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A BRAIN DISORDER
Autism is not a disease. Autism is a little-understood brain disorder that affects approximately 4 to 5 out of 10,000 people. It is 3 to 4 times more common in boys than in girls. There are well over 400,000 autistic individuals in the United States. Autism is usually diagnosed in early childhood, usually between 1 to 3 years of age (before the age of 3) and is characterized by a marked unresponsiveness to other people and to the surrounding environment. In spite of more than 50 years of research into the varying manifestations of autism and the families affected by it, the disorder continues to mystify health care providers, psychologists and scientists. According to the Autism Society of America, autism is the third most common developmental disability, more common than Down's Syndrome. More alarming is the increasing prevalence of autism in successively younger children, particularly those born between 1987 and 1992. The increases continued after 1992, but researchers report that the rate has not been as great. Analysis of the data suggests that this is a real phenomenon, not a statistical artifact or a case of "Diagnosis Shifting," in which autism would be diagnosed in cases where previously a patient might have received a different classification.
How autistic individuals are affected by the disorder varies widely. In fact, the variety of autistic-like disorders has necessitated the creation of the term Autism Spectrum Disorders.
AUTISM FREQUENT SIGNS & SYMPTOMS
COMMON AUTISTIC BEHAVIORS
Physically, autistic individuals do not appear different from others, but the do exhibit marked differences in behavior from an early age. While most babies love to be held and cuddled, autistic infants appear indifferent to love and affection. As autistic children grow older, they fail to form attachments to others in the way most children do, and instead seem to withdraw into themselves. Many autistic children also exhibit unpredictable and unusual behaviors that can range from constant rocking, head banging, arm flapping, to pounding their feet while sitting, to sitting for long periods of time in total silence. Autistic children will rigidly adhere to routines and fixate on specific subjects or toys. Some experience bursts of hyperactivity that include biting and pounding on their bodies. Autistic children have learning disabilities, and are often mentally disabled. Speech development is usually delayed, and in many cases is absent or limited to nonsensical rhyming or babbling. Some autistic children seem to have lower than normal intelligence, while others seem to fall into the normal range. Some in fact, are quite intelligent. Still others have low intelligence in most areas but almost supernatural abilities in others, such as mathematics or music. IQs of autistic children can range from "mental retardation to genius level". It is considered a spectrum disorder. Most develop a strong resistance to any changes in familiar environments or routines. Autistic children tend to overreact to stimuli.
Asperger syndrome is a condition found on the high end of the spectrum. It is a condition in which verbal skills are generally quite good, but qualities known as language pragmatics - such as tone of voice and facial expression - are compromised.
Children with Asperger syndrome usually have poor social skills due to their inability to read and transmit nonverbal cues accurately.
They have problems understanding how other people feel - with empathizing, with putting themselves in others' shoes.
Although often quite intelligent, people with Asperger syndrome tend to become obsessed with one particular subject (which varies from person to person) and talk about it as if it were the only topic in the entire world.
NON-VERBAL LEARNING DISORDER
This disorder involves an inability to read social cues. Children with this disability, however, are generally less prone to obsessive, repetitive behavior and less rigid than those with Asperger syndrome.
There is debate on whether the milder forms of social impairment (Non-Verbal Learning Disorder and Asperger syndrome) ought to be lumped under autism. It is estimated that between 3.6 and 7.1 children per 1,000 suffer from Asperger syndrome - numbers which are seen as much as 7 times higher than traditional estimates of autism.
RARE AUTISM SPECTRUM DISORDERS
Rett syndrome is relatively rare, affecting almost exclusively females, one out of 10,000 to 15,000. After a period of normal development, sometime between 6 and 18 months, autism-like symptoms begin to appear. The little girl's mental and social development regresses - she no longer responds to her parents and pulls away from any social contact. If she has been talking, she stops; she cannot control her feet; she wrings her hands. Some of the problems associated with Rett syndrome can be treated. Physical, occupational, and speech therapy can help with problems of coordination, movement, and speech.
Scientists sponsored by the National Institute of Child Health and Human Development have discovered that a mutation in the sequence of a single gene can cause Rett syndrome. This discovery may help doctors slow or stop the progress of the syndrome. It may also lead to methods of screening for Rett syndrome, thus enabling doctors to start treating these children much sooner, and improving the quality of life these children experience.
CHILDHOOD DISINTEGRATIVE DISORDER
Very few children who have an autism spectrum disorder (ASD) diagnosis meet the criteria for childhood disintegrative disorder (CDD). An estimate based on four surveys of ASD found fewer than two children per 100,000 with ASD could be classified as having CDD. This suggests that CDD is a very rare form of ASD. It has a strong male preponderance. Symptoms may appear by age 2, but the average age of onset is between 3 and 4 years. Until this time, the child has age-appropriate skills in communication and social relationships. The long period of normal development before regression helps differentiate CDD from Rett syndrome.
The loss of such skills as vocabulary are more dramatic in CDD than they are in classical autism. The diagnosis requires extensive and pronounced losses involving motor, language, and social skills. CDD is also accompanied by loss of bowel and bladder control and oftentimes seizures and a very low IQ.
AUTISM SPECTRUM DISORDERS
The autism spectrum disorders are more common in the pediatric population than are some better known disorders such as diabetes, spinal bifida, or Down syndrome. Prevalence studies have been done in several states and also in the United Kingdom, Europe, and Asia. Prevalence estimates range from 2 to 6 per 1,000 children. This wide range of prevalence points to a need for earlier and more accurate screening for the symptoms of ASD. The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions. Pediatricians, family health care providers, daycare providers, teachers, and parents may initially dismiss signs of ASD, optimistically thinking the child is just a little slow and will "catch up." Although early intervention has a dramatic impact on reducing symptoms and increasing a child's ability to grow and learn new skills, it is estimated that only 50 percent of children are diagnosed before kindergarten.
All children with ASD demonstrate deficits in:
In addition, they will often have unusual responses to sensory experiences, such as certain sounds or the way objects look. Each of these symptoms runs the gamut from mild to severe. They will present in each individual child differently. For instance, a child may have little trouble learning to read but exhibit extremely poor social interaction. Each child will display communication, social, and behavioral patterns that are individual but fit into the overall diagnosis of ASD.
- Social interaction.
- Verbal and nonverbal communication.
- Repetitive behaviors or interests.
Children with ASD do not follow the typical patterns of child development. In some children, hints of future problems may be apparent from birth. In most cases, the problems in communication and social skills become more noticeable as the child lags further behind other children the same age. Some other children start off well enough. Often-times between 12 and 36 months old, the differences in the way they react to people and other unusual behaviors become apparent. Some parents report the change as being sudden, and that their children start to reject people, act strangely, and lose language and social skills they had previously acquired. In other cases, there is a plateau, or leveling, of progress so that the difference between the child with autism and other children the same age becomes more noticeable.
ASD is defined by a certain set of behaviors that can range from the very mild to the severe. The following possible indicators of ASD were identified on the Public Health Training Network Webcast, Autism Among Us.
POSSIBLE INDICATORS OF AUTISM SPECTRUM DISORDERS
Does not babble, point, or make meaningful gestures by 1 year of age. Does not speak one word by 16 months. Does not combine two words by 2 years. Does not respond to name. Loses language or social skills.
SOME OTHER INDICATORS
Poor eye contact. Does not seem to know how to play with toys. Excessively lines up toys or other objects. Is attached to one particular toy or object. Does not smile. At times seems to be hearing impaired.
From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most children with ASD seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and they avoid eye contact. They seem indifferent to other people, and often seem to prefer being alone. They may resist attention or passively accept hugs and cuddling. Later, they seldom seek comfort or respond to parents' displays of anger or affection in a typical way. Research has suggested that although children with ASD are attached to their parents, their expression of this attachment is unusual and difficult to "read." To parents, it may seem as if their child is not attached at all. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.
Children with ASD also are slower in learning to interpret what others are thinking and feeling. Subtle social cues - whether a smile, a wink, or a grimace - may have little meaning. To a child who misses these cues, "Come here" always means the same thing, whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people with ASD have difficulty seeing things from another person's perspective. Most 5-year-olds understand that other people have different information, feelings, and goals than they have. A person with ASD may lack such understanding. This inability leaves them unable to predict or understand other people's actions.
Although not universal, it is common for people with ASD also to have difficulty regulating their emotions. This can take the form of "immature" behavior such as crying in class or verbal outbursts that seem inappropriate to those around them. The individual with ASD might also be disruptive and physically aggressive at times, making social relationships still more difficult. They have a tendency to "lose control," particularly when they are in a strange or overwhelming environment, or when angry and frustrated. They may at times break things, attack others, or hurt themselves. In their frustration, some bang their heads, pull their hair, or bite their arms.
By age 3, most children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is "no." Some children diagnosed with ASD remain mute throughout their lives. Some infants who later show signs of ASD coo and babble during the first few months of life, but they soon stop. Others may be delayed, developing language as late as age 5 to 9. Some children may learn to use communication systems such as pictures or sign language. Those who do speak often use language in unusual ways. They seem unable to combine words into meaningful sentences. Some speak only single words, while others repeat the same phrase over and over. Some ASD children parrot what they hear, a condition called echolalia. Although many children with no ASD go through a stage where they repeat what they hear, it normally passes by the time they are 3.
Some children only mildly affected may exhibit slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining a conversation. The "give and take" of normal conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. Another difficulty is often the inability to understand body language, tone of voice, or "phrases of speech." They might interpret a sarcastic expression such as "Oh, that's just great" as meaning it really IS great.
While it can be hard to understand what ASD children are saying, their body language is also difficult to understand. Facial expressions, movements, and gestures rarely match what they are saying. Also, their tone of voice fails to reflect their feelings. A high-pitched, sing-song, or flat, robot-like voice is common. Some children with relatively good language skills speak like little adults, failing to pick up on the "kid-speak" that is common in their peers. Without meaningful gestures or the language to ask for things, people with ASD are at a loss to let others know what they need. As a result, they may simply scream or grab what they want. Until they are taught better ways to express their needs, ASD children do whatever they can to get through to others. As people with ASD grow up, they can become increasingly aware of their difficulties in understanding others and in being understood. As a result they may become anxious or depressed.
Although children with ASD usually appear physically normal and have good muscle control, odd repetitive motions may set them off from other children. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or walking on their toes. Some suddenly freeze in position. As children, they might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of the toys, the child may be tremendously upset. ASD children need, and demand, absolute consistency in their environment. A slight change in any routine - In mealtimes, dressing, taking a bath, going to school at a certain time and by the same route - can be extremely disturbing. Perhaps order and sameness lend some stability in a world of confusion.
Repetitive behavior sometimes takes the form of a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Often there is great interest in numbers, symbols, or science topics.
PROBLEMS THAT MAY ACCOMPANY ASD
Sensory Problems. When children's perceptions are accurate, they can learn from what they see, feel, or hear. On the other hand, if sensory information is faulty, the child's experiences of the world can be confusing. Many ASD children are highly attuned or even painfully sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin almost unbearable. Some sounds - a vacuum cleaner, a ringing telephone, a sudden storm, even the sound of waves lapping the shoreline - will cause these children to cover their ears and scream. In ASD, the brain seems unable to balance the senses appropriately. Some ASD children are oblivious to extreme cold or pain. An ASD child may fall and break an arm, yet never cry. Another may bash his head against a wall and not wince, but a light touch may make the child scream with alarm.
