According to Liz Wasserman, True Goods Founder & CEO, "Parents can now benefit from Dr. Debby's guidance by reading this thorough and informative book – ideally before they start trying for a baby. Finally, there’s hope and help for families who want to make prevention an integral step in their fight against autism and ADHD!” To purchase a copy of Dr. Debby’s new book, click here.

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Dr. Debby Hamilton, MD, MSPH is a pediatrician, physician nutrition specialist, and certified in alternative and holistic medicine. She also serves as medical advisor for True Goods and recently published the book “Preventing Autism & ADHD,” which focuses on risk factors for children before conception, during pregnancy, as well as post birth and the preventative measures parents can take to protect their children. The following passage introduces her hypotheses, which can lead to healthier lives for families as well as potentially protect future children from Autism and ADHD:

The Triangle of Prevention

Clues for prevention of Autism and ADHD strategies came from how I treat hundreds of children with autism and ADHD. I realized that I focused primarily on three areas: (1) healthy diet/nutrition, (2) strong digestion, and (3) detoxification.

If these three areas are the cornerstones of successful treatment, then they must be important in prevention. If I could explain to parents why we need to treat each of these areas when their child has autism, then I could explain to potential parents, pregnant women, and mothers of young children why we need to address each of these areas to prevent autism.

In order to simplify the understanding of the prevention program, I developed the Triangle of Prevention and it focuses on these three areas. Each area is important individually, but also in relation to each other.

1. Healthy diet/nutrition (essential nutrition, critical supplementation, and harmful food avoidance) 
2. Strong digestion (probiotics, absorption, and elimination) 
3. Detoxification (avoiding/removing toxins and improving the body’s detoxification system)

Hypothesis

I reviewed the published medical studies for one risk factor for each of these three areas. If my clinical autism treatment approach, which reduces the symptoms of autism, aligns closely with these risk factor studies, then there is strong justification that helping mothers to address the modifiable risk factors will prevent many cases of autism.

Autism Prevention Hypothesis

1. Children with autism present with a variety of negative symptoms. We have effective treatments for these symptoms.
2. We know that there are dozens of risk factors for autism, many of them modifiable. 
3. By reducing risk factors starting before pregnancy, we can prevent symptoms of autism from occurring in new children and we will reduce the incidence of autism.

To test this hypothesis, I examined evidenced-based research studies to see if there was scientific support for the Triangle of Prevention. I examined one risk factor in each of the three areas: nutrition, digestion, and detoxification.

Hypothesis Test for Nutrition – Risk Factor: Omega-3 Fatty Acids

Most people know omega-3 fatty acids such as fish oil or cod liver oil. When I began practicing integrative medicine and later working on this prevention book, my father responded to me, “You mean we are back to cod liver oil?” Yes, we are! Most people now know about the many health benefits of taking cod liver oil or omega-3 fats. Many obstetricians recommend pregnant woman take omega-3 fatty acid supplements.

My hypothesis test for nutrition begins with the concept that if something important is missing before and/or during pregnancy, it will have a negative effect on the future development of the child. For this example, studies show that an insufficient amount of omega-3 fatty acids consumed during pregnancy leads to infant developmental delays in social behavior, speech, and cognition.

Scientific studies lend strong support for the hypothesis that adequate levels of omega-3 fatty acids in mothers and babies will lead to children with better neurologic development and decreased autistic symptoms. These studies show that children with autism, who have delays in social behavior, speech, and cognition, also have fatty acid deficiencies. However, symptoms of autism decrease following omega-3 supplementation. 

New research supports the hypothesis. A 2013 study found that women supplemented with omega-3 fatty acids during and after pregnancy had more normal size babies at birth and was associated with better growth during infancy. A 2012 study found that maternal omega-3 supplementation was associated with better cognitive skills in young children. Therefore, it makes sense that if women and new babies get adequate levels of omega-3 fatty acids, their risk for autism will be reduced. 

Hypothesis Test for Digestion – Risk Factor: Probiotic Bacteria

Probiotics are the “good bacteria” in our intestines and are essential to our digestive health. Probiotics are important not only for digestive function but also for the immune system. In fact, approximately 70% of our immune system is in the intestine. These good bacteria also happen to exist in the genital tract of women. 

Infants primarily get probiotics from the mother during a vaginal birth as the baby ingests probiotics by passing through the birth canal. Infants may also receive probiotics from breastfeeding. A cesarean or C-section birth does not allow infants to obtain probiotics from the mother, and bottle-feeding does not provide probiotics. If the mother does not have an adequate supply of probiotics, then she cannot pass them onto her infant, even during a vaginal delivery and nursing.  

