dr. Rimland’s website:
http://www.autismwebsite.com/ari/index.htm
The DAN! website:
http://www.autismwebsite.com/ari/dan/dan.htm
A New Conceptualization of Autism
Traditional Concepts:
Originally, autism was
thought to be a psychological disorder emanating from bad parenting.
However, in recent years autism has been thought to be a brain disorder,
or neurological disorder, strongly determined by genetic factors
beginning in utero or shortly after birth. This concept has focused
medical research on a search for ‘the gene’ or ‘genes’ causing autism
and has led to a therapeutic nihilism in medicine over the past fifteen
years, with the exception of behavioral and educational interventions.
Genes vs. Environment:
It is true that autism is the
most strong of the genetically-determined developmental behavioral
disorders, or psychological disorders, with a heritability rate of 0.90
in identical twins. This led to the belief that there was one gene
responsible for autism, or at most a hand full of genes. After fifteen
years of searching for the gene, or genes, and the expenditure of untold
millions of dollars, no single gene, or set of genes, has been found.
Possible gene loci have been identified but what is very clear is that
autism is a polygenetic condition with the environment probably playing
a significant role in the expression of genetic factors. It is no
longer genes vs. environment. It is genes and environment!
The Latest Research:
Just within the past two years there
have been several important research papers published which are creating
a paradigm shift in concepts about autism. The first area has been that
of gastrointestinal dysfunction in autism. The second has been a
growing realization that, in autism, the immune system is quite abnormal
and that neuroinflammation may play a major role in the development of
autism. The third area concerns detoxification and the emerging
findings that many children with autism have impaired detoxification
which, in turn, leads to significant oxidative stress in the brain.
Thus the shift, in autism, is to think not only of the brain but to
think in terms of an ‘Autism Quadrangle’.
The Autism Quadrangle of
System Involvement: This
exciting concept of thinking about autism as an interconnected and
interdependent quadrangle is that it can, not only, guide and improve
research but it also provides for new treatment options for autism.
Many existing treatments that are presently available for
gastrointestinal dysfunction, immune dysfunction, and detoxification
dysfunction, now become available for use in autism by virtue of
thinking and practicing systemically. To conceptualize this, Dr. Hardy
has developed the following diagram to help portray the dynamic,
synergistic, and interdependent features of autism.
Gastrointestinal System:
40 – 50 % of children with autism have
major bowel problems characterized by chronic constipation, chronic
diarrhea, or alternating combinations of both. Historically, this has
been referred to as ‘the constipation of autism’ or ‘the diarrhea of
autism’ with little thought given to causation or treatment. There are
a number of reasons why children with autism have these problems and
many of the conditions are treatable, if properly identified. Treatment
of the gastrointestinal tract can lead to a reduction in the severity of
the autism for reasons that will be made clear in the next section.
Also, because the gastrointestinal dysfunction leads to malnutrition in
autism, the evaluation of nutrition and the correction of nutritional
deficiencies can improve the symptoms of autism: behavior,
socialization, learning, etc.
Immune System:
Increasingly over the last fifteen
years, immune system abnormalities have been discovered in autism. The
most significant advance in this field came when a publication, in
January 2005, demonstrated that the brains of children with autism, who
suffered accidental death, have significant signs of neuroinflammation.
What is important to realize is that nearly 70% of the immune system
surrounds the intestinal tract (Gastrointestinal Associated Lymphoid
Tissue, GALT) and is directly affected by
the health of the gastrointestinal system. It is now understood that
the bacterial ecology within the lumen of the intestine helps to
regulate the GALT. The GALT, in turn, has communicating effects upon other organ systems within the
body such as the skin and the brain. By treating the immune
dysfunction, one can beneficially impact the degree of symptoms and
signs of the autism.
Detoxification System:
The detoxification system of the body
has not been well studied in autism until very recently. Several recent
studies suggest that children with autism cannot efficiently detoxify
foreign substances such as pesticides and heavy metals. Therefore,
these poisons gradually accumulate in the children adversely affecting
proteins, enzymatic functioning, and producing oxidative stress. By
trying to correct these abnormal detoxification pathways, one can lower
the toxic burden and oxidative stress in the bodies of children with
autism. In turn, the signs and symptoms of autism can be improved.
Nervous System:
Dysfunction in the gastrointestinal
system, immune system, and detoxification system individually, and
collectively, adversely impact the nervous system producing the signs
and symptoms of autism. At this time there are no specific medical
treatments for the neurological dysfunction in autism. Therefore, one
must rely on treatment of the other systems. This is the cornerstone of
the DAN! approach for treating autism.
The Genome:
The genetics of autism are far more
complex than has generally been recognized. The discoveries of the
recently completed Human Genome Project reveal that many genes have
variations in form which are referred to as single nucleotide
polymorphisms (SNPs) or ‘snips’. Some genes can have multiple
polymorphisms, further multiplying the permutations and combinations of
genes. This great complexity is the reason the genetic research to date
has been so disappointing.
The Environment:
The environment interacts with genes and
SNPs to produce many of the diseases an individual may experience in
life, and this is true for autism as well. This may explain the
variations in the forms of autism that children develop, and that we
have all struggled to understand. Increasingly, it is the various
toxins in our environment are thought to contribute to the types of
autism we see (phenotypes).
The Phenotypes of Autism:
Phenotype means the type we can see or
observe. Because of the great variations in biologic individuality,
there are actually many phenotypes of autism. Each person with autism,
in a sense, is unique and should be evaluated and treated as such. The
failure of many research studies in autism is, in Dr. Hardy’s opinion,
the failure to properly sub-classify the phenotypes of autism.
Methodology and Hierarchy of
Assessment
The evaluation of a person with autism
is similar to peeling away layers of an onion. The initial evaluation
which includes a detailed history, the review of previous records, and a
physical examination determines where to begin the process. Often, a
thorough evaluation of gastrointestinal functioning is the first layer
to consider. This next layer may be immune function, or an evaluation
of detoxification and oxidative stress. This may be followed by a
thorough evaluation of the brain: radiological imaging studies and
electrophysiological studies. In many cases, it is not until the
gastrointestinal system is treated adequately that other systems can be
effectively treated.
Treatment
The biological treatments of autism are
many, and they are often interdependent: one affecting the other and
dependant on the other. The latest version of the DAN! treatment guide,
AUTISM: EFFECTIVE BIOMEDICAL TREATMENTS (2005) goes into considerable
detail about the rationale and specific implementation of these many
treatments. An overview of these treatments in the context of the
Autism Quadrangle is depicted as follows:
Applicability to a wide range of
disorders
This approach to evaluating and treating
autism, the severest of the developmental disorders, has applicability
to many other developmental disorders such as Down’s syndrome, Rhett’s
syndrome, Praeder-Willi syndrome, and even individuals with epilepsy.
Nutritional issues and bowel problems are common in many developmental
conditions. |
