Brian Udell, MD - The Autism Spectrum (2017 Conference) (LDN, low dose naltrexone)


Brian Udell, MD - The Autism Spectrum (2017 Conference) (LDN, low dose naltrexone)

This is Dr. Brian Udell, speaking to you from actually Fort Lauderdale, Florida. Today is July 19th, 2017, and what we're presenting today is information, that is bare bones information maybe, about low dose naltrexone, for the great conference that's going to take place on September 21st to September 24th in the Portland, Oregon, at the Sheraton Portland Airport hotel. As I said, I am Dr. Brian Udell. I have several websites. One of them is, and that's where I put up a weekly blog to talk about the latest issues in autism, from the standpoint of a traditionally-trained pediatrician. I've been a pediatrician for 40 years. I was a neonatologist. From 1975 through 2000 I took care of very sick babies who had add cocaine and drugs in their system. Then in the late part of the last century, it was mostly children who had AIDS. I saw those children in the follow-up clinic until they were 3 years old. I really didn't see anything that looks like autism until about 8 years after I left that clinic. And so, something else has happened in this century.

My first case of autism was in 1975, so I knew what autism looked like. And yet with all those high-risk pregnancies, we still did not see a problem. Not like autism. Another of my websites that's up there is, which is my actual practice where since 2009, we've seen 2,000 patients with special needs. And about 50% of them or more have autism spectrum disorder.

What we're going to talk about today is my learning that naltrexone is a very important aid in treating patients who have autism spectrum disorder. In the1980s, work was done using high dose naltrexone, and they were actually having some results. And then in 2006, Dr. Jackie McCandless recorded a report where she concluded that it was an effective, non-toxic, non-addicting, and inexpensive behavioral and immune modulating intervention. It's definitely already joined our biomedical arsenal to help more and more children recover from autism as well as helping anyone with autoimmune diseases and cancer.

My specialty is children who have autoimmune diseases and autism. The first question that might come up at this time is, well, can you really recover from autism? And the answer that I have is that there are many different kinds of autism, as you'll see through this talk; and you absolutely can recover from the signs and symptoms that people call autism. And so, if a doctor or a specialist saw that patient today, they would not think the child has any special developmental challenge. In 2008, when I first saw my cases in the clinics here in Fort Lauderdale, it was something like 1 in 110 children. Now it's 1 in 68 children, and it affects about 2% of the boys in the US.

The strict definition of epidemic is any disorder, any disease that happens more than the expected amount. So, it's an epidemic. You don't have to have a specific number. According to Webster, it just has to be more than an expected number of cases. And certainly, when I saw my first case in 1975, it was 1 in 5,000 to 10,000. And now we're down to 2% of boys.

Treatment has been traditional therapies, which are physical therapy, occupational therapy, speech and language therapy, and other behavioral therapies of different types. That has really been the mainstay, and there's no treatment that I am aware of at this time that wouldn't include those traditional therapies, whether it's way out treatments that are very expensive and possibly risky, or traditional treatments with any kind of medication. You've got to combine my alternative therapies, as I call them biomedical therapies, you've got to combine them with the traditional therapies for real recovery to take place.

The LDN protocols that we will cover are old ones from the 1980s, which were higher dose and did have actually some results. As for recent results, I actually have altered a little bit my use of naltrexone, and my recent results reflect that and conclusions that we can make.

This slide shows a number of different signs and symptoms that we call autism spectrum disorder. I do not think that I think outside the box. I think that what I'm doing is that I'm connecting the dots, and for me, the dots start with repetitive movements, communication problems, and social isolation, which are traditionally called autism. And whether it's DSM-IV or DSM-V, the combination of social problems and repetitive movements is enough to call a patient under the spectrum umbrella. It does include a lot of patients, and it includes patients that used to be called Asperger's syndrome, and used to be called PDD NOS, which is Pervasive Developmental Delay not otherwise specified. The reason, at least in the US, the DSM has been changed is because the powers that be felt that services could be provided to everyone regardless of the specificity of the diagnosis. And indeed, that has helped children get placed in necessary services. But it does slightly increase the number of cases that one might call autism by a very small percentage. As to this question about whether these patients are really real or we just didn't recognize it before, I can promise you that as a physician who sees lines of patients trying to be seen in our clinic here in South Florida. The other 50 or so physicians who have been doing the same work for even 10 or 20 years, even longer than I have, agree that we have definitely seen more and more children who have developmental problems that we did not see in the last century, except for very rarely.

