Sensory Integration, Asperger’s Syndrome, Obsessive Compulsive Disorder, Oppositional Defiant Disorder, Tourette’s Syndrome, Pervasive Developmental Disorders NOS and Autism
At the Mane Center we offer the knowledge and experience from Dr. Nelson Mane, a board certified chiropractic neurologist. Dr. Nelson Mane has a subspecialty training in childhood neurobehavioral disorders. Our doctor is dedicated to offer the treatment required when treating neurobehavioral disorder such as Attention Deficit Disorder, Attention Deficit Hyperactive Disorder, Learning Disabilities including Dyslexia and Dyscalculia, Sensory Integration Disorder, Asperger’s Syndrome, Obsessive Compulsive Disorder, Oppositional Defiant Disorder,Tourette’s Syndrome, Pervasive Developmental Disorder and Autism. Early intervention has been shown to provide the best outcomes.
Dr. Nelson Mane is a board certified chiropractic neurologist with specialty training in balance disorders, movement disorders and childhood neurobehavioral disorders. His approach is that of a combination of functional neurology and functional medicine with biomedical interventions.
DR. NELSON MANE’S APPROACH TO AUTISM SPECTRUM DISORDERS
First realize that this is a spectrum and that most times these conditions mix and match, i.e., ADHD with Asperger’s syndrome and OCD (obsessive compulsive disorder.)
First, we assess the child’s overall health using a functional medicine model. We’re looking for biochemical glitches in the child’s system as well as environmental influences such as infections, food allergies and toxins which may create negative consequences for your child. Next, once we determine that your child is healthy enough to undergo a neurological rehabilitation program we perform an examination to determine what areas are functionally deficient or underdeveloped. We like to address both issues (biomedical and neurology) so your child can progress as quickly as possible and in the most efficient manner. Brain centered rehabilitation is based on the concept of neuroplasticity. This is to say that current neuroscience has determined that the brain is alive and changing from the day you are born until the day you die. If you have been informed that changes can not be made in your child after the age of six, this information is incorrect and outdated. This is the same reason that they now tell the elderly to do puzzles, learn a musical instrument or learn a new language in an attempt to avoid senile dementia. We can then use the brain’s ability to change to try to make positive changes using targeted stimulation to the areas which are deficient as determined by a functional neurological examination.
Just as with a physical rehabilitation program, if you target the right muscle, use the appropriate weight and increase that weight progressively, the muscle will become stronger. In this case, we target the appropriate pathway or circuit with the right stimulus such as light, sound, smell, movement, etc. If we do this with the proper stimulus, proper intensity and frequency we can make not only short term change but long term change in the nervous system. It is the ability to apply these principles in an office setting and adapt this program for children in a way that makes it fun, that’s what makes our office unique. The approach is non pharmaceutical and, in fact, our goal is to reduce or eliminate the need for medication when possible.
The history portion of the examination will begin with questions about the pregnancy and continue on through to the present. In addition to General Health history questions, you will be asked questions relating to things such as developmental milestones, digestive issues, sensory issues, language, academics, social interaction, environmental exposure, antihistamine and antibiotic use, among others. Please bring any laboratory analysis as well as consultations and evaluations with you so we can have as complete a picture as possible relating to your child and proceed through the process in an efficient manner.
Laboratory analysis may include typical blood tests such as a complete blood count and metabolic profile. Additionally, at times specialty labs may be used such as stool, saliva, urine and hair.
The examination will include the evaluation of the nervous system from the receptors and progressively to the brain. Functional evaluation of vestibular function, cerebellar function, basal ganglia, brain stem, mid brain and lobe of the brain will be performed in order to localize the suspected functional lesion. Lesion localization refers to trying to find the one area of the brain that is malfunctioning and that explains most of the symptoms. At times, there may be several lesions with one primary lesion evident. This is similar to looking for roadblocks on a map. For example, we know that if a person cannot move their arms or legs, a problem in the neck may explain the lack of use in all limbs. A problem in one leg would not explain issues relating to the other leg and the arms. A problem in the lower back may explain issues relating to the legs but not to the arms. Thus, we know that the problem would have to be higher up in the nervous system in order to create symptomalogy relating to both the arms and legs. Next we would have to determine that this is truly a functional lesion and that there is not a hard lesion (i.e. something that can be seen on an MRI) or a systemic issue involved. What I have just described is called localizing the longitudinal level of the lesion. That is, finding where the problem is from the outside in or the bottom up.
