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Rapid Responses: Rapid Responses published:
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Autism.. ?Basic Cause
- A. Breck McKay (18 May 2007)
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Clues to Midbrain Impairment in Autism
- Eileen Nicole Simon, PhD, RN, 11 Hayes Ave, Lexington MA 02420 USA (20 May 2007)
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Immediate cord clamping must stop - no excuses!
- David JR Hutchon (21 May 2007)
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Evidence Should End the Bafflement
- Eileen Nicole Simon, PhD, RN, 11 Hayes Ave, Lexington MA 02420 USA (25 May 2007)
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Autism’s Common Denominator: IQ
- George M Morley MD (6 June 2007)
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WHOLE body function not unitary reductionism
- A. Breck McKay (7 June 2007)
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Nothing is more important than learning to speak
- Eileen Nicole Simon, PhD, RN, 11 Hayes Ave, Lexington MA 02420 USA (9 June 2007)
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The End of the Autism Epidemic
- George M. Morley MD (15 June 2007)
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A. Breck McKay, Ffamily/Musculoskeletal Physician Brisbane, Australia
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For the diagnosis of autism, the important criteria include poor responses to visual, auditory or olfactory stimuli. Now if we look at Ivan Pavlov's 1910 description of "The Orienting (Focusing) Response" (1), these are the three key external activators for 'orientation' and hence survival, for all animals. These three senses have direct links to the mid-brain and the autonomic nervous system central control(2),resulting in reflex activation of the flight/fight, fear/freeze or return to normal process. The usual reflex response rates of 150-200 millisecs, (long before the required 400+ millisecs for congition and considered response), suggests that it is the reflex activating links to the midbrain of these three senses that may be at fault, as other higher brain functions are subservient to initial survial. This also suggests that consideration might be given to the embryological developmental stage (3) at which these links occur for a causation to be found, such as environmental factors, toxins or drugs/chemical. After all, the child is born and develops well, until the stage at which these responses become critical to responding to the external environment and survival. Interestingly these autistic children also seem to respond differently to music, visual stimuli and smells, further suggesting that there is a related developmental link at this embryological stage, which then allows another or some pathways to develop supernaturally because they have less inhibition, thus producing the classical sauvant. Maybe Pavlov has more answers in his observations than we originally thought? As Sernt-Gyorgyi stated: "Discovery is seeing what everyone sees but thinking what no one has thought" Dr A Breck McKay Ref 1. Pavlov IP, "The Orienting or Focusing Response" Lectures on Conditioned Reflexes Vol 1 New York International Publishers 1928:133-35 2. Yates BJ, Millar AR Vestibular Autonomic Regulation CRC 1999 (ISBN 8493 -7668-8) 3. Larsen WJ Essentials of Human Embryology, Chapter 4 The Fourth Week, Churchill-Livingstone 1993:55-57 Competing interests: None declared |
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Eileen Nicole Simon, PhD, RN, Private researcher conradsimon.org, 11 Hayes Ave, Lexington MA 02420 USA
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Learning to speak, in early childhood, is what children with autism seem unable to do. This most likely results from problems within the auditory system. My son was stillborn, and brought back to life through resuscitation. Thus before he received the label "autism" I had begun searching the medical literature for a link from oxygen insufficiency to developmental language disorder, which I found in an article describing damage to the midbrain auditory system caused by asphyxia at birth [1]. The midbrain auditory system has the highest rates of blood flow and metabolism in the brain. Thus perhaps this is the "vigilance center" of the brain. What other explanation for such high metabolic activity can be offered? This center of high activity is also vulnerable to toxic substances, prenatal exposure to alcohol, and toxic metabolic products from disorders like phenylketonuria (PKU) and other genetic disorders associated with autism. Statistics on the prevalence of autism are similar to those for "respiratory depression" at birth [2]. Parents should ask what protocols will be followed in the event that their baby does not breathe right away at birth. Current practice is to clamp the umbilical cord immediately at birth, cutting off the baby's lifeline to its mother. This needs to be questioned. It is not safe for infants like my son, who was on the other side of the delivery room with a team of people trying to get air into his limp, ashen white body. The teaching until sometime in the mid 1980s was to wait at least for the baby to be breathing before cutting the cord, and the new protocol parallels the period of increased prevalence of autism. I have posted my ideas most recently at http://www.inferiorcolliculus.org/imfar.html. I wish I could get someone to pay attention to this possible reason for the increase in autism. Most children with autism do not recover. Autism is a tragic catastrophe that demands attention to what impairments in the brain prevent normal language development, plus all the associated disorders like failure to orient normally to sounds. Eileen Nicole Simon, PhD, RN References: 1. Windle WF. Brain damage by asphyxia at birth. Scientific American 1969 Oct;221(4):76-84. 2. Baskett TF et al. Predictors of respiratory depression at birth in the term infant. BJOG. 2006 Jul;113(7):769-74. Competing interests: None declared |
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David JR Hutchon, Consultant Obstetrician Darlington Memorial Hospital, DL3 6HX
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Sir,
Eileen Nicole Simon rightly questions the current practice of clamping the cord immediately at birth and the link with this practice and autism is perfectly feasible. There is a blinkered thinking among obstetricians and paediatricians who judge neonatal resuscitation and delayed cord clamping to be mutually exclusive. This is clearly not the case although it may require some forethought and some additional effort to combine the two.