So, if I'm connecting the dots, the repetitive movements that you see at the top right, and the restricted interests that are just below that, are often called OCD. I have patients that are getting strong medications for obsessive compulsive disorder, and really what they're exhibiting is repetitive movements and restricted interests. The reason that I feel that's an important distinction is number 1: the medications are rarely helpful, and number 2: they carry a lot of side effects and risks. I have seen children as young as 3 or 4 years old getting very potent medications with severe side effects, because the idea was to decrease those disruptive behaviors.

And that's very difficult to do, and it really doesn't address the other more important behaviors which are at the top: the communication. It starts with the speech apraxia, the inability to speak; and social isolation. The kids act like they're in their own world. They definitely look like they're on their own planet. Frankly, on the scale of things that are the most disturbing when you're trying to get a patient better, repetitive movements and restricted interests are lower than the number 1, which is getting speech to come in, and then, for speech to get useful.

At the top right on this slide, underneath social isolation is sensory issues. Just about every system can be involved in these individuals, every part of your sense can be involved. Mostly I find it's usually 1 or 2 that are involved in each kid. You won't see a whole lot of children who exhibit problems with all five of those areas.

The important thing that I'm talking about vis a vis low dose naltrexone that I want to talk more on so you, the listener, will understand, is why I use low dose naltrexone so much, and why I find it so helpful. It’ss because that whole top area <on the slide>. I've just touched on the different signs and symptoms that many children have. And all of those can be addressed successfully sometimes, not all the time, with low dose naltrexone (LDN).

As you go clockwise <on the slide>, the next one underneath the sensory issues is eye contact. I don't see a whole great improvement in eye contact necessarily when I give low dose naltrexone, but I definitely see a healthier child who is more aware of their environment, and therefore, eye contact may be noted to be more improved.

Under that <on the slide> is sleep disturbances, because as we'll talk about later, the best time to give LDN is when the children fall asleep. I'm often asked if it's going to disturb their sleep, and I can say that it's really only about 1 or 2% of patients where it actually disturbs their sleep. In fact, more than 50% of the parents claim that the child slept better than ever.

Underneath that <on the slide> is the low tone. Low tone is a core tone problem that our children have. Again, this is less likely to be addressed by naltrexone, but as we are able to improve the child's energy production, we're able to reverse the signs and symptoms that people call autism.

Gastrointestinal problems are definitely addressed by low dose naltrexone. That's because the one that's just to the left of that <on the slide> as you're going clockwise, is immune regulation. Many parents continue the low dose naltrexone protocol for years because they say that it was the last time that the kid ever got really sick. Many of our children have been sick multiple times and received multiple doses of antibiotics. And just the fact that the child no longer requires that and those setbacks, I keep the LDN on board. So as opposed to a lecture I might've given two years ago where I was trying to find out how many responded, I practically give every child a chance at low dose naltrexone now. I'll talk about it, how I do that.

The last area, the last box <on the slide> that we didn't talk about is those behavioral issues. Again, many of those behavioral issues will get addressed by the use of low dose naltrexone. I don't know if it's because the child has been asleep or their immune system is better, and their focus is definitely better. I often tell my parents that they can expect the oppositional behavior to diminish a lot. We give it at nighttime, and in the morning they wake up in a better mood.

The two boxes <on the slide> that are not attached are children who have seizures and children who have cognitive defects. They're not attached because I'm not sure how they relate. Not that they don't relate. I'm just not sure of the exact relationship.

