A naturopathic approach to the treatment of children with autism spectrum disorder: combining clinical practicalities and theoretical strategies

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Australian Journal of Herbal Medicine 2013 25(4)
172 © National Herbalists Association of Australia 2013
Article
Introduction
Autism spectrum disorder (ASD) is a complex
condition involving multiple bodily systems. It affects
social interaction, communication, sensory perception,
development, concentration, attentiveness and learning
outcomes. At present, it can be considered a disorder
which is genetic, neurological, developmental,
immunological, gastrointestinal, musculoskeletal,
metabolic, pro-inammatory and pro-oxidant. As such,
dening an evidence based treatment approach has
inherent difculties. Many therapies that theoretically
may be useful have yet to be studied. Other therapies
that have traditional application for various elements of
this disorder lack specic scientic validation in ASD.
A naturopathic approach to the treatment of
children with autism spectrum disorder: combining
clinical practicalities and theoretical strategies
Belinda Robson
Goulds Naturopathica, Hobart, Tasmania
Email: belindarobson@gmail.com
Table 1: Key therapeutic issues in ASD
Issue Clinical Research Clinical Outcome
Incidence Incidence of ASD is rapidly increasing at rates
greater than can be explained by improvements in
diagnosis. Current studies suggest this may be as
high as 1-2% (London 2007)
Increased number of children requiring support.
Neuro-transmitters Hyperserotonaemia in 25-40% of children with ASD;
dopaminergic imbalances are common; reduced
GABA production and down-regulation of GABA
receptors (Aldred 2003, Kidd 2003).
Increased rates of anxiety and depression;
impulsivity; reduced inhibitory responses.
Neurological
differences
Increased number of neurons in the cerebral cortex;
decreased number of neurons in the cerebellum;
decreased activity in temporal lobe; reduced global
connectivity (Wagner 2006, Vaccarino 2009); inability
to filter out background sensations (Shandley 2010).
Developmental delays; slower processing speed;
transition difficulties; language difficulties; sensory
processing disorder. Enhanced memory or splinter
skills alongside impaired social cognition and
executive function.
Oxidative Stress Raised markers of oxidative stress; raised levels of
inflammatory cytokines; lower levels of systemic
antioxidants (McGinnis 2004).
Higher rates of gastrointestinal inflammation;
hyperpermeable blood brain barrier; raised
inflammatory mediators in the brain; increased
potential for neurodegeneration and demyelination.
Allergies 42% children with autism have C4B null allele
(Mostafa 2008).
Higher incidence of autoimmune and allergic
disease.
Gastro-intestinal
hyper-permeability
Increased rates in children with ASD Higher incidence of dietary allergies and intolerances;
raised inflammation.
Lactase deficiency Lactase deficiency in up to 58% of children with ASD
≤5 years old (Kushak 2011).
Lactose intolerance.
Familial patterns Parents with one ASD child have a 27% chance of
having a subsequent ASD child; neurotypical siblings
are more likely to exhibit language delay, behavioural
difficulties, or some degree of subclinical ASD
symptoms (Tomeny 2012, Constantino 2010).
Family stress levels can be extremely high.
Parental separation is twice as likely with an ASD
child (Hartley 2011, Baeza-Velasco 2013).
Abstract: Autism spectrum disorder is affecting an increasing number of children and is multifactorial in its aetiology, pathophysiology
and treatment. Natural medicines to date have limited research in this area. Sound evidence does exist for some natural therapies, but
many others which may have therapeutic application lack specific research in children with autism. Therapies that have clinical research
in disorders with similar underlying pathophysiology may also be beneficial. Further research is necessary into dietary approaches,
nutritional supplementation and herbal medicines that may have therapeutic benefit for children with autism spectrum disorder.

Australian Journal of Herbal Medicine 2013 25(4)
173© National Herbalists Association of Australia 2013
Article
While clinical therapies should have a sound evidence
base, either traditional or scientic, there is potential to
limit therapeutic outcomes by restricting therapy to this
ideal. This paper will explore the evidence for therapies
that may have clinical application in ASD, often drawing
upon research into other conditions. A summary of key
therapeutic issues in ASD are listed in Table 1.
While many herbal medicines, dietary regimes and
nutrients lack sufcient research to support their use
in autism spectrum disorder, some have been studied
Table 2: Summary of evidence for specific therapies for the treatment of ASD in children
Therapy Rational & Evidence References
Gluten-free
casein-free
(GFCF) diet
A high incidence of gastrointestinal malabsorption and gastrointestinal symptoms
has been observed in children with ASD. Improvements in core autistic behaviours
have been noted in studies with strict adherence to diet over a long period of study
(8-24 months).
Whiteley 2010
Reduced gluten and casein diet did not demonstrate improvement. Harris 2012
3 month elimination of gluten and dairy did not demonstrate improvement. Johnson 2011
A survey based study found that 83% of parents of ASD children implementing a
GFCF diet at the time of the survey reported improvement.
Winburn 2013
Authors note: there are inherent difficulties in blinding a GFCF diet, as well as
difficulties with compliance if adequate food substitutes are not provided. This may
contribute to inability to replicate a consistent result.
Adams 2008
Vitamin C Pilot study reported reduced symptom severity over 10 week study period,
consistent with theoretical dopamine potentiating effect of vitamin C.
Dolske 1993
Multi-vitamin &
mineral supplement
Demonstrated improvements in sleep outcomes and gastrointestinal symptoms. Adams 2004
Vitamin B6 Involved in multiple metabolic pathways and is a co-factor for 113 enzymes. High
dose vitamin B6 (100-600mg/day) has been shown to improve mental and physical
function in ASD.
Adams 2006
Bihari 2006
Pfeifferi 1995
Magnesium &
vitamin B6
Red blood cell magnesium has been observed to be lower in children with ASD. Meletis 2007
Magnesium (6mg/kg/d) and B6 (0.6mg/kg/d) in children with ASD demonstrated
significant improvement.
Meletis 2007
Folate &
vitamin B12
Reduced methylation capacity and increased oxidative stress have been observed
in patients with ASD. 75mcg/kg injected methylcobalamine combined with 400mg
folinic acid daily for 3 months demonstrated significant improvement in behavioural
symptoms.
James 2009
Bertoglio 2010
Carnosine Antioxidant; appears to enhance frontal lobe function; neuroprotective. Meletis 2007
800mg L-carnosine per day resulted in significant improvement in behaviour,
communication and social ASD traits.
Chez 2002
Omega 3 fats EPA and DHA are required for neurological development and neuroplasticity. To
date, studies are variable and those producing a positive result consist of small
groups. Two meta-analyses have reported that there is little quality evidence to
support the use of omega 3 fats in ASD.
Bent 2009
James 2011
Significant improvement was demonstrated in a small pilot study using 840mg
EPA, 700 mg DHA, 7mg vitamin E. Improvements included reduced inappropriate
speech (39%), stereotypy (72%) and hyperactivity (71%).
Amminger 2007
Exercise Exercise programs have demonstrated improvements in motor skills, social skills,
communication skills, self-efficacy, self-confidence, sensory receptivity and
attentiveness. Studies generally consist of small cohorts, and were not blinded.
Bass 2009
Cawley 1994
Pan 2010
Rosenthal-Malek 1997
Sowa 2012
Todd 2010
Acupuncture Meta-analysis demonstrated improvements in secondary outcomes but not primary
outcomes. Secondary outcomes included improved communication, linguistic
ability, cognitive function and global functioning.
Cheuk 2011
Animal assisted
therapy
Studies have demonstrated that a pet may help a child develop empathy,
consideration of others’ feelings and self-confidence. Prosocial behaviours have
been observed upon introduction of a pet to a family with an ASD child. These
behaviours include offering comfort and offering to share.
Adams 2010
Law 1995
Grandgeorge 2012

Australian Journal of Herbal Medicine 2013 25(4)
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Article
extensively. These therapies, however, should by no
means be the only treatments used in autism as they do
not address all therapeutic concerns. Additionally, some
therapies studied in autistic children have inconsistent
results. A summary of complementary therapies with
specic research in children with ASD is included in
Table 2.
In addition to the above therapies with specic
evidence to support clinical efcacy, an understanding of
the pathophysiology of ASD can be used to explore other
therapies that may be of benet.
Key issues in autism spectrum disorder
and potential natural therapies
Gastrointestinal inflammation
Gastrointestinal disease occurs with increased
frequency in children with ASD. Russo and Andrews
(2010) demonstrated that autistic children were almost
seven times more likely to suffer gastro-oesophageal
reux, twice as likely to suffer chronic diarrhoea, three
times as likely to suffer constipation, and nine times more
likely to suffer irritable bowel syndrome (IBS), than their
non-autistic siblings. Furthermore, Krigsman et al (2010)
found ileal and/or colonic inammation present in 74%
of autistic children with gastrointestinal symptoms upon
diagnostic ileocolonoscopy. Intestinal hyperpermeability
has also been observed in autistic patients (Li 2005, Bihari
2006). Identifying and appropriately treating causes of
gastrointestinal inammation is of vital importance from
a naturopathic perspective.
Dietary allergy has been identied as a common
cause of gastrointestinal symptoms in autistic children.
Improvements in gastrointestinal and behavioural
symptoms were observed in autistic children on a gluten-
free casein-free (GFCF) diet over an eight to twelve
month period (Whitely 2010). Similar improvement was
not observed for patients on a reduced-gluten diet, nor
was improvement observed in a trial of only three months
duration (see Table 1) (Harris 2012, Johnson 2011).
Other dietary allergies and intolerances also need to be
explored and eliminated. A 2008 study found that 52% of
autistic children had at least one type of allergic disease
and that severity of allergy correlated with severity of
autism (Mostafa 2008). Furthermore, exposure to pollen
in atopic children with autism has been associated with
neurobehavioral regression (Boris 2004).
Healing the gastrointestinal tract: potential
therapies in children with ASD
Probiotic therapy Two specic probiotic organisms
have been demonstrated to enhance recovery of the
intestinal epithelium: Lactobacillus rhamnosus GG
and Saccharomyces boulardii (Biocodex strain).
Supplementation with L. rhamnosus GG has been shown
to produce an anti-inammatory effect and mediate
homeostasis of intestinal epithelial cells (IECs) (Lebeer
2012). A human study conducted in 1996 demonstrated
that Saccharomyces boulardii (S.b.) positively inuenced
the intestinal architecture. Seventy-ve percent of
subjects showed an increase in surface area of intestinal
villi, while twenty ve percent had a decrease. Increased
brush border enzyme activity was observed, specically
with regard to improved lactase production in subjects
who had measureable lactase activity prior to treatment.
This effect was not observed in subjects who had no prior
lactase activity (Jahn 1996). Furthermore, S.b. has been
shown to promote recovery of the intestinal mucosa,
following Giardia infection when supplemented over
a thirty day period (Guillot 1995). This is relevant for
children with ASD considering the higher incidence of
lactose intolerance, intestinal inammation and other
intestinal abnormalities identied in this population.
Glutamine Glutamine has been shown consistently
to decrease intestinal permeability, reduce intestinal
inammation and improve intestinal morphology (Quan
2004, Benjamin 2012, Vermeulen 2011). Glutamine
is considered a non-essential amino acid. It has been
extensively studied for post-operative recovery, cancer
cachexia and Crohn’s disease (Benjamin 2012, Miller
1999). While there is no direct research to support the
use of glutamine in ASD, it is potentially useful given
that intestinal hyperpermeability and inammation are
key issues for ASD patients.
Herbal demulcents Marshmallow (Althaea
ofcinalis) and slippery elm (Ulmus fulva) powder may
also be useful in reducing intestinal inammation in ASD
patients. Both of these agents have been traditionally
used to soothe gastric irritation and inammation (Grieve
1931). The application of these two herbs in children,
however, may be limited by inherent difculties of
compliance. Marshmallow and slippery elm as powders
absorb uid and become a slimy semi-solid mass. In
children who can swallow capsules, this should not be
a problem. However, in younger children, the texture of
these powders may pose difculties. Parents may need to
experiment with different ways of disguising or blending
the powder, either in smoothies or mashed into food.
Nutritional intake Nutritional intake can be quite
limited in children with ASD. Food “fussiness” is
common, as are dietary allergens (Cermak 2010).
