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Hardy Healthcare, PLLC
One Phoenix Mill Lane, Suite 101
Peterborough, NH 03458
Telephone: 603-784-5266
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“To affect the quality of the day is the highest art.” – Henry David Thoreau
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PERVASIVE DEVELOPMENTAL DISORDERS

Autism, Asperger's Syndrome, PDD–NOS (Pervasive Developmental Disorder-Not Otherwise Specified), Rett’s Syndrome:  
• Differential Diagnosis
• Diagnosis & Treatment with a special emphasis on nutrition, metabolic functioning & neuro-psychopharmacology
• Implementation of the Autism Research Institute Protocol
• Gastrointestinal Disorders associated with Autism
 
Neuropsychiatric Disorders associated with Developmental Disorders:
• Downs Syndrome
• Prader-Willi Syndrome
• Mitochondrial Disorders
• Chromosomal Disorders

NEUROPSYCHIATRIC DISORDERS

ADD / ADHD:
• Sub-types that respond poorly to stimulants and other types of medications
• Sub-types that are related to diet, food dyes, or to environmental agents
• Sub-types that are related to co-existing disorders

Anxiety Disorders
• Obsessive-Compulsive Spectrum of Disorders
• Social Anxiety Disorder – persistent fear of social situations
• Panic Disorder – panic attacks, agoraphobia
• Generalized Anxiety Disorder – free-floating anxiety
• Body Dysmorphic Disorder – preoccupation with an imagined defect in appearance
• Specific or Multiple Phobias
• School Anxiety

Mood Disorders
• Dysthymia – "chronic low-grade foul mood"
• Cyclothymia – mild form of Bipolar Disorder
• Major Depression – severe sadness with inability to take pleasure in anything
• Bipolar Disorder
        Type I: At least one Manic episode
        Type II: Recurrent Major Depression with Mania or Hypomania

• Treatment-resistant Mood Disorder

Tic Disorders
• Tourette Disorder
• Chronic Motor or Vocal Tic Disorder
• Transient Tic Disorder

Behavioral & Psychiatric Disorders associated with Epilepsy

Special Category

• “Been everywhere, done everything, nothing has really helped”
• “Falling between the cracks” of the medical specialties: Pediatrics, Neurology, Immunology, Psychiatry
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BACKGROUNDS AND INTERESTS

Dr. Hardy's interest in autism and developmental disorders dates back to his fellowship in medical ethics sponsored by the Joseph P. Kennedy Jr. Foundation in 1976-1977. This fellowship led to his first position with the Eunice Kennedy Shriver Center in Waltham, Massachusetts where he served as a neurologist at both the Paul A. Denver State School and the Walter E. Fernald State School in Massachusetts. During this time, he was exposed to a wide variety of developmental disabilities including severe forms of mental retardation, chromosomal disorders, metabolic disorders, as well as a wide variety of patients with autism.

During those early years of his career Dr. Hardy developed a subspecialty in the neuropsycho-pharmacology of autism and the developmental disabilities. It was also during this time that he worked under Dr. Raymond Adams at the Massachusetts General Hospital and the Harvard Medical School Department of Neurology. In 1980, Dr. Hardy moved over to the Tufts University School of Medicine, joining the Departments of Neurology and Psychiatry, where he specialized in treating both children and adults with developmental disabilities, epilepsy with comorbid behavioral disorders, and persons with acquired brain injury.

In 1992, Dr. Hardy left Tufts University School of Medicine to form Hardy Healthcare in order to expand his clinical interests in Behavioral Neurology/Neuropsychiatry, especially the Developmental Disabilities, for all age groups.
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NEW CONCEPTULIZATION OF AUTISM

Traditional Concepts: Originally, autism was thought to be a psychological disorder emanating from bad parenting. However, in recent years autism has been thought to be a brain disorder, or neurological disorder, strongly determined by genetic factors beginning in utero or shortly after birth. This concept has focused medical research on a search for ‘the gene’ or ‘genes’ causing autism and has led to a therapeutic nihilism in medicine over the past quarter century, with the exception of behavioral and educational interventions.

Genes versus Environment: It is true that autism is the strongest of the genetically-determined developmental behavioral disorders, or psychological disorders, with a heritability rate of 0.90 in identical twins. This led to the belief that there was one gene responsible for autism, or at most a handful of genes. After twenty years of searching for the gene, or genes, and the expenditure of untold millions of dollars, no single gene, or set of genes, has been found. Possible gene loci have been identified, but what is very clear is that autism is a polygenetic condition with the environment probably playing a significant role in the expression of genetic factors. It is no longer genes versus environment – it is genes and environment!