Mental Retardation. Many children with ASD have some degree of mental impairment. When tested, some areas of ability may be normal, while others may be especially weak. For example, a child with ASD may do well on the parts of the test that measure visual skills but earn low scores on the language subtests.
Seizures. One in four children with ASD develops seizures, often starting either in early childhood or adolescence.4 Seizures, caused by abnormal electrical activity in the brain, can produce a temporary loss of consciousness (a "blackout"), a body convulsion, unusual movements, or staring spells. Sometimes a contributing factor is a lack of sleep or a high fever. An EEG (electroencephalogram - recording of the electric currents developed in the brain by means of electrodes applied to the scalp) can help confirm the seizure's presence. In most cases, seizures can be controlled by a number of medicines called "anticonvulsants." The dosage of the medication is adjusted carefully so that the least possible amount of medication will be used to be effective.
Fragile X syndrome. This disorder is the most common inherited form of mental retardation. It was so named because one part of the X chromosome has a defective piece that appears pinched and fragile when under a microscope. Fragile X syndrome affects about two to five percent of people with ASD. It is important to have a child with ASD checked for Fragile X, especially if the parents are considering having another child. For an unknown reason, if a child with ASD also has Fragile X, there is a one-in-two chance that boys born to the same parents will have the syndrome.5 Other members of the family who may be contemplating having a child may also wish to be checked for the syndrome.
Tuberous Sclerosis. Tuberous sclerosis is a rare genetic disorder that causes benign tumors to grow in the brain as well as in other vital organs. It has a consistently strong association with ASD. One to 4 percent of people with ASD also have tuberous sclerosis.
ONGOING RESEARCH STUDIES
The cause of autism is unknown. Studies comparing twins suggest that there may be a hereditary component to this disorder.
It is known that autism is NOT caused by parental neglect or actions, as was once believed.
The apparent rise in autism, ADD (attention deficit disorder) and autism-spectrum disorders may be the result of either better diagnosis counting or of a judgmental society and the cause may be some environmental factor.
Some experts believe that it is a result of some neurological imbalance or malfunction that renders the autistic individual painfully oversensitive to external stimuli.
Many researchers believe that autism may be the result of genetics and/or some environmental factors, such as certain viruses or chemicals.
Researchers are also studying how brain function differs in autistic individuals. Some theories suggest that brain development may have been interrupted in the early fetal stages in people who become autistic. Other studies reveal a possible signaling problem within the brain.
At one time there was some concern that there was a link between the MMR (measles-mumps-rubella) vaccine or the vaccine preservative thimerosal (ethyl mercury) and the onset of autism. A report released in May 2004 by the Institute of Medicine (IOM) Immunization Safety Review Committee has concluded that there is no such link. It must be noted that the National Autism Association disagrees to this day and believes there is some type of link. Whatever the truth might be, since 1999 drug companies have either removed or reduced significantly the amount of thimerosal in their vaccines, just as a precautionary measure.
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Research continues to try to find the biological basis for ASD. The emergence of brain imaging tools such as computerized tomography (CT), positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) has allowed researchers to examine, in detail, portions of the brain never before seen in living people. In fact, instead of being able to single out one area of the brain that is affected, it looks as if many major brain structures are implicated in autism. These include the cerebellum, the cerebral cortex, the limbic system, the corpus callosum, basal ganglia, and the brain stem. Other research has focused on neurotransmitters such as serotonin, dopamine, and epinephrine. Evidence now points to genetic factors as the cause of autism, a theory that has been strengthened by twin and family studies, which suggest an underlying genetic vulnerability. Recent neuroimaging studies have shown that abnormal brain development, beginning in an infant's first months, appears to be a contributing cause. This has resulted in a "growth dysregulation hypothesis" that holds genetic defects in brain growth factors to be responsible.
AUTISM DIAGNOSIS CRITERIA
According to the National Institute of Neurological Disorders & Stroke, the criteria used to diagnose autism include the following:
Absence or impairment of imaginative and social play. Impaired ability to make friends with peers. Impaired ability to initiate or sustain a conversation. Stereotyped, repetitive, or unusual use of language. Restricted patterns of interests that are abnormal in intensity or focus. Apparent inflexibility with regard to changes in routine or rituals. Preoccupation with parts of objects.
An autistic adult or child might at first appear to be mentally retarded or hard of hearing. But autism caregivers stress that it is important to distinguish autism from other conditions. Physically, autistic individuals do not appear different from others but exhibit marked differences in behavior from a very early age. Autism is usually diagnosed in early childhood (before the age of three) and is characterized by a marked unresponsiveness to other people and to the surrounding environment. While most babies love to be held and cuddled, autistic infants appear indifferent to love and affection, or may be overly agitated, crying, most of the time they are awake. Autistic children cannot form attachments to others in the way most children do and seem to withdraw into themselves. Many exhibit various unpredictable and unusual behaviors that can range from constant rocking, feet-pounding, or sitting for long periods of time in total silence, Some experience bursts of hyperactivity that include biting and pounding on their bodies.
About half of the people with autism score below 50 on IQ tests, 20 percent between 50 and 70, and 30 percent score higher that 70. To be accurately diagnosed with autism, a child must be observed by a skilled professional, because diagnosis is difficult for a practitioner with limited training or exposure to autism. Specialists suggest a multidisciplinary team that would include, for example, a neurologist, a psychologist, a developmental pediatrician, a speech-language therapist, and a learning consultant.
Individuals diagnosed as autistic savants attract a great deal of attention from the media and general public. Many movies, television reports, and newspaper articles highlight the extraordinary skills of these individuals, most particularly in the areas of mathematics, art, music, and memory. Such an individual might, for example, be able to multiply and divide large numbers or calculate square roots with little hesitation, paint like Rembrandt without ever having a drawing lesson, memorize an entire phone book, or be capable of reciting the birth date of every person he or she has ever met. Less than 1 percent of the general population is capable of such feats, but the incidence of such abilities is 10 percent in individuals who are autistic. No one knows why this occurs. One speculation is that autistic people have incredible concentration abilities and can focus complete attention on a specific area of interest.
THE DIAGNOSIS OF AUTISM SPECTRUM DISORDERS
Although there are many concerns about labeling a young child with an ASD, the earlier the diagnosis of ASD is made, the earlier needed interventions can begin. Evidence over the last 15 years indicates that intensive early intervention in optimal educational settings for at least 2 years during the preschool years results in improved outcomes in most young children with ASD. In evaluating a child, clinicians rely on behavioral characteristics to make a diagnosis. Some of the characteristic behaviors of ASD may be apparent in the first few months of a child's life, or they may appear at any time during the early years. For the diagnosis, problems in at least one of the areas of communication, socialization, or restricted behavior must be present before the age of 3. The diagnosis requires a two-stage process. The first stage involves developmental screening during "well child" check-ups; the second stage entails a comprehensive evaluation by a multi-disciplinary team.
A "well child" check-up should include a developmental screening test. If your child's pediatrician does not routinely check your child with such a test, ask that it be done. Your own observations and concerns about your child's development will be essential in helping to screen your child. Reviewing family videotapes, photos, and baby albums can help parents remember when each behavior was first noticed and when the child reached certain developmental milestones.
Several screening instruments have been developed to quickly gather information about a child's social and communicative development within medical settings. Among them are the Checklist of Autism in Toddlers (CHAT), the modified Checklist for Autism in Toddlers (M-CHAT), the Screening Tool for Autism in Two-Year-Olds (STAT), and the Social Communication Questionnaire (SCQ) (for children 4 years of age and older). Some screening instruments rely solely on parent responses to a questionnaire, and some rely on a combination of parent report and observation. Key items on these instruments that appear to differentiate children with autism from other groups before the age of 2 include pointing and pretend play. Screening instruments do not provide individual diagnosis but serve to assess the need for referral for possible diagnosis of ASD. These screening methods may not identify children with mild ASD, such as those with high-functioning autism or Asperger syndrome.
During the last few years, screening instruments have been devised to screen for Asperger syndrome and higher functioning autism. The Autism Spectrum Screening Questionnaire (ASSQ), the Australian Scale for Asperger's Syndrome, and the most recent, the Childhood Asperger Syndrome Test (CAST), are some of the instruments that are reliable for identification of school-age children with Asperger syndrome or higher functioning autism. These tools concentrate on social and behavioral impairments in children without significant language delay.
If, following the screening process or during a routine "well child" check-up, your child's health care provider sees any of the possible indicators of ASD, further evaluation is indicated.
COMPREHENSIVE DIAGNOSTIC EVALUATION
The second stage of diagnosis must be comprehensive in order to accurately rule in or rule out an ASD or other developmental problem. This evaluation may be done by a multi-disciplinary team that includes a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals who diagnose children with ASD.
Because ASD's are complex disorders and may involve other neurological or genetic problems, a comprehensive evaluation should entail neurologic and genetic assessment, along with in-depth cognitive and language testing.7 In addition, measures developed specifically for diagnosing autism are often used. These include the Autism Diagnosis Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS-G). The ADI-R is a structured interview that contains over 100 items and is conducted with a caregiver. It consists of four main factors - the child's communication, social interaction, repetitive behaviors, and age-of-onset symptoms. The ADOS-G is an observational measure used to "press" for socio-communicative behaviors that are often delayed, abnormal, or absent in children with ASD.
Still another instrument often used by professionals is the Childhood Autism Rating Scale (CARS). It aids in evaluating the child's body movements, adaptation to change, listening response, verbal communication, and relationship to people. It is suitable for use with children over 2 years of age. The examiner observes the child and also obtains relevant information from the parents. The child's behavior is rated on a scale based on deviation from the typical behavior of children of the same age.
Two other tests that should be used to assess any child with a developmental delay are a formal audiologic hearing evaluation and a lead screening. Although some hearing loss can co-occur with ASD, some children with ASD may be incorrectly thought to have such a loss. In addition, if the child has suffered from an ear infection, transient hearing loss can occur. Lead screening is essential for children who remain for a long period of time in the oral-motor stage in which they put any and everything into their mouths. Children with an autistic disorder usually have elevated blood lead levels.
Customarily, an expert diagnostic team has the responsibility of thoroughly evaluating the child, assessing the child's unique strengths and weaknesses, and determining a formal diagnosis. The team will then meet with the parents to explain the results of the evaluation.
Although parents may have been aware that something was not "quite right" with their child, when the diagnosis is given, it is a devastating blow. At such a time, it is hard to stay focused on asking questions. But while members of the evaluation team are together is the best opportunity the parents will have to ask questions and get recommendations on what further steps they should take for their child. Learning as much as possible at this meeting is very important, but it is helpful to leave this meeting with the name or names of professionals who can be contacted if the parents have further questions.
CONVENTIONAL MEDICAL TREATMENT
MEDICATIONS USED IN TREATMENT
Medications are often used to treat behavioral problems, such as aggression, self-injurious behavior, and severe tantrums, that keep the person with ASD from functioning more effectively at home or school. The medications used are those that have been developed to treat similar symptoms in other disorders. Many of these medications are prescribed "off-label." This means they have not been officially approved by the FDA for use in children, but the health care provider prescribes the medications if he or she feels they are appropriate for your child. Further research needs to be done to ensure not only the efficacy but the safety of psychotropic agents used in the treatment of children and adolescents.
A child with ASD may not respond in the same way to medications as typically developing children. It is important that parents work with a doctor who has experience with children with autism. A child should be monitored closely while taking a medication. The health care provider will prescribe the lowest dose possible to be effective. Ask the health care provider about any side effects the medication may have and keep a record of how your child responds to the medication. It will be helpful to read the "patient insert" that comes with your child's medication. Some people keep the patient inserts in a small notebook to be used as a reference. This is most useful when several medications are prescribed.
ANXIETY & DEPRESSION: The selective serotonin reuptake inhibitors (SSRI's) are the medications most often prescribed for symptoms of anxiety, depression, and/or obsessive-compulsive disorder (OCD). Only one of the SSRI's, fluoxetine, (Prozac) has been approved by the FDA for both OCD and depression in children age 7 and older. Three that have been approved for OCD are fluvoxamine (Luvox), age 8 and older; sertraline (Zoloft), age 6 and older; and clomipramine (Anafranil), age 10 and older. Treatment with these medications can be associated with decreased frequency of repetitive, ritualistic behavior and improvements in eye contact and social contacts. The FDA is studying and analyzing data to better understand how to use the SSRI's safely, effectively, and at the lowest dose possible.
BEHAVIORAL PROBLEMS: Anti-psychotic medications have been used to treat severe behavioral problems. These medications work by reducing the activity in the brain of the neurotransmitter dopamine. Among the older, typical antipsychotics, such as haloperidol (Haldol), thioridazine, fluphenazine, and chlorpromazine, haloperidol was found in more than one study to be more effective than a placebo in treating serious behavioral problems. However, haloperidol, while helpful for reducing symptoms of aggression, can also have adverse side effects, such as sedation, muscle stiffness, and abnormal movements.
Placebo-controlled studies of the newer "atypical" antipsychotics are being conducted on children with autism. The first such study, conducted by the NIMH-supported Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, was on risperidone (Risperdal). Results of the 8-week study were reported in 2002 and showed that risperidone was effective and well tolerated for the treatment of severe behavioral problems in children with autism. The most common side effects were increased appetite, weight gain and sedation. Further long-term studies are needed to determine any long-term side effects. Other atypical antipsychotics that have been studied recently with encouraging results are olanzapine (Zyprexa) and ziprasidone (Geodon). Ziprasidone has not been associated with significant weight gain.
SEIZURES: Seizures are found in one in four persons with ASD, most often in those who have low IQ or are mute. They are treated with one or more of the anticonvulsants. These include such medications as carbamazepine (Tegretol), lamotrigine (Lamictal), topiramate (Topamax), and valproic acid (Depakote). The level of the medication in the blood should be monitored carefully and adjusted so that the least amount possible is used to be effective. Although medication usually reduces the number of seizures, it cannot always eliminate them.
INATTENTION & HYPERACTIVITY: Stimulant medications such as methylphenidate (Ritalin), used safely and effectively in persons with attention deficit hyperactivity disorder, have also been prescribed for children with autism. These medications may decrease impulsivity and hyperactivity in some children, especially those higher functioning children.
OTHER MEDICATIONS: Several other medications have been used to treat ASD symptoms; among them are other antidepressants, naltrexone, lithium, and some of the benzodiazepines such as diazepam (Valium) and lorazepam (Ativan). The safety and efficacy of these medications in children with autism has not been proven. Since people may respond differently to different medications, your child's unique history and behavior will help your health care provider decide which medication might be most beneficial.
ADULTS WITH AUTISM SPECTRUM DISORDER
Some adults with ASD, especially those with high-functioning autism or with Asperger syndrome, are able to work successfully in mainstream jobs. Nevertheless, communication and social problems often cause difficulties in many areas of life. They will continue to need encouragement and moral support in their struggle for an independent life.
Many others with ASD are capable of employment in sheltered workshops under the supervision of managers trained in working with persons with disabilities. A nurturing environment at home, at school, and later in job training and at work, helps persons with ASD continue to learn and to develop throughout their lives.
The public schools' responsibility for providing services ends when the person with ASD reaches the age of 22. The family is then faced with the challenge of finding living arrangements and employment to match the particular needs of their adult child, as well as the programs and facilities that can provide support services to achieve these goals. Long before your child finishes school, you will want to search for the best programs and facilities for your young adult. If you know other parents of ASD adults, ask them about the services available in your community. If your community has little to offer, serve as an advocate for your child and work toward the goal of improved employment services. Research the resources listed in the back of this brochure to learn as much as possible about the help your child is eligible to receive as an adult.
LIVING ARRANGEMENTS FOR ASD ADULTS
Independent Living. Some adults with ASD are able to live entirely on their own. Others can live semi-independently in their own home or apartment if they have assistance with solving major problems, such as personal finances or dealing with the government agencies that provide services to persons with disabilities. This assistance can be provided by family, a professional agency, or another type of provider.
Living At Home. Government funds are available for families that choose to have their adult child with ASD live at home. These programs include Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Medicaid waivers, and others. Information about these programs is available from the Social Security Administration (SSA). An appointment with a local SSA office is a good first step to take in understanding the programs for which the young adult is eligible.
Foster Homes & Skill-Development Homes. Some families open their homes to provide long-term care to unrelated adults with disabilities. If the home teaches self-care and housekeeping skills and arranges leisure activities, it is called a "skill-development" home.
Supervised Group Living. Persons with disabilities frequently live in group homes or apartments staffed by professionals who help the individuals with basic needs. These often include meal preparation, housekeeping, and personal care needs. Higher functioning persons may be able to live in a home or apartment where staff only visit a few times a week. These persons generally prepare their own meals, go to work, and conduct other daily activities on their own.
Institutions. Although the trend in recent decades has been to avoid placing persons with disabilities into long-term-care institutions, this alternative is still available for persons with ASD who need intensive, constant supervision. Unlike many of the institutions years ago, today's facilities view residents as individuals with human needs and offer opportunities for recreation and simple but meaningful work.
