Symptom Triggers in Autism: Part 2 What's behind the STIMS?
One of the most frustrating and challenging aspects of managing the care of a person on the autistic spectrum is how difficult it can be to find the right treatment approach for each child and adult who are affected.
There just is no 'one-size' approach, and what works wonders for one child can cause aggravation and set backs for another. This is partly because it is almost impossible to say
'Symptom x is caused by this factor'.
Similar symptoms can be triggered by entirely different causes. Even though they look the same, they may arise from a completely different system or stressor.
Stimming for example, is one of those symptoms that can be a benchmark for how a child is doing in general. If a parent tells me 'A or B is very stimmy at the moment' they usually mean this as he or she is not doing great, there is definitely something awry or out of balance. Identifying what this is and treating it successfully can not only ease the stress of this symptom for the child and their family (stims can so often be incredibly stressful for those around), but very often there will be global improvement, affecting other areas of symptom stress too.
So what has been identified as being a potential trigger for stimming behaviour? By this I don't mean 'overstimulation' or external factors that might aggravate, I am talking about the internal bio-chemistry or health landscape that causes these external factors to be so problematic.
UNDERLYING MEDICAL & ENVIRONMENTAL FACTORS CONTRIBUTING TO STIMS or STIMMING
Dysbiosis : Yeast overgrowth, Clostridia overgrowth and infection
Mineral deficiencies – in particular Zinc, Magnesium – which help to regulate glutamate
Elevated glutamate or Ammonia – especially from high protein intake, ammonia may also be produced by yeast or compromised liver function
Retained primitive reflexes
Asterixis due to Encephaolopathy
Low tryptophan (low serotonin as a consequence)
Acetylcholine chloride imbalance or dysfunction at receptor sites
Dopamine imbalance or dysfunction at receptor sites – can be related to dysbiosis or neuroinflammation. This can also be related to sensory seeking behaviour, as it has been hypothosised that beta-endorphins produced by repetitive behaviour stimulate the production of dopamine.
Norepinephrine and the LC (locus coeruleus) modulation
Histamine balance and clearance/sulfation and transulfation pathways: Supplements such as quercitin, sulforaphane have proved helpful for stimming symptoms in trials : Sulforaphane has also been shown to upregulate genes that fight oxidative stress, inflammation and DNA damage, which are all thought to contribute to stimming behaviour.
Neuroinflammation : Vitamin D, Omega 3 and Cucrumin have also shown reduction of stimming in trials
Highly anti-inflammatory Korean Red Ginseng -shown therapeutic potential for stimming behaviour
Early exposure (pre 3 years old for more than 3 hours daily) of screen time, leading to neurochemical and neurotransmitter imbalances that replicate some ASD like traits.
This is by no means a definitive list, however it does show the variety of potential causes and triggers that may be behind an increase of stimming type behaviour, as well as potential therapeutic avenues that may help to reduce or address stimming.
Tests can help to show which of these issues are key or more significant, and our clinic uses test results from outside laboratories as well as our own screening results as part of our treatment assessment to help determine the health pattern affecting each patient and the best steps forward to reduce stims, whether auditory, tactile, visual, vestibular, olfactory, or vocal.