Case Study of an Adult With Autistic Spectrum Disorder

Introduction

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts and restricted, repetitive patterns of behavior, interests, or activities.1
The causes of ASD are currently unknown.1 Current research suggests that ASD is genetic as is observed with twins, in 9 out of 10 sets of twins if one is observed to be ASD the other is as well. Currently diagnosis is based on clinical observations using a set of criteria established in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.2
There is very limited research on adults with ASD as it is a condition that is recommended to be diagnosed and treated early in life. The NIH has information on how care for adults with ASD and it is only recommended that they live on their own if they have gone through proper adaptive rehabilitation in order to deal with their own finances and interface with persons of law enforcement.1 Previous case studies have shown improvement in the behavior and associated symptoms of children with ASD through reduction of vertebral subluxations, however no information was found on chiropractic in adults with ASD.3-6

Case Report

History
The patient was a thirty-one year old female who had originally sought chiropractic care for headaches 3 years prior to receiving care in this office. Before chiropractic care she would experience cervicogenic headaches on a daily basis. She said she knows it is time to be checked by the chiropractor when she gets a headache which, at the time of starting in this office had been reduced to less than once a month with an HDI of 26%.

When she was in the second grade she was brought to a neurologist who determined through brain scans that she had Asperger’s which has since been redefined as Autistic Spectrum Disorder. Several different medications were given during high school and they were not good because they made her feel several emotions at the same time. She described her condition as a brain fog that prevents her from having the ability to concentrate. Phone consultation with previous chiropractor confirmed that patient would experience a noticeable difference in personality from pre to post adjustment.

Chiropractic Examination
An initial examination included cervical x-rays, thermographic scanning, prone leg check, supine leg check, static palpation and muscle palpation in order to specifically locate and analyze this patient’s subluxation pattern. Upper Cervical X-Rays included: lateral cervical, nasium and vertex views.

A thermal scan was obtained from the posterior cervical region of the patient with a Tytron C-3000. The Tytron contains infrared probes that glide paraspinally from the 1 st thoracic vertebra to the base of the occiput. The autonomic nervous system controls cutaneous body temperature via the arteriole system and is activated by centers located in the spinal cord, brain stem, and hypothalamus.7 The infrared technology of the Tytron detects skin temperature superficially to measure the integrity of the nervous system. Uematsu8 states that these heat differentials can be used to determine if dysfunction of the autonomic nervous system is present. A study has shown that aberrant thermal temperature can decrease one’s physical health perception, as seen on an SF-12.9 In this case a pattern analysis was established in order to determine when the patient was showing a stress reading of similar qualities indicating that there was compromise to the integrity of the nervous system thus indicating upper cervical subluxation.

Based on Grostic’s Dentate Ligament – Cord Distortion theory, a misalignment of the upper cervical vertebrae via the dentate ligament results in spinal cord tension and irritation, thus affecting the muscles of the pelvic girdle and lower extremities, prompting contracture of the muscles and causing the appearance of a short leg.10 The measurement of supine leg length differentials is considered to be of high inter- and intraexaminer reliability.

Chiropractic Intervention
The x-ray views previously mentioned were analyzed using the Grostic protocal in order to obtain a specific misalignment for this patient’s upper cervical subluxation complex. L(R1 A3)I1.5/M was the listing obtained from the films. L indicates that the headpiece should be set 1 inch lowered from neutral. This headpiece placement in combination with an inferior torque component in the adjustment were used in order to correct the lower cervical angle of 1.5. Information inside the brackets indicates that the adjustment is to be given using a specific line of drive vector where the chiroprator’s pisiform contacts the atlas transverse process and directs their episternal notch to 1 inch above and 3 inches anterior to their contact point. The M gives an indication that the upper angle (head tilt) and lower angle (lower cervicals) are ipsilateral and there is no need to angle the headpiece to accommodate for a kink of angles.

On the first visit thermographic pattern was established having 3 scans, taken 15-20 minutes apart, with similar deviation patterns. Prone leg check revealed the right leg to be 1/2” short, supine leg check revealed the right leg to be 1/4” short, static and muscle palpatory findings revealed a scoliosis of unmeasured degree in the mid thoracic region and subluxations of sacrum apex posterior as well as atlas with right laterality and anteriority.

