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Altered Developmental Trajectories In Autism Are Not Mutually Exclusive

Note this from a personal perspective reflecting on aspects of development

Donna Williams’ wrote a blog which I have included in mine about the connection between “autism and trauma” now these two things are not mutually exclusive. She was very much a person who thought outside of the box and did not her confine her views to rhetoric or fads making for refreshing and reflective reading.

Early Experience “Nature vs. Nurture” 

Many things part of my autism are to do with early birthing issues such as placental abruption, brain injury, c-section, circumcision due to phimosis in 1991 age 5 and ear infections which lead to grommets and adenoidectomy age 4 in 1990. Many of these factors had an impact on my developmental trajectory some of them are to do with altered states of development which then in turn create a person who nervous system reacts.

Premature 1

What “Makes Up” My Autism?

For me my autism is due to birthing complications placental abruption, prematurity hemiplegia, language processing disorder and visual perceptual disorders making up about 70% of my autism.

The 30% remaining is genetic components such as a family history of dyslexia, mood, anxiety disorders and OCD on my Mother and Father’s side.

Auto-immune disorders of various types are on my Father’s & Mother’s side. Mum had chronic childhood Ezchema, My Nan on my Father’s side had Non-Hodgekin Lymphoma and My Father Chronic Lymphocytic Leukaemia.

A Broader Perspective Of “Autism” 

Looking at the broader palette of what is “autism”? What if people are becoming progressively distant and/or scared of different “Roads To Rome” when it comes to the different factors that come with an “autistic package”. What if things that “look like autism” can actually be apart of what makes someone “non-autistic” and vice versa? Maybe we need stop finding the magic “bullet” for what autism “looks like” and what it is made up of and start looking a specific realities and all that is within them?

People Who Don’t Have Autism?

People who don’t have autism can have things that can be apart of person’s “autism package” to varying degrees – developmental delays, personality types, mental health, environment and learning styles can have an impact on anybody in the end.

Lets Stop Calling it ‘the autism’: Autism and Trauma – what’s the connection?

Donna Williams’ Blog

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Recent studies in reputable medical journals have linked Autism to seemingly farfetched things like being born to mothers with pre eclampsia, being born prematurely, being born to older fathers, being born to smokers, being born by cesarean, being circumcised under the age of 5.

And as an autism consultant since 1996 I would say that of over 1000 families I saw as a consultant, that a rather strikingly significant number of them claimed to notice the onset of their child’s autism in the week following the child’s first birthday party (being posed for photos, candles, cake, room full of visitors, clown etc). And then of course are the plethora of families who swear their child began developing autism anywhere from 24 hours to 3 months after heavy vaccination schedules. Could these seemingly unrelated things have anything in common? Could it even be there is a cascade effect where the child’s autism is present (subclinical) but not showing following a cesarean birth, then becomes progressively more obvious if the same child gets circumcised, has a heavy vaccination schedule and is then thrown a full on first birthday party? It may sound utterly whacky, but is it possible?

“Children can develop a kind of ̳hard-wired‘ autonomic nervous system response to trauma and its triggers due to the ongoing need to utilise the circuitry to promote adaptive defence strategies. Over time they decrease their capacity to access their social engagement system (since this has not been used successfully in great amounts), and as more and more of the world is perceived as unsafe, they come to rely on their defensive states to negotiate their environments, making social engagement very difficult.

Porges research has revealed that how our nervous system interacts with our environment depends on not just the absence of threat, but the absence of nervous system perceived threat. He has developed the term ‘neuroception‘ to describe our perception of safety not just consciously but also – and often exclusively – at a below cognitive level (Porges 1998, 2001, 2003). It is this neurological response of safety that promotes the ability to utilise our newer system and circuits, whilst conversely, the lack of safety promotes a return to using older circuits to mobilise or immobilize in the face of neurologically perceived danger.

When our nervous system detects safety our system adjusts and makes it possible to enjoy closeness without fear, and keeps us from entering defensive physiological states of mobilised hyper arousal and immobilized hypo arousal, whilst still enable the use of these circuits in safe ways.”

