2 Core Symptoms that define Autism Spectrum Disorder
What are the core symptoms that define autism spectrum disorder?
Autism spectrum disorder is often referred to as a ‘social disorder.’ Generally, this means that people diagnosed with autism cannot develop social interaction skills suitable for their age. However, this is simply an outcome of their symptoms. There are many disorders other than autism that impact sociality. There are various causes ranging from intellectual impairment to auditory and visual impairment, and psychological disorders such as depression. To be able to understand what autism spectrum disorder really is, necessary to have a clear understanding of what the root cause is that results in an inability to develop social interactions.
Along with reduced sociality, stereotyped behavior and sensory seeking behavior are often considered key identifiers of autism. However, it should be noted that stereotyped and sensory seeking behaviors are not the fundamental causes of autism. In cases of mild and borderline autism spectrum disorder, stereotyped and sensory seeking behaviors are often absent. Conversely, intermittent abnormalities in behavior may be observable in children who have fully recovered from autism, this is attributable to improved sensory seeking patterns. Therefore, neither stereotyped nor sensory seeking behaviors can equate to an autism spectrum disorder.
To understand the fundamental symptoms of autism spectrum disorder, one should pay close attention to how autism progresses. Autism is by no means a congenital disease. The child is born without autism and progresses into it over the course of infancy. Observing the reductive process of children with autism, who at first develop normally up till 12 months of age and then gradually regress will give you a clear understanding of the cause of autism.
A common observation during the normal development period is eye contact becoming weaker and the child becoming increasingly less interested in people. The child’s response to calling weakens, and the child does not respond to what others say and show photic reactions to certain sounds. This displays the gradual progression of visual and auditory sensory processing disorders. In addition, abnormalities in the vestibular sensation begin to appear, for example, standing on tiptoes or spinning around. Also observable is abnormal tactile responses such as seeking or refusing to touch specific objects. In other words, the child experiences abnormalities in the overall sensory processing, and the ability to interact with people declines. If the sensory disorder is associated with only one or two sensations, abnormality in the neural network connected to the sensory organs should be suspected. However, one should presume that problems in the overall sensory processing is caused by abnormalities in the brain stem, which processes sensory signals and transmits them to the cerebrum.
Sensory disorders are accompanied by abnormalities in the overall autonomic nervous system. The most common observation in degenerative children is sleep disturbance. Sleep disturbance is one of the peculiar symptoms of autism, and this begins to appear simultaneously with the degeneration. Also, digestive disorders occur. This causes abnormal vomiting, diarrhea, or constipation. In some cases, severe bad breath or fecal odor may be observed. In addition, the child often exhibits extreme temper, anxiety, or fear. As a result, they often lose interest in interacting with people and avoid people in fear. The manifestation of comprehensive autonomic nervous system abnormalities is indicative of the collapse of the regulatory function of the infant’s autonomic nervous system, which is thought to originate from anomalies in or around the hypothalamus adjacent to the brain stem.
The autism spectrum is not just a social disorder. It means the deterioration of social interaction abilities caused by sensory processing disorder and autonomic nervous regulation disorder. Symptoms of autism vary by the degree of damages caused by infections in the brain stem and hypothalamus. Accurate diagnosis of autism spectrum disorder requires an understanding of this pattern. Also, increases in speech or improvement of instruction execution in the course of treatment do not mean that autism is being treated. The neurological treatment of autism involves improvements in sensory and autonomic nervous system disorders, hence development in social interactions. Therefore, one should understand the patterns of these two types of disorders to identify how autism improves. Now, let’s delve into the multifaceted manifestation of the sensory processing disorders and autonomic nerve regulation disorder.
Sensory processing disorder – input disorder, output disorder, and immersion disorder
I have claimed for a significant amount of time that autism is caused by sensory processing disorders in the brain stem. For more details, please refer to my book You Can Overcome Autism published in 2017. Susanne Schmid, Associate Professor at the University of Western Ontario, made the same argument in an article published a few years ago. Schmid, too, found sensory processing disorders as the key symptom of autism and presented a hypothesis that such disorders would be caused by damages in the brain stem. The Dr. Tomato protocol is completely in accord with this.