Nutritional counselling is important with these patients
to ensure they have an adequate nutritional intake of
all macro and micronutrients. Whitely et al (2010)
compared the nutritional intake of ASD children with
neurotypical children and found that macro and micro
nutrient intake were similar. However, inadequate dietary
intake of vitamins A, B6, C and folic acid, as well as the
minerals calcium and zinc, have been reported in other
studies (Xia 2010). Plasma levels of specic nutrients in
children with ASD have been shown to be low, including
folic acid, zinc, magnesium, selenium and vitamins
A, B6, C, E and D (McGinnis 2004). A thorough diet

Australian Journal of Herbal Medicine 2013 25(4)
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history should be taken with these patients, followed by
discussion with the parent as to creative ways to improve
nutritional intake. In patients with additional problems
of malabsorption, intestinal hyperpermeability and
inammation, supplementation may also be warranted.
A comprehensive multivitamin and mineral supplement
may be a useful adjunct to support the nutritional needs
of growth and development.
Anxiety and depression
Anxiety and depression are prevalent in children
with ASD. Current research suggests that up to 84%
of people with autism will experience problems with
anxiety (Davis 2011, White 2009) and 50% will suffer
depression (Teirney 2004). Furthermore, 45% will meet
the criteria for ADHD (Skokauskas 2012) and 10%
will meet the criteria for obsessive compulsive disorder
(OCD) (Gjevik 2010). Sensory overload and sensory
defensiveness contribute to anxiety levels being higher
in autistic children than neurotypical children (Curtis
2010). Sensory overload occurs because ASD children
typically lack the ability to lter out background sensory
information and become overwhelmed (Shandley 2012).
This sensory input involves all of the senses: smell, taste,
sight, sound, touch and proprioception. Furthermore,
children with ASD may have dysregulated processing of
one or more of these senses. The result of this is that they
typically need more time to process information and have
greater difculty formulating responses. Raised anxiety
levels may also result in inappropriate responses, violent
outbursts or emotional distress when social interactions
are difcult, unsuccessful or exceed their skill base.
Supporting the nervous system through nutrition and
herbal medicines (see Table 3) may be benecial.
Magnesium Magnesium has been studied in the
treatment of anxiety. Magnesium levels have been
observed to be lower in children with ASD (Meletis
2007). Grases et al (2006) examined the relationship
between exam stress in chemistry students and
magnesium. This study found that raised anxiety levels
correlated with raised magnesium excretion via the
kidneys and lower plasma magnesium levels (Grases
2006). Furthermore, animal research has demonstrated
that magnesium deciency enhances anxiety related
behaviour in response to stressful events (Sartori 2012).
Supplemental magnesium has been shown to have a
positive effect in 70% children with autism at a dose
of 6mg/kg/d combined with vitamin B6 (0.6mg/kg/d)
(Meletis 2007). Signicant clinical improvement of
anxiety symptoms has also been demonstrated using
magnesium in combination with Crataegus oxyacantha
and Eschscholtzia californica (Hanus 2004).
Vitamin D Serum levels of vitamin D have been
observed to be signicantly lower in autistic children
compared to healthy neurotypical children (Meguid
2010, Molloy 2010, Mostafa 2012). Mostafa and
Al-Ayadhi (2012) found that 40% of a population of
autistic children were vitamin D decient and a further
48% were vitamin D insufcient. Additionally, auto-
immune antibodies have been shown to be signicantly
raised in 70% of autistic children and in 90% of children
with severe autism (Mostafa 2012). Vitamin D deciency
has also been correlated with increased incidence of
autoimmunity and allergic disease (Jones 2012). Vitamin
D is involved in regulatory mechanisms of the immune
system, as well as the production of inammatory
mediators (Jones 2012). Current research suggests that
auto-immune antibodies and inammatory mediators
are involved in the pathogenesis of autism in-utero and
remain signicantly raised lifelong (Zimmerman 2008).
Vitamin D deciency is also associated with increased
incidence of anxiety, depression, lowered cognitive
function (Wilkins 2009), psychosis and increased suicide
risk (Tariq 2011). Supplementation of vitamin D has been
shown to improve mood in seasonal affective disorder
(Lansdowne 1998). Studies examining the relationship
between vitamin D supplementation and depression have
to date been variable, and while dosage amounts range
substantially, even studies using comparable amounts
were inconsistent (Li 2013).
Vitamin D is able to cross the blood-brain-barrier (Li
2013) and is involved with neuronal development and
connectivity (Mostafa 2012). Vitamin D has an integral
role in key areas of autistic pathophysiology. While studies
regarding supplementation lack consistency, research
suggests that vitamin D deciency may adversely impact
autistic presentation and should therefore be addressed.
Herbal medicines for anxiety and depression Herbal
medicines should also be considered as part of the
treatment of anxiety and depression in autistic children.
The herbalist, however, must consider taste and other
compliance issues when mixing liquid herbal medicines
for children. In older children, tablets or capsules may
be used, although this limits the individualisation of
prescriptions. Table 3 contains a list of herbal medicines
that could be considered, along with their potential
therapeutic benets. This list is by no means exhaustive;
many other herbal medicines may be used to support
specic therapeutic goals on a case by case basis.
Zinc, copper, selenium and heavy metals
There is research to suggest that zinc levels are
consistently low in autistic children (Faber 2009,
Bjorklund 2013). Zinc deciency may result from
malabsorption in the gastrointestinal tract or inadequate
dietary intake. Furthermore, zinc deciency negatively
impacts upon appetite and taste perception, which may
further limit nutritional intake. Zinc may play a large role
in the ‘food fussiness’ and feeding difculties reported
by many parents of children with autism. Excessive
copper levels have also been observed in autistic children
(Bjorklund 2013). Disordered metallothionein function
appears to be implicated in abnormal zinc:copper ratios

Australian Journal of Herbal Medicine 2013 25(4)
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(Kidd 2002, Faber 2009). Furthermore, heavy metals
lead and mercury have been observed to be high in
children with autism, while magnesium and selenium
have been measured to be signicantly low (Lakshmi
2011). The presence of raised heavy metals, and lowered
zinc, selenium and magnesium appear to be correlated
with increased autism severity (Lakshmi 2011).
Supplementation of zinc, magnesium and selenium may
therefore be warranted in children with autism.
Supporting neurological development.
