Archive for December, 2010

The Girl Kind

Wednesday, December 29th, 2010

I find that a good place to start when classifying infantile autism is “the boy kind” and “the girl kind”. Obviously, the common threads are the delays in speech and language, the restricted interests and/or repetitive movements or stereotypies, and the social isolation that defines the disorder. Beyond that are the concomitant conditions such as poor gastro-intestinal health, rashes, “the fog” and other behaviors that also determine a patient’s ability to adapt and hopefully thrive. For the boys, aggression often underlies many of their behaviors, whereas the majority of the girls are sweet and mostly passive. Maybe not surprisingly, it has been easier to recover those passive appearing females when they were able to acquire speech and language. The “juicing” supplements help get their attention, rather than exacerbate disruptive behaviors.

So, this afternoon I had two of my most challenging girl patients in the office at the same time. Two aggressive females. It wasn’t planned, but it was entertaining. Both children are beautiful preadolescents who have speech and language delay (with apraxia) and spend a lot of time “off the grid”. Consequently, verbal stimming was the expressive behavior that these interesting individuals chose to – I don’t know – establish their place in the room? High screeches. Running back and forth for one, planting themselves in a car seat for the other. Then, a changing of the guard! Needless to say, the office was a mess, and so was the staff (including the doctor).

I honestly do not know how their wonderful parents have the patience to put up with unusual behaviors (including below-tummy rubbing stims – you know what I mean), seeming lack of awareness of the world, and take them to all of the therapies and doctors that their condition requires. But, somehow, against all the “stuff” that they have been told, they are true “mother warriors” who have taken these girls to new levels of function. The girls are better than they were before, and they continue to show progress from their schools’ points of view. I know that as medical and behavioral intervention continues to be applied for the children there is hope for improvement and the possibilty of recovery.

A Different Face of Autism

Monday, December 27th, 2010

The oft-repeated statement “autism is not a real epidemic, doctors didn’t realize it,” or “they just renamed it” has some limited degree of validity. It accounts for about 20 % of my patients, slightly higher than the reported incremental increase in ASD diagnoses.

Danny (I’ll call him that) came to his Barcelona, Spain family at 3-1/2 years of age after a miserable existence in a Russian orphanage with a sketchy history other than being “very sick at 2 months of age, admitted to a hospital and abandoned by his parents.” At first, Danny did not speak, could barely walk, did not respond to his name, had no hair, rotten teeth, and decreased vision – among other maladies! The family reported that he was markedly improved after 2 years. By the time that I met Danny at 8 years old, his family had provided love, nutrition, and an intense sensory stimulation program. He was a pleasant, loving young boy who was mute and seemed rather simple, he could barely read and write and seemed to adore human contact (however inappropriate it could appear).

On physical examination, there were lots of patches of scaly rashes, allergic shiners, he exhibited weak core tone and appeared to have a developmental age of about 5 years.

Danny was put on a protocol which paralleled many of the treatments used in “traditional” ASD – bowel evaluation and treatment, resources to improve cellular energy and decrease inflammation, and continued work with behavioral and traditional therapies. After 5 months, he was speaking more and performing better in school (both reading with comprehension and writing), social interactions were mixed with more interactions but some aggression, and better core tone on examination.

Today, I was looking at someone who possessed both skills and potential. According to his parents, he has improved markedly in the past year in all areas of his life. He was conversant and appropriate (especially about soccer), and even had questions about his upcoming Disney vacation.  His maturity level was much more on par with his size and age, and he had experienced a great Christmas. His family has renewed hope about what his future will hold. Is everything OK now? Well, he still suffers from fear of being left alone, inappropriate aggression toward his younger brother and betwetting; but he continues to show progress.

By the way, “Danny” is not my only patient who suffers from such a tragic infancy, and Russia is not the only country of origin committing such atrocities.

I hope to continue to report about this brave young man as he conquers his past and confronts medicine’s flawed understanding.

Alternative Medicines Safe for Kids?

Sunday, December 26th, 2010

New research shows vitamins, herbs may actually do harm

This report appeared on the Fox News Channel this week, so I thought that readers might be interested in my thoughts on this subject. “Alternative medicines can be dangerous and sometimes even deadly for kids.” While that is true, where is the outcry about how deadly conventional medicines can be? Who is questioning why pediatricians give out antibiotics like candy? With ever increasing broad spectrum usage, your children may someday have a REAL infection that can’t be treated, either because the child has become allergic to the antibiotic or the organism is no longer sensitive.