The brain stem consists of the sensory and motor areas and is responsible for transmitting the sensory signals from the sensory organs to the cerebral cortex. In particular, while passing through the reticular body, the sensory signals are not transmitted mechanically. Some are over-amplified, others are weakened, causing disturbance in the cerebral cortex. As a result, the visual, auditory, tactile, and vestibular senses experience total confusion, resulting in errors in sensory processing, hence failing to properly detect signs of communications from people. Driven by this propensity, autism causes communication failure and isolation. I divide these sensory processing disorders into three types.
a. Input disorder
The human sensory organs are nothing more than organs that mechanically perceive reality. The eyes are a camera, and the ears are a sound wave sensor. The skin perceives tactile, pressure, and temperature sensation. These sensory organs do not sense selectively. They equally sense all the senses that respond to the sensory organs. This can be compared to a photograph of scenery. The camera captures all information equally.
However, these signals go through sensory amplification and attenuation in the brain stem for survival. In other words, humans process such information by maximizing information necessary for their survival and attenuate information that is not. This is a system developed by the long evolution process for sociality. Through this process, humans completed a system that prioritizes the perception of sensory signals generated by other people and puts information on objects aside. In other words, the camera now focuses on humans and blurs other information as background information. Through this process, we humans run a human-centered sensory processing system that focuses on seeing and hearing people in any environments.
However, children with autism spectrum disorder have impairment in this process. They do not blur background and perceive reality as-is like a camera. Thus, humans are not prioritized and treated the same as any other objects. That is why they do not focus on people. As the error in visual processing worsens, they gradually become incapable of making eye contact. This is not limited to vision only. The same goes for auditory processing. Likewise, they over-react to all sensations, whether it be tactile sensation or any others and in some cases they refuse human touches. Now their sensory disorder has reached the level where they refuse to interact with humans. This is how autism progresses.
I call this process the input disorder. They are unable to focus on looking at people and catch the presence of objects first, rather than humans. For us it is normal to hear human sounds first, but in their ears the sounds of objects and machines are amplified. They do not feel the warmth of people but over-sense the texture of clothes. Now they have degenerated to a state not to be able to sense people, hence have become autistic. You should thoroughly understand this process. After all, becoming free from the symptoms of autism is a process to overcome such disorders and recover the normal sensory system.
b. Output disorder
Damages in the brain stem not only cause the input disorder. They also cause sensory output disorders. To execute orders made by the cerebral cortex, the terminal sensory organs in the human body should recognize the order and express it as actions.
No human movement is expressed by a single organ. A number of organs must work together to produce the desired motion. Let’s take an example, walking is a very complex process. To stand up, balance must be maintained, meaning the stabilization of the vestibular sense and in order to maintain continuous equilibrium, lateral balance must be maintained in any movements. In this process, the left and right feet must perform specific movements while maintaining the same level of muscular strength to overcome gravity. After all, the muscles in the lower body must maintain equilibrium and at the same time make motor changes in the muscles to execute the order to move forward. This complex movement is commanded by the cerebral cortex, and the brain stem takes charge of orchestrating the order by delivering motor sensations.
Damages to the brain stem interfere with the output process of this harmonious motor function, hence difficulties in maintaining lateral balance while walking. They cannot move their arms accordingly when moving their legs, and as a result they keep falling because they cannot produce rhythmical motor outputs even though they have muscular strength in the lower body. For this reason, autistic children walk slower than others. A neurotypical baby would start walking at 12 months, but in many cases children can start walking at 14 months of age, or if very late, around 18 months.
The process of making sounds such as “Mom” or “Dad” is more difficult. It requires good control of breathing in and out of the lungs and regulating abdominal tension to blow the air out instantly. At that time, the lips should be in an appropriate shape, and the tongue should move accordingly to make the sound “Mom” or “Dad.” This process is very challenging and explains delays in language development in children with autism. In severe cases, they can make odd noises as they stick to non-verbal autism.