We also want to determine if there is laterality to the lesion. That is, is there a sidedness to this problem. We know that the right and left sides of the brain are specialized. For example, we know that the right brain pertains to things such as attention, impulsive behavior, anxiety, concepts, abstract thoughts, issues with reading comprehension, math reasoning, nonverbal communication, appropriate social behavior and gross motor skills. The left brain pertains to things such as difficulty reading (not comprehension), speech delays (verbal communication), auditory processing, motivation and graphomotor skills (handwriting). Dealing with the laterality is part of what is known as hemispheric integration. Realize that most children do not fit solely into one category or the other. It is not as simple as just left and right.
All of the above are just generalities to help you better understand the functional neurology approach. In the end, each person’s nervous system is different and each person’s metabolic capacity is different. Thus in reality we simply need to find the specific lesion in the child in front of us and create a rehabilitation program targeted to his or her particular needs.
Typically the treatment consist of various stimulation to the body through the use of the senses. This may include things such as strengthening exercises, balance and coordination exercises, cognitive exercises, rhythm and timing exercises as well as different types of sounds, lights, taste or smells. The stimulation to it will be performed with the target area of the nervous system in mind in addition to being performed in a progressive matter so as to increase the demand on the nervous system without exceeding the patient’s metabolic capacity. This is a non pharmaceutical approach. The goal of this treatment is too restore as much function as possible within the child as well as reduce or eliminate the need for medication.
Please additionally read the section on ADHD and learning disabilities as the approach to dealing with these issues is exactly the same. The target areas and probable areas of involvement may be slightly different. The ADHD section will contain additional information which may help you understand these concepts better. Also, the section on functional medicine is an area you should review if your child has a spectrum disorder as this is an integral part of the treatment approach.
First, please be aware that there is no DAN! (Defeat Autism Now!) certification. Thus, if a health care practitioner of any type says that they are DAN! certified beware. DAN! is a philosophy and that philosophy is listed below. The DAN! organization provides informational seminars to doctors and parents alike. However, there is no test or certification that takes place. If a Dr. attends a weekend DAN! seminar, he can be listed on the web site. Also, as you will see below, there is no specific DAN! protocol, although it seems that methyl B12, fish oil and Super Nu Thera seemed to be ubiquitous. Plus, please beware some have made an effort to become fluent in what I call functional medicine but more commonly is known as biomedical treatments in the autism community and some have not. We pride ourselves in combining the best of functional medicine and functional neurology for the treatment of Autism Spectrum Disorders.
The Defeat Autism Now! Philosophy:
We believe autism encompasses spectrum of disorders with multiple provoking stressors and multiple possible susceptibilities. The Defeat Autism Now! Philosophy does not endorse a set protocol for treating autism because our approach is based on paying careful attention to the unique symptoms, history, examinations and data of each child. We offer a process of choosing various options for biomedical intervention. Autism and related problems reflect dysfunction of the neural, metabolic, immune and/or digestive systems in individuals genetically predisposed to such problems as sub-optimal nutrition, food, intolorances, microbial overgrowth, metabolic abnormalities, immune deregulation and reduced ability to eliminate toxins. People with autism spectrum disorders have difficulty processing sensory, perceptual, cognitive, biochemical and immunologic messages and have faulty mechanisms for regulating, organizing, expressing, processing and detoxifying various inputs.
We believe that a combination of environmental factors may interact with genetic predispositions that are due to variations in the human genotype. Timing of the appropriate treatment is important because certain insults appear to occur at vulnerable times in human development when the brain’s neuronal network connectivity is being established.
Appropriate treatment involves identifying and alleviating the problems causing symptoms in a particular individual, rather than attempting to suppress symptoms through the use of psychoactive drugs. Our focus is on biomedical balance in the individual emphasizing two questions: Does he or she have a special unmet need that would advance healing if it were met? Does he or she have a special need to avoid or get rid of toxins, allergens or metabolic by-products?
The answers to these questions come by a careful sequential process in which the patient is recognized as the expert who, by his or her history, physical examinations, lab results and responses to therapy, helps practitioners choose the best options for each diagnostic and therapeutic step. With our patients and their parents, we conduct collaborative conversation with an abiding respect for the intelligence and intuition of parents and their children. We involve families as full participants in the search for answers and recognize that the child is often listening, even when he or she appears inattentive.
We reject one-size-fits-all strategies while including the broad range of diagnostic and treatment modalities that are appropriate to each patient. We look for ways to support nature’s strong impulse toward healing.
We also value relational, occupational, physical, speech, educational, and other external therapies, many of which become far more efficacious once underlying biomedical conditions are addressed. While our focus in on biomedical interventions, we look for opportunities to collaborate with our education, behavioral, physical, and speech therapies and colleagues.
We draw information and inspiration from the fact that autistic children are treatable by systematic means that address the need to restore deregulated biochemical and immunological processes to the virtuous pathways from which they descend. We believe that autism is also preventable by paying greater attention to environmental issues and parental health. We endorse Dr. Bernard Rimland’s position of trying to disregard our egos and remembering that most of the important elements in our understanding of the treatment options for autistic individuals have come from listening to parents.
What is a Functional Disconnect Syndrome?
A major part of Hemispheric Integration Therapy and the functional neurology approach to the treatment of Autism Spectrum Disorders deals with the term “Functional Disconnect Syndrome.” A Functional Disconnect Syndrome is a situation where connections between neuronal pools do not work at a level synchronized enough for normal behavioral and executive function of the human brain to take place. This may result in difficulty with language, social skills and learning among others. Allow me to attempt to clarify that in plain English. The disconnect refers to different areas of the brain not being connected in the sense that the areas do not communicate well with each other. This suboptimal communication relates to the fact that “the wires are there, they just are not working well. That is to say, if the wires between brain circuits were cut, then we would have a physical disconnect syndrome as there would be a literal disconnection. In this case, the wires are there, connected but they are not functioning well. This under functioning causes poor communication between the areas as though there were some physical damage when in reality there is not. It is for this reason that if we perform an MRI of the brain of a patient with Autism Spectrum Disorder it seems relatively normal. That is, there is no tumor, infection or vascular accident for example present to explain the child’s symptoms. Think about it, if the child did have a tumor, then his diagnosis would be “brain tumor” or “mini stroke” not autism. You would have a concrete answer for his symptoms. Something that you could see and touch and get your hands around. What makes the human brain superior and able to conceive higher thoughts is the synchronous firing of its parts. If the brain becomes desynchronized or parts begin to underfunction then its ability to perform these higher functions such as speech and do calculus may be lost. Basic functions such as eating may be preserved but depending on the level of desynchronization and underfunctioning things such as digestion, bowel movements, immune responses (allergies, asthma) and sensory processing may be lost or diminished. Like a Ferrari, a high performance car, if our high performance human brains, need a tune up, they may still run but not at 180 mph and depending on how bad the timing and firing is, maybe not at 50mph. This is the heart of the Functional Disconnect Syndrome. Much of these concepts have come about as a result of the fact that in the 1990’s, “the decade of the brain” imaging such as functional MRI and SPECT scanning allowed us to look at brain function and not just brain structure. We now know that even though brain structure may appear similar between the hemispheres, the brain function of the hemispheres is different and specialized.
So in the Hemispheric Integration Therapy model we strive to balance under connected electrical activity in the brain hemispheres and/or neural networks as well as strengthen weakened pathways. When areas of the brain can no longer communicate optimally, compare and contrast information, even if good information reaches the brain through its receptors, there is a problem with interpretation. If the two sides of the brain become unbalanced then this functional disconnection can cause conditions such as ADHD, Asperger’s Syndrome, Sensory Integration Disorders, Tourrete’s Syndrome, O.C.D., PDD and Autism with an underfunctioning right hemisphere. While learning disabilities such as Dyslexia and Dyscalculia as well as Depression are associated with left brain deficiencies. Yes, we hate labels but this is the language of the system. At our office, we treat what we find regardless of the diagnosis. Realize also that there is much overlap in these disorders i.e. A.D.H.D. with O.C.D. or A.D.H.D with tics. What areas do we stimulate? The ones we find are weakened. I can not say this enough, we treat what we find. Are there certain areas that are more common to find problems with? Yes, but each child is different and must be evaluated on and individual basis. These findings may also change throughout the treatment program as the patient with Autism spectrum disorder or a learning disability progresses through this treatment.
WHAT IS FUNCTIONAL NEUROLOGY?
Due to the treatment methods applied by Functional Neurologists, the types of conditions that one typically sees are conditions such as learning disabilities, autism spectrum disorders, post stroke rehabilitation, balance disorders, movement disorders, dystonias, peripheral neuropathy and headaches.
Traditionally, neurology tends to look at disease of the nervous system as black-and-white with white being optimal neurologic function and black being neurological disease such as tumors, strokes, etc. Functional Neurology looks at dysfunction of the nervous system as different shades of gray looking for subtle changes in the nervous system before they become distinct pathologies.
You will often hear it said by functional neurologists that neurons need fuel and activation in order to thrive and survive. Fuel can be defined as oxygen, glucose and essential nutrients. Activation refers to stimulation of the nervous system which causes changes in the structure and metabolism of the nerve cell. More recently, Functional Neurology Practitioners are also involved with eliminating possible negative effects on neurons such as toxins, infectious agents and immune responses.