On this slide we see three cogs in this wheel of why do we see more autism now? We have individual susceptibility. When there was a plague in England in the Middle Ages, everyone didn't die. Why didn't everyone die? Why doesn't everybody have autism? Because certain people are susceptible and certain people aren't. I don't know why it needs to be any more complicated than that. We'll talk about what confers individual susceptibility in a little while: a toxic environment.

If we don't think that, at least in the US, that the 85,000 chemicals in the air, food and water are adding to the burden for those susceptible individuals, and the challenge of normal development, then we're thinking that all chemicals are good for all people all the time, and that would be impossible. And just as impossible would be finding out which are the responsible chemicals or chemical combinations in an 85,000-ingredient chemical soup. It would take a really complicated computer algorithm. What we see is the phenotypic expression. What this slide represents is that combinations lead to variations in what they show, but again, the core symptoms of social isolation, speech delay, movement issues, repetitive movements, restricted interests, that those core issues are what we call autism and there's no mistaking it. I didn't get it wrong 30 years ago when I was seeing cocaine babies. There's no mistaking how these children look.

This next slide is an example of the types of autism that I see. At least 15% of our patients have a genetic type. And again, the reason I'm going over this is so the listener can understand better where naltrexone, especially the low dose naltrexone protocol, fits in. It doesn't really matter which type of autism I'm seeing. There are many reasons that the low dose naltrexone protocol is working, even in a genetic variation that may be affecting the gastrointestinal system or the immunologic system. So in that sense, you are overcoming a genetic weakness.

The gastrointestinal problems that we see are those who are most commonly affected, absolutely greater than 60% of our children have a signature history of either reflux as a child, or poor breastfeeding, I can't emphasize enough to anyone who's out there that if a child is not breastfeeding well, it's not the mother's fault. In today's world, most times it's not a milk allergy, is not what she's doing. It's that the child doesn't have an adequate suck. And those children who start out with an inadequate suck often have gastroesophageal reflux, and go on to have multiple infections. To the extent that low dose naltrexone can help their immune system, that can be ameliorated.

The immunologic is included in that. A question that a lot of people ask is, do I believe that vaccinations ever cause autism. The answer is that you'd have to say that all vaccinations are good for all children all the time in order to justify that there is no risk. And once you agree to that issue, then you'd have to say which vaccinations at what age, given over what period of time, and what dose, to what children. Right now only about 5% of my patients give a good proximate history that it was related to vaccination. They have a picture of the child before, they have a picture of the child the next day and he's crying his head off, he's got red face, high fever; and the next day after that, he doesn't talk. And I know that that sounds crazy to what the scientific world understands, but when you see case after case like that, and if 5% of my cases is a significant number, you start to believe the parents,

Mitochondrial syndromes will definitely have metabolic disturbances that are sometimes addressed in this way. Birth complications are a type of autism that really aren't that amenable to too much help when you're looking at the autistic side of thing. The new one for us is the premature babies. I took care of premature babies for many years, and they did not develop autism. And all of a sudden in this century, there's definitely an increased risk. The metabolic and nutritional deficiencies, obviously, unless you fix those first and you address them, which means you have to do tests for them. I find that in many countries, doctors don't even do minimal testing, like a blood count and liver and kidney function, vitamin D, vitamin A; how do they know if it's thyroid that's affecting a child with low tone? There are so many easy tests to do in every country that could help determine the kind of autism. But again, you'd have to fix those issues before you could really see a therapy like low dose naltrexone do its job.

I actually have seen a difference in the boys versus the girls. The boys are 75% more aggressive and the girls are 75% less aggressive, for example. I’m less likely to use naltrexone in the girls, unless they are more aggressive and I'm trying to decrease their aggression; or, if they have an immune problem. And then there's the early versus late kind. There are children who from the earliest time have reflux. At 6 months old they're not quite sitting; instead of crawling at 9 months old, they're doing an army crawl. And then by 2 years old, they're still not speaking versus the child who's been developing normally and babbles at 12 months and says a few words at 18 months old. And then, all of a sudden, stop speaking.

