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Autism: A Public Health Crisis

Autism_Blocksby Dr. Lawrence Rosen
Autism and related neurodevelopmental disorders are now believed to affect one in six American children.  The reasons for the meteoric rise in autism spectrum disorder (ASD) diagnoses are hotly debated, but it is clear that we are in the midst of a unique public health crisis.  We are seeing tremendous effects on health care and educational resource utilization.  In a recent article I wrote for the journal Alternative & Complementary Therapies (October 2006) titled “Autism Spectrum Disorder: A New Paradigm for Integrative Management,” I emphasized the need for a new model of care for children with ASD.  This paradigm shift acknowledges the overwhelming evidence that ASD is a complex, multisystemic medical disorder, and it supports a holistic approach integrating conventional and complementary/alternative (CAM) therapies.
 
“The Medical Home” is one such model proposed to better serve the needs of children with special health care needs, including autism.  A medical home is defined by the American Academy of Pediatrics (AAP) as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.  It is my belief that pediatric integrative medicine is ideally suited as a model of care to support this medical home concept.  Integrative pediatricians emphasize family centered and culturally effective care, focusing on the whole child – the child is not an island unto themselves but exists within a context of family and community.  We value wellness and believe optimal health is not simply the absence of disease, but a presence of healthy mind, body and spirit.  We advocate individualizing therapies, knowing that a “one-size-fits-all” approach does not adequately address the diversity of clinical and biochemical issues noted in children with ASD.  Integrative pediatricians take into account the effect of the environment on health, and the impact of human living on the environment.  Both the environment and social interactions are seen as potential allies for healing.  In fact, the relationship between primary care provider and family is seen as part of the healing process.  Respectful collaboration is the model for the doctor – patient relationship, and for that matter, for the relationship between all healthcare providers.  This model allows families to work comfortably with CAM providers while their primary care provider assists in coordinating care; this is the medical home concept in a nutshell.
 
Families often incorporate use of CAM therapies (92% in a study I co-authored in the Journal of Developmental and Behavioral Pediatrics) in part because they believe conventional medicine does not address both root causes and clinical symptoms particularly well.  One of these strongly held beliefs is that there are environmental factors responsible for the epidemic of autism.  Medical establishment historically has been slow to accept such claims, focusing predominantly on genetic etiologies.  But, as author Richard Lathe notes in his book, “Autism, Brain, and Environment” (Jessica Kingsley, 2006), it is plausible that children with a genetic predisposition are more likely to express autistic clinical symptoms under certain environmental conditions.  The environmental stressors may include infectious agents (viruses), nutritional contaminants and allergens, and toxic exposures including heavy metals.  A recent landmark paper by Drs. Grandjean and Landrigan published in the well-respected journal Lancet  (Early Online Publication at DOI:10.1016/S0140-6736(06)69665-7) details the important role industrial chemical pollution plays in developmental neurotoxicity.  We can no longer ignore the impact that changes in our environment have had on our children’s health.  The human cost is too great.
 
Additional References
AAP Committee on Children with Disabilities: Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability.  Pediatrics 107: 598-601, 2001.
 
AAP Medical Home Initiatives for Children With Special Needs Project Advisory Committee: The medical home.  Pediatrics 110: 184-186, 2002.
 
Centers for Disease Control and Prevention (CDC):  How common are ASD’s? http://www.cdc.gov/ncbddd/autism/asd_common.htm, accessed Aug 10, 2006.
 
Harrington JW, Rosen L, et al: Parental perceptions and use of complementary and alternative medicine practices for children with autistic spectrum disorders in private practice.  J Dev Behav Pediatr 27: S156-161, 2006.
 
Herbert MR, et al: Autism and environmental genomics.  Neurotoxicology 2006, in press.
 
Koger SM, et al: Environmental toxicants and developmental disabilities.  American Psychologist 60: 243-255, 2005.
 
London E, Etzel R: The environment as an etiologic factor in autism: a new direction for research.  Environ Health Perspect 108: S3, 2000.
 
Mercer L, et al: Parental perspectives on the causes of an autism spectrum disorder in their children.  J Genet Couns 15: 41-50, 2006.
 
Nataf R, et al: Porphyrinuria in childhood autistic disorder: implications for environmental toxicity.  Toxicol Appl Pharmacol 214: 99-108, 2006.
 
Newacheck PW, et al: Health services use and health care expenditures for children with disabilities.  Pediatrics 114: 79-84, 2004.
 
Szpir M: Focus: New thinking on neurodevelopment.  Environ Health Perspect 114: A100-107, 2006.
 
rosen_thumbAbout Dr. Lawrence Rosen
 
Dr. Lawrence Rosen is a board-certified general pediatrician committed to family-centered, holistic child health care. He practices in northern New Jersey and consults at the Maria Fareri Children's Hospital in Westchester County, NY.  An Assistant Professor in the New York Medical College Department of Pediatrics, he directs the MFCH Integrative Pediatrics Service. Dr. Rosen is a founding member (with Dr. Kathi Kemper) of the AAP's provisional Section on Complementary, Holistic and Integrative Medicine. He is a frequent speaker at both professional and consumer functions, discussing topics such as holistic care of the newborn and the integrative management of autism.
 
Dr. Rosen currently serves as Director of the Division of Pediatrics at Pascack Valley Hospital in Westwood, N.J. He is a graduate of New York Medical College and the Massachusetts Institute of Technology. Dr. Rosen completed his residency and chief residency in pediatrics at Mount Sinai Hospital in New York and is a Fellow of the American Academy of Pediatrics. Most importantly, he is blessed by the presence of his beautiful and charming wife, Laura, and his inspiring children, Matthew and Talia.
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