Four factors that are of high importance to the functional neurologist are:
- Determining where the failure in the nervous system lies.
- What would be the right stimulation to activate that area?
- What the health and condition of the failing area is, so as to determine how much stimulation would be too much.
- Adapting this vital information in order to apply that precise amount of stimulation to the patient in our office.
It is important to note that the stimulation used must be specific to the particular patient who is being treated. There is bio-individuality to the nervous system, just as individual as a fingerprint, and such that even those with similar symptoms may require different stimulation at different frequencies and intensities in order to achieve the best success. This cannot be done in a generalized or cookbook type program. For example, you cannot treat every patient with a balance disorder or ADHD with the same treatment protocols. Generalized treatments run the risk of exciting an area of the nervous system that is already overexcited, or stimulating an area that should be inhibited. Results are maximized due to the fact that the program of stimulation is tailored to the individual patient’s problem and capacity, and not a one-size-fits-all program where results may be limited or the program may actually be inappropriate. In other words: different people, different brains, and therefore, different treatments.
It is important to note that the functional neurological examination although very detailed is noninvasive and, therefore, can be performed on many different types of patients without patient anxiety being a factor. This is very significant especially for those practitioners treating children on the autism spectrum, because there is a tendency for these children to have higher anxiety. The skilled Functional Neurology Practitioner realizes that everything from the patient’s posture, to tics, to faulty eye movements, and alignment are all expressions of what is going on in the patient’s nervous system. Although these expressions may be subtle, to the highly skilled Functional Neurologist, these “little things mean a lot!”
Activation of the nervous system via specific exercises or stimulation to targeted areas of the brain, pathways or circuits can create powerful results in the patient, but should be carefully monitored, so that the metabolic capacity of the patient’s nervous system is not exceeded and damage does not occur instead of the intended rehabilitation.
Functional neurology is a field of study that achieves successful results by applying current neuroscience in an office setting. This means that the Functional Neurology Practitioner is taking current neuroscience from the research laboratory and devising ways of applying that research in the office to treat patients. The training begins with neuron theory and progresses to a level that allows the practitioner to evaluate and treat dysfunction of the nervous system without the use of, or in conjunction with medications.
The concept of functional neurology is relatively new and, therefore, begs the question, “What exactly is functional neurology?” This is an inquiry that I get asked when doing presentations, and by email on a regular basis. Hopefully, the above helps to clarify some of the questions and misconceptions out there regarding Functional Neurology.
Symptoms of Autism- Mayo Clinic
Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because autism symptoms vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, severe autism is marked by a complete inability to communicate or interact with other people.
Some children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life but then suddenly become withdrawn, become aggressive or lose language skills they’ve already acquired. Though each child with autism is likely to have a unique pattern of behavior, these are some common autism symptoms:
- Fails to respond to his or her name
- Has poor eye contact
- Appears not to hear you at times
- Resists cuddling and holding
- Appears unaware of others’ feelings
- Seems to prefer playing alone — retreats into his or her “own world”
- Starts talking later than age 2 and has other developmental delays by 30 months
- Loses previously acquired ability to say words or sentences
- Doesn’t make eye contact when making requests
- Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
- Can’t start a conversation or keep one going
- May repeat words or phrases verbatim, but doesn’t understand how to use them
- Performs repetitive movements, such as rocking, spinning or hand-flapping
- Develops specific routines or rituals
- Becomes disturbed at the slightest change in routines or rituals
- Moves constantly
- May be fascinated by parts of an object, such as the spinning wheels of a toy car
- May be unusually sensitive to light, sound and touch and yet oblivious to pain
Young children with autism also have a hard time sharing experiences with others. When read to, for example, they’re unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.
As they mature, some children with autism become more engaged with others and show less marked disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the adolescent years can mean a worsening of behavioral problems.
Most children with autism are slow to gain new knowledge or skills, and some have signs of lower than normal intelligence. Other children with autism have normal to high intelligence. These children learn quickly yet have trouble communicating, applying what they know in everyday life and adjusting in social situations. A small number of children with autism are “autistic savants” and have exceptional skills in a specific area, such as art, math or music.
When to see a doctor?
Babies develop at their own pace, and many don’t follow exact timelines found in some parenting books. But children with autism usually show some signs of delayed development by 18 months. If you suspect that your child may have autism, discuss your concerns with your doctor. The earlier treatment begins, the more effective it will be.
Your doctor may recommend further developmental tests if your child:
- Doesn’t babble or coo by 12 months
- Doesn’t gesture — such as point or wave — by 12 months
- Doesn’t say single words by 16 months
- Doesn’t say two-word phrases by 24 months
- Loses previously acquired language or social skills at any age