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Moshe Heller LAc.

Pervasive Development

Disorders PDD

� The term "pervasive development disorders"

(PDDs) refers to a group of conditions that

involve delays in the development of many

basic skills, most notably the ability to

socialize with others, to communicate and to

use imagination. Children with these

conditions often are confused in their

thinking and generally have problems

understanding the world around them

Pervasive Development Disorders

PDD

� Because these conditions typically are

identified in children around 3 years of age --

a critical period in a child's development --

they are called development disorders.

Although the condition begins far earlier than

3 years of age, parents often do not notice a

problem until the child is a toddler who is

not walking, talking or developing as well as

other children of the same age.

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There are five types of PDDs:

� Autism

� Asperger's syndrome

� Childhood disintegrative disorder

� Rett's syndrome

� Pervasive development disorder not

otherwise specified (PDDNOS)

Autism

� Children with autism have problems with

social interaction, pretend play and

communication. They also have a limited

range of activities and interests. Many

(nearly 75%) of children with autism also

have some degree of mental retardation.

� To Diagnose Autistic disorder requires

impairments in all three domains:

communication, social interaction and

repetitiveness

Asperger's syndrome

� Like children with autism, children with Asperger's syndrome have difficulty with social interaction and communication, and have a narrow range of interests. However, children with Asperger's have average or above average intelligence, and develop normally in the areas of language and cognition (the mental processes related to thinking and learning). Children with Asperger's often also have difficulty concentrating and may have poor coordination.

� Asperger’s disorder is distinguished by the lack of communication impairments and better-preserved intellectual functioning.

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Pervasive development disorder not

otherwise specified (PDD NOS)

� This category is used to refer to children who

have significant problems with

communication and play, and some difficulty

interacting with others, but are too social to

be considered autistic

� PDD NOS is diagnosed in cases when

diagnostic criteria for autistic or Asperger’s

disorders are not met.

Rett's syndrome

� Children with this very rare disorder have the symptoms associated with a PDD and also suffer problems with physical development. They generally suffer the loss of many motor, or movement, skills -- such as walking and use of their hands -- and develop poor coordination. This condition has been linked to a defect on the X chromosome, so it almost always affects girls

Childhood disintegrative

disorder

� Children with this rare condition begin their

development normally in all areas, physical

and mental. At some point, usually

between 2 and 10 years of age, a child with

this illness loses many of the skills he or

she has developed. In addition to the loss

of social and language skills, a child with

disintegrative disorder may lose control of

other functions, including bowel and

bladder control.

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Autism Diagnosis (DSM IV)

Impaired social interaction (at least two):

� Markedly deficient regulation of social interaction through multiple nonverbal behaviors, such as eye contact, facial expression, body posture, and gestures

� Lack of peer relationships that are appropriate to developmental level

� Absence of seeking to share achievements, interests, or pleasure with others

� Absence of social or emotional reciprocity

Autism Diagnosis (DSM IV)

Impaired communication (at least one):

� Delayed or absent development of spoken language, for which the patient doesn't try to compensate with gestures

� In patients who can speak, notable deficiency in ability to begin or sustain a conversation

� Language that is repetitive, stereotyped, or idiosyncratic

� Appropriate to developmental stage, absence of social imitative play or spontaneous, make-believe play

Autism Diagnosis (DSM IV)

Activities, behaviors, and interests that are repetitive, restricted, and stereotyped (at least one):

� Abnormal (in focus or intensity) preoccupation with interests that are restricted and stereotyped (such as spinning things)

� Rigid performance of routines or rituals that don't appear to have a function

� Repetitive, stereotyped motor mannerisms (such as hand flapping)

� Persistent absorption with parts of objects

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Autism Diagnosis (DSM IV)

Before age three, the patient shows delayed

or abnormal functioning in one or more of

these areas:

� Social interaction

� Language used in social communication

� Imaginative or symbolic play

These symptoms are not better explained by Childhood

Disintegrative Disorder or Rett's Disorder.

Asperger's Diagnosis (DSM

IV)At least two demonstrations of impaired social interaction:

� Markedly deficient regulation of social interaction through multiple non-verbal behaviors, such as eye contact, facial expression, body posture, and gestures.