Chronic ear infections have been linked to PTSD so why shouldn’t Upper Respiratory Tract Disorders or gut disorders, even chronic severe constipation in children with immune and autonomic dysfunction equally result in such entrapment with pain from their bodies that some children might develop a neurological developmental response akin to PTSD?

In mild brain injury could the brain similarly interpret as trauma things like chronic sensory confusion/overload, extreme emotional dysregulation, the CNS disorientation from untreated food allergies and intolerances, the entrapment of being non verbal in a verbal world or having a body you can’t make work for you. And as one reached age 2-3 when functioning demands of the environment dramatically increase, could inability to organise one’s senses, emotions, communication, self help contribute to a trauma related cascade that progressively derails development accordingly?

What of the trauma potential to an infant of relentless torment from hyperacusis, or the whooshing sounds of Pulsatile Tinnitus, or severe Tourette’s, even relentless ear popping tics nobody can see, the repeated disorientation, unpredictability and loss of control of constant seizures?

If being born to a carer who is in the grip of post natal depression would predispose a child to not having established that initial bonding, would this leave such a child more predisposed to PTSD than one born to a healthy mother? And what of infants who fail to develop normally whose carer then goes through years of mourning the loss of the ‘normal’ child they had expected? Is this also experienced by the child in a similar way to being born to a carer with post natal depression? And what of the maternal separation of premature babies too small to be held by their mothers?

What of immune deficient or other unwell infants left in the care of hospitalswhere they experienced the absolute vulnerability of and utter foreignness of significant medicalisation in the hands of a range of strangers? With a 45% higher incidence of autism associated with circumcision before age 5, could this be traumatising for those children already genetically predisposed to trauma? Could this be extended to children handed over to doctors for heavy vaccination schedules without any later autism having anything directly to do with the vaccinations themselves?

And what of the trauma of a birthday party? We all have different personality traits. Babies too. Some of us are simply not wired for full on, in your face sociable parties when we are one year old. If our personality traits would later make us an attention seeking, self confident, adventurous party animal there’d be no foreseeable problem. But what if our nature was sensitive, solitary, vigilant, idiosyncratic…

It seems predisposition to PTSD is genetically predisposed. Would there then be children already more at risk from a progressive cascade effect of accumulated perceived traumas that would leave other children unaffected? If the children of older dads are more prone to mental illness would this include a higher predisposition to PTSD?

Ehlers Danlos Syndrome is a genetic collagen disorder with overlap with autism. Collagen is the stuff of connective tissue throughout the body, including the vascular system and the brain and is also responsible for immune regulation and brain connectivity but those with EDS also have autonomic dysfunctionassociated with sudden fluctuations in blood pressure (ie floppy veins) due to faulty collagen. These sudden fluctuations commonly get interpreted by the brain as panic attacks. So a child experiencing continual panic attacks caused by autonomic dysfunction would logically also be predisposed to developing chronic fight flight states and associated compulsive involuntary avoidance, diversion and retaliation responses.

Being born c-section leaves the child with lower levels of the calming hormone Oxytocin which is essential to having resistance to heightened threat and anxiety. We also all begin life with a reflex for crawling out of the womb. After using this infantile reflex it becomes neurologically inhibited which leaves us ready for the use of other reflex responses, each essential in the developmental process. Being born c-section leaves this infantile reflex uninhibited.

“Normal performance of primitive reflexes in newborns can be linked to a greater likelihood of having higher Apgar scores, higher birth weight, shorter hospitalization time after birth, and a better overall mental state”.

>http://en.wikipedia.org/wiki/Primitive_reflexes

What about if the mother experienced trauma during the pregnancy? If a mother was living in an abusive relationship would the unborn child be experiencing her own trauma as its own? Is the baby awash with stress hormones? Does the baby also feel this same level of threat that the mother is feeling?