Why would a mother not have an adequate level of probiotics? Antibiotic use (often overuse) is the most common reason probiotics are destroyed. Antibiotics are readily given for infections, and they are also added to our food supply and vaccines. It is no wonder that many women have low levels of these important probiotics. Antibiotic use in infants can also lead to destruction of good bacteria. 

Inadequate probiotics in babies leads to many digestive symptoms such as colic, gastroesophageal reflux, food allergies, and feeding issues. Many of these symptoms are more commonly seen after C-section births. Interestingly, more children with autism and ADHD are born by C-section than children without these disorders. 

Although almost all children have occasional digestive problems, a higher proportion of children with autism (in fact, 70%) suffer from these issues. Digestive problems often involve food allergies/sensitivities and infections in the intestines, which can affect behavior. "Gut and Psychology Syndrome," a book by Dr. Natasha Campbell-McBride, illustrates the interrelationship between the brain, behavior, and the digestive system. One cornerstone to treating children with autism is to address their digestive disorders. 

The hypothesis test for digestion shows that supplementing probiotics in mothers-to-be leads to less digestive problems in infants, which subsequently leads to less behavioral issues frequently seen in children with autism. Treating digestion problems of children with autism reduces behavioral problems. Therefore, it makes sense that ensuring mothers and babies have adequate probiotic bacteria will reduce their chances for digestive problems – a common symptom of children with autism. 

Hypothesis Test for Toxins – Risk Factor: Mercury & Lead

The diet and digestion examples described earlier are concerned about the lack of something critical. However, this hypothesis test for toxins is concerned about the addition of something harmful. Research shows that if mothers are exposed to mercury and/or lead when they are pregnant, their infants show specific developmental delays.

These delays include problems with attention, which is seen in most children with autism and all children with ADHD. Other delays include those of language and the sensory processing system such as vision and hearing. Both mercury and lead are potent neurotoxins. In plain terms, they poison the nervous system, and a developing nervous system is particularly vulnerable to harm.

Many children with autism have elevated levels of heavy metals. They also exhibit symptoms consistent with neurologic problems that are seen with mercury and lead exposure. During treatment, as mercury and lead are slowly removed, these children get better, and their language and cognition improve.

Therefore, preventing exposure to these metals (as much as possible) will lower the levels of these toxins in children and subsequently result in less neurologic and developmental issues including autism. Toxin testing, measurement, and removal are complex. In my opinion we need to focus a lot of new research in this area – for our children and our future children.

These hypotheses show that we can reduce the incidence of autism through modification of risk factors. While these hypothesis diagrams only show three risk factors, the remaining chapters of the book will show dozens of risk factors that also can be modified to prevent autism and ADHD. 

Challenges of Researching a Prevention Program

In an ideal world, we would be able to confirm a prevention program by doing clinical studies. The type of study that is considered the gold standard is the randomized double blind placebo controlled trial. That string of words means that we take two groups of people to study, for example, two groups of women who are pregnant. Then we randomly assign one group of women to receive one treatment and the other to receive no treatment.

As an example, we could give one group omega-3 fatty acids from fish oil and the other group will receive no fish oil. We don’t want one group to know they are receiving the good oils and the other are not receiving any so we would need to give a fish flavored oil to the group not receiving the fish oil.

Then we follow the pregnant women through the end of their pregnancies and then follow the health of their children. At two years old, we would then see how many of these children had autism if their mothers received fish oil versus those whose mothers did not receive fish oil. If the fish oil helped prevent autism, there should be fewer children with autism from the mothers who took fish oil during pregnancy.

Now here is the serious ethical problem from doing a randomized double blind placebo controlled trial for prevention: we already know that fish oil is helpful for brain development, so we cannot do a study where we prevent a woman from taking something that we know is beneficial. 

Alternatively, suppose we want to do a study on the negative effects of mercury on the development of a child. In order to perform the gold standard in research we would have to give some pregnant women mercury and others would have to avoid it. It would be unethical to give pregnant women mercury, not to mention no pregnant woman would volunteer to take a known neurotoxin! 

To confirm or deny the entire prevention program, we would do these studies for each of the known risk factors. However, each study would have serious ethical issues because we cannot keep from women approaches that we know would help baby’s health or give them substances that we know will harm baby’s health.