Marked gains in speech, behaviour and social adaptation in a child with an autism-spectrum neurodevelopmental disorder

History

The child was born at term after an uncomplicated pregnancy and a normal delivery. Early development initially went relatively well.

At around three years of age the parents noted an abrupt halt in speech and psychological development, followed by regression. Marked changes in behaviour appeared at the same time, together with stereotyped movements, sensory hypersensitivity and the gradual establishment of persistent tiptoe walking.

At various points in his care the child was given a diagnosis of autism spectrum disorder, since the clinical picture included the characteristic features:

• severe speech delay
• impaired social interaction
• stereotyped movements
• sensory hypersensitivity
• restricted and repetitive interests
• episodes of hyperactivity
• marked behavioural rigidity
• self-injurious behaviour

The parents and some of the specialists who saw the child drew attention to an unusual feature of the illness: up to a certain age development had gone considerably better, after which a fairly rapid deterioration and regression occurred.

Because symptoms worsened after infectious episodes, anti-streptococcal titres were raised and there was improvement after penicillin and intravenous immunoglobulin, the hypothesis of PANS/PANDAS or a post-infectious neuropsychiatric process was also considered later.

The child's clinical picture thus combined a marked autistic phenotype with neurobehavioural regression and tic and obsessive-compulsive features.

Before treatment

One of the most marked problems was the speech impairment.

Despite reasonably good comprehension of speech addressed to him, expressive speech was almost absent. The child tried to produce individual sounds and unintelligible speech-like constructions, while using only isolated words functionally.

The following were noted:

• marked delay in expressive speech
• difficulty with social interaction
• reduced ability to make full contact
• stereotyped movements
• episodes of marked hyperactivity
• low tolerance of frustration
• abrupt changes in behaviour
• episodes of crying, dropping to the floor and banging his head against hard surfaces
• marked sensitivity to noise
• intolerance of bright light and wind
• obsessive interests and repetitive behaviour
• walking mainly on tiptoe
• marked muscle tension
• reduced independence

At school the child needed additional support from a teacher.

His intellectual potential appeared uneven but partly preserved: he knew the alphabet, was beginning to read individual words, recognised numbers, showed good visual memory and a marked interest in books, music and machinery.

The main aim of the programme was to support further speech and psychological development, improve communication and the capacity to learn, reduce the behavioural and sensory disturbance and widen the child's independence.

The programme

A personalised cell and neuroregenerative programme using a related-donor protocol was drawn up for the child.

At the preparatory stage bone marrow was collected from the child's father, acting as the related donor, for the subsequent preparation of the cell component of the programme.

The protocol that followed included:

• therapy with mesenchymal stromal cells of related-donor origin
• a systemic cell component
• concentrated exosome therapy
• intranasal administration of a highly concentrated exosome preparation
• neuroregenerative support

The exact doses, the sequence of procedures and the technical parameters formed part of an individual internal protocol.

Course after treatment

After the programme the parents and the specialists working with the child noted marked positive change across several areas at once.

Speech

The most noticeable result was a substantial improvement in speech function.

The child began to use speech far more actively, the number of meaningful attempts at speech increased, and his ability to express what he wanted and to enter into verbal contact improved.

In the family's assessment, it was the change in speech that stood out most after treatment.

Behaviour

The child became considerably calmer.

Sharp emotional reactions became less marked and the number of destructive and self-injurious episodes fell.

He dropped to the floor and banged his head against hard objects less often.

Contact and socialisation

Marked improvement in social interaction was noted.

The child found it easier to make contact with adults and interacted more actively with his family and his teachers.

At school the teachers noted that he engages better with them, accepts instructions more readily and sustains productive interaction for longer.

Learning and stamina for work

His capacity for lessons and for completing tasks increased.

The child began to hold his attention for longer, engage better in schoolwork and show more stamina.

His general curiosity and readiness to take on new skills also increased.

Independence

At the same time his independence at home and in behaviour increased.

The child showed more initiative, depended less on constant adult supervision and coped better with familiar everyday tasks.

Sensory sensitivity

The sensory hypersensitivity became less marked.

The child began to react more calmly to loud and sudden sounds, covered his ears less often and tolerated the sensory load around him more easily.

Motor function

Improvement in muscle tone and in overall motor control was noted.

Tiptoe walking also became less frequent – the child began to use a more physiological gait pattern more often.