AVAILABLE PROGRAMS AND ASSISTANCE AIDS
When your child has been evaluated and diagnosed with an autism spectrum disorder, you may feel inadequate to help your child develop to the fullest extent of his or her ability. As you begin to look at treatment options and at the types of aid available for a child with a disability, you will find out that there is help for you. It is going to be difficult to learn and remember everything you need to know about the resources that will be most helpful. Write down everything. If you keep a notebook, you will have a foolproof method of recalling information. Keep a record of the health care provider's reports and the evaluation your child has been given so that his or her eligibility for special programs will be documented. Learn everything you can about special programs for your child; the more you know, the more effectively you can advocate.
For every child eligible for special programs, each state guarantees special education and related services. The Individuals with Disabilities Education Act (IDEA) is a Federally mandated program that assures a free and appropriate public education for children with diagnosed learning deficits. Usually children are placed in public schools and the school district pays for all necessary services. These will include, as needed, services by a speech therapist, occupational therapist, school psychologist, social worker, school nurse, or aide. By law, the public schools must prepare and carry out a set of instruction goals, or specific skills, for every child in a special education program. The list of skills is known as the child's Individualized Education Program (IEP). The IEP is an agreement between the school and the family on the child's goals. When your child's IEP is developed, you will be asked to attend the meeting. There will be several people at this meeting, including a special education teacher, a representative of the public schools who is knowledgeable about the program, other individuals invited by the school or by you (you may want to bring a relative, a child care provider, or a supportive close friend who knows your child well). Parents play an important part in creating the program, as they know their child and his or her needs best. Once your child's IEP is developed, a meeting is scheduled once a year to review your child's progress and to make any alterations to reflect his or her changing needs.
If your child is under 3 years of age and has special needs, he or she should be eligible for an early intervention program; this program is available in every state. Each state decides which agency will be the lead agency in the early intervention program. The early intervention services are provided by workers qualified to care for toddlers with disabilities and are usually in the child's home or a place familiar to the child. The services provided are written into an Individualized Family Service Plan (IFSP) that is reviewed at least once every 6 months. The plan will describe services that will be provided to the child, but will also describe services for parents to help them in daily activities with their child and for siblings to help them adjust to having a brother or sister with ASD.
Autism Society of America
7910 Woodmont Ave. Suite 650
Bethesda, MD 20814-3015
ASD TREATMENT OPTIONS
There is no single best treatment package for all children with ASD. One point that most professionals agree on is that early intervention is important; another is that most individuals with ASD respond well to highly structured, specialized programs. Before you make decisions on your child's treatment, you will want to gather information about the various options available. Learn as much as you can, look at all the options, and make your decision on your child's treatment based on your child's needs. You may want to visit public schools in your area to see the type of program they offer to special needs children.
Guidelines used by the Autism Society of America include the following questions parents can ask about potential treatments:
- Will the treatment result in harm to my child?
- How will failure of the treatment affect my child and family?
- Has the treatment been validated scientifically?
- Are there assessment procedures specified?
- How will the treatment be integrated into my child's current program?
Do not become so infatuated with a given treatment that functional curriculum, vocational life, and social skills are ignored. The National Institute of Mental Health suggests a list of questions parents can ask when planning for their child:
Among the many methods available for treatment and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment.
- How successful has the program been for other children?
- How many children have gone on to placement in a regular school and how have they performed?
- Do staff members have training and experience in working with children and adolescents with autism?
- How are activities planned and organized?
- Are there predictable daily schedules and routines?
- How much individual attention will my child receive?
- How is progress measured?
- Will my child's behavior be closely observed and recorded?
- Will my child be given tasks and rewards that are personally motivating?
- Is the environment designed to minimize distractions?
- Will the program prepare me to continue the therapy at home?
- What is the cost, time commitment, and location of the program?
A Report of the Surgeon General states, "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior." The basic research done by Ivar Lovaas and his colleagues at the University of California, Los Angeles, calling for an intensive, one-on-one child-teacher interaction for 40 hours a week, laid a foundation for other educators and researchers in the search for further effective early interventions to help those with ASD attain their potential. The goal of behavioral management is to reinforce desirable behaviors and reduce undesirable ones.
An effective treatment program will build on the child's interests, offer a predictable schedule, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior. Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home.
As soon as a child's disability has been identified, instruction should begin. Effective programs will teach early communication and social interaction skills. In children younger than 3 years, appropriate interventions usually take place in the home or a child care center. These interventions target specific deficits in learning, language, imitation, attention, motivation, compliance, and initiative of interaction. Included are behavioral methods, communication, occupational and physical therapy along with social play interventions. Often the day will begin with a physical activity to help develop coordination and body awareness; children string beads, piece puzzles together, paint, and participate in other motor skills activities. At snack time the teacher encourages social interaction and models how to use language to ask for more juice. The children learn by doing. Working with the children are students, behavioral therapists, and parents who have received extensive training. In teaching the children, positive reinforcement is used.
Children older than 3 years usually have school-based, individualized, special education. The child may be in a segregated class with other autistic children or in an integrated class with children without disabilities for at least part of the day. Different localities may use differing methods but all should provide a structure that will help the children learn social skills and functional communication. In these programs, teachers often involve the parents, giving useful advice in how to help their child use the skills or behaviors learned at school when they are at home.
In elementary school, the child should receive help in any skill area that is delayed and, at the same time, be encouraged to grow in his or her areas of strength. Ideally, the curriculum should be adapted to the individual child's needs. Many schools today have an inclusion program in which the child is in a regular classroom for most of the day, with special instruction for a part of the day. This instruction should include such skills as learning how to act in social situations and in making friends. Although higher-functioning children may be able to handle academic work, they too need help to organize tasks and avoid distractions.