Pre-eclampsia and other pregnancy and birth related emergencies have left mothers acutely anxious and sometimes traumatised and pre-eclampsia in particular has been recently shown to have another high association with autism . In response to this blog article I heard from a commenter who drew my attention to the recent links between Paracetamol and both pre-eclampsia and autism.
They wrote:

I would suggest that the missing link is not trauma but the use of paracetamol (acetaminophen, Tylenol). Rebordosa found that paracetamol use during pregnancy increases the risk of pre-eclampsia. Paracetamol is often used in conjunction with vaccines,ear infections and viruses. We have been circumcising for centuries but autism is a new and escalating phenomenon. So how could circumcision increase the risk of autism? What has changed about circumcision in recent times? The use of PARACETAMOL (acetaminophen, Tylenol) with the procedure to treat pain. This practice began in the mid 1990’s, with recommendations by WHO and the American Academy of Pediatrics. It has been shown that infants have significant difficulties metabolizing paracetamol in the first days of life. Paracetamol is known to have a narrow threshold of toxicity under the best of circumstances.

Three studies investigating prenatal use of paracetamolhave found adverse neurodevelopment in the offspring- ADHD and autism phenotypes in 3 year olds. It is not such a stretch to think paracetamol given directly to the infant could also have deleterious effects. This study supports the paracetamol hypothesis set forth by Bauer and Kriebel and highly warrants further investigation.

Could it be that in some cases paracetemol (acetaminophen, Tylenol) derails neurodevelopment pre-nataly which in turn leaves the child neurologically less equipped to handle acute stress and so has an early trauma response to things someone else would not, then once an acute fight-flight states becomes a chronically triggered/regenerated pattern, that becomes the default social-emotional response to such a wide range of new experiences the person is then further developmentally derailed. Paracetemol is also given to babies following circumcision and after the MMR vaccination. Parents have systematically given Tylenol to their infants for teething, for nappy rash, even for trouble sleeping.

In adults, single doses above 10 grams or 200 mg/kg of bodyweight, whichever is lower, have a reasonable likelihood of causing toxicity.[4][5] Toxicity can also occur when multiple smaller doses within 24 hours exceed these levels.[5] In rare individuals, paracetamol toxicity can result from normal use.[11] This may be due to individual (“idiosyncratic”) differences in the expression and activity of certain enzymes in one of the metabolic pathways that handle paracetamol (see paracetamol’s metabolism).

US television adverts of this drug psychologically target carers to ‘care for their child’ by quickly reaching for the Tylenol. These advertisements do then rush through the disclaimer at the end, often so quickly it is hard to process and usually completely out of sync with the reassuring tones used in advertising the product moments before.

IF trauma is found to have the most significant impact on brain development, communication development, social and emotional development presenting as ‘autism’, then what is the future? Would it also mean that autism is both born and made? Would we have to accept that a more mildly autistic child could become progressively more autistic if progressively accumulating further retraumatisation through everything from a bad fitting form of intensive intervention to bullying at primary school, to actual abuse from a carer unequipped to healthily care for a challenged child?

Do we have then develop screening for genetic predisposition to PTSD before a child is put through the same approaches and treatments as those without such predispositions? Would the strategies used to turn around chronic fight-flightstates and involuntary diversion, avoidance and retaliation responses in Exposure Anxiety become the most important first interventions?

I could suggest a protocol something like this:

Possible protocol for turning around chronic fight flight states.

a) inform the carers/diagnosticians about the presentation features of ‘autistic post traumatic developmental disorder’ and that trauma and the sources of retraumatisation can have a range of quite unconventional causes.

b) where possible identify initial traumas in each case and ensure these are addressed

c) identify additional re-traumatisation triggers that keep this being reinforced

d) put in place a treatment plan to address any underlying gut/immune/metabolic disorders and associated pain, sensory perceptual disorders and associated sensory distress, communication disorders, movement disorders, chronic information overload as socially non invasively as is possible to stop feeding chronic fight-flight responses.

e) to bring in omega 3s as a natural mood leveller and L-Glutamine where suited to raise GABA in order to facilitate lower doses of mood levelling/anti anxiety medication necessary to give respite to an overreactive nervous system.

f) to start a program designed to raise Oxyitoxin levels to tame over active anxiety responses: start music, massage, body brushing, art and movement programs, animal therapy, singing, laughter yoga, non invasive touch, to help calm the nervous system, get dissociated people feeling safe back in their bodies.

g) to counsel and support families in retaining the approaches that will progressively turn around chronic fight-flight states and thereby facilitate freed up development of more adaptive information processing, communication, and interaction.

