Through the eyes of autism

Visual distortions could be the cause of autistic symptoms, according to an American expert. And a simple treatment with vitamin A might be the answer. Jerome Burne reports
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Indy Lifestyle Online

Virtually every fortified cereal packet broadcasts the message that vitamin A is vital for good eyesight. But even the most gung-ho marketing manager would pause before claiming that the vitamin can dramatically improve the symptoms of autistic children by repairing damage to their retina. However, this is precisely the claim being made by an American paediatrician, who has evidence that treating these children with the right sort of vitamin A is not only highly effective but provides valuable new insights into some of the most puzzling symptoms of this disorder.

Virtually every fortified cereal packet broadcasts the message that vitamin A is vital for good eyesight. But even the most gung-ho marketing manager would pause before claiming that the vitamin can dramatically improve the symptoms of autistic children by repairing damage to their retina. However, this is precisely the claim being made by an American paediatrician, who has evidence that treating these children with the right sort of vitamin A is not only highly effective but provides valuable new insights into some of the most puzzling symptoms of this disorder.

"Once you understand the way autistic children 'see' their world," says Dr Mary Megson, a professor of paediatrics at the Medical College of Virginia, "the fact that they don't look you in the eye and can't bear for things to be changed makes perfect sense." She emphatically rejects the widely accepted hypothesis that these children have no theory of mind (ie, no understanding that other people have their own thoughts, plans, points of view), and that they relate to other people as just another type of thing.

Instead, she maintains that their seemingly alienated behaviour is perfectly rational. It is their way of surviving in an extraordinary and terrifying visual world, the result of damage to a protein pathway that affects the way that certain specialised cells in their retinas work. "Imagine that everything appeared to you like a some paintings by Picasso, flat and two-dimensional, with various features superimposed," urges Dr Megson, who has specialised in developmental disorders for the last 15 years. "Or think of a Hockney collage, digitally remastered with all the depth cues taken out."

At a conference on nutritional psychiatry in London earlier this year, Dr Megson described how she has found that a proportion of her patients have only a tiny visual window on the world where things are reasonably clear and appear in 3D. All around this they only see colours and vague shapes. This makes it very hard for them to follow movement, especially the subtleties of facial expressions. Making sense of a new scene is equally challenging - hence their desperate insistence that everything should follow ritualised, predictable patterns.

What concerns Dr Megson, like many other clinicians in this field, is the massive increase in the number of children coming to her with this sort of damage. "Since I've been practising, the number of cases has gone up from one in 10,000 to one in 600, and it may be more," she says. "There are officially 1,522 cases in the state of Virginia, but I've got 1,200 in my practice, which just covers one district."

She is certain that vaccination is at least one of the factors fuelling the rise. But although she agrees with Andrew Wakefield's controversial ideas about the effects of the MMR vaccine on the gut, she is particularly concerned about the vaccine for whooping cough and the "pertussis toxin" it contains. The evidence that she has seen has convinced her that certain children have a genetic susceptibility that makes certain proteins in their bodies vulnerable to damage by the toxin, which can have wide-ranging effects.

Known as "G proteins", they are found all over the body, but especially in the brain and guts, and are involved in boosting or dampening down the signals coming in from our senses (such as sight via the retina), as well as controlling such vital pathways as those for fats and glucose. The scary visual world of the children provides a close-up of how far-reaching the damage can be.

The theory is that receptors in the brain that control the "rod" cells in the retina have been affected by the whooping-cough vaccine. Rods are the cells that convey shading and depth, and allow us to see in black and white in the dark. They are more thickly clustered around the edge of the retina. "When these children look away from you," says Dr Megson, "they are turning their eyes so that the light reflected from your face lands on the outside of their retina, where the rods still have some function."

Controversial as her theory is, what has made her clinic in Richmond, Virginia, such a magnet for desperate parents is that it leads to a form of treatment that seems to be having considerable success. The key to getting the G-protein pathways working again is a form of natural vitamin A. "The results can be dramatic," says Dr Megson. "Within a few days, these children regain eye contact. They may start looking at their mother and speaking. Watching it happen, you get a strong sense of something being unblocked."