During middle and high school years, instruction will begin to address such practical matters as work, community living, and recreational activities. This should include work experience, using public transportation, and learning skills that will be important in community living.
THE ADOLESCENT YEARS
Adolescence is a time of stress and confusion; and it is no less so for teenagers with autism. Like all children, they need help in dealing with their budding sexuality. While some behaviors improve during the teenage years, some get worse. Increased autistic or aggressive behavior may be one way some teens express their newfound tension and confusion.
The teenage years are also a time when children become more socially sensitive. At the age that most teenagers are concerned with acne, popularity, grades, and dates, teens with autism may become painfully aware that they are different from their peers. They may notice that they lack friends. And unlike their schoolmates, they are not dating or planning for a career. For some, the sadness that comes with such realization motivates them to learn new behaviors and acquire better social skills.
All through your child's school years, you will want to be an active participant in his or her education program. Collaboration between parents and educators is essential in evaluating your child's progress.
In the medical sense, there is no cure for the differences in the brain that result in autism. However, researchers are finding better ways to understand the disorder and help people cope with the various symptoms. Some symptoms can lessen as the child ages and others disappear altogether. With appropriate intervention, many auristic behaviors can be changed for the better, even to the point that the affected individual may, to the untrained eye, seem perfectly normal. The majority of autistic people continue to display some symptoms throughout their lives.
Many medications ranging from antidepressants to antipsychotics, can help control irritability, compulsions, and other problems. Early diagnosis leading to disability education involving speech therapy, motor training, social skills training, and other specially designed education programs can give autistic people a chance to function better than ever before, making the prognosis for autism better today than it used to be.
The onset of puberty can be a difficult time for autistic children. Many experience more Frequent and severe behavioral problems, and nearly 20 percent of those affected begin to experience seizures during puberty. This is believed to be the result of hormonal changes.
During adulthood, appropriate living arrangements for autistic people vary depending on the severity of each individual case. While those who are only mildly affected may be able to live on their own, other options can include living in a group home or residential home, or living with parents. For those who are severely affected individuals, an institutional setting may be the only choice. While some autistic adults are unable to adapt to a regular lifestyle, others graduate from college, have careers, form relationships and marry.
Allergies and food sensitivities are beginning to receive more attention than ever before, because research and case studies are beginning to suggest that they contribute to autistic behaviors.
Researchers have also detected the presence of abnormal protein levels in the urine of autistic individuals. It is thought that this protein may be due to the body's inability to break down certain dietary proteins into amino acids. These proteins are gluten (found in wheat, barley, oats, and other foods) and casein (found in human and cow's milk). Many parents of autistic children have removed these foods from their children's diets and have, in many cases, observed positive changes in health and behavior. Research strongly suggests that many autistic people are sensitive to dairy products and certain foods eaten most often in the spring and summer. These foods include strawberries and citrus fruits, which can affect an autistic individuals's sensitive immune system. Health care providers have noted that a variety of problems, including headaches, nausea, bed-wetting, appearing "spaced out", stuttering, excessive whining and crying, aggression, and depression - can be magnified by these food products. Such a reaction can be almost immediate or appear up to 36 hours after the suspect food is eaten. Besides eliminating problem foods, increasing the amount of vitamins such as vitamin C may reduce allergy and sensitivity symptoms.
MoonDragon's Health & Wellness Disorders: Allergies
Secretin, a neurotransmitter hormone found in the pancreas, liver, and upper intestinal tract that has been used for years as a test injection in the evaluation of intestinal problems, reportedly produced marked improvements in approximately 200 autistic individuals in the United States, according to the Center for the Study of Autism. Following infusions of secretin, many subjects appeared to improve within a few days, with sudden improvement in speech-language, sleep, eye contact, and attentiveness. However, 3 more recent controlled studies failed to reproduce the results.
Autistic children may benefit from taking vitamin B-6 (pyridoxine) and magnesium, as well as other nutrients vital to biochemical reactions in the body. One theory is that these children may have leaky gut syndrome and are unable to absorb nutrients from their diets efficiently. In studies of autistic children, a significant number have been found to have gastrointestinal disorders, including celiac disease and other food intolerances. Allergy induced Autism (AiA), a British support group and charity for autism, notes that some children with autism in England are taking enzymes to help them digest foods more easily.
Elevated serum and tissue copper levels may be a factor in autism and other mental problems, as may excessive exposure to lead and mercury. Excessive copper also seem to contribute to autism. Even low-level lead exposure in young children has been associated with impaired intellectual development and behavior problems.
Infants and toddlers whose diets consist largely of processed baby foods need supplemental vitamins and minerals to ensure that all of their nutritional needs are met. Nutritional deficiencies are a factor in many psychological disorders.
The prognosis for autistic children is difficult to predict. There have been documented cases of apparent recovery from autism, usually after adolescence. Some children seem to progress well only to unexplainably regress. Many become marginally self-sufficient and independent. However, most autistic individuals ultimately need lifelong care of some kind.
MoonDragon's Health & Wellness Disorders: Hypoglycemia
MoonDragon's Health & Wellness Disorders: Hyperactivity
Ginkgo Biloba is a powerful free radical destroyer that protects the brain. It also improves brain function by increasing circulation to the brain. Take it in capsule or extract form as directed on the product label, 3 times daily.
LIFESTYLE & DIETARY RECOMMENDATIONS
CHECK FOR ALLERGIES & TOXICITIES
Use an elimination diet to test for food allergies, which can aggravate the condition.
Have a hair analysis done to rule out heavy metal poisoning.
MoonDragon's Health & Wellness Disorders: Allergies
MoonDragon's Health Therapy: Hair Analysis
EXERCISE & OXYGEN
Get regular moderate exercise.