Many studies have demonstrated that there are
distinctive differences when comparing the brains of
autistic patients with those of neurotypical patients. The
autistic brain has a greater number of neurons in the
cerebrum, fewer neurons in the cerebellum and shows
less connectivity between different sections of the brain
(Wagner 2006, Vaccarino 2009). Neurotransmitter levels
are also measurably different. Up to 40% of people
with ASD have raised serotonin levels; dopaminergic
imbalances are also common (Kidd 2003). Additionally
the brain is more vulnerable to oxidative damage in
patients with ASD due to having a hyperpermeable blood
brain barrier (BBB) (McGinnis 2004). Studies have
shown that hyperpermeability and inammation in the
gastrointestinal system increase systemic inammatory
mediators, which in turn increase the permeability of the
BBB and create raised inammatory mediators in the
brain (McGinnis 2004).
Table 3: Potential herbal medicines for the treatment of anxiety and depression in children with ASD
Botanical name Common name Traditional Use Taste considerations
Avena sativa Oats green Relaxing nervine, thymoleptic Mild taste. Caution in coeliac disease or
gluten intolerance
Bacopa monniera Bacopa; Brahmi Anxiolytic, improves memory and
concentration
Mild, sweet. Caution: may cause gastric
irritation and diarrhoea
Codonopsis pilosula Codonopsis Adaptogen, improves appetite, aids
digestion
Mild and sweet, high dosage range
Eschscholtzia
californica
Californian poppy Anxiolytic, sedative, anodyne Unpleasant, but can be disguised by
other sweeter or more avoursome herbs
Hypericum
perforatum
St John’s wort Antidepressant, anxiolytic, nerve tonic Mild taste, easily disguised
Lavandula
angustifolia
Lavender Antidepressant, anxiolytic, carminative Bitter in isolation, combines well with
other aromatic herbs
Leonurus cardiaca Motherwort Anxiolytic, thymoleptic Bitter, dicult to disguise taste, currently
unavailable as tablet in Australia
Matricaria recutita Chamomile Anxiolytic, mild sedative, carminative Mildly bitter, aromatic. Pleasant as a tea
diluted with apple juice, combines well
with other avours
Melissa officinalis Lemon balm Anxiolytic, thymoleptic, carminative,
improves memory and concentration
Mild and pleasant as both tea and
tincture; masks taste of less pleasant
herbs
Nepeta cataria Catnip Anxiolytic, sedative, carminative Mildly aromatic, pleasant tasting
Ocimum tenuiflorum Tulsi; Holy basil Anxiolytic, thymoleptic,
improves memory and concentration,
antioxidant
Aromatic, pleasant tasting
Passiflora incarnata Passionower Sedative, anxiolytic, anodyne Mild tasting
Piper methysticum Kava Anxiolytic, anodyne, sedative, muscle
relaxant
Mild tasting
Rosmarinus
officinalis
Rosemary Antioxidant, carminative, improves
memory and concentration, circulatory
stimulant
Aromatic, but not unpleasant tasting
Scutellaria lateriflora Scullcap Anxiolytic, sedative, nerve tonic Bitter
Valeriana officinalis Valerian Anxiolytic, sedative, muscle relaxant Pungent taste and smell
Withania somnifera Ashwaghanda;
Winter cherry.
Adaptogen, sedative, anxiolytic Mild tasting

Australian Journal of Herbal Medicine 2013 25(4)
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Essential fatty acids
Many strategies used in the treatment of autism in
children, including speech therapy and occupational
therapy, rely on neuroplasticity. Neurological structure,
function and connectivity are responsive to stimuli,
activities and training (Mundkur 2005, Doman 2008,
Cramer 2011). New neural extensions and connections can
be encouraged by specic repetition of desired activities
or behaviours in preference to less desirable activities or
behaviours. Omega 3 fatty acids, EPA and particularly
DHA, are essential for maintaining high neural membrane
uidity which is ideal for neuroplasticity (Kidd 2007).
However, published research regarding the therapeutic
benet of omega-3 fatty acids has shown inconsistent
results to date. Inherent difculty exists in interpreting
existing research due to small cohort sizes, difculty in
blinding subjects and assessors, and the small doses used
in many of the trials. According to two meta-analyses,
sufcient evidence is currently lacking to support the use
of essential fatty acids in children with ASD (Bent 2009,
James 2011).
Turmeric (Curcuma longa)
The therapeutic applications of curcumin, the
active component in Curcuma longa (turmeric), have
been well researched and documented. Curcumin is
a potent antioxidant and anti-inammatory, and has
immune modulating effects (Gupta 2013). Curcumin
has been demonstrated to have an anti-inammatory
effect in many gastrointestinal disorders, including
Crohn’s disease, inammatory bowel disease, irritable
bowel syndrome, peptic ulcers and non-specic gastric
inammation (Hanai 2009, Baliga 2012, Gupta 2013).
It has also demonstrated anti-inammatory effect in
chronic inammatory conditions such as cancer, arthritis,
cardiovascular disease, uveitis, vitiligo, psoriasis,
atherosclerosis, diabetes and diabetic nephropathy
(Gupta 2013).
Curcumin reduces inammation through several
mechanisms, including the down-regulation of
production of inammatory transcription factors and
pro-inammatory cytokines, and its impact on oxidative
stress (Shehzad 2013). Curcumin is safe, non-toxic
and well tolerated (Baliga 2012, Gupta 2012, Hanai
2009, Noorafshan 2013, Shehzad 2013). Curcumin has
very poor bioavailability as it has low gastrointestinal
absorption, is rapidly metabolised and is rapidly excreted
(Gupta 2013). Adjunctive therapies can improve
bioavailability. Piperine, the major alkaloid in Piper
nigrum (black pepper) has been shown to increase
absorption of curcumin by 2000% (Dudhatra 2012).
Clinical caution must be exercised, however, as piperine
may also increase the absorption of other nutrients
and some medications (Dudhatra 2013). Clinical trials
conducted on Meriva® (Indena S.p.A, Milan), a patented
complex combining curcumin with phosphatidylcholine,
also found a 2000% increase in absorption via oral
administration (Belcaro 2010). This extract may have
broader therapeutic application as it can be condently
be used alongside most pharmaceutical medications.
Given the inammatory nature of autistic
pathophysiology systemically, in the gastrointestinal
tract and specically in the brain, curcumin has multiple
potential therapeutic benets. Curcumin is able to
cross the blood brain barrier and has specic effects on
neurogenesis and the production of neurotransmitters
norepinephrine, dopamine and serotonin (Kulkarni
2009). Curcumin has a potential role in the treatment of
depression and other inammatory conditions in autism,
as well as being a supportive adjunct to therapies that
utilise neuroplasticity. Curcumin has a well demonstrated
safety prole and is bioavailable when combined with
piperine or with phosphatidylcholine in the patented
product Meriva®.
Oxidative stress
Oxidative stress may play a key role in the pathogenesis
and behavioural difculties present in children with ASD
(McGinnis 2004). Oxidative stress occurs when oxidants
exceed the functional capacity of anti-oxidants and
results in free radical damage to tissues and functional
impairment (McGinnis 2004). Studies examining the
plasma levels of anti-oxidants present in the serum of
autistic children have demonstrated lower levels than
those present in neurotypical children (Frustaci 2012).
Anti-oxidant supplementation may help reduce oxidative
stress and should be considered in children with autism.
This could be through anti-oxidant rich foods in the diet
or specic supplementation.
Clinical considerations: sensory overload
and sensory defensiveness
When treating people with autism, it is important
to consider the clinic space and how it might appear
to someone with heightened and unltered sensory
perception. This includes lighting levels, clutter, smells
and background noises. Awareness also of the clinician’s
own behaviours, perfume, deodorant and clothing must
also be considered. Finding practical ways of limiting
sensory input may help reduce stress and anxiety for
the autistic patient and be conducive to a therapeutic
relationship.
Communication
Communication can be quite challenging for children
with autism, even those who are high functioning. Direct
communication with the patient will vary based on age
and language competence. The patient may struggle
with a stutter, may rely heavily on echolalia or may be
non-verbal. Language interpretation is typically quite
literal, therefore it is important to use clear concise
communication and avoid the use of colloquial phrases.
It is important to monitor the stress levels of the patient

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Article
and limit the duration of the consultation based on
individual needs. Positive therapeutic relationships
should foster acceptance of the patient, while being
mindful of individual challenges and talents. One should
be protective of the patient’s self-esteem in the way
they are discussed. It is important to praise any progress
(for both parent and child), particularly with difcult
milestones, and to nd positive ways to explain the goals
of the treatment regime.
Further research
Clearly there is need for further research into the
therapeutic potential of herbal medicine, dietary
intervention and nutritional supplementation for children
with autism. Parents seem motivated to participate in
clinical trials to improve research-based knowledge in
this area (Adams 2008), though parental reluctance has
been observed with the blinding of these trials (Winburn
2013). A survey-based study found that 78% of parents
of ASD children said that they would consider being part
of a randomised controlled trial; of this group, 45% said
they would be more likely to participate if the study was
not blinded (Winburn 2013). Early intervention in autism
has a critical impact on life-long outcomes (Tierney
2004, Matson 2009). As such, being within the control or
placebo group may be seen by these parents as valuable
therapeutic time lost. Many parents will use the Internet
to search for therapies for their children, though they will
often lack the skill to critically assess the information
they nd. It is arguably unreasonable to expect parents to
delay potential treatments while we wait for the research
to catch up. The clinician can potentially approach
this dilemma by employing therapies that have clear
therapeutic benet and demonstrated safety in related
disorders with similar underlying pathologies.
Conclusion
Natural therapists have the potential to support the
health, growth, development and learning outcomes
of children with autism. This may be through dietary
intervention, nutritional supplementation or herbal
medicines. With recent increases in the incidence of
autism, research into the efcacy of natural medicines
is extremely important. Some natural therapies have
been extensively studied. Other natural therapies, while
theoretically useful, have yet to be studied specically in
autistic children. Further research into natural medicines
with demonstrated clinical efcacy in disorders with
similar pathophysiological processes is therefore
necessary.
References
Adams JB, George F, Audhya T. 2006. Abnormally High Plasma Levels
of Vitamin B6 in Children with Autism Not Taking Supplements
Compared to Controls Not Taking Supplements. J Altern
Compliment Med 12:1;59–63.
Adams JB, Holloway CA. 2004. Pilot study of a moderate dose
multivitamin/mineral supplement for children with autistic spectrum
disorder J Altern Complement Med 10:6;1033-9.
Adams N. 2010. Review of Animal-assisted interventions for
individuals with autism. J. Autism Dev. Disord 40:1;132-3.
Adams SJ, Burton N. Cutress A, Adamson AJ, McColl E, O’Hare A,
Baird G, Le Couteur A. 2008. Development of double blind gluten
and casein free test foods for use in an autism dietary trial. The
British Dietetic Association Ltd. J Hum Nutr Diet 21:373–406.
Aldred S, Moore KM, Fitzgerald M, Waring RH. 2003. Plasma Amino
Acid Levels in Children with Autism and Their Families. J. Autism
Dev. Disord 33:1;93-7.
Amminger GP, Berger GE, Schäfer M, Klier C, Frierich MH, Feucht M.
2007. Omega-3 fatty acids supplementation in children with autism:
A double-blind randomized, placebo controlled pilot study. Biol
Psychiatry 61:4;551-3.
Baeza-Velasco C, Michelon C, Rattaz C, Pernon E, Baghdadli A.
2013. Separation of Parents Raising Children with Autism Spectrum
Disorders. J Dev Phys Disabil 25:6;613-24
Baliga MS, Joseph N, Venkataranganna MV, Saxena A, Ponemone V,
Fayad R. 2012. Curcumin, an active component of turmeric in the
prevention and treatment of ulcerative colitis: preclinical and clinical
observations. Food Funct 3;11:1109-17. doi: 10.1039/c2fo30097d.
Bass MM, Duchowny CA, Llabre MM. 2009. The effect of therapeutic
horseback riding on social functioning in children with autism. J.
Autism Dev. Disord 39:1261–7.
Belcaro G, Cesarone MR, Dugall M, Pellegrini L, Ledda A, Grossi
MG, Togni S, Appendino G. 2010. Efcacy and safety of Meriva®,
a curcumin-phosphatidylcholine complex, during extended
administration in osteoarthritis patients. Altern Med Rev 15;4:337-44.
Benjamin J, Makharia G, Ahuja V, Anand Rajan KD, Kalaivani M,
Gupta SD, Joshi YK. 2012. Glutamine and whey protein improve
intestinal permeability and morphology in patients with Crohn’s
disease: a randomized controlled trial. Dig Dis Sci 57;4:1000-12.