In spite of all the evidence of harm from immediate cord clamping why is so little notice taken by the medical profession. The RCOG has no guideline on cord clamping although the Cochrane Collaboration produced a review on delayed cord clamping in preterm labour in 2005. I believe there are several reasons why so little importance is attached to the harm caused by immediate cord clamping. How well do most obstetricians, pediatricians and even cardiologists really understand the transistion of the circulation at birth. I have reviewed a number of textbooks which describe the physiological process of transition from fetal to adult pattern circulation at birth. Gray’s Anatomy describes the process well and makes no mention of a cord clamp. In every other physiology, pediatric and cardiology book that I looked at there is reference to a clamp removing the placental circulation. These are meant to be physiological descriptions and a cord clamp cannot be part of physiology. The fact that a clamp is commonly applied while placental circulation continues is irrelevant. A clamp can only be applied after the placental circulation has ceased naturally without interfering with physiology. With textbook explanations such as these is it any surprise that the majority of doctors and even midwives think that “delayed clamping” is an intervention rather than realising that immediate clamping is the intervention. As such the intervention of immediate cord clamping, regardless of the need for convenient resuscitation on a conventional resuscitaire, needs to be shown to be beneficial to the neonate. At minimum the combination of immediate cord clamping and resuscitation on a resuscitaire needs to be shown to result in better outcomes than resuscitation with the cord intact. Until such a practice is tested in a controlled trial, immediate cord clamping for any reason must stop. The requirement for cord blood gas analysis is another reason often given to support immediate cord clamping. (RCOG and ACOG) However the justification is for risk management and medico-legal purposes. The results are rarely available in less that 10 minutes after delivery and by that time many assessments and resuscitation measures will have already been applied to the baby. It is unlikely that such information will be of much help. Cord blood gas analysis, which requires immediate cord clamping, is an invasive test which puts newborn babies at high risk of hypovolaemia. How can this possibly be justified? It is not dissimilar to taking a brain biopsy from the baby at birth so that it could be later shown that the brain was normal when it was born! I suggest readers take a short time to go to their library and look at the physiology descriptions in the various textbooks. Competing interests: None declared |
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Eileen Nicole Simon, PhD, RN, Private researcher conradsimon.org, 11 Hayes Ave, Lexington MA 02420 USA
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I am grateful for Dr. Hutchon's response to mine on the rise in autism prevalence and obstetric protocols. Evidence is plentiful and longstanding on the association of autism and complications at birth. The reports of birth complications give no more than passing mention to how the brain might be affected. The evidence for what happens to the brain was provided long ago in experiments with monkeys subjected to asphyxia at birth. The midbrain auditory system was the primary site of damage, but subsequent maturation of the brain did not follow a normal course [1]. The experiments with monkeys were intended to produce a primate model of cerebral palsy. In their first report, Ranck and Windle (1959) noted that the brainstem pattern of damage, most prominent in the auditory pathway, resembled the lesions usually associated with kernicterus, except for lack of bilirubin staining [2]. Lucey et al. (1964) then demonstrated that bilirubin only affects the same nuclei that are damaged first by asphyxia [3]. Because the expected damage of the cortical motor system underlying cerebral palsy was not produced by asphyxia, and the monkeys suffered only transient developmental delay, the brainstem pattern was dismissed as "minimal." How can any damage in the brain be considered minimal? Asphyxiation of monkeys would no longer be allowed, but clamping the umbilical cord of human babies before the first breath may cause asphyxia, and a low Apgar score even at one minute cannot be viewed as benign. I am glad to see a few obstetricians questioning the safety of current standards of care. References 1. Faro MD, Windle WF. Transneuronal degeneration in brains of monkeys asphyxiated at birth. Exp Neurol. 1969 May;24(1):38-53. 2. Ranck JB, Windle WF (1959). Brain damage in the monkey, Macaca mulatta, by asphyxia neonatorum. Experimental Neurology 1:130-154. 3. Lucey JF, Hibbard E, Behrman RE, Esquival FO, Windle WF (1964) Kernicterus in asphyxiated newborn monkeys. Experimental Neurology 9:43- 58. Competing interests: None declared |
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George M Morley MD, Retired Obstetrician Gynecologist 10252 E. Johnson Road, Northport, MI 49670