Patient presented on the first visit with a headache and cognitive “fogginess”. having made a move from Georgia to South Carolina over the past month she had been very stressed and had not seen a chiropractor for 2 months. She had been under chiropractic care for 3 years prior to her first visit and reported having improved cognitive function under care. Phone consultation with previous chiropractor confirmed that when the patient was in a subluxated state she would be noticeably distant, less responsive and report that she was having “brain fog”, post adjustment there was noticeable alertness.

As this patient came to the office having already established a pattern and plan of care with a previous practitioner the new plan of care based on history and current findings started with once every 2 weeks. Over the course of 10 months the patient was seen 20 times. The same analysis protocol was applied on each visit as was described for the first visit. She received a specific C1 adjustment using the Grostic protocol on visits when her thermographic pattern was present and supine leg check revealed the right leg to be 1/4” or greater short. C1 was adjusted on a total of 10 visits. Due to the patient’s scoliosis and the limitations of matter, Thompson protocol was used when the prone leg check indicated that sacrum ought to be addressed. Sacrum was found to be apex posterior and adjusted on 12 visits.

Outcomes
Patient reported fogginess on the majority of visits where she was found to have a C1 subluxation. On these visits the practitioner also noted patient had difficulty focusingon one topic and reduced reaction time to instructions even though the same procedural steps were used on every visit. After adjustment to the C1 vertebra the patient had noticeable change in alertness and subjectively reported improved cognitive function. The patient only reported having a headache on the first visit. Her HDI did not reduce significantly as it started at 26% and reduced to 22% however, it is believed that her headaches did not return because she was consistent with her plan of care.

Discussion
In their review, Schroeder et al.12 examined three possible models based on the core characteristics of ASD, which revealed a link to joint complex dysfunctions altering circuitry, thus aberrantly affecting the structure and function of the cerebellum and the frontal lobe.6 Hoffmann and Russell describe the impact that a subluxation has on the cerebrum and cerebellum by suggesting that as a result of “altered biomechanics of thespine, a subluxation can lead to an imbalance in sensory input into both the cerebrum and the cerebellum.”6 They further stated that “this sensory dysafferentation then leads to alteration in the central state of the neuronal cells involved with initiating the response to the environmental stimuli.”

Conclusion
This case study explores the possible link between the objective reduction of a vertebral subluxation and the subjective improvement in the behavioral patterns and cognitive function of an adult diagnosed with Autistic Spectrum Disorder. There has been similar cases reported in children, however there continues to be a limited amount of evidence supporting the efficacy of chiropractic care for either children or adults with ASD. Further research is warranted in both.

References
1) National Institute of Mental Health. Autism Spectrum Disorders. http://www.nimh.nih.gov/health/topics/autism-spect…
2) American Psychiatric Association (APA). Diagnostic and statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association, Washington, DC, 2013.
3) Cohn A. Improvement in Autism Spectrum Disorder Following Vertebral Subluxation Reduction: A Case Study. J. Pediatric, Maternal & Family Health, 2011; 87-91
4) Cleave J, Alcantara J, Holt K. Improvement in Autistic Behaviors Following Chiropractic Care: A Case Series. Pediatric, Maternal & Family Health, 2011; 125-131
5) Noriega A, Chung J, Brown J. Improvement in a 6 year-old Child with Autistic Spectrum Disorder and Nocturnal Enuresis under Upper Cervical Chiropractic Care. J. Upper Cervical Chiropractic Research, 2012; 1-8 6) Hoffmann N, Russell D. Improvement in a 3 ½ -year-old autistic child following chiropractic intervention to reduce a vertebral subluxation. J Vert Sublux Res. 2008 Mar 24:1-4.
7) Guyton AC, Hall JE. Textbook of Medical Physiology. 10 th ed. Pennsylvania: W.B. Saunders Company; 2000. 8) Uematsu S, Edwin DH, Jankel WR, et. al. Quantification of Thermal Asymmetry, Part 1: Normal Values and Reproducibility. J Neurosurg, 1988;69(4):552-555.
9) Hart J, Omolo B, Boone WR. Thermal patterns and health perceptions. J Can Chiropr Assoc. 2007;51(2):106-111.
10) Grostic JD. Dentate Ligament –Cord Distortion Hypothesis. Chiropr Res J. 1988; 1(1):47-55.
11) Hinson R, Brown S. Supine leg length differential estimation: an inter- and intra-examiner reliability study. Chiropr Res J, 1998; 6(1):17-22. 12) Schroeder JH, Derocher M, Bebko JM, Cappadocia MC. The neurobiology of autism: theoretical applications. Research in Autism Spectrum Disorders 4. (2010) 555-564.

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