Bent S, Bertoglio K, Hendren RL. 2009. Omega-3 Fatty Acids for
Autistic Spectrum Disorder: A Systematic Review. J Autism Dev
Disord 39:1145–54.
Bertoglio K, James J, Deprey L, Brule N, Hendren RL. 2010. Pilot
Study of the Effect of Methyl B12 Treatment on Behavioral and
Biomarker Measures in Children with Autism. J Altern Complement
Med 16:5;555–60.
Bihari T. 2006. Assessing CAM Options for Treating Autism.
Alternative and Complementary Therapies 12:5;233.
Bjorklund G. 2013. The role of zinc and copper in autism spectrum
disorders. Acta Neurobiol :Exp (Wars) 73:2;225-36.
Boris M, Goldblatt A. 2004. Pollen Exposure as a Cause for the
Deterioration of Neurobehavioral Function in Children with Autism
and Attention Decit Hyperactive Disorder. Journal of Nutritional &
Environmental Medicine:14;1: 39–45
Cawley R; Cawley D; Retter K. 1994. Therapeutic Horseback Riding
and Self-Concept in Adolescents with Special Educational Needs.
Anthrozoos: A Multidisciplinary Journal of The Interactions of
People and Animals: 7:2;129-134.
Cermak S, Curtin C, Bandini LG. 2010. Food Selectivity and Sensory
Sensitivity in Children with Autism Spectrum Disorders. J Am Diet
Assoc 110;238-46.
Cheuk DKL, Wong V, Chen WX. 2011. Acupuncture for autism
spectrum disorders (ASD) (Review) The Cochrane Collaboration.
Published by JohnWiley and Sons, Ltd.
Chez M, Buchanan CP, Aimonovitch MC, Becker M, Schaefer K,
Black C, Komen J. 2002. Double-Blind, Placebo-Controlled Study
of L-Carnosine Supplementation in Children With Autistic Spectrum
Disorders Michael G. Chez, Journal of Child Neurology 17:11;833-
7.
Constantino JN, Zhang Y, Frazier T, Abbacchi AM, Law P. 2010.
Sibling recurrence and the genetic epidemiology of autism. Am J
Psychiatry 167;1349–56.
Cramer SC, Sur M, Dobkin BH, O’Brien C, Sanger TD, Trojanowski
JQ, Rumsey JM, Hicks R, Cameron J, Chen D, Chen WG, Cohen LG,
deCharms C, Duffy CJ, Eden GF, Fetz EE, Filart R, Freund M, Grant

Australian Journal of Herbal Medicine 2013 25(4)
179© National Herbalists Association of Australia 2013
Article
SJ, Haber S, Kalivas PW, Kolb B, Kramer AF, Lynch M, Mayberg
HS, McQuillen PS, Nitkin R, Pascual-Leone A, Reuter-Lorenz P,
Schiff N, Sharma A, Shekim L, Stryker M, Sullivan EV, Vinogradov
S. 2011. Harnessing neuroplasticity for clinical applications. Brain
134(Pt 6);1591-609. doi: 10.1093/brain/awr039. Epub 2011 Apr 10.
Curtis T. 2010. FABIC Touring Conference (Positive Behavioural
Interventions for People Using Challenging Behaviours). Hobart
Sept 2010.
Davis TE, Moree BN, Dempsey T, Reuther ET, Fodstad JC, Hess
JA, Jenkins WS, Matson JL. 2011. The relationship between
autism spectrum disorders and anxiety: The moderating effect of
communication. Research in Autism Spectrum Disorders 5;324–9.
Dolske MC, Spollen J, McKay S, Lancashire E, Tolbert L. 1993. A
preliminary trial of ascorbic acid as supplemental therapy for autism.
Prog Neuropsychopharmacol Biol Psychiat 17;765–74.
Doman RJ. 2008. Neurodevelopmental Perspectives on Autism and
Asperger’s Syndrome. NACD Journal 22;10.
Dudhatra GB, Mody SK, Awale MM, Patel HB, Modi CM, Kumar
A, Kamani DR, Chauhan BN. 2012. A comprehensive review on
pharmacotherapeutics of herbal bioenhancers. ScienticWorldJournal
doi: 10.1100/2012/637953. Epub 2012 Sep 17.
Faber S, Zinn GM, Kern JC 2nd, Kingston HM. 2009. The plasma zinc/
serum copper ratio as a biomarker in children with autism spectrum
disorders. Biomarkers 14:3;171-80
Frustaci A, Neri M, Cesario A, Adams JB, Domenici E, Dalla
Bernardina B, Bonassi S. 2012. Oxidative stress-related biomarkers
in autism: systematic review and meta-analyses. Free Radic Biol
Med 52:10;2128-41.
Gjevik E, Eldevik S, Fjæran-Granum T, Sponheim E. 2010. Kiddie-
SADS Reveals High Rates of DSM-IV Disorders in Children and
Adolescents with Autism Spectrum Disorders. Journal of Autism and
Developmental Disorders: Published online: http://link.springer.
com/article/10.1007/s10803-010-1095-7/fulltext.html#Sec6
Grandgeorge M, Hausberger M, Tordjman S, Lazartigues A, Lemonnier
E, Deleau M. 2012. Does Pet Arrival Trigger Prosocial Behaviors in
Individuals with Autism? PLoS ONE 7:8; e41739.
Grases G, Pérez-Castelló JA, Sanchis P, Casero A, Perelló J, Isern B,
Rigo E, Grases F. 2006. Anxiety and stress among science students.
Study of calcium and magnesium alterations. Magnes Re 19:2;102-6.
Grieve M. 1931. A Modern Herbal. Merchant Book Company Ltd,
Finland.
Guillot CC, Bacallao EG, Dominguez MSC, Garcia MF, Gutierrez
PM. 1995. Effects of Saccharomyces boulardii in children with
chronic diarrhoea, especially cases due to giardiasis. Rev. Mex. de
Puericultura 2:12;1-5.
Gupta SC, Patchva S, Aggarwal BB. 2013. Therapeutic roles of
curcumin: lessons learned from clinical trials. AAPS J 15:1;195-218.
Gupta SC, Patchva S, Koh W, Aggarwal BB. 2012. Discovery of
curcumin, a component of golden spice, and its miraculous biological
activities. Clin Exp Pharmacol Physiol 39:3;283-99.
Hanai H, Sugimoto K. 2009. Curcumin has bright prospects for
the treatment of inammatory bowel disease. Curr Pharm Des
15:18;2087-94.