� Lack of peer relationships that are appropriate to developmental level

� Absence of seeking to share achievements, interests, or pleasure with others

� Absence of social or emotional reciprocity

Asperger's Diagnosis (DSM

IV)At least one demonstration of activities, behavior, and interests that are repetitive, restricted, and stereotyped:

� Abnormal (in focus or intensity) preoccupation with interests that are restricted and stereotyped (such as spinning things)

� Rigid performance of routines or rituals that don't appear to have a function

� Repetitive, stereotyped motor mannerisms (such as hand flapping)

� Persistent absorption with parts of objects

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Asperger's Diagnosis (DSM

IV)� The symptoms cause clinically important impairment

in social, occupational, or personal functioning.

� There is no clinically important general language delay (the child can speak words by age two, phrases by age three).

� There is no clinically important delay in developing cognition, age-appropriate self-help skills, adaptive behavior (except social interaction), and normal curiosity about the environment.

� The patient doesn't fulfill criteria for Schizophrenia or for another specific pervasive developmental disorder.

PDD NOS(DSM IV)

� Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS) for severe, per-vasive developmental disturbances that do not meet criteria for one of the specific disorders described above or for Schizophrenia, SchizotypalPersonality Disorder, or Avoidant Personality Disorder. DSM-IV particularly mentions atypical autism, which is a label used for disturbances that don't meet criteria for Autistic Disorder because of late age of onset, too few symptoms, or atypical symptoms.

Rett's Disorder(DSM IV)

All of the following suggest normal early

development:

� Prenatal and perinatal development

� Psychomotor development, at least until age 5

months

� Head circumference at birth

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Rett's Disorder(DSM IV)

After this apparently normal beginning, all of these occur:

� Head growth slows abnormally between 5 and 48 months.

� Between 5 and 30 months, the child loses already acquired purposeful hand movements and develops stereotyped hand movements, such as hand washing or hand wringing.

� Early in the course, the child loses interest in the social environment. (However, social interaction often develops later.)

� Gait or movements of trunk are poorly coordinated.

� Severe psychomotor retardation and impairment of expressive and receptive language.

Childhood Disintegrative Disorder

(DSM IV)

� At least until age two, the child develops

normally, as shown by age-appropriate

adaptive behavior, play, social relationships,

and both nonverbal and verbal

communication.

Childhood Disintegrative Disorder

(DSM IV)

Before age 10, the child experiences

clinically important loss of previously

learned skills in the following areas (two or

more required):

� Language (expressive or receptive)

� Adaptive behavior or social skills

� Bladder or bowel control

� Play

� Motor skills

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Childhood Disintegrative Disorder

(DSM IV)

The child functions abnormally in two or more

of the following ways:

� Social interaction is characterized by impaired

nonverbal behaviors, peer relationships, or

emotional or social reciprocity.

� Communication is characterized by delayed or

absent spoken language, inability to converse,

language use that is repetitive or stereotyped,

or absence of varied make-believe play.

Childhood Disintegrative Disorder

(DSM IV)

� Activities, behavior, and interests are

repetitive, restricted, and ste-reotyped;

this includes motor mannerisms and

stereotypies.

� These symptoms are not better

explained by Schizophrenia or by

another specific pervasive

developmental disorder.

Diagnosis (Western)

� Autistic disorder, Asperger’s disorder and

PDD NOS are referred to as autism

spectrum disorders (ASD).

� The current gold standard for diagnosing

ASD is based on clinical history and patient

observation performed by trained clinicians

with the use of structured diagnostic tools

such as the Autism Diagnostic Interview –

revised (ADI-R) and the Autism Diagnostic

Observation Schedule (ADOS).

