So I began this GFCF diet kicking and screaming. I agreed to try it for three months. I circled June 1st on my calendar, and I lived for that day. Figuring out what to feed an already picky 2½-year-old was no fun! Four sippy cups of milk a day? Replace with diluted, organic vegetable juice. Toaster-ready pancakes? Replace with rice and amaranth pancakes made from scratch, with allergen-free chocolate chips and ground flax added for good measure. Macaroni and cheese? Replace with nothing—there's just no good way to make GFCF macaroni and cheese! I've never been the Martha Stewart type, but I was buying cookbooks and trying new recipes every day.

June 1st came and we'd not only survived, but—despite his continual complaining about the diet (particularly about losing his beloved macaroni and cheese)—Brian had definitely improved. In those three months, he'd gained some much-needed pounds and inches, having stagnated on the growth charts in the months before. He'd made nice language gains, he'd increased his eye contact, his poop was normalizing, and his ears were bothering him less. All this was great. There was only one piece of bad news, which my husband broke to me over another bottle of wine: "Al, you know we have to keep doing this diet." "I know," I sighed. To this day, Brian remains gluten and casein free. He's also egg-free, soy-free, citrus-free, and free of all artificial colors, flavors, and preservatives.

Healing Brian's gut has made him less autistic, and removing offending foods certainly played a huge part. Dr. Usman also used antibiotics to reduce some nasty bacteria in his gut. When those bacteria were under control, Brian stopped hitting, scratching, and pulling hair. Amazing! While some doctors need to reduce a child's heavy-metal burden with the drug chelation, our doctor has been able to take a
less invasive approach and support Brian's detoxification with supplements. Interestingly, recent research has shown that children with Asperger's disorder have less metal toxicity than children with full-blown autism.

We've learned to manage Brian's physical health much the way parents would who had a child with diabetes. We think of him as having a chronic medical condition. When the medical condition is well managed, it recedes into the background. When we see old behaviors return, we look at what might be getting out of balance in his body and make plans to correct it.

Remediating the Core Deficits

In addition to repairing Brian's "hard drive"—his brain structure and biochemistry—we're working on his "software"—his development, behavior, cognition, and psychology—through various forms of therapy. There are three distinct ASD treatment approaches: Applied Behavior Analysis (ABA), Floortime (DIR), and Relationship Development Intervention (RDI) (go to www.psychotherapynetworker.org for more information). Our research and personal experience led us to feel most connected to RDI.

RDI therapy was developed in the late 1990s by Steven Gutstein, a clinical psychologist with a background in family therapy. He observed that autism spectrum disorders "belonged" much more to the world of developmental disabilities than to the world of developmental psychology or family therapy. By breaking down typical developmental targets into infinitely smaller milestones and examining those closely, Gutstein created a way of thinking about ASDs that goes far beyond the DSM's description of symptoms. For example, children with ASDs frequently demonstrate average or above-average levels of static (rote) intelligence, but show deficits related to dynamic (interactive) intelligence. Gutstein identified five "core deficits," both unique to autism and descriptive of all children on the spectrum: in declarative communication, referencing, regulating, episodic memory, and flexible thinking.

To address these core deficits in dynamic intelligence, Gutstein created a clinical treatment program that trains parents to teach dynamic-intelligence skills and motivation to their child. Rather than using concrete rewards and reinforcers, RDI teaches the joy of connecting and helps people on the autism spectrum learn how to express friendship and empathy and to genuinely love sharing their world and experiences with others. Although RDI is relatively new to the scene, early research is promising. Within 18 months of starting treatment, more than 70 percent of children in an initial study improved their diagnosis, based on the Autism Diagnostic Observation Schedule (ADOS). The majority of children moved from a special education to a regular classroom, and didn't need an aide.

Although parents are the guides and children the apprentices in this work, usually families meet with an RDI certified consultant once every two weeks. Using a structured, four-session assessment protocol, the RDI consultant determines the child's current developmental stage, which is usually Stage 1. For each stage, there are more than 20 objectives the child must achieve before he or she can progress to the next stage. Families tackle one developmental objective at a time, and each one is at the edge of the child's learning capacities. In addition to working directly on the current developmental objective, families commit to adopting overarching lifestyle practices, such as waiting until the child is oriented to the parent before beginning to speak to him or her and utilizing an 80-to-20 ratio of declarative to imperative language (go to www.psychotherapynetworker.org for more information).

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rquagan  - Psychology Disappearing?   |Registered |2009-07-28 14:56:04 In “Carrying the Hope” (July/August) I was disappointed to find --- or not to find --- much psychology in what might have been an extremely interesting case. A child demonstrates normal development until age two, when following the administration of immunizations, experiences bouts of illnesses for three months. There is some inference as to a possible connection between the vaccines and the illnesses, although my understanding from the insert is that this was not substantiated. Following this period of sickness, the child begins to develop atypical behavior. (Psychology opportunity for exploration: At a pivotal point in the child’s early development he becomes unexpectedly sick and the way some of the grown-ups in his environment relate to him suddenly changes. There is a growing concern, fussing, accommodating…how does he respond to this new attention? How does his orientation to the world begin to change?... mimiwolfe  - Carrying the Hope   |Registered |2009-07-26 14:22:56 Extremely well written, touching and informative article.

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