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Until the researchers can define “autism,” bafflement will continue. Professor Chapman cites the oxymoron, “a broadening definition” and “children with average intelligence as well as below average intelligence.” Why not include children with above average intelligence in the “narrow and broad” non-definitions of autism? The researchers miss the crucial point; the HANDICAPPED autistic child is mentally retarded. A standardized IQ test defines the degree of handicap and of “autism.” Previous responses to the article are illustrative. McKay correctly links “autism” to defective response to the three primary senses – hearing, sight and smell, and points out the importance of the mid-brain (as does Eileen Simon) as a “connector” between sense organ and response organ(s). However, McKay’s hypothesis that the defect may be in links to autonomic reflexes as opposed to cognitive responses is not plausible. The auditory / speech mechanisms (cognitive) are most commonly defective; “Autistic children cannot learn how to speak.”(Simon) Echolalia (parrot speech) is typical. The severely autistic/echolalic child “hears” perfectly. A loud bang makes it blink and jump reflexively. If the words DOG, CAT, and COCK-A- DOODLE-DOO are spoken, the child may repeat them perfectly, but when asked, “Say that again” it replies, “Say that again.” The functions of sound memory and recall, and the association of sounds and words with visual memory/recall and smell memory/recall do not coalesce or correlate to form COGNITION in the autistic child. When subjected to an IQ test, most “autistic” children are mentally retarded; the IQ measures the degree of mental retardation. Thinking requires UNDERSTANDING words, not just memory and recall. What does all this mean? At some point in the development of the autistic brain, input from the basic three senses (especially in the auditory pathway) was partially disrupted from, or misconnected to corresponding areas of the cerebral cortex – the cognitive / intellectual part of the brain where memory, recall, association and cognition reside. Development of the human cerebral cortex is NOT an embryonic feature (McKay); its rapid development and maturation occurs from the formation of the germinal matrix (24+ weeks gestation.) and continues until well AFTER birth through infancy. Connections (in the midbrain) between the sense organs and the cortex must develop accordingly. Growth and development of the auditory pathway (midbrain) must parallel that of the temporal cortex to form normality. The undisputed association of autism with birth complications (Simon) indicates that some birth brain injury disrupts this development – causing autism. Hutchon and Simon identify the injury – immediate cord clamping. (ICC) Depending on birth circumstances, ICC removes some or most of a neonates blood volume. Extreme blood loss may result in ischemic encephalopathy with ischemic necrosis of the basal nuclei – visualized on MRI scan – and cerebral palsy. The ICC child often develops infant anemia; the degree of anemia indicates the amount of blood volume clamped in the placenta and the degree of neonatal brain “ischemia” immediately after birth. Multiple studies [1] show infant anemia correlating with childhood behavioral and cognitive disorders. The hemoglobin at 6 months of age determines the IQ at 6 years of age [2] For each decrement in infant hemoglobin, the risk of mental retardation increases accordingly. [3] At each degree of infant anemia, boys were more than twice at risk for mental retardation than girls. [3] Anemia in low birth weight infants had four times the risk of mental retardation than term infants. [3] It is thus no coincidence that autistic boys outnumber autistic girls. Cord clamping delayed until the placenta has delivered supplies enough blood and iron to prevent anemia during the first year of life. A full placental transfusion prevents neonatal ischemia, cerebral palsy, infant anemia and childhood mental retardation. If the researchers had used a standard IQ test to define “autism” instead of nebulous, arbitrary signs and symptoms, the results would not have been baffling. In North America, there is a “cohort” of physiological norms for cord clamping – at every home birth conducted by a midwife the cord is not clamped until the placenta is delivered. Amish communities, where this is widely practiced, report no autism epidemic. A comparison of IQ’s for North American home births and similar hospital births would be very illustrative. The response from Hutchon implicates RCOG and ACOG in the continued practice of ICC. These venerable institutions need to either justify this practice or proscribe it. Full discussion and further references are available at the following web sites: www.autism-end-it-now.org www.birth-brain-injury.org G. M. Morley, MD, FACOG Email obgmmorley@aol.com References: 1. Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev 2006 May, 64; (5 Pt 2):S34-S43. 2. Palti H, Pevsner B, Adler B. Does anemia in infancy affect achievement on developmental and intelligence tests? Hum. Biol. 1983;55:189-194 3. Elyse Krieger Hurtado, Angelika Hartl Claussen, and Keith G, Scott. Early Childhood Anemia and mild or moderate mental retardation. Am. J. Clin. Nutr. 1999: 69:115-9. Competing interests: None declared |
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A. Breck McKay, Family/Musculoskeletal Physician Brisbane
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Morley seems to have misunderstood my point. The baby, prior to birth grows into a whole functioning body that is in a relatively protected environment up to birth. From birth, full of total body stimulation,development is by responding to both internal and external environments by classical Pavlovian conditioning reflexes by developing all the brains secondary networks. (Other animals advance much more before birth than humans, so that they can survive better after birth). Each and every learnt progression can be examined and explained using Pavlov's Conditioned reflexes (1904), Orienting Reflex (1910), Reflex of Purpose & its intensity(1916) plus Reflex of Freedom (1917) that modifies all the previous conditioned reflexes. The body responds to the environments to develop Survival/Functioning behaviours and also to develop the parallel and subservient pain/nociception pathways by using interpretation of the massive amount of afferent and efferent networking to which Chaos Theory applies neatly. (Chaos Theory describes the management of the neural and hormonal messages by a complex differential equation with constants. Change a constant and everything changes. Restore a constant and everything restores.) Now the most BASIC of these Survival/Functional responses to the external world are interpreted by the olfactory, auditory and visual inputs directly to the midbrain first and higher cortical areas secondly. The direct stimulation to the body via the skin (touch, pressure, thermal etc) is added to the whole afferent input, but also goes via the autonomic vestibular areas of the midbrain. These survival responses occur via the midbrain areas at <200 millisecs (and this is where the autonomic system is dominant)and the secondary higher centre function (usually >200 millisecs and for cognition >400 millisecs), develops step by step, in classical Pavlovian processes as the brain builds up its many networks of memory... each reinforced and stabilised by repetition, as well described by de Bono, 1969 (Edward de Bono: Mechanism of Mind). If these basic midbrain survival functions are faulty or do not develop correct higher centre networks, then the classical autism syndromes present. Development of one pathway normally, without modualtion by the others may result in the Sauvant autistic. We cannot assess olfactory function well in these chidlren and so only the errors in visual/auditory cueing is observed. Please remember that each and every child/person is ONE whole Functioning unit, with the central, peripheral, autonomic nervous systems and endocrine system being the messaging system (Windows, OS of Linux) of the body and all responses follow the simple Monitor the environments (external and internal), Orient to the changes, Memory check the observations then Manage/respond by the simple trio of Fight/Flight or Fear/Freeze or Restore to Normal. (MOMM + Trio). It is scientifically corrupt to lump together all the series of reductionist observations of chemicals, cells, tissues, organs and systems and hope they will function as ONE unit by simple addition,,,They all work together via complex integration!! We all need to go back to Pavlov's brilliant observational Physiology and relearn the whole body conditioned reflex process again and understand better single, whole body function! Competing interests: None declared |
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Eileen Nicole Simon, PhD, RN, Independent researcher conradsimon.org, 11 Hayes Ave, Lexington MA 02420 USA
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I am so grateful for expressions of concern from obstetricians over recently written standards of care that include clamping the umbilical cord within seconds following birth. Fear of jaundice appears to have motivated this radical change from tradition, when the cord would never have been clamped before the first breath. My second son did not breathe right away at birth, and it never occurred to me to ask before the birth of any of my children what would be done if my baby were slow to begin breathing. It took some time to resuscitate my son, and he had many problems during infancy – respiratory and gastrointestinal at first, then he did not learn to speak. Experiments with monkeys, that could never be repeated, provide evidence that a lapse in respiration at birth can cause impairment of the midbrain auditory system. Hearing may not appear to be affected, but orientation to sounds and ability to extract word and syllable boundaries are abnormal. Now more and more research is revealing the hazards of immediate clamping of the cord. It should be immediately mandated (without waiting for more research) that a newborn infant must be breathing before clamping off the lifeline to its mother. Competing interests: None declared |