The Latest Research: Within the past ten years, there have been a number of important research papers published which are creating a paradigm shift in concepts about autism. The first area has been that of gastrointestinal dysfunction in autism. The second has been a growing realization that, in autism, the immune system is quite abnormal and that neuroinflammation may play a major role in the development of autism. The third area concerns detoxification and the emerging findings that many children with autism have impaired detoxification which, in turn, leads to significant oxidative stress in the brain. Thus the shift, in autism, is to think not only of the brain but to think in terms of an ‘Autism Quadrangle’.

The Autism Quadrangle of System Involvement: This exciting concept of thinking about autism as an interconnected and interdependent quadrangle is that it can not only guide and improve research, but it also provides for new treatment options for autism. Many existing treatments that are presently available for gastrointestinal dysfunction, immune dysfunction, and detoxification dysfunction, now become available for use in autism by virtue of thinking and practicing systemically. To conceptualize this, Dr. Hardy has developed the following diagram to help portray the dynamic, synergistic, and interdependent features of autism.

autismquadrangle

Gastrointestinal System: 40 - 50 % of children with autism have major bowel problems characterized by chronic constipation, chronic diarrhea, or alternating combinations of both. Historically, this has been referred to as 'the constipation of autism' or 'the diarrhea of autism' with little thought given to causation or treatment. There are a number of reasons why children with autism have these problems and many of the conditions are treatable, if properly identified. Treatment of the gastrointestinal tract can lead to a reduction in the severity of the autism for reasons that will be made clear in the next section. Also, because the gastrointestinal dysfunction leads to malnutrition in autism, the evaluation of nutrition and the correction of nutritional deficiencies can improve the symptoms of autism: behavior, socialization, learning, etc.

Immune System: Increasingly over the last fifteen years, immune system abnormalities have been discovered in autism. What is important to realize is that nearly 70% of the immune system surrounds the intestinal tract (Gastrointestinal Associated Lymphoid Tissue, GALT) and is directly affected by the health of the gastrointestinal system. It is now understood that the bacterial ecology within the lumen of the intestine helps to regulate the GALT. The GALT, in turn, has communicating effects upon other organ systems within the body such as the skin and the brain. By treating the immune dysfunction, one can beneficially impact the degree of symptoms and signs of the autism.

Detoxification System: The detoxification system of the body has not been well studied in autism until very recently. Several recent studies suggest that children with autism cannot efficiently detoxify foreign substances such as pesticides and heavy metals. Therefore, these poisons gradually accumulate in the children adversely affecting proteins, enzymatic functioning, and producing oxidative stress. By trying to correct these abnormal detoxification pathways, one can lower the toxic burden and oxidative stress in the bodies of children with autism. In turn, the signs and symptoms of autism can be improved.

Nervous System: Dysfunction in the gastrointestinal system, immune system, and detoxification system individually, and collectively, adversely impact the nervous system producing the signs and symptoms of autism. At this time there are no specific medical treatments for the neurological dysfunction in autism. Therefore, one must rely on treatment of the other systems. This is the cornerstone of the Autism Research Insttute approach for treating autism.

The Genome: The genetics of autism are far more complex than has generally been recognized. The discoveries of the recently completed Human Genome Project reveal that many genes have variations in form which are referred to as single nucleotide polymorphisms (SNPs) or ‘snips’. Some genes can have multiple polymorphisms, further multiplying the permutations and combinations of genes. This great complexity is the reason the genetic research to date has been so disappointing.

The Environment: The environment interacts with genes and SNPs to produce many of the diseases an individual may experience in life, and this is true for autism as well. This may explain the variations in the forms of autism that children develop, and that we have all struggled to understand. Increasingly, the various toxins in our environment are thought to contribute to the types of autism we see (phenotypes).

The Phenotypes of Autism:
Phenotype means the type we can see or observe. Because of the great variations in biologic individuality, there are actually many phenotypes of autism. Each person with autism, in a sense, is unique and should be evaluated and treated as such. The failure of many research studies in autism is, in Dr. Hardy's opinion, the failure to properly sub-classify the phenotypes of autism.
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METHODOLOGY AND HIERARCHY ASSESSMENT

The evaluation of a person with autism is similar to peeling away layers of an onion. The initial evaluation which includes a detailed history, the review of previous records, and a physical examination determines where to begin the process. Often, a thorough evaluation of gastrointestinal functioning is the first layer to consider. This next layer may be immune function, or an evaluation of detoxification and oxidative stress. This may be followed by a thorough evaluation of the brain: radiological imaging studies and electrophysiological studies. In many cases, it is not until the gastrointestinal system is treated adequately that other systems can be effectively treated.
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TREATMENT

The biological treatments of autism are many, and they are often interdependent: one affecting the other and dependant on the other.
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APPLICABILITY TO A WIDE RANGE OF DISORDERS

This approach to evaluating and treating autism, the severest of the developmental disorders, has applicability to many other developmental disorders such as Down's syndrome, Rhett's syndrome, Praeder-Willi syndrome, and even individuals with epilepsy. Nutritional issues and bowel problems are common in many developmental conditions.


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