Even if they overcome language development delays and possess a high IQ, many autistic children are ‘bad dancers.’ They find it difficult to execute complex dance moves and other complex actions such as using chopsticks, blowing out candles, or blowing their nose. All these abnormalities are caused by sensory output disorders attributable to damages in the brain stem.
Correcting their awkward movements with sensory integration is not the worst approach However, doing so is similar to training them for racing cars with a broken car. What really matters is eliminating the output disorder itself. If successful, the child will start speaking, using both feet to jump, and moving faster. The sensory output disorder is another key factor to understand autism spectrum disorder.
c. Immersion disorder
If the sensory processing disorders involve ‘input’ and ‘output’ disorders only, the child will only face very mild autism spectrum disorder, or Asperger syndrome limited to input and output disorders if using the previous diagnostic standard. The sensory input and output disorders are caused by damages in the brain stem. However, the degeneration process that causes autistic disorders does not remain in the brain stem only. It spreads and affects other areas in the brain that are responsible for higher functions. When the damages are spread to the cerebral cortex, it causes the immersion disorder and severe autism disorders are fixated.
The immersion disorder is self-discharging resulting from damages in the cerebral cortex, i.e., revisiting the past by internal electrical stimuli without any external stimulation. If the immersion disorder worsens, the child is completely isolated from external sensory stimulation and fully immersed into self-stimulating signals from the cerebellum, hence autism, or complete isolation from reality.
Autistic children with immersion disorder have no temporal and spatial concepts. For example, they may be in the present moment, but the cerebral cortex stimulates them to recall a sad thing that happened one year ago, and a funny thing that happened one month ago all at the same time. They may face the present in the sadness they felt a year ago, or in the joy they had a month ago. Laughing out of the blue and getting mad at people around them for no reason are often attributable to the immersion disorder.
Now they do not respond to calling at all and their response to external stimuli weakens. This is what parents often describe as “blank and drowsy.” The child does not respond to light sensory stimulation from the outside. They may be brought back to this side of the world with very strong stimulation, for example pressing them hard while calling, or calling their name in very high, sharp tone.
The immersion disorder is observed in most autistic children with significant delays in language development. What is difficult about the immersion disorder is that it accompanies intellectual impairment. The brain repeats self-discharging, which is thought to cause the contraction and damages to nerve tissue. The worse the immersion disorder is, children are less responsive to treatment and often show intellectual impairment after treatment. The immersion disorder is more severe in its effects compared to a sensory processing disorder. It causes irrevocable damages in the brain tissues. To treat autism in children with the immersion disorder, it is important to urgently stop this degeneration process. I believe putting children with a severe immersion disorder in training and education and expecting them to improve is no different from teaching children suffering in a fire pit about social skills.
Autonomic nervous dysregulation – Anxiety disorder, phobic disorder, indigestion, unstable sleep, arousal control disorder
It is a well-known fact that sleep disorders, indigestion, anxiety disorders, and phobic disorders are commonly observed in children with autism. However, they are considered symptoms additional to the autistic disorders and not major causes of social disorders. Only symptomatic therapies are applied thereto, for example using melatonin for sleep disorders, enemas for constipation, or prescribing aripiprazole or methylphenidate for severe arousal disorders. However, this is the wrong approach.
These symptoms are caused by errors in regulation by the autonomic nervous system. In other words, damages to the hypothalamus effect the regulation function of the autonomic nervous system. Therefore, it is evident that a symptom-focused approach can never work. For fundamental treatment, the overall control function of the autonomic nervous system should be restored. This is possible only when the inflammatory response in and around the brain stem and hypothalamus is stabilized.
For the betterment of severe autism, the first thing to focus on should be to make improvements of sensory processing disorders. To understand the various signals that people make, they should have normal sensory processing. After all, the autonomic nervous system should be stabilized in order to achieve the complete resolution of the autistic disorders and complete recovery. In severe autism, the sensory processing disorders are highlighted as a prominent issue, but in mild Asperger syndrome, the autonomic nerve disorder is relatively more prominent than the sensory disorders.
To build a social life, one should overcome anxiety and fear to actively engage with people. Consistent execution in daily life is possible only when the arousal disorder is stabilized. Preventing the collapse of the intestinal bacterial flora requires the improvement of indigestion. And the sleep disorder should be addressed to allow the brain to maintain the self-recovery mechanism.
Since the improvement of sensory processing disorders is the beginning of autism treatment, the recovery of the autonomic nervous system corresponds to the completion of the treatment. When I treat autistic children, I do not consider rapid improvement in social skills as the end of the treatment. In many cases, they would relapse and re-degenerate after stopping the treatment. What gives me confidence about treatment is the full recovery of the autonomic nervous system. The recovery of the autonomic nervous system is an important milestone in autism treatment. The following are brief overviews of individual symptoms of autonomic nervous system abnormalities:
a. Anxiety and phobic disorders
It is widely known that people with autistic disorders are more sensitive to fear than others. MRI studies have confirmed that people with autism have a bigger amygdaloid body, an area in the brain that responds to the feeling of fear. This means that they are more sensitive and respond more frequently to fear.
The hypertrophy of the amygdaloid body in people with autism is by no means congenital. They once went through normal development but the fear-anxiety reaction steps in during the degeneration process where the regulatory function of the autonomic nervous system fails. The increased sensitivity to fear in turn results in the further hypertrophy of the amygdaloid body, hence creating a vicious cycle. If autism is found and treated early, this fear and anxiety disappears in most cases. However, if treating at older ages, it is difficult to completely remove fear and anxiety, presumably because it is unviable to completely erase the memory in the hypertrophied amygdaloid body. However, I think that this issue can be resolved if the autonomic nervous system is kept in a stable condition.
The feelings of anxiety and fear decrease quickly with treatment, but the auditory fear reaction appears to persist longer. Even in cases where treatment works, many children can be afraid of loud sounds, which in turn interferes with their social life. The feelings of fear and anxiety are also triggered when another person raises their tone during conversation, and they may take it as anger at or aggression against them, hence produce overly protective reactions. In particular, people with Asperger syndrome often find it challenging to try new things in fear. As such, anxiety and phobic disorders stop them from returning to a normal social life.
Overcoming autism means more than recovering social skills. When a child has completely overcome anxiety and photic disorders, he/she will look mischievous, or act like a troublemaker. What I always emphasize is that simply restoring social skills is never enough. Complete recovery means that the child shows positivity in social activities, which is confirmed by him/her being mischievous and naughty.
It is also well known that children with autistic disorders often have digestive disorders. This may be accompanied by repeated bellyache, diarrhea, and constipation. Many parents would think their kids were okay judging from these seeming symptoms. But that is wrong.
There are a variety of digestive symptoms. The most common are stodgy feelings, drowsiness or lethargy after meals. Young children cannot explain such discomfort, and parents cannot notice the symptoms they do not complaint about. Overgrowth of harmful intestinal bacteria and candidiasis are also considered symptoms of digestive disorders. It is rare that bacteria or candida overgrow in the normal digestive system with abundant digestive enzymes and good gastric acid secretion. It is very difficult for parents to notice this.
The restoration of the digestive system is very important. Dr. Tomato first finds the root cause of the abnormal proliferation of intestinal bacteria, i.e., dysbiosis, from the reduction of digestive functions. The full recovery of digestive functions is a prerequisite to the restoration of the intestinal microbiome. It is very difficult to determine whether the digestive functions have been fully normalized. This can be confirmed by the following four observations, along with the elimination of abnormal symptoms such as bellyache, diarrhea, and constipation.