In order to decide how we're going to go about treating any patient, I know that every doctor out there usually does a medical workup to determine what exactly the precise diagnosis is. A detailed history and physical needs to be done, including a review of systems, but mostly a review of the family history. Knowing that there were two uncles who had Asperger's and there was a grandfather who had schizophrenia, and the mother and her mother both had thyroid conditions, is going to increase your awareness and suspicion of an autoimmune or a central nervous system condition that this child could have somehow inherited.

The specialized treatment starts with audiology. We actually had a patient from Canada who hadn't had an audiology test and came to our clinic with the diagnosis of autism because he wasn't responding to his name, and it was actually his hearing. And so of course that should be checked. An MRI is questionable at this time, whether or not the anesthesia is worth the risk of what you're going to learn from an MRI. I'd say that as part of a medical workup at this time, it's controversial.

An EEG, electroencephalogram, especially in the face of a possible seizure, is important. Again, through using low dose naltrexone and being able to reduce the repetitive behaviors and restricted interests, the patient's physical exam may warrant less use of a medical evaluation like ay EEG.

A type of autism is a chromosomal copy number variation, and that can represent up to 15% of cases. It’s 2017 now, and it's sort of amazing to me that every patient who is suspected to have this wouldn't have that checked.

Checking the blood count is of course a basic thing. We want to know whether the child is a malnourished or anemic, whether we can help the child with just simple things like iron and better nutrition. And again, the ability for naltrexone treatment to work is going to be dependent on whether or not you've found the underlying conditions that the child is exposed to.

Thyroid screening is definitely indicated. Other appropriate information is gotten by a thorough exam and history.

In this slide, I've summarized what the medical workup will find for most of our patients who have signs and symptoms that are called autism spectrum disorder. The most common type of autism that we see are children who have some kind of GI health problem, either diarrhea or constipation, gastroesophageal reflux, a history of poor suck, a history of poor feeding, a history of very picky eaters, children who won't chew and everything has to be pureed. It's not going to be easy to toilet train a child who doesn't have good GI health. So just by helping that we can help the family.

Food allergy: I'm looking for IgG food allergies. It's an important finding for us, for what those patients might avoid so that they don't use up their intracellular reduced glutathione levels and therefore have poor energy production. There's often a misunderstanding about why we're asking parents not to use those foods that would be highly allergenic on an IgG side. Not because it directly causes the behavior, but because the body uses up a lot of energy ridding itself of the inflammation or the toxins from diet.

The importance of vitamin D levels have already been shown in many, many studies. Studies just 6 months ago showed that just treating with vitamin D helps ameliorate signs and symptoms of autism. It's complete mystery to me how a physician can make a diagnosis in today's world of autism and not check vitamin D levels. Being successful with any compounds, including naltrexone, is going to be hindered if the child has underlying vitamin deficiencies.

The metabolic profile depends a lot on the resources that are available and the resources that the doctor and the parents can muster to get to more granular levels about why the child is not developing appropriately.

We do look at lipid panels. Low lipids are more important in autism than high lipids, which are cardiovascular disease, obviously.

The conventional treatments are strong medications like Abilify or risperidone. A less strong medication, guanfacine (Intuniv, Tenex) is also a blood pressure medication. What we need to understand about these anxiety medications is that they're just bandaids. They only represent decreasing apparent anxiety. If a 5 year old is having problems in a situation with other five-year-olds, where he doesn't have the skillset of those other children, then they're going to be appropriately anxious. Maybe the right thing to do is to give that child some low dose naltrexone, which can calm them down and let them observe the other children without getting so anxious and therefore not needing very strong anti-anxiety medications.

I'm often asked when I start naltrexone, is this a medication? Are they going to get addicted to it? Is it bad? How long will they have to take it? And yet, when a physician, a neurologist, or a psychiatrist, or some pediatricians who use stimulant medication, when they order that for children, the parent rarely asks those questions and yes, they are addicted and yes, they are going to take it for a long period of time, and yes, it is going to cause significant side effects. When we look at the risks from a protocol like this versus the strong drugs, I don't see how they're even equivalent. As methamphetamines are still used in children as young as 5 and 6 years old to “slow them down”, I find that low dose naltrexone can do a much better, much safer job, and is much more likely to be successful than giving these strong stimulant medications.

Likewise, the SSRIs such as Zoloft or Prozac, we have 4 or 5 and 6 year olds on Prozac. We have to question why a child that young should be taking a drug with so many potential side effects. In today's world a child might live to the age of 100. There's no study to say that there's a patient who's lived for 95 years on Prozac. There nothing like that, and there really is a lot of it experimenting on children that's going on right now, with psychiatrist and the neurologist using these medications that were not meant for young children. It's a no-brainer as far as I'm concerned, to give a trial of naltrexone to those children.

I've even seen children on antiseizure medications as strong as Trileptal or Depakote, which calmed down their behaviors, but could have been much more appropriately treated.

This slide summarizes the available treatments. One of the things that I like to point out to all of my colleagues who think that a parent who goes for a stem cell transplant, or hyperbaric chambers, or would put worms in the child's stomach to help their immune system, that they're not crazy. They're not stupid. They're desperate. We do not have good answers for autism today. We don't understand why, we don't understand how, we don't understand about prevention, we don't understand about treatment. A parent who is getting a whole lot of information from the doctors and maybe some positive information from Dr. Google and the like, is going to give these things a try. They're not going to just give up on their child. And that has been why for me and naltrexone has been such a godsend They can see just by using this basically innocuous therapy, that there is hope for their child. This slide goes over what I said, I said before, which is that you always have to do traditional treatment as well. Nothing that we're talking about today is going to work unless you teach the child how to talk correctly, how to act correctly, how to be with other children, provide physical therapy and occupational therapy. A lot of them are very sensory. Touch is very difficult for them. Naltrexone can be very helpful in those sensory children. The treatment depends on the underlying condition.

This slide shows treatment, behavioral difficulties, and speech apraxia. The reason that I showed this slide is because behavioral difficulties and speech apraxia are the most difficult to address, especially with conventional therapies. The use of  low dose naltrexone basically helps me calm down the communication disorders that the children have, rather than spending a lot of time on the repetitive behaviors or the negative behaviors that they may exhibit.

This slide is of one of the first studies that came out <he remarked there was an error: it was 1988>. It described the endorphin response to giving naltrexone. It describes a beta endorphin dysregulation in autistic children, with the implication that you had a therapy that could address that, that you might be able to address some of these behaviors. It shows that there's this disruption and dysregulation of endogenous opiates in the children anyway; and that may be the reason why we're seeing some of the repetitive behaviors, some of the self-injurious behaviors. The use of naltrexone would be indicated just for that reason alone.

This is that 1988 study that I talked about where they looked at children and gave different doses. The important thing about this slide for me is when I'm trying to convince my parents that 3 mg of naltrexone is okay. The reason I show this slide as because safety was proven even at 100 mg dose. That's an important thing to parents when you're about to give a strange medication to 3 year olds or 4 year olds. They can at least know that you really mean it, that the doses that were given 30 years ago that were much higher were proven safe.

This slide is a review that was done in 1991.It summarize results of a series of open and double blind trials that have yielded positive therapeutic effects with low doses of naltrexone, including reductions in autistic stereotypes, aggressiveness and self-injurious behaviors; and the production of heightened pro social, emotional attitudes that are accompanied by increased smiling, eye contact, attention, and attempts to communicate. How we can see a child 25 years later who has obvious signs and symptoms that are included in this slide and not give them a chance at low dose naltrexone, seems to be a shortcoming of modern medicine.

This slide shows the conclusion of that study. The positive behavioral change seems to be enhanced by social support, and how such features of therapeutic situations can be maximized to optimize clinical benefits. Again, you have to have the traditional therapies plus these therapies. No one is saying that that low dose naltrexone is going to cure autism. It is a valuable treatment modality, and it's been proven to be that.

Our colleagues may say, well, there are no a randomized control, prospective, double-blind studies; or that this is not evidence-based medicine; are going to have to argue with 30 years of studies where it is evidence-based. The biggest hole in our evidence is in the use of the low dose naltrexone protocol that was outlined by Dr. McCandless in 2006. That probably will take some time. I display slides like this for any of the listeners, so that if you come across traditional professionals who are questioning whether or not this is evidence-based medicine, my position is they would have to argue with the authors of studies such as this, and not try to argue with someone like me, who's just trying to clinically figure out what these studies mean in order to treat patients.

We’re going to quickly through a number of slides here. I provide these to the user so that you would be able to show those who are skeptical that this is evidence-based medicine.

This is another placebo-controlled study, Placebo controlled acute dosage naltrexone study in young autistic children.

This next study summarizes for those who are skeptical about the opioid system being involved, and how low dose naltrexone affects the opioid system. For those who want a more in-depth discussion of that, I supplied this slide.

This is another double-blind study. Again, generally, these few studies that I'm showing now are higher dose naltrexone, but it does help in making your point to parents that it's okay to use low dose naltrexone.

This is another study that can be used by the listener. This was a study from the beginning of the century, from 1999.

You can see that what I've covered in the slides is repetitive behavior, self-injurious behaviors, communication problems. These are core weaknesses in autism. And we're looking at slides that claim that naltrexone is a valuable treatment.

I like to look at this next slide because this is not Dr. McCandless’ work in 2006. This is Dr. ElChaar’s work This also is a higher dose naltrexone study, but it does show efficacy and safety.

I provided this next slide so that the user could go straight to Dr. McCandless’ paper from 2006, where she writes that she completed a preliminary 8 week informal study of 15 patients who were given naltrexone after they fell asleep, when supposedly endorphin levels rise. It's a great deal for us pediatricians, because it's something that the parents can give when the child is already asleep. They don't have to have a fight about how to give it. They don't have a fight that the child doesn't like the taste. I think it was brilliant that Dr. McCandless’ made it available for us in this way. Practically, I use it even on patients who might rather take pills, because I would rather a 7 year old fell asleep and then was given the naltrexone, rather than giving it to him right before he goes to bed. In that study, Dr. McCandless reported that greater than half the children had positive results.

That's what I reported the last time I talked about this to the LDN Research Trust, that much greater than 50% of the parents were satisfied that there were improvements in their child with the low dose naltrexone protocol. More importantly for many of the parents is the lack of side effects, and rarely can it not be utilized by my patients. Just the word low dose naltrexone though: practitioners need to overcome that whole idea so that the parent understands the value of this FDA-approved medication. At the Child Development Center of America, I have changed my talk on this. One of the big changes that I make is that I'm not testing it on children anymore. It's part of my general treatment protocol. I use it after I have gut health, and either before or after that, I need to address a speech apraxia. And the decision about using naltrexone protocol is based on whether or not the child is extremely sensory or extremely self-injurious; or has a lot of what we call stims: stimulatory behavior, repetitive behaviors, repetitive ideation.

If a child is really affected by what I consider mostly to be a gastrointestinal problem - the aggression, children who are aggressive or not paying attention - I address gut first. Then the next part of my protocol is using naltrexone. I can prepare them for 2 proven protocols for speech and language acquisition. And those two protocols are methyl B-12 by subcutaneous injection, and folic acid in oral form in high doses over 15 mg. The side effect of both of those therapies that improve speech is a lot of agitation, a lot of stimming, a lot of cell aggression. Now, depending on how aggressive the child is, I might start naltrexone before I even give them one of those two proven therapies.