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Treatment (Western Alternative)

� Gluten Free / Casein-Free diet

� Allergies (Mast Cell Activation)

� Enzymatic therapy

� Craniosacral therapy

Chinese Medicine

� In trying to understand Autism Spectrum

Disorder (ASD) in Chinese medical

terms it is Important to look at :

1. Possible etiological factors

2. Physiology of the organs involved

3. Common symptoms

Etiology

� Immunizations – Although there is

still a debate weather

immunizations can be associated

with Autism, from a Chinese

medical perspective it is

important to take into

consideration that they may be

contributing to toxicity

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Etiology

�Antibiotics – In certain cases

(when used inappropriately)

can be the cause of Lingering

Pathogenic Influences (LPF)

and their cold nature can

contribute to the formation of

Phlegm

Etiology

�Parasites – parasitic infections

(worms, fungal and viral) are

more common then we think and

they have a strong influence on

both physiological and

psychological functions (Gu

Syndrome)

Etiology

� Digestive disorders – Children with

Autism almost always present with

digestive disturbances. It is interesting

to note that although in main stream

western medicine this link is

controversial in western alternative

therapies it is very much the hallmark.

In Chinese medicine diet is extremely

important in the treatment of autism

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Etiology

�Constitutional predisposition –

The development of this disorder

at young age as well as the fact

that it is a developmental disorder

point to the involvement of Jing.

Thus in order to address autism

the Kidney Jing must be

addressed

Physiology of the organs

involved

� Heart – “ Hthe heart controls all mental

activities of the mind and is responsible

for insight and cognitionH”, “A healthy

Heart and mind will positively influence

our ability to relate to other peopleH”

Giovanni Maciocia, Foundations of

Chinese Medicine. The heart is also in

charge of appropriate behavior and

understanding of social cues

Physiology of the organs

involved

�Spleen – “The Spleen houses the

intellect (Yi)” Giovanni Maciocia,

Foundations of Chinese Medicine.

The “Yi” is responsible for applied

thinking, studying and generating

ideas. It is interesting to see that

Autistic Children often suffer from

digestive disorders.

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Physiology of the organs involved

�Kidneys - The Kidneys store

essence – control growth and

development – Developmental

issues always involve Kidneys.

The Kidney are also in charge of

the production of marrow that fills

up the brain.

Physiology of the organs involved

�Liver – The Liver Houses the

Hun. The Hun provides for a

sense of direction as well as a

way to sense other peoples

emotions. The Hun and the Shen

work together in the interactions

with other people.

Pathological factors

contributing to Autism

�Phlegm – Is a very common

factor in ASD. Phlegm can be

both the etiological factor as well

as the pathological factor.

Patterns will vary From Phlegm

Damp to Phlegm misting the

mind to Phlegm wind or fire

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Pathological factors

contributing to Autism

�Heat - Heat can cause hyperactivity

and violent behavior particularly

when combined with phlegm

�Pathogenic factors – may influence

the mind especially when they

become lingering, or the infestation of

parasites

Gu Syndrome

� Black alcamy

� Infestation of a pathogenic influence

� Gu pathogens represent a type of toxin (gu du). This makes reference to their virulent epidemic quality, but also to the only recently corroborated fact that the metabolic byproducts of parasitic organisms have a toxic affect on the body.

� Cause a variety of symptoms

Gu Syndrome

� the authoritative 6th century encyclopedia Beiji Qianjin Yaofang (Thousand Ducat Formulas) explains, "Some of them will cause bloody stools, while others initiate the desire to lay in a dark room; others may bring about bouts of irregular emotions, such as depression that alternates with periods of sudden happiness; others again cause the extremities to feel heavy and ache all over; and then there are myriads of other symptoms H"

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Disperse Gu toxins (with diaphoretic

herbs) (san du)

� Zi Su Ye (Follum Perillae Frutescentis),

� Bo He (Herba Men-thae),

� Bai Zhi (Radix Angelicae),

� Lian Qlao (Fructus ForsythiaeSuspensae),

� Gao Ben (Rhizoma et Radix LigusticiSinensis),

� Sheng Ma (Rhizoma Cimicifugae)

� Ju Hua (Flos Chrysantherrit Morifolli).