It is vital to use unsaturated "cis" vitamin A, as found in cold-water fish such as salmon or cod, as well as liver, kidney and milk fat. "These are foods that children often don't get in modern diets," says Dr Megson. "Synthetic vitamin A, the sort often found in supplements and cereals, can actually make matters worse because it has to be properly absorbed. This in turn needs a healthy gut, but many of these children have damage to the gut due to food allergies and overuse of antibiotics." That is why treatment is usually supported by removing certain foods from the diet, most commonly wheat and milk, and giving probiotics - beneficial gut bacteria.

Autistic children are also often hyperactive, they appear to be running on overdrive. If they were adult, they would be described as highly stressed, with the "sympathetic" side of their nervous system going full blast. Their pupils are frequently dilated and their heart rate and blood pressure is up. This, says Dr Megson, is the result of another one of the effects of the G-protein malfunction, which leaves a number of metabolic pathways without an off-switch.

Just as this messes up the retinoid receptors, it also prevents the proper function of the neurotransmitter acetylcholine that controls the relaxing (parasympathetic) side of the nervous system. To get this going again, after a couple of months on cis-vitamin A, Dr Megson may give a single dose of a drug called bethanecol, which mimics the effects of acetylcholine.

Again, the results can be dramatic. "We suddenly see these withdrawn children laugh, concentrate, show a sense of humour and talk after just 30 minutes," she says. A recent placebo-controlled study of 38 autistic children given cod-liver oil and bethanecol, showed significant improvement.

Besides treating the damage, Dr Megson has also being attempting to detect links between the genetic vulnerability of these children and the diseases suffered by their parents. She has found that, often, a parent or close relative has one of the rare disorders caused by a genetic defect in G protein, such as night blindness, which involves damage to the rods in the retina.

Surprisingly, the same mutation in the gene involved is also connected to a raised risk of colon cancer, and there is also a higher incidence of colon cancer among the parents - along with high levels of fats and cholesterol in their blood, and thyroid problems - all linked with faulty G proteins. "You'd be amazed at how many times I ask a parent of a child with autism if they have a dazzle effect when driving at night - a marker for night blindness - and they say that they do," says Dr Megson.

Such findings are all part of the evidence that G-protein damage is involved, but are far too vague to provide useful guidance on their own as to which children might be at risk. For now, Dr Megson advises that parents with such factors in their medical history check the child's cis-vitamin A level with a blood test before giving a vaccine, and raise it if necessary.

Currently, there are two places in the UK that are familiar with Dr Megson's work, and may be able to offer help with treatment. One is the autism research unit at the University of Sunderland. "Her approach is useful but not the whole answer," comments Paul Shattock, the director. "If cod-liver oil were the cure, you couldn't have autism in Norway." The unit's website features many research papers and an extensive treatment protocol based on nutrition. The other is the Brain Bio Clinic in London, which is just starting to use her approach.

None of this has been proved, and much more work needs to be done to firm up the biochemistry. The official position is that these vaccines are perfectly safe, and that people such as Dr Megson are scaremongering. But something is going on, the number of cases is rising, and the treatment she has developed does seem to help.

Autism Research Unit: www.osirissunderland.ac.uk/autism

Brain Bio Clinic: 020-8871 2949; www.mentalhealthproject.com

www.megson.com

COULD VACCINATIONS DAMAGE YOUR CHILD?

* A new fear about the link between vaccines and autism is causing concern in the US.

* Thimerosal, a form of mercury, is added to many vaccines as a preservative and to reduce the risk of infection in multi-use phials. It is known to be a potent neurotoxin.

* In 1999, an American official calculated that a baby who had all the recommended vaccines at the two-monthly check-up would receive 118 times the Environmental Protection Agency's official limit for daily exposure.

* There have been Congressional hearings about the use of thimerosal, and an action claiming damage to 3,500 children by thimerosal is currently being heard before the federal vaccines injury court.

* Thimerosal is no longer used in American vaccines, but stockpiles of old doses containing it are still being used up.

* Almost alone among Western nations, the UK still uses vaccines containing thimerosal. If you know to ask for a non-mercury containing vaccine for whooping cough, you will be given one. Most parents do not know to ask.

* A report in the journal Molecular Psychiatry this month traces some of the pathways that can be inhibited by mercury. "This may lead to serious disorders that manifest themselves during childhood," say the authors, "including autism and ADHD."

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