My success with low dose naltrexone depends on whether I've made an accurate diagnosis, and the patient. If the patient has an underlying metabolic disease or a serious chromosomal problem, we're going to have to look at other treatments to address the side effects that the treatments are doing to those more effected children.

You always have to address gut and metabolic issues first. We have to see if they're having repeated ear infections or urinary tract infections, because those comorbidities will set the children back. Low dose naltrexone has been very successful in my practice in preventing children from having recurrent infections.

The form that it can be given in is a liquid, a pill, or a cream. The taste of it is very bitter, so the pill form if they'll take it. The cream form is great.

Parents always ask when they will see a difference? Some parents have seen a difference in as few as a few days. If you're going to see a definite improvement, we're seeing improvement in the first few weeks.

As I said, naltrexone decreases the number of repeated infections, so I'll ask parents to continue it for months and months at a time, and see if the number of recurrences and infections go down. So if a mom says her child normally gets sick 3 or 4 times a year, and in the next year we use a naltrexone protocol, she finds that the child might only get sick once that year.

It takes some time of use before you're going to understand how valuable an intervention this can be. About 5% of my patients discontinue because their child gets stimmy, the child gets aggressive, the child gets more active, and it won't go away after giving just a half dose over a week or two. Most parents are not going to try too many therapies for more than 2 or 3 weeks when their child is too stimmy from it. It's just impossible to live with the kids. So you have to find another way around it. Now, what I may do is, get the gut under better control first, and then go back in some of those children and give them naltrexone again.

We’re at the conclusions that you can make from what I'm talking about, from my use of low dose naltrexone for the past several years. The first point is that autism is a complex multi-system condition. It's a set of conditions. There isn't one autism. It leads to behavioral and developmental signs and symptoms that we call autism. Since there are different causes and different effects on different children, it's very difficult to pin down. The second is that we have to agree that it's of epidemic proportions, and it is. The third is that there are many treatable conditions, and the combination of therapies and medical intervention at the earliest stage provides the best chances for recovery.

The latest research is that autism involves brain, gut, and inflammation issues. At least there's an understanding in modern times that it's a whole-body issue, as first described by Martha Herbert in her sentinel book, The Autism Revolution. There are safe medications that are useful, but they are very few and far between. Since I started doing this over 10 years ago, and the doctors that have been doing this for over 20 years, have seen very few therapeutic breakthroughs. Surprisingly few.

We had to learn about genetics and susceptibility, and that we needed to combine what's going on in the environment. It is very complicated.

And that's where we are with the state of knowledge for a lot of autism right now. Given all those variables, low dose naltrexone is certainly worth a try in any patient who exhibits signs and symptoms. The continued problem is that we don't have an actual randomized control, prospective, double-blind study on using low dose naltrexone in children. You know, from where I sit, that seems fine, but I'm a clinician and I'm not here to study my patients. I'm here to treat them.

This represents my chapter in The LDN Book, which was kindly edited and all the work was done, and all I did was try to get stuff in on time.

Let me thank Linda Elsegood for all her work. It has been a great collaboration on my part. When we first met, I didn't know that naltrexone was given to adults; and apparently, most adults that take it don't know that it's given to children.

I want to thank everyone who listened to this. And if I have some inaccuracies, please write to me and I'll try to understand them and get back to you on any of those. This is just the beginning of a treatment protocol that I think is going to be real valuable for all our patients who have a developmental delay. Thank you very much. 


Keywords: low dose naltrexone, LDN, autism, pediatrician, autism spectrum disorder, autoimmune, cancer, repetitive movements, communication problems, social isolation, is Pervasive Developmental Delay not otherwise specified, PDD NOS, obsessive compulsive disorder, OCD, speech apraxia, sensory issues, eye contact, sleep disturbances, low core tone, immune regulation, behavioral issues, gastrointestinal problems, reflux, poor suck, genetic, vaccination, mitochondrial syndromes, vitamin D, thyroid, Abilify, risperidone, endorphin, opioid system, stimulatory behavior, stims, stimming