Kill parasites (sha Chong) and expel

demons (qu gui)

� Da Suan (Bulbul Alli Sativi),

� Yu jin (Tuber Curcumae),

� Shen (Radix Sophorae Flavescentis),

� Huai Hua (Flos Sophorae Japonicae Immaturus),

� She Chuang Zi (Fructus Cnidii Monnieri),

� Jin Yin Hua (Flos Lonicerae Japonicae),

� Qing Hao (Herba Arteinislae Apiaceae),

� Shi Chang Pu (Rhizome Acori Graminei),

� Ding Xiang (Flos Caryophylli),

� He Zi (Fructus Terminaliae Chebulae)

� Bing Lang (Semen Arecae Catechu),

Calm the spirit (by nourishing the qi and

yin of the Lung and Heart) (an Shen)

� Huang Jing (Rhizome Polygonati),

� Bai He (Bulbus Lilii),

� Bei Sha Shen (Radix Glehniae Littoralis),

� Xuan Shen (Radix Scrophulariae

Ningpoensis),

� Sheng Di Huang (Radix Rehmanniae

Glutinosae),

� Xi Yang Shen (Radix Panacis Quinque-folli),

� Fu Shen (Poriae Cocos, Sclerotium)

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Tonify qi and blood (pungent/detoxifying

substances) (bu qixue)

� Dang Gui (Radix Angelicae Sinensis),

� Bai Shao (Radix Pae-oniae Lactiflorae),

� He Shou Wu (Radix Polygoni Multiflori),

� Gan Cao (Radix Glycyrrhizae Uralensis),

� Huang Qi (Radix Astragals)

� Wu Jia Pi (Cortex Acanthopanacis Radicis).

Move qi and blood (with anti parasitic

herbs) (xingqi poju)

� Chuan Xiong (Radix Ligustici Wallichii),

� Chai Hu (Radix Bupleuri),

� E Zhu (Rhizoma Curcumae Zedoariae),

� San Leng (Rhizoma Sparganii),

� Chen Pi (Pericarpium Citri Reticulatae),

� Mu Xiang (Radix Saussureae seu Vladimirae),

� Ze Lan (Herba Lycopi Lucidi)

� San Qi (Radix Notogin-seng).

Common Symptoms

� Sleep disturbances

� Digestive symptoms

� Irregular appetite

� Hypersensitivity to touch, smell and

sound

� Repetitive Behavior

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Treatment Modalities

� Shoni Shin

� Cutaneous Electro Stimulation

� Acupuncture

� Tiger warmer

� Magnets

� Herbs

� Nutrition

Shoni ShinBachi Bari (Plectrum), Heragata Arrow, Choto, Hoki, Choki,

Kakibari Rake, Solid Copper Yoneyama and Matsuba

(Pineapple)

Cutaneous electro stimulation

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Cutaneous electro stimulation

Acupuncture

� With children up to 2 years of age we

use non retention technique. Between 2

to 6 years we try to leave the needle for

a few of minutes, 7-12 retain 4-10

minutes and 12 – 18 between 10 and 20

minutes

� I Use Serin reds (40G) 1 inch needles

but I have commonly seen the use of

thicker gauges.

Common Points Used

� Si Shen Zhen (Four Spirits Needles): A.k.a. Si Shen Cong (M-HN-1), the four points located 1.5 inches in front, behind, and to the left and right of Bai Hui (GV 20)

� Ding Shen Zhen (Stabilizing the Spirit Needles): 5 inches above each of Yin Tang (M-HN-3) and Yang Bai (GB 14)

� Nie San Zhen (Temporal Three Needles): 2 inches perpendicularly above the apex of the ear and 1 inch in front and back of that on the same level; three points in total

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Common Points Used

� Nie Shan San Zhen (Temporal Above

Three Needles): 3

inches perpendicularly above the apex

of the ear and 1 inch in front and back of

that on the same level; three points in

total

Common Points Used

� Nao San Zhen (Brain Three Needles):

Nao Hu (GV 17), both Nao Kong (GB

19)

� Zhi San Zhen (Intelligence Three

Needles): Shen Ting (GV 24), both Ben

Shen (GB 13)

� Xing Shen Zhen (Arousing the Spirit

Needles): Ren Zhong (GV 26), Shao

Shang (LU 11), Yin Bai (Sp 1)

Tiger warmer

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Magnets� Qi flows in the con-nective tissue energetic

pathways from the bionorth (-) pole to the biosouth (+) pole

� The designation of bionorth (-) and biosouth(+) is based on the earth's geographic North and South Poles. The bionorth (-) side of the magnet will point to the geographic South Pole (the Antarctic) and will attract the north-seeking needle of a compass. The biosouth(+) side of the magnet will be repelled by the north-seeking needle of a compass and will point to the geographic North Pole (the Arctic). It should be noted that this is opposite to the definition used by the National Bureau of Standards (NBS).

