Archive for July, 2012

The Earliest Findings in Autism

Sunday, July 29th, 2012

Problems abound throughout the gastrointestinal system of many ASD patients. Of the eleven originally-described autistic children (8 boys and 3 girls), Dr. Kanner noted:

Donald… was breast fed, with supplementary feeding, until the end of the eighth month; there were frequent changes of formulas. “Eating,” the report said, “has always been a problem with him. He has never shown a normal appetite…

Richard…  mother began to “train” him at the age of 3 weeks, giving him a suppository every morning “so his bowels would move by the clock…

Paul… vomited a great deal during his first year, and feeding formulas were changed frequently with little success…

Barbara… nursed very poorly and was put on bottle after about a week. She quit taking any kind of nourishment at 3 months. She was tube-fed five times daily up to 1 year of age…

Herbert… vomited all food from birth through the third month. Then vomiting ceased almost abruptly and, except for occasional regurgitation…

Alfred… For the first two months, “The feeding formula caused considerable concern…

Charles… developed an obsession about feces, would hide it anywhere ( for instance, in drawers), would tease me if I walked into the room… he is still not toilet trained. He never soils himself in the nursery school, always does it when he comes home. the same is true of wetting. He proud of wetting…

John… The father said: “The main thing that worries me is the difficulty in feeding. That is the essential thing… During the first days of life he did not take the breast satisfactorily. After fifteen days he was changed from breast to bottle but did not take the bottle satisfactorily. There is a long story of trying to get food down…

See a pattern there? Apparently, not the same one as Dr. Kanner, who focused on faulty parenting. Perhaps surprisingly, he also noted the delayed motor responses, “According to Gesell, the average child at 4 months of age makes an anticipatory motor adjustment by facial tension and shrugging attitude of the shoulders when lifted from a table or placed on a table.” This was a common skill that his patients seemed to lack. All of this from the father of modern child psychiatry.

That was 1943. Too often, the public is fed media stories proclaiming “breakthrough” discoveries of the “earliest signs of autism.” Recent articles have reported on MRI scans, head lag, and new parental concerns indicating earlier diagnosis, Many books have been written on the subject and screening kits are available. Even my description of core hypotonia is simply another early sign of motor weakness.

The earliest signs were detailed in the earliest literature. Feeding problems and low tone either leading to developmental delay or presenting as signs and symptoms of it, have been written about for 70 years. Yet, little progress has been made towards a more precise diagnosis; let alone etiology, effective treatment, prognosis or prevention of this modern epidemic.

Granted, earlier diagnosis can lead to earlier interventions and improvement. A thorough evaluation with a high index of suspicion will help identify even more at-risk youngsters. Increasing the number of diagnosed children should boost research funding. Now, let us hope that the focus shifts towards making a more precise diagnosis and assigning successful interventions to the various presentations of this condition. I fear that the new language of the DSM 5.0 and a continuous stream of debates about whether there are more cases of ASD interfere with such progress. Furthermore, thinking that autism is hard-wired and not subject to medical intervention often frustrates treatment efforts.

So, for now, doctors such as myself working with families such as our patients will just have to do it ourselves.

Where to Start when Autism is Diagnosed

Sunday, July 22nd, 2012

The first challenge that parents encounter when faced with a child who may not be developing in a typical fashion is getting a correct diagnosis. One doctor says “PDD-NOS,” another claims “Just a speech delay and some ADHD,” and yet another specialist suggests ”Let’s wait and see.” We are knee-deep into an autism epidemic, Ladies and Germs! If your child produces few words by 15 months (or displays a loss of words), has problems with eye contact or socialization, exhibits repetitive behaviors and has signs of core hypotonia (central weakness), you are dealing with the red flags that signal ASD.

The top Google searches for what to do about your suspicions include an inaccurate (at least, dated) list of signs and symptoms, an accurate reference article by the NIH, a parent guide that offers good advice, a fairly helpful (but less-than-practical) step-by-step guide, a webMD primer, and several columns expressing sympathy and empathy. What they all seem to have in common is the advice that parents need to learn everything they can in order to help their child. While that is an admirable and helpful pursuit, isn’t it more common, when a family member is struck with a complicated medical condition, that a trusted medical professional is pursued in order to assist in the best course of action? Doctors take note – you have been left out of the loop.

Where to start:

1. Forget about all of the other opinions and seek a physician who understands that “high risk” for autism means close observation and initiating therapies to address the developmental condition ASAP. If the child is simply a “late bloomer,” so what? Unfortunately, this is often the most difficult step. Generation Rescue’s website is a good start, and the emerging Medical Academy of Pediatric Special Needs is working on providing significant resources.

