By Jerome Burne

Virtually every fortified cereal packet broadcasts the message that vitamin A is vital for good eyesight. But even the most gung-ho marketing manager would pause before claiming that the vitamin can dramatically improve the symptoms of autistic children by repairing damage to their retina. However, this is precisely the claim being made by an American paediatrician, who has evidence that treating these children with the right sort of vitamin A is not only highly effective but provides valuable new insights into some of the most puzzling symptoms of this disorder.
 
"Once you understand the way autistic children 'see' their world,"
says Dr Mary Megson, a professor of paediatrics at the Medical College of
Virginia, "the fact that they don't look you in the eye and can't bear for
things to be changed makes perfect sense." She emphatically rejects the
widely accepted hypothesis that these children have no theory of mind (ie,
no understanding that other people have their own thoughts, plans, points of
view), and that they relate to other people as just another type of thing.
Instead, she maintains that their seemingly alienated behaviour is
perfectly rational. It is their way of surviving in an extraordinary and
terrifying visual world, the result of damage to a protein pathway that
affects the way that certain specialised cells in their retinas work.
 
"Imagine that everything appeared to you like a some paintings by Picasso,
flat and two-dimensional, with various features superimposed," urges Dr
Megson, who has specialised in developmental disorders for the last 15
years. "Or think of a Hockney collage, digitally remastered with all the
depth cues taken out."
 
At a conference on nutritional psychiatry in London earlier this year,
Dr Megson described how she has found that a proportion of her patients have only a tiny visual window on the world where things are reasonably clear and appear in 3D. All around this they only see colours and vague shapes. This makes it very hard for them to follow movement, especially the subtleties of facial expressions. Making sense of a new scene is equally challenging - hence their desperate insistence that everything should follow ritualised, predictable patterns.
 
What concerns Dr Megson, like many other clinicians in this field, is
the massive increase in the number of children coming to her with this sort
of damage. "Since I've been practising, the number of cases has gone up from one in 10,000 to one in 600, and it may be more," she says. "There are
officially 1,522 cases in the state of Virginia, but I've got 1,200 in my
practice, which just covers one district."
 
She is certain that vaccination is at least one of the factors fuelling the rise. But although she agrees with Andrew Wakefield's controversial ideas about the effects of the MMR vaccine on the gut, she is particularly concerned about the vaccine for whooping cough and the "pertussis toxin" it contains. The evidence that she has seen has convinced her that certain children have a genetic susceptibility that makes certain proteins in their bodies vulnerable to damage by the toxin, which can have wide-ranging effects.
 
Known as "G proteins", they are found all over the body, but
especially in the brain and guts, and are involved in boosting or dampening
down the signals coming in from our senses (such as sight via the retina),
as well as controlling such vital pathways as those for fats and glucose.
The scary visual world of the children provides a close-up of how
far-reaching the damage can be.
 
The theory is that receptors in the brain that control the "rod" cells
in the retina have been affected by the whooping-cough vaccine. Rods are the cells that convey shading and depth, and allow us to see in black and white in the dark. They are more thickly clustered around the edge of the retina.
 
"When these children look away from you," says Dr Megson, "they are turning their eyes so that the light reflected from your face lands on the outside of their retina, where the rods still have some function."
 
Controversial as her theory is, what has made her clinic in Richmond,
Virginia, such a magnet for desperate parents is that it leads to a form of
treatment that seems to be having considerable success. The key to getting
the G-protein pathways working again is a form of natural vitamin A. "The
results can be dramatic," says Dr Megson. "Within a few days, these children
regain eye contact. They may start looking at their mother and speaking.
Watching it happen, you get a strong sense of something being unblocked."
It is vital to use unsaturated "cis" vitamin A, as found in cold-water
fish such as salmon or cod, as well as liver, kidney and milk fat.
 
"These are foods that children often don't get in modern diets," says Dr Megson. "Synthetic vitamin A, the sort often found in supplements and cereals, can actually make matters worse because it has to be properly absorbed. This in turn needs a healthy gut, but many of these children have damage to the gut due to food allergies and overuse of antibiotics." That is why treatment is usually supported by removing certain foods from the diet, most commonly wheat and milk, and giving probiotics - beneficial gut bacteria.
 
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