Magnets

� Simple tonification of one acupoint: place the biosouth pole of the magnet facing downward on the skin, with the bionorthpole of the magnet facing outward. This would direct Universal Qi to flow into the child and therefore tonifies.

� Simple sedation of one acupoint: place the bionorth pole of the magnet on the skin, with the biosouth pole facing outward. This directs Qi flow away from the body and is therefore dispersing or sedating.

Basic Autism FormulasBasic Autism FormulasBasic Autism FormulasBasic Autism Formulas

Deficiency pattern

• Shi Chang Pu (Rhizoma AcoriGraminei)

• Yuan Zhi (Radix PolygalaeTenuifoliae)

• Tian Zhu Huang (Concretio SiliceaBambusae)

• Qian Shi (Semen Euryales Ferox)

• Long Chi (Dens Draconis)

• Bai Zhu (Rhizoma AtractylodisMacrocephalae)

• Tian Nan Xing (Rhizoma Arisaematis)

• Bei Xie (Rhizoma Dioscoreae)

• Bai Zi Ren (Semen Biotae Orientalis)

• Xi Yang Shen (Radix PanacisQuinquefolii)

• Chuan Xiong (Radix LigusticiWallichii)

Excess pattern

• Shi Chang Pu (Rhizoma AcoriGraminei)

• Yuan Zhi (Radix PolygalaeTenuifoliae)

• Tian Zhu Huang (Concretio SiliceaBambusae)

• Qian Shi (Semen Euryales Ferox)

• Long Chi (Dens Draconis)

• Huang Lian (Rhizoma Coptidis)

• Rou Gui (Cortex Cinnamomi Cassias)

• Suan Zao Ren (Semen ZiziphiSpinosae)

• Hu Po (Succinum)

• Dan Zhu Ye (Herba LopthatheriGracili)

• Yu Jin (Tuber Curcumae)

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Autism TreatmentAutism TreatmentAutism TreatmentAutism Treatment

Main PointsMain PointsMain PointsMain Points

HtHtHtHt9999, Ht, Ht, Ht, Ht8888, Ht, Ht, Ht, Ht7777, Ht, Ht, Ht, Ht3333

UBUBUBUB15151515, UB, UB, UB, UB44444444, Du, Du, Du, Du16161616, GB, GB, GB, GB20202020, Du, Du, Du, Du20202020, Du, Du, Du, Du26262626

Eight extra channels, Neck PointsEight extra channels, Neck PointsEight extra channels, Neck PointsEight extra channels, Neck Points

For Sp type For Sp type For Sp type For Sp type use:use:use:use:

Sp3, Sp10

St36

Liver Liver Liver Liver QiQiQiQiConstraintConstraintConstraintConstraint

use:use:use:use:

LivLivLivLiv2222, Liv, Liv, Liv, Liv14141414

UBUBUBUB18181818

Kidney Vacuity Kidney Vacuity Kidney Vacuity Kidney Vacuity –Kid3

UB23

PhlegmPhlegmPhlegmPhlegm

Ht 5, St 40

A 3 year old with PDDNOS

S/S

� Developmental delays with speech

� Hyperactive

� Frequent ear infection and fluid accumulation behind the eardrum

� Urine reflux

� Bowls tend to be soft but on multiple suplements

� Finger vien very dark and reaching the qi gate

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Treatment

� Shoni Shin

� TW5, GB41

� SP9

� GB20

� Formula: Xiao Chai Hu Tang based

B 7 year old ASD, ADD,SID

S/S:

� Developmental delays in speech, gross and fine motor skills, social interaction;

� Inability to follow directions; � Inability to remain focused and behave appropriately in a classroom setting.

� Repetitive self-stimulative behaviors.� Narrow Range of Interests,� Very narrow range of diet� Eye contact is very difficult.� Sensory Input can be too much, or not enough.� Low muscle tone.� Echolalia