Hanus M, Lafon J, Mathieu M. 2004. Double-blind, randomised,
placebo controlled study to evaluate the efcacy and safety of a xed
combination containing two plant extracts (Crataegus oxyacantha
and Eschscholtzia californica) and magnesium in mild-to-moderate
anxiety disorders. Curr Med Res Opin 20;63-71.
Harris C, Card B. 2012. A pilot study to evaluate nutritional inuences
on gastrointestinal symptoms and behavior patterns in children with
Autism Spectrum Disorder. Complementary Therapies in Medicine
20;437—40.
Hartley SL, Barker ET., Mailick Seltzer M, Greenberg JS, Floyd FJ.
2011. Marital satisfaction and parenting experiences of mothers and
fathers of adolescents and adults with autism spectrum disorders.
American Journal of Intellectual and Developmental Disabilities
116;81-95
Jahn H-U, · Ullrich R, Schneider T, Liehr R-M, Schieferdecker HL,
Holst H, Zeitz M. 1996. Immunological and Trophical Effects of
Saccharomyces boulardii on the Small Intestine in Healthy Human
Volunteers. Digestion 57:2;95-104.
James S, Montgomery P, Williams K. 2011. Omega-3 fatty acids
supplementation for autism spectrum disorders (ASD). The
Cochrane Collaboration. Published by JohnWiley and Sons, Ltd.
James SJ, Melnyk S, Fuchs G, Reid T, Jernigan S, Pavliv O, Hubanks
A, and Gaylor DW. 2009. Efcacy of methylcobalamin and folinic
acid treatment on glutathione redox status in children with autism.
Am J Clin Nutr 89;425–30.
Johnson CR, Handen BL, Zimmer M, Sacco K, Turner K. 2011. Effects
of Gluten Free / Casein Free Diet in Young Children with Autism: A
Pilot Study. J Dev Phys Disabil 23;213–225
Jones AP, Tulic MK, Rueter K, Prescott SL. 2012: Vitamin D and
allergic disease: sunlight at the end of the tunnel? Nutrients 4;13–28.
Kidd PM. 2002. Autism, an extreme challenge to integrative medicine.
Part: 1: The knowledge base. Altern Med Rev 7:4;292-316.
Kidd PM. 2003. An Approach to the Nutritional Management of
Autism. Alternate Therapies 9:5;22-31.
Kidd, PM. 2007. Omega 3 DHA and EPA for Cognition, Behavior, and
Mood: Clinical Findings and Structural-Functional Synergies with
Cell Membrane Phospholipids. Altern Med Rev 12:3;207-27.
Krigsman A, Boris M, Goldblatt A, Stott C. 2010. Clinical Presentation
and Histologic Findings at Ileocolonoscopy in Children with Autistic
Spectrum Disorder and Chronic Gastrointestinal Symptoms. Autism
Insights 2;1–11.
Kulkarni S, Dhir A, Akula KK. 2009. Potentials of curcumin as an
antidepressant. ScienticWorldJournal 1;9:1233-41.
Kushak R, Lauwers G, Winter S, Buie T. 2011. Intestinal disaccharidase
activity in patients with autism. Autism SAGE Publications and The
National Autistic Society 15:3;285–94.
Lakshmi Priya MD, Geetha A. 2011. Level of trace elements (copper,
zinc, magnesium and selenium) and toxic elements (lead and
mercury) in the hair and nail of children with autism. Biol Trace
Elem Res 142:2;148-58.
Lansdowne AT, Provost SC. 1998. Vitamin D3 enhances mood in
healthy subjects during winter. Psychopharmacology (Berl):
135:4;319-23.
Law S, Scott S. 1995. Pet care: A vehicle for learning. Focus on Autistic
Behavior: 10:2;17.
Lebeer S, Claes I, Tytgat HL, Verhoeven TL, Marien E, von Ossowski
I, Reunanen J, Palva A, Vos WM, Keersmaecker SC, Vanderleyden
J. 2012. Functional analysis of Lactobacillus rhamnosus GG pili
in relation to adhesion and immunomodulatory interactions with
intestinal epithelial cells. Appl Environ Microbiol 78:1;185-93.
Li G, Mbuagbaw L, Samaan Z, Zhang S, Adachi JD, Papaioannou
A, Thabane L. 2013. Efcacy of vitamin D supplementation in
depression in adults: a systematic review protocol. Syst Rev. 8:2;64.
London E. 2007. The role of the neurobiologist in redening the
diagnosis of autism. Brain Pathol 17:4;408-11.
Matson JL, Fodstad, JC, Dempsey T. 2009. What symptoms predict
the diagnosis of autism or PDD-NOS in infants and toddlers with
developmental delays using the baby and infant screen for autism
traits. Developmental Neurorehabilitation 12:6;381–8
McGinnis WR. 2004. Oxidative Stress in Autism. Alternative Therapies
10:6;22-36
Meguid NA, Hashish AF, Anwar M, Sidhom G. 2010. Reduced
Serum Levels of 25-Hydroxy and 1,25-Dihydroxy Vitamin D in
Egyptian Children with Autism. The Journal of Alternative and
Complementary Medicine 16:6; 641–5.
Meletis CD, Zabriskie N. 2007. Is Autism the Coal Miner’s Canary
of America’s Health Status? Alternative and Complementary
Therapies: 13:4;193-8.
Miller A. 1999. Therapeutic Considerations of L-Glutamine: A Review
of the Literature. Alternative Medicine Review 4:4;239-48.
Molloy CA, Kalkwarf HJ, Manning-Courtney P, Mills JL, Hediger
ML. 2010. Plasma 25(OH)D concentration in children with autism
spectrum disorder. Dev Med Child Neurol 52:10;969-71.
Mostafa GA, Al-Ayadhi LY. 2012. Reduced serum concentrations

Australian Journal of Herbal Medicine 2013 25(4)
180 © National Herbalists Association of Australia 2013
Article
of 25-hydroxy vitamin D in children with autism: relation to
autoimmunity. J Neuroinammation 17:9;201.
Mostafa GA, Hamzaa RT and. El-Shahawib HH. 2008. Allergic
manifestations in autistic children: Relation to disease severity.
Journal of Pediatric Neurology 6:2;115–23.