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George M. Morley MD, Retired obstetrician gynecologist 10252 E. Johnson Road, Northport, MI 49670
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The whole point of the original article is that the current attempt at understanding autism, its epidemiology and its causation is utterly confused. Most Rapid Responses offer rational resolutions of that confusion; McKay offers an interesting theory of autism using Pavlov and the Chaos Theory, but places the time of brain injury in the embryo stage without any corroborating facts. McKay offers this point in support of her hypothesis: “OTHER ANIMALS ADVANCE MUCH MORE BEFORE BIRTH THAN HUMANS, SO THEY CAN SURVIVE BETTER AFTER BIRTH.” They do, reflexively, without cognition; ducklings will bond to a moving balloon if they hatch when the mother duck is elsewhere at the time. Ungulates bond to their mother immediately and follow her after aerating their lungs and clamping their own cords. Most primates can cling to their mother soon after birth, and most marsupials can cling to their mother after leaving the pouch. The normal human newborn is incapable of any of this. The eyes may follow a moving object within a week or two, but it usually takes several weeks for the child to smile at the sight of its mother’s face, and hearing her voice – COGNITIVE reactions. The severely autistic child may never learn to smile at its mother’s face and may be emotionless forever. Windle’s [1] birth brain-damaged monkey newborns had severe “visual learning” disabilities; [2] they also had problems finding the correct mother to cling to. [1] McKay’s statement, “the [autistic] child is born and develops well, until the stage at which these responses become critical to responding to the external environment and survival” is not accurate. Many autistic children do not “develop well” emotionally and behavior-wise FROM THE TIME OF BIRTH; other major defects become very apparent as milestones are missed. While most neurological defects of childhood autism are very probably in the midbrain and its cortical / cerebellum links, later lesions (e.g. tumors) of the temporal cortex can also result in ASD in “normal” children / adults. Basing the infinite number of signs and symptoms of autism on a defective EMBRYOLOGICAL autonomic nervous system linked to the auditory / sight / olfactory senses is not plausible. If these defects originated in the embryonic stage of development, then c-section babies and babies with low 5-minute Apgar scores should be equally prone to autism as “normal birth” babies; they are not, they are many times more likely to be autistic. They very likely have suffered ICC. The normal human newborn at birth has very few survival responses. The “Cold Crying Reflex” [3] may evoke a “pick-up” response from the mother (3) and a “suckling response/reflex” from the child when the mother reflexively puts the crying child on the breast. Immediate Cord Clamping (ICC) may destroy even this sequence: Loss of placental transfusion renders the child hypovolemic and very weak, [4] incapable of crying with deficient pulmonary circulation. [5] It may be too weak to suckle. [6] The end result is an ISCHEMIC ANATOMICAL MIDBRAIN LESION [7] that injures Pavlov’s survival networks and renders them dysfunctional. ICC was not a habit in Pavlov’s day. A spastic child cannot be conditioned to be non-spastic, and I have not heard of any autistic child being “conditioned” to speak. However, there are reports of some autistic children improving in learning ability with hyper-baric oxygen therapy – that increases brain circulation / perfusion on MRI scan – and may seem to re-activate some dormant neural networks. No claim for cure is made by HBO. The ischemic lesion is MRI visible in the basal nuclei in (birth asphyxia / ICC) spastic paralysis. [7] Windle’s asphyxiated / ICC mentally retarded monkeys [2] had (visible, microscopic) defects in the inferior colliculus. Births that incur ICC have a high incidence of autism. [8] Hutchon has every logical justification to demand that ICC must stop. Further rational examination of the subject should extend the prohibition of cord clamping at every birth until the cord has closed itself PHYSIOLOGICALLY. Physiology is healthful; disruption of physiology is injurious. Physiology is not baffling. Define autism in terms of IQ – a number! Then the autism “numbers” will make common sense. G. M. Morley, MD FACOG Email obgmmorley@aol.com www.atutism-end-it-now.org www.cordclamp.com www.birth-brain-injury.org References: 1. Windle WF. Brain damage by asphyxia at birth. Scientific American 1969 Oct;221(4):76-84. 2. www.atutism-end-it-now.org Primate Studies, 3. www.cordclamp.com Why Do Babies Cry? 4. “Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child.” Erasmus Darwin, Zoonomia, 1801 5. Morley GM. LETTERS OBSTETRICS & GYNECOLOGY, Vol 97, No.6,June 2001, 1024-1026 6. Cowan F et al. Origin and timing of brain lesions in term neonates with neonatal encephalopathy. Lancet 2003; 361:736-42 7. www.birth-brain-injury.org 8. www.autism-end-it-now.org The Autism Epidemic Competing interests: None declared |
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