First, bowel movements must stable. Normally, loosening the bowels once every two or three days would not be a problem. However, defecation delays are a major problem in autism. Because the longer the over-proliferated intestinal bacteria stay in the intestines, the more severe the inflammation becomes. In the Dr. Tomato protocol, discharging slightly soft stool once a day is considered stable.
Second, it is important to address excessive weight gain or loss. Excessive weight loss is primarily caused by gastrointestinal malabsorption, which is attributable to SIBO , where intestinal bacteria occupy the small intestine and interfere with absorption. In this case, weight gain is often observed during treatment despite the strict diet regimen. If the child is unusually overweight for his/her age, it is most likely associated with poor blood sugar control. In this case, stabilizing the blood sugar control will resolve the excess weight.
Third, this can be confirmed by the IGg analysis. If the digestive function is seriously compromised, it may lead to leaky gut syndrome, hence inflammation caused by over-sensitivity to various food ingredients. The repetition of this process results in chronic damages to the intestinal walls. It should be confirmed by the IGg analysis that the over-sensitivity to food ingredients the child consumes routinely has been stabilized.
Fourth, it should be confirmed by the urine organic acid analysis that the intestinal bacterial flora has been stabilized. Also, the carbohydrate and fat metabolism process should be stable. The organic acid test results do not determine the success or failure of autism treatment. Still, I find it a useful way to check if the child’s metabolism is kept stable.
c. Sleep disorders
Most children with autism suffer from chronic sleep disorders. It takes a long time to fall asleep when they go to bed. In the bed, they do not sleep through the night and wake up frequently. Once awake, they may end up staying awake all night. When the symptoms worsen, they may have their days and nights mixed up. Stable sleep means two conditions satisfied. First, the child should get to sleep with ease. Second, the child should sleep through without waking up in the middle of the night.
A child’s brain develops through sleep. Chronic sleep disturbance means that the brain is not growing. In addition, the brain removes inflammatory substances and restores damaged brain tissues during sleep. Unstable sleep implies the aggravation of inflammation in the brain, which causes autistic disorders. Therefore, sleep disorder is not simply about whether the child can sleep well or not. It is a matter of the growth, healing, and recovery of brain tissues.
Using nutritional supplements with sleep-inducing effects, for example melatonin or tryptophan, may have sleep-stabilizing effects in children with autism. However, sleep disorder will relapse if stopping the use of these supplements. It is not a fundamental treatment. It only addresses the symptoms but does not address the root cause, which is the instability of the autonomic nervous system. Treating them with the Dr. Tomato protocol not only addresses sleep disorder but is also effective for anxiety, photic disorder, indigestion, and arousal disorder, hence an overall treatment.
d. Arousal disorder
Another major problem in autism spectrum disorders is arousal disorder. During the day, the child may look drowsy and does not maintain attention. If more severe, they show a tendency to sit idly, look blank, and keep lying down. Due to this, at night, they become hyperactive with a high level of arousal. As the symptoms worsen, the child may would not sleep at night and keep playing and speaking during the night. Typically, the arousal level should rise during the day for daily activities and go down at night for rest, but these children have compromised regulatory abilities.
Children with arousal disorder lose vitality in their daily activities and become inefficient in learning and at work. For this reason, they are sometimes misperceived to have ADHD. The fundamental cause is abnormalities in the autonomic nervous system that leads to failure in regulating brain blood circulation. The brain blood circulation declines during the day, hence low brain pressure and weaker responsiveness. At night, in contrast, the brain blood circulation and pressure go up, thus creating an over-aroused state.
These symptoms, too, will gradually be stabilized as the autonomic nervous system is recovered by the Dr. Tomato protocol. The normalization of the arousal level can be confirmed by the following two observations. First, the child should show a very high level of arousal with bright eyes during the day. Autistic children with arousal disorder may look drowsy during the day and sometimes are mistakenly considered to have an intellectual impairment. However, as their arousal level becomes normal, most of them will look sharp and smart with clear, bright eyes. Second, the child should look calm in the evening without excitement so that he/she can rest.