Mundkur, N. 2005. Neuroplacticity in Children. Indian Journal of
Paediatrics 72;855-857.
Noorafshan A, Ashkani-Esfahani S. 2013. A review of therapeutic
effects of curcumin. Curr Pharm Des 19:11;2032-46.
Pan CY. 2010. Effects of water exercise swimming program on
aquatic skills and social behaviors in children with autism spectrum
disorders. SAGE Publications and The National Autistic Society
9–28; 339496 1362-3613.
Pfeifferi SI, Norton J, Nelson L, and Shott S. 1995. Efcacy of Vitamin
B6 and Magnesium in the Treatment of Autism: A Methodology
Review and Summary of Outcomes. Journal of Autism and
Developmental Disorders 25:5;481-93.
Quan ZF, Yang C, Li N, Li JS. 2004. Effect of glutamine on change in
early postoperative intestinal permeability and its relation to systemic
inammatory response. World J Gastroenterol 10:13;1992-4.
Rosenthal-Malek A, Mitchell S. 1997. Brief Report: The Effects of
Exercise on the Self-Stimulatory Behaviors and Positive Responding
of Adolescents with Autism. Journal of Autism and Developmental
Disorders 27:2;193-202.
Russo AJ, Andrews K. 2010. Is There a Relationship Between Autism
and Gastrointestinal Disease? Autism Insights 2010:2;13-15.
Sartori SB, Whittle N, Hetzenauer A, Singewald N. 2012. Magnesium
deciency induces anxiety and HPA axis dysregulation: modulation
by therapeutic drug treatment. Neuropharmacology 62:1;304-12.
Shandley K, Austin DW. 2012. Reconceptualizing Autism: Moving
Beyond the Behavioral to Address Cause, Cure and Prevention.
Autism Insights 2010:2.
Shehzad A, Rehman G, Lee YS. 2013. Curcumin in inammatory
diseases. Biofactors: 39;1:69-77.
Skokauskas N, Gallagher L. 2012. Mental health aspects of autistic
spectrum disorders in children. Journal of Intellectual Disability
Research 56:3;248-57.
Sowa M, Meulenbroek R. 2012. Effects of physical exercise on Autism
Spectrum Disorders: A meta-analysis. Research in Autism Spectrum
Disorders 6;46–57.
Tariq MM, Streeten EA, Smith HA, Sleemi A, Khabazghazvini B,
Vaswani D, Postolache TT. 2011. Vitamin D: a potential role in
reducing suicide risk? Int J Adolesc Med Health 23:3;157-65.
Teirney E. 2004. Co-Morbidity in Autism. The Exceptional Parent 34:2.
Todd T. 2010. Cycling for Students With ASD: Self-Regulation
Promotes Sustained Physical Activity. Adapted Physical Activity
Quarterly 27;226-41.
Tomeny TS, Barry TD, Bader SH. 2012. Birth order rank as a
moderator of the relation between behavior problems among
children with an autism spectrum disorder and their siblings. Autism
doi: 10.1177/1362361312458185
Vaccarino FM, Grigorenko EL, Mueller Smith K, Stevens HE. 2009.
Regulation of Cerebral Cortical Size and Neuron Number by
Fibroblast Growth Factors: Implications for Autism. J Autism Dev
Disord 39;511–520.
Vermeulen MA, de Jong J, Vaessen MJ, van Leeuwen PA, Houdijk AP.
2011. Glutamate reduces experimental intestinal hyperpermeability
and facilitates glutamine support of gut integrity. World J
Gastroenterol 17:12;1569-73.
Wagner GC, Reuhl KR, Cheh M, McRae P, Halladay AK. 2006. New
Neurobehavioral Model of Autism in Mice: Pre- and Postnatal
Exposure to Sodium Valproate. J Autism Dev Disord 36;779–93
White SW, Oswald D, Ollendick T, Scahill L. 2009. Anxiety in children
and adolescents with autism spectrum disorders. Clinical Psychology
Review 29;216–29.
Whiteley P, Haracopos D, Knivsberg A, Reichelt KL, Parlar S, Jacobsen
J, Seim A, Pedersen L, Schondel M, Shattock P. 2010. The ScanBrit
randomised, controlled, singleblind study of a gluten- and casein-
free dietary intervention for children with autism spectrum disorders.
Nutritional Neuroscience 13:2;87.
Wilkins CH, Birge SJ, Sheline YI, Morris JC. 2009. Vitamin D
deciency is associated with worse cognitive performance and
lower bone density in older African Americans. J Natl Med Assoc
101:4;349-54.
Winburn E, Charlton J, McConachie H, McColl E, Parr J, O’Hare A,
Baird G, Gringras P, Wilson DC, Adamson A, Adams S, Le Couteur
A. 2013. Parents’ and Child Health Professionals’ Attitudes Towards
Dietary Interventions for Children with Autism Spectrum Disorders.
J Autism Dev Disord doi:10.1007/s10803-013-1922-8
Xia W, Zhou Y, Sun C, Wang J, Wu L. 2010. A preliminary study on
nutritional status and intake in Chinese children with autism. Eur J
Pediatr 169:10;1201-6.
Zimmerman AW, Connors SL, Matteson KJ, Lee L, Singer HS,
Castaneda JA, Pearce DA. 2007. Maternal antibrain antibodies in
autism. Brain, Behavior, and Immunity 21;351–7.
To the editor continued from page 163
cohesive group and rmly establish a place within the
Australian health care system? I believe there is a strong
place for naturopaths and Western herbalists and that
the Australian public values the service we provide, and
appreciates and respects our holistic approach. However,
unless we can collect ourselves, identify and address
areas of deciency and build our strengths, we are at risk
of becoming obsolete and superuous as other registered
health professions and indeed the retail supplement
industry move into our territory. Critical thinking and
intelligent debate is fundamental and it starts with
critical thinking about ourselves and our profession. To
quote my insightful Clinical Studies teacher, Dr Karen
Bridgeman, “It is difcult to regulate (or aggregate) a
group of people whose main aim is to be alternative.” It
is essential that we are able to come together, to sensibly
debate issues at hand, and to rely on our own resources
as intelligent professionals rather than remain disparate
and vulnerable to marketeers with their own commercial
interests. Thanks again to Dr John Wardle for raising the
debate – I appreciate the opportunity to contribute, and
look forward to hearing the views of others.
Susan Arentz
Arncliffe NSW

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