2. Parents desire to do everything they can, within reason, to help their child. In an abundance of caution, initiating intervention at the earliest possible age can be therapeutic at best and reassuring at least. ’Kick-starting’ speech and language and/or assisting developmental milestone acquisition with physical therapy are some great ways to get started. The family will become more comfortable about the diagnosis, understand ‘the journey’ better, and will frequently get to observe some quick improvement.

3. A popular reflex after searching the web is for parents to give the gluten-free/casein-free diet “a try.” Talk About Curing Autism offers a great deal of helpful information on this intervention. While this step may be important, there are some pitfalls that accompany this decision. If a child who is put on a casein-free (milk protein) diet is very sensitive to soy, the diet may not appear to be ‘working’, if there was a change to soy milk. Likewise, if the child is eating lots of peanut butter, for example, and is allergic to it, the diet may not appear to be helping. Finally, if the child has no problem with dairy or wheat, the diet won’t be helpful. Also, dietary intervention sometimes takes time (months) and patience before improvements can be seen in communication or behavior.

4. If you haven’t done step #1 yet, it belongs here: Find a competent autism practitioner who understands and has TREATED autism (not just diagnosed it). If you don’t do this step, you are getting into territory which can result in little improvement, significant regression, or a sense that you are not doing “everything that can be done.” An appropriate medical workup should include a blood count, liver, kidney and thyroid function, nutritional health, and gastrointestinal testing. Blood, urine and stool samples may be required in order to gather such valuable and pertinent information about the patient.

5. Make sure that the child’s overall medical condition is clear. Simply because the child appears healthy, don’t forget that they are relatively non-verbal, resistant to pain and have a narrow range of expressive behaviors. How do we really know if the child is healthy unless appropriate lab work has been collected and reviewed so that your child is in top shape? I had a patient last week who was mildly anemic. Now, it may not seem like much, but, why worry about HBOT (which is an expensive and resource-intensive intervention that brings oxygen to distant tissues), when all a patient may have needed was a bit more iron in their diet? Similarly, gut-related signs and symptoms are rampant in ASD, and an astute practitioner needs to ferret out and treat such maladies.

6. Follow a protocol. This is one of the most difficult parts of the initial treatment, because apparent regression can follow even the most uncomplicated interventions. For example, the negative behaviors that may result from bacterial or fungal ‘die-off’ when strong probiotics are initiated is frightening to families and requires coaching and counseling in order for the patient to achieve G-I balance. This step alone has discouraged too many parents from continuing biomedical intervention. As we increase cellular energy with supplementation, I frequently advise parents, “The side effect of giving a patient more energy is that the child will have more energy!” For aggressive or disruptive children, this is no small matter and there may need to be some changes or additional supplements to handle that alteration. In practically all areas of medicine, following protocols and altering them as things change is the hallmark of a successful course of action.

That’s it. Just a few steps that should be taken once the diagnosis is entertained to insure that, by today’s standards, everything that CAN be done is being done for your potentially-affected child.

Probiotic Use in Autism Spectrum Disorder

Sunday, July 15th, 2012

The following is the text that I sent to all of my patients at The Child Development Center of America this week:

“Although I have been taking a vacation (first one in years – like all of you!), I have been staying close to my staff and patients through emails and calls, when necessary. So I am fully aware of the iFlora recall, and I wanted to write to inform you how we should proceed.

First, we have been reversing autism in hundreds of patients over the past several years by using low-risk, highly effective protocols. Before I employed the combination of probiotics and oral glutathione, helping children with diet alone was a very slow and not-so-successful practice. 

As all of my patients are aware, the probiotics help establish normal gut flora and the glutathione increases cellular energy so that new connections can be made in the central nervous system. Almost all of you have seen improvements and even recovery in your children, and so my practice has continued to grow at a time when most conventional doctors are telling you that your children are doomed to years of ABA and other therapies, special education, few social improvements, with the only hope of improvement being a ‘chance’ recovery. 

In order to establish a consistent protocol, I use very few products. The supplements that we have in our office are sold at their cost plus the shipping and handling that is required. I am not a vitamin (or probiotic) salesman. I don’t make the products; I choose products that are simple, natural, safe and effective. 

