Archive for March, 2017

Getting the Most from Behavioral Therapies

Sunday, March 26th, 2017

The ever-increasing number of children who experience significant developmental problems requires a proportional addition of skilled professionals for assessment and intervention.

At The Child Development Center, we have noted the emergence of certain patterns of treatment choices. Intelligent, involved parents express their concern about the paucity of well-trained professionals, the cost of treatment, the lack of insurance, and frustration with the speed or course of their child’s progress.

Applied Behavioral Analysis
The general consensus is that the proven protocols of behavioral intervention are most likely to result in significant symptom reduction in patients with ASD. As reported in the 2001 publicationEducating Children with Autism, “teaching parents how to use pivotal response training as part of their applied behavioral analysis instruction resulted in happier parent-child interactions, more interest by the parents in the interaction, less stress, and a more positive communication style. The use of effective teaching methods for a child with autism can have a measurable positive impact on family stress. As a child’s behavior improves and his or her skills become more adaptive, families have a wider range of leisure options and more time for one another… To realize these gains, parents must continue to learn specialized skills enabling them to meet their child’s needs.”

Why does utilization of ABA lag behind other treatments
in so many regