When lecturing, one of the most common things I hear is a doctor telling me that he or she did a talk in their community on how chiropractic care can help children with autism and how well received the information was. The doctor will then tell me that they started getting children in their office with autism. Great news, right? Then the kicker comes. The doctor then proceeds to tell me how the children that were coming in would run around uncontrollably, kick, hit, spit, bite, head bang, knock pictures off the walls and more! Many were non-verbal and there was no way one could put their hands on them in attempt to adjust them. Then THE question comes, "How or where do you even start working with these children?" While they are telling me their story, I can see the look of desperation on their face. They truly want to help this population group but feel overwhelmed when such low functioning, or difficult to work with children, present in their offices.
One in six children in this country is said to have a neurodevelopmental disorder. In March of 2012, The Centers for Disease Control said rate of autism among 8 year-olds in 2008 was 1 in 88. Calculating the yearly increase (13%) yields the following estimates of the autism rate for 8 year-olds: 1 in 78 (2009); 1 in 69 (2010) and 1 in 61 (2011).
Current Working Paradigm
Having an understanding of the current causal paradigm of neurodevelopmental disorders is important when considering what type of practice profile is right for you, as well as to help you determine what level of care you may wish to offer within your practice. For example, working with children that have been diagnosed with ADHD or High Functioning Autism (HFA) is much different than working with a child that has been diagnosed with low functioning autism or, better yet, multiple diagnosis' such as: Pervasive Developmental Disorder-NOS (PDD-NOS) along with oppositional defiant disorder, mental retardation, ADHD, seizure disorder and reactive attachment disorder all in one; not an uncommon patient profile in my particular practice.
The current causal paradigm is one that is multi-factorial and takes into account the following: 1. Genetic predispositions; 2. Environmental/Epigenetic insults (chemical, physical and emotional); and 3. The timing within the developmental process that the insults occur.
Genetic Predispositions
In the past several decades, there has been vast amount of research into finding that "magic genetic bullet" that will lead us to the cause of autism; however, to date, not one exists. Within the past few years, research is leading us to now understand that approximately 70% of these disorders are due to environmental toxins and only about 30% to genetic pre-dispositions. However, it is important for those working in this paradigm to understand that there are a few genetic mutations that may play a part in a child's presentation and that they can be addressed by various supplemental support. One relatively common mutation is one that leads to inborn errors of folate metabolism, methylenetetrahydrofolate reductase deficiency, caused by mutations in the MTHFR gene. Dealing with these types of issues may or may not be within one's comfort zone depending on the level of advanced education and training they have in neuronutritional care and knowledge of functional laboratory testing.
Environmental/Epigenetic Insults
There are many chemical, physical and emotional stressors that may occur; especially in utero and during the first year of life, that can contribute to a later diagnosis of a neurodevelopmental disorder. Chemical factors include both endotoxins of mother and baby as well as exotoxins. Physical factors include in utero malposition and birth trauma; both can lead to spinal subluxations which can interfere with nervous and immune system development. Emotional factors include stressors the mother may have experienced or been under during critical periods of development in utero. It is now rather widely accepted that children with neurodevelopmental disorders; particularly that of autism, have underlying physiological conditions that manifest themselves in behavior/symptoms that are associated with this population group. Many of these children have immune system dysregulation, gut dysbiosis, and autonomic nervous system dysregulation; all of which have a great deal of regulation form the Vagus Nerve. As chiropractors, this should be of particular interest to our profession. A subluxation, particularly of the upper cervical spine, may cause abnormal regulation of Vagal Nerve function and may be a contributing cause of clinical presentation in this population of children. It is also important for us to remember our roots; that subluxations may occur as the result of any chemical, physical, or emotional stressors. Therefore, it is critical that these children be under our care. However, due to many of these children having Sensory Processing issues and hypersensitivities; they are sensory defensive and will not allow one to touch them, which makes adjusting them very difficult or sometimes impossible. In many cases, it may be necessary to first address immune and gut issues via neuronutritional/biomedical means and various sensory issues via calming and neurointegrative techniques.
[pb]Timing of Development
Depending on your practice profile and the level of care you wish to offer in your office, it may be necessary to understand various developmental periods and what the result may be should insult occur during different times in utero and/or within the early years of life. Working on the premise of synaptic and neuroplasticity, one may want to offer neurofunctional/neurointegrative programs within their office or within their care protocol to help lay down or further develop weak neuropathways.
Chiropractic Care in the Neurodevelopmental Paradigm
I have had the privilege of working with some of the top researchers, pediatricians and other professionals in the autism world. One thing many of them have made clear is that the chiropractic profession is the best suited to be on the forefront of helping these children because of our philosophical beliefs that the body has the innate ability to heal itself given the right environment. It is my personal belief that chiropractic care is not an option for this population group, rather a must. However, those wishing to work in this paradigm must define their level of expertise as well as the functional level of the patient that they wish to accept under their care.
Defining Your Practice Profile
What is right for you and your practice? To help you determine if this is a paradigm that is right for you and, at what level would you like to incorporate such a population group, ask yourself the following ten questions:
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