Unfortunately, in this case, the manufacturer has reported that a possible salmonella (an organism that can cause diarrhea and other illnesses) contamination, due to the presence of Galactooligosaccharide (GOS). There have been no reported complications, and the warning is just that – a warning. In response, we have taken a look at what comes through our office, and we are happy to take back ALL bottles – opened or not – for a full refund. 

I am explaining all of this because I want my patients to continue to employ this system for autism recovery. Every food or product that we take ourselves or give to our children is subject to problems. The fact that I use so few products makes our job easier and SAFER for the patients because there aren’t so many items to evaluate. Just think, if all of the parents gave whatever probiotic they ‘discovered’ on the Internet, how difficult it would be to evaluate improvements, complications or recalls.

At this time, if your child is doing well and the lot # is not on the list, I would continue to use that product (if it came from our office). Whether the product is on the list or not, if you are concerned, then, sure, don’t give it. In the meantime, I am asking that you use another over-the-counter probiotic that you can buy at the drug store. In this manner, your children will continue their course to better health and recovery.

In short, WE ARE ON TOP OF THIS situation. Our patients are doing fine and you all have immediate access to ME through Karen and Daylin, who will contact me immediately if there is a problem. I will return to the States on Tuesday, July 17th. Next week, I will be happy to see any patients who are having a problem that you think is related to this recall, call you by phone, or answer your emails.”

What I have learned from this experience:

  1. Even the most benign-appearing supplements can potentially be dangerous. Notifying the pediatrician about any product that your child takes is an important step in assuring continued good health.
  2. Fortunately, we keep precise records about the supplements that we supply to our patients, so that we can identify any child who may be at risk in such a situation.
  3. Parents, likewise, need to keep a close eye on the bottles and packaging that accompanies any supplement that they obtain from other retailers, or from the Internet.
  4. My patients are the greatest… they are well-informed and up-to-date on much of the literature about ASD. Plus, in this case, it was one of our patients who notified us that they saw the news about this voluntary recall.
  5. My staff is fantastic. With emails (in English and in Spanish) and phone calls, we were able to quickly apprise patients of the situation and offer advise.
  6. When choosing any products that I recommend or supply, I will make sure that the company acts in a responsible and proactive manner to professionals and patients alike. Physicians need to be alerted about any potential problems as quickly and efficiently as possible, and given guidance about how to proceed.

ADHD and Autism

Sunday, July 8th, 2012

There are a plethora of physical problems that may accompany being an ASD patient. Sometimes referred to as ‘co-morbidities’, meaning “one or more disorders in addition to a primary one”, I prefer to think of the additional diagnoses as part of the autism spectrum itself. G-I problems, eczema, allergy, hyperactivity, apraxia, sensory disorders and behavioral conditions may each present as a single, separate pediatric medical condition. However, when such problems arise in ASD, I do not believe that they are separate at all. To effectively help ASD patients, diagnosis and treatment MUST include the whole picture. Or else, as many parents have experienced, their children go from one specialist to another, sometimes addressing the single problem, sometimes not even that. But NEVER – in my experience – addressing the autism itself.

ADHD encompasses a unique medical history and pathophysiology that is still the subject of much debate. Lectures and books offer various and sundry opinions, depending on the author’s background and point of view. Originally coined ‘hyperactivity’, the diagnosis has been expanded to include ‘impulsivity’ and ‘inattentiveness’ outside the range of normal for the child’s age.

In a similar manner, when the parent of an ASD patient describes their child’s (often disruptive) symptoms, depending on the practitioner, various theories and treatments are offered. Pediatricians tend to offer stimulant medications such as Ritalin or Adderall, neurologists may wish to focus on behavioral therapies, and psychiatrists sometimes suggest Abilify or Risperdal. There are several problems with such a variety of approaches.

Many times, I treat very young children who have been prescribed 2 or more stimulant and/or psychotropic medications. Often, I find that parents see only incremental or no improvement from complicated pharmacologic protocols. Worse, I encounter youngsters who suffer from many of the various medications’ side effects; such as tics, over- or under-eating, violent outbursts and sleep disturbances. Furthermore, what studies are available to assure parents that such medications are safe, especially long-term, and especially when they are prescribed in combination? “There are no studies to show…” is an oft-used phrase espoused by the conventional medical community to downplay the assistance offered by alternative and complementary practitioners. That doesn’t seem to apply when a doctor orders focalin, lithium and Prozac for a disorderly child. When a four, five, or six year-old child receives potent medications – what medications will be required by the age of nine, or twelve, or fifteen years and older?