And finally what of identification with one’s autism? What if it turns out that we do in fact ‘all have a bit of autism’ and that traumatisation (and retraumatistion) makes the difference in how much we each end up with? Do all people with autism then have ‘autistic post-traumatisation developmental disorder’? A kind of ‘Traumatism’? And would they want treatment or be happy with how they adapted?

At the end of the day, stress may break some of us, but stress also makes us. Stress trains the brain, trains the body. The trick is to build that slowly, progressively, so it isn’t experienced as trauma followed by continual perceived retraumatisation:

Donna Williams, BA Hons, Dip Ed.
Author, artist, singer-songwriter, screenwriter.
Autism consultant and public speaker.
http://www.donnawilliams.net

I acknowledge Aboriginal and Torres Strait Islander people as the Traditional Owners of this country throughout Australia, and their connection to land and community.

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Autism, Alexithymia, Body Disconnection, Mental Health & Loss

Tulips

 

Note – This is from a personal perspective

In short space of time two people dear to me had sadly passed away my Gramp Gilbert Harpwood and my friend Donna Williams (Polly Samuel).

I knew that because of alexithymia I would find this process lag and that I wouldn’t be “emotionally connected” straight away this led me to going day to day with no sort of emotional context at all despite showing on the surface seemingly “connective” emotions they were not connecting with me on the inside.

Alexithymia /ˌlɛksəˈθmiə/ is a personality construct characterized by the subclinical inability to identify and describe emotions in the self.[1] The core characteristics of alexithymia are marked dysfunction in emotional awareness, social attachment, and interpersonal relating.[2

Expression Of Grief

After the month and half since my Gramp’s loss and not long after Polly’s I started getting pains in my arm, stabbing and throbbing like a vice was clamped on my left arm. I quickly ruled out tetanus (which is serious bacterial infection) this then progressed into neuropathic – like  pain which was shooting from my neck, jaw, arms, legs, feet and groin “settling” in places for minutes and hours with a “warm”, “tingling” feeling as it moved.

I know this based on having a family history of mood, compulsive and anxiety disorders many things came into place as well as somatisation disorder which is a pseudo pain diversion.

Anxiety and Somatic Disorder

Somatic symptom disorder occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life.

Anxiety Neuropathic-like Symptoms

Anxiety doesn’t actually create peripheral neuropathy. While anxiety and stress have been thrown around as possible issues that lead to neuropathy, peripheral neuropathy is about nerve damage, not nerve symptoms, and since anxiety is unlikely to cause nerve damage, it can’t technically be peripheral neuropathy.

Dermatillomania (skin picking disorder)

Dermatillomania may be a reflection of a mental health problem. Psychological and behavioural theories suggest that skin picking may be a way of relieving stress or anxiety.

A Dolly Mixture Of Mental Health Conditions

I  know that I have mixture of differing overlapping co-conditions going with my mood disorder being an understandable and normal reaction to grief, skin picking and impulse control disorder which has resulted in my hair being riddled with scabs which is my sub-concious at work, to having excess adrenaline  that is being “stuck” in my body from time to time.

Externalising To Process My Own Emotional States

The alexithymia and associated problems that go with such as body disconnectivty (body agnosias and hemiplegia)  leaving me detached from my own emotional states leaves me also waiting for the emotions to come at a frantic, unprocessed rate leaving me to pick up the pieces of the jigsaw puzzle. I have created my own strategies such as writing, poetry and art which help me externalise and thus connect with my own emotional states, thoughts and feelings.

Visual Perceptual Disorders and Mentalising

Another aspect is the visual perceptual disorders which includes simultagnosia (object blindness) assoicated with prosopagnosia (face blindness) and semantic agnosia (meaning blindness) which I have that means my memory isn’t “visual-assoicative ” and I have no “pictures” of “emotional association” so my “meta-reality” (which all people have) has to be externalised.

Remembering

I know that with the slow realisation of my internal states will aid me in the this journey which is a normal journey for human beings, remembering people fondly, the good times, the laughs, the smiles and interactions.

Paul Isaacs 2017