Try to improve blood oxygen supply to the brain with deep breathing exercises. Hold your breath for 30 seconds every half hour for a 30 day period. This stimulates deeper breathing and helps to increase oxygen levels in the tissues of the brain.
Do not go without food. Eating frequent small meals daily is better than eating 2 or 3 large meals.
BENEFICIAL DIETARY SUGGESTIONS
Drink steam-distilled or quality bottled water. Stay well hydrated. Avoid tap water since it may contain trace heavy metals, such as lead, chemicals and unwanted micropollutants.
Eat a High-Fiber Diet consisting of 50 to 75 percent raw foods, including large amounts of fruits and vegetables plus brown rice, lentils, and potatoes. For protein, eat beans and legumes, fish, raw nuts and seeds, skinless white turkey or white chicken breast, tofu, and low-fat yogurt.
Eliminate alcohol, caffeine, canned and packaged foods, carbonated beverages, chocolate, all junk foods, refined and processed foods, salt, sugar, sweets, saturated fats, soft drinks, and white flour from the diet. Avoid foods that contain artificial colors or preservatives. Avoid fatty foods such as bacon, cold cuts, fried foods, gravies, ham, luncheon meats, sausage, and all dairy products except for low-fat soured products.
Omit wheat and wheat products from the diet. Consider following a Gluten Free or Gluten Restricted Diet.
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For children between the ages of 12 and 17, reduce the dose to 3/4 the recommended amount. For children between the ages of 6 and 12 years old, reduce the dose to 1/2 the recommended amount. For children under 6 years old, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments Essential Calcium 1,500 mg daily. Essential for normal brain and nervous system function. Magnesium 1,000 mg daily. Essential for normal brain and nervous system function. Needed to balance calcium. Choline 500 to 2,000 mg daily. Improves brain function and circulation to the brain. Coenzyme Q-10 As directed on label. Antioxidant properties improves brain function. Neuro-Logic As directed on label. Contains elements essential for quick assimilation of brain nutrients. Enhances neuron function. Dimethylglycine (DMG) 100 mg daily. An oxygen carrier to the brain. Important for normal brain and nervous system function. DMG is a ethylated amino acid found in all cells. DMG is an antioxidant and methyl donor that has a number of beneficial effects. It has shown to have potential in increasing immune response to the flu and salmonella. S-Adenosylmethionine (SAM-e) As directed on label. Critical in the manufacture of many body components, especially brain chemicals. A natural antidepressant. Caution: Do not use if you have manic-depressive disorder or take prescription antidepressants. Ginkgo Biloba Take in capsule or extract form, as directed on label, three times daily. A powerful free radical destroyer that protects the brain. It improves brain function by increasing circulation to the brain. Vitamin B-Complex 50 mg three times daily, with meals. Essentail for normal brain and nervous system function. A sublingual form is recommended. Vitamin B-3
(Niacin & Niacinamide)
Niacin: 50 mg 3 times daily, with meals.
Niacinamide: 300 mg daily.
Aids and Improves circulation. Helpful for many psychological disorders. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure. Vitamin B-5
500 mg daily. Helps reduce stress. Vitamin B-6
50 mg daily three times daily. Do not exceed this amount except at the direction of your health care provider. Deficiencies have been linked to autism. Vitamin C
5,000 to 20,000 mg daily, in divided doses. A powerful free radical scavenger. Helps immune function. See Ascorbic Acid Flush Helpful Multivitamin
As directed on label. All nutrients are needed in balance. Use a high potency formula. Vitamin A
Beta Carotene & Carotene Complex
Vitamin A: 15,000 IU daily.
Beta Carotene: 25,000 IU daily
Powerful antioxidant properties. Helpful for healthy immune function. Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. All nutrients are needed in balance. Selenium 200 mcg daily. All nutrients are needed in balance. L-Glutamine
500 mg each daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg Vitamin B-6 and 100 mg Vitamin C for better absorption. Amino acids are needed for normal brain function. Caution: Do not take phenylalanine if you are pregnant or nursing, or suffer from panic attacks, diabetes, high blood pressure or PKU. Melatonin 2 to 3 mg daily for adults. 1 m or less daily for children taken 2 hours or less before bedtime. If this is not effective, gradually increase the dosage until an effective level is reached. Helpful if symptoms include insomnia. Methylsulfonymethane (MSM) As directed on label. Increases alertness, mental calmness, the ability to concentrate. RNA & DNA RNA: 200 mcg daily.
DNA: 100 mg daily.
To aid in repairing and buidling of new brain tissue. Caution: Do not take this supplement if you have gout. Vitamin E 200 to 600 IU daily. Improves circulation and brain function. Vitamin D 400 IU daily. Protects against muscle weakness and is involved in regulation.
NOTIFY YOUR HEALTH CARE PROVIDER
If You have questions about autism and therapies available. If You or a member of your family are having symptoms of autistic behavior. If You have any unusual or unexpected symptoms, or if symptoms increase in intensity. Some medications and/or nutritional therapies used in the treatment of autism may produce side effects or allergic reactions in sensitive individuals.
RELATED AUTISM LINKS
The Autism Society of America Home Page
Center for the Study of Autism
Autism Research Institute
NAAR, National Alliance for Autism Research
AUTISM SUPPLEMENT PRODUCTS
QUALITY SUPPLIES & PRODUCTS
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AUTISM SUPPLEMENT & PRODUCTS
Amazon: Autism Health & Personal Care Products
Tooth & Oral Care
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Amazon: Autism Dietary Books & Autism Cookbook Products
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NEURO-LOGIC SUPPLEMENT PRODUCTS
Amazon: Neuro-Logic Supplement Products
Nutrition Basics: Mental Clarity Supplements Information
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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