AUTISM- FIND THE THRUST AREAS OF AYURVEDIC MANAGEMENT
Man is a social animal; because he transfers emotions, uses language and communicate each other. He has several other skills to make fit himself in to the society. This is attained by proper neuronal formation and maturation which starts from the intra uterine environment and completes with the help of the environment proper outside the womb. This is the essence of pervasive development, and the disorder of the above said physiology is called pervasive developmental disorder [PDD]. The best known PDD is Autism. This may be the reason why the doctors are speculating their role in the autism management as it has a physical basis. Autism was previously a symptom in adult schizophrenia1. In this condition there is marked and sustained impairment in social interaction, deviance in communication, and restricted or stereotyped patterns of behavior and interest. Abnormalities in functioning in each of these areas must be present by age 3 years. Approximately 70 percent of individuals with autistic disorder function at the mentally retarded level, and mental retardation is the most common comorbid diagnosis2. Humanity is now astonishing with the rising scene of autism features among the children. Obviously the disease is a stroke to the family as well as to the society. The curative management of the condition is still a mirage because the cause of the disease is still unknown. However the management teams like religious persons, traditional healers and ayurvedic hospitals are mushrooming with golden blind offers to exploit the helplessness and hopes of the suffering family members. Even the visual media is now a day identifying this trend and trying to highlight Ayurveda as a ridicule method to treat autism. So it is the responsibility of scientific Ayurveda people to publish and highlight the real thrust areas of Ayurveda in autism management. Following are some of the areas where Ayurveda has a pronounced role in the autism management according to the limited experience of author.
Neuronal Migration problems and autism
Neuronal migration disorder refers to a heterogenous group of disorders that, it is supposed, share the same etiopathological mechanism: a variable degree of disruption in the migration of neuroblasts during neurogenesis3. The recent autopsy studies are revealing the the children with PDD has migrational defects4. So the PDD has to be considered as the garbha vikritis caused by the deficient quality of gametes[sukla and artava], defective uterine environment, time of conception, diet and activities of mother5. The features of PDD will be expressed as, defective pravritti of vayu[sanga] in the areas of budhi and mana[praana and udaana]. Language developemental problems, sterotypies, defective socializations are example of it6. Sometimes in PDD the vata vitiated[vriddhi] lakshanas in the pakwasaya, siraa and snaayu will be expressed as walking difficulties, microcephaly, loss of bladder control etc7. This clearly indicates the srotorodha is in the brain itself so as to produce a bipolar feature of vayu viz atipravritti and sanga. So the medhya with ushna teekshna drugs and budhi prabodhaka procedures [gomutra preperations and pradhamana ] along with tiktapaachana drugs mainly with guloochee is showing some hopes to alleviate the symptoms. Here we have to exploit the neuronal plasticity, the wonderful capacity of neurons to mould and rewire according to the inputs from the sensory organs and proprioceptive stimulus. Ayurveda is a science with good treasure of procedures which promotes the neuronal growth by the mechanism of neuronal plasticity. Udwarthana, abhyanga, some vastis are such examples. These procedures can be effectively implemented aiming the management of migration issues.
NGut problems in autism & deficiencies
Usual gut problems of autistic children are some specific allergies especially to gluten and casein. Frequent spells of either diarrhea or constipation is usual among these children. All these issues are invariably featuring similarity to either aama/ajeerna or doosheevisha concept in ayurveda. The amaasayastha or pakwasayastha dosheevisha lakshanas are more prominent in this context. The kaalasaakadi kashaya, villwadi gulika, hinguvachaadi churnam, doosheevisharigulika are the chief agents which acts powerfully to manage these problems. But interesting point is that management of food allergies is finally reaching to the good management of hyperactive symptoms associated with autistic children. This is due to the fact that both faculties [gut and mind] are the functions of rasadhatu. The references of enterocolonic encephalopathy theory have to be read in connection with this similarity. The management of deficiencies has been started since 1960 for the autism treatment plan. Vitamin B6, magnesium,zinc are the usual supplements of foods which gives positive results in speech,attention,irritability and learning skills8. These are all indicative of an inherent agnimandya of autistic babies either at the level of koshta or at the level of dhatuparinaama.
Toxins in autism
Several endotoxins and exotoxins are hypothesized to have a prominent role in the etiogenesis of autism diseases. Endotoxins are chiefly by several infections9, intermediary metabolic substances like ammonia, lactate, pyruvate, endomorphin10 etc. Exotoxins are chiefly by heavy metals, food addictives, drugs, pesticides etc11. Here the endotoxins are to be treated as dhatugata aama and doosheevisha and should be treated accordingly. Exotoxins are the real vishaas and heavy metals and all vishahara chikitsas are inevitable in most of the cases. Heavy metals such as mercury from several vaccines and fishes have been chiefly blamed in the causation of autism disorders12. Current chelation therapy in biomedicine is one such an effort in this regard. The patoladi ganam, aragwadhadi ganam are the chief agents which we are utilizing for this aspect in autism management.
Hyperactivity and autism
Poor affect modulation and the display of emotions inappropriate to a given social situation are common. Some individuals may show sudden mood changes, and laugh, cry, or giggle to themselves for no apparent reason. The controlling and stimulating power of the vayu on mind is getting totally underdeveloped here to produce almost similar features of vata paittika unmada. Interestingly all those children are showing other paittika symptoms like diarrhea, self injurious behavior, head banging etc..Maximum other co morbidities like fragile X syndrome[FRAXA],tuberous sclerosis are mostly seen with this prominent symptom of hyperactivity in autism. So the management protocol should be directed towards these co morbidities. Snehapaana with kaaraskara ghrita[Indicated in vatasonita chikitsa by sahasrayoga] usually alleviate hyperactivity in tuberous sclerosis and FRAXA. The typical vatapittika unmaada hara chikitsas like seka with himasagaram tailam, yashti madhu+gudoochee kwatha, rajanyaadi churna, sirolepam etc..is giving positive changes. Sleep issues are also getting relieved by this management scheme.
Autism spectrum disorders(ASDs)
Rett’s syndrome, Asperger syndrome, childhood disintegrative disorder(CDD) and pervasive developmental disorder not otherwise specified are the ASDs. Of these exposure to asperger syndrome is less to the author where as PDD –NOS is the mostly encountered case. Rett’s syndrome and CDD are the diseases in which the doshas in the rasadhatu makes its manifestation both in somatic and psychic areas prominently. The samprapti finally progress to the further dhatus and upadhatus to create the symptoms like, vasti vikaras, dourbalyam, kampam, akshepakam, apasmaaram etc.
General informations and conclusions13
Research based acceptable methods, principles, techniques and rationale are the only applicable interventions allowed ethically in autistic children. Ayurveda is not one among them at present. The accepted interventions are Applied Behaviour Analysis(ABA), the TEACCH approach[Treatment and Education of Autism and related Communication Handicapped Children], Lovaas and discrete trial teaching, augmentative and alternative communication,Higaashi daily life therapy, sensory integration therapy are few of them. A multidisciplinary team and transdisciplinary team is inevitable to manage those children and that team should inevitably consist of an experienced Ayurveda specialist. If it is a classical case of autism best approach is multidisciplinary and if it is co morbidity along with other multiple problems transdisciplinary approach is best.
Organization of multi didisciplinary model of service delivery(source Orelove and Sobsey 1987)
A transdisciplinary team should have one or two persons as primary facilitators of the services and other team members acts as consultants.
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