Another approach is to insist that ABA is the only proven – and therefore necessary – therapy for the negative behaviors that are encountered in ASD patients. Such advice poses great difficulties for families who either 1) do not have private insurance or 2) their carrier does not cover this intervention. Sure, OT, PT, and/or S&L treatments have value, but they were never intended to address all of the behavioral problems that often accompany the ASD diagnosis.

Rather than merely declaring that the ADHD is “just another symptom of the autism”, patients who are ‘on the spectrum’ deserve an appropriate medical workup. Those suffering from impulsivity really need to have their gastrointestinal health evaluated. When kids “act like they have ants in their pants,” sometimes they actually have ants in their pants (that is, fungus, harmful bacteria, or parasites). When parents are concerned about constant activity, the medical workup needs to include thyroid and other metabolic studies (such as calcium, magnesium and vitamin D levels), in order to rule out treatable conditions. If the major problem is lack of focus, the professional should rule out sleep disturbances, dyslexia, problems with eyesight or an inappropriate educational setting.

Taking a detailed history and performing a thorough physical examination often provides clues as to why a child exhibits unusual behaviors. Then, even if ALL of the ADHD symptoms do not resolve with targeted interventions, there is enough abatement of extreme behaviors that, hopefully, less or even no medications are warranted in very young children. The traditional therapies that children receive also seem to work better when underlying medical problems are discovered and addressed.

Additionally, young children deserve to be evaluated by other professionals who might offer hearing therapy, RDI, neurofeedback, hippo therapy, and other valuable alternatives, which can be quite helpful. Over-the-counter remedies such as pycnogenol, tryptophan, magnesium or phosphatidylcholine can be useful by decreasing the anxiety that may exacerbate behaviors.

By taking such a holistic approach to the ASD patient with ADHD symptoms, the use of medication may be delayed, decreased, and even eliminated from the complicated course that families with autism must navigate.

Autism and Apraxia

Sunday, July 1st, 2012

The two most troubling symptoms that plague young children who suffer from ASD are difficulties with communication and cognition. There are many other problems, for sure, such as sensory processing, ADHD, OCDs, repetitive movements and social isolation. But, for parents, those first meaningful words are a sentinel sign of the child’s improvement.

The official definition of apraxia is a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked, even though:

  • √ the request or command is understood
  • √ they are willing to perform the task
  • √ the muscles needed to perform the task work properly
  • √ the task may have already been learned

In every individual autistic patient, there are one or more hurdles to this set of conditions. To the extent that there are multiple factors, each barrier needs to be addressed in order to assist speech & language. For example, simply the age of the child may preclude conditions #1 and #2.  This is why, traditionally, pediatricians and other professionals have advised caution and patience towards children exhibiting a delay in this milestone.

In most instances, infants say one or two meaningful words by their first birthday, and continue to acquire words throughout the next year.

Occasionally, in my practice, there are Dads (especially), or even several generations of males who spoke ‘late’ (even 3 or 4 years), according to the history. Since we live in the era that shall be known as of The Autism Epidemic of Two Thousand, such a family history should not provide comfort, but rather it should raise a red flag that offspring may be susceptible to ASD. And, for ANY patient, the loss of words can be a significant harbinger of other developmental problems.

When parents notice that their child is not achieving (or losing) the ‘words’ milestone, a medical evaluation should be initiated in which a doctor thoroughly examines, documents and treats both the currently accepted signs and symptoms of ASD, plus the other co-morbid conditions as well. The second year of life is THE CRITICAL EARLIEST PERIOD when the diagnosis of autism can be best ascertained. As opposed to the current, “Let’s wait and see until he/she’s three” attitude, the earliest signs of hypotonia and not imitating or using speech should trigger S&L and other indicated interventions. In my estimation, pediatricians and neurologists who offer PDD-NOS or other non-specific classification (such as encephalopathy) appear to be a common factor, often delaying correct diagnosis, confusing parents and putting off treatment.

Importantly, at The Child Development Center and other alternative medical practices, we have found that, by making an early, precise diagnosis, then combining the traditional therapies (OT, PT, S&L, ABA) along with properly addressing cellular energy, inflammation and gut health, apraxia in young children can be significantly improved.

Possible over-treatment is not an expensive precaution, or risky. At best, a disaster may be prevented. At worst, Primum non nocere.

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Brian D. Udell MD
2751 Executive Park Drive
Suite 201
Weston, FL 33331
Office phone – 954-873-8413
Fax – 954-384-2287

Email bdumd@childdev.org
Website http://www.childdev.org

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