The  journals and newsletters published by American Academy of Pediatrics have dozens of advertisements for various medications (such as Abilify and Lexapro) that have definitely been linked to teenage depression and suicide. Yes, there are disclaimers and warnings, but why is my OWN academy supporting such risky business? We are told that gluten free diets could be risky, but the swine-flu vaccine is safe (with very little evidence). I believe that money is at the root of the effort to put down alternative treatments – the drug companies have a stake in mis-informing the public about the “dangers” of complementary and alternative medicine.

“Realize that the alternative treatment that you are using IS a medication!” That’s true. So are antibiotics, so are vaccinations, and so is Children’s Tylenol.

The most important statement in the piece, “… a physician should be involved in all cases… Parents cannot play doctor to their own children.” Well, at least I agree with that!

Coping With The Holidays

Monday, December 13th, 2010

Anyone who treats patients who are autistic will tell you know how stressful the holiday season can become. Expectations are frequently dashed, making the ensuing drama even more poignant. Beloved family members don’t seem to understand, making even familiar conversations more stressful.

There are numerous reasons from many perspectives that add up to make things so stressful. Schedules are thrown out the window. Spectrum patients like schedules; it helps them organize a disorganized world. Compounding this are the sensory issues that affect so many children.

Bright lights. Blinking. Stims anyone? Very loud unusual sounds and too many noisy strangers in stores. Tantrums anybody? New and often-forbidden foods everywhere. Did someone say “yeast”?

Travelling vacations can even be more anxiety producing. As Karen Vossen, our office manager put it, “Disney is no place to take some of the children – especially during the holidays!” So many strangers, odors, and stimuli that challenge the most sanguine adult assault the children who are supposed to be having fun! What about traveling to the relatives’ house? Sleep couldn’t possibly get disturbed when the child is put into a crowded bedroom rife with allergens and unimaginable unfamiliar stimuli.

So, what is the prescription for a more successful school holiday? First thing – planning. Think about what issues your child has which are particularly stressful and most likely to lead to disruptive or aversive behaviors. If your plans are going to affect those “itchy” behaviors, you need to either make other plans or prepare the child adequately. If that answer seems too “pat”, you haven’t experienced a really bad vacation yet. Children who have visual or auditory issues will definitely have problems at the airport. If they have a preferred activity such as dvd or iphone that will keep them busy, you might need to give up the ABA’s proscription against “giving in”. Social stories about the trip have been found to be helpful. Be especially sensitive to the child’s anxiety and attempt to avoid long waits (doctor’s note) whenever possible. Sometimes a little Benadryl can go a long way by making the child drowsy enough to sleep off some of the time.  Also, consider carrying an extra dose of any calming supplements such as pycnogenol or htp . Melatonin given at the incorrect time may actually make things worse by resetting the child’s biologic clock. Finally, any “juicing” medications such as B12 might be delayed or even discontinued while travelling or in especially stimulating times.

Your planning should assess what activities your family anticipates and whether an affected child will really enjoy and understand what is happening. If a particular child likes to stay with grandma, it might be OK if the child has special time with a preferred caretaker.

If your child is not feeling well, consider postponing the trip to another time. Refundable tickets and trip insurance aren’t a bad idea if you can afford the extra cost. Document all of the child’s medicines and supplements and put them in your carry-on to avoid carnage should baggage be lost or delayed. Bring a doctor’s note if some of the medicines might be considered “dangerous” or otherwise cause difficulty with the TSA. This is especially true if you are travelling outside the country.

During trips, child supervision needs to be beefed up. Consider inviting a (responsible) teenage relative, friend or neighbor to help out. Don’t forget about the neurotypical children in the family. Trips require a great deal of patience for them as well, with plenty of anxious moments and unfamiliar territory. The added work that a special child requires must be tempered with attention to everyone’s temperament and needs. An affected child might want to go on the same ride over and over, while the other children need to have the freedom to experience a wider selection of options.

Meals are important part of any holiday, and the unique nutritional requirements of children on the spectrum puts extra stress on an otherwise enjoyable experience. Consider bringing along some digestive enzymes should the child ingest an increased load of really allergenic foods. It may be prudent to double the dose of probiotics during the holiday. When the child’s behaviors indicate a possible yeast outbreak, it may be worthwhile to speak with your doctor about an antifungal agent.

This advice is meant to help make your family holiday less stressful for everyone. You and your children can have more fun when you don’t expect things to turn out perfectly. I invite your comments and helpful advice to make this holiday season more successful and fun for everyone.

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Brian D. Udell MD
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Weston, FL 33331
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Email bdumd@childdev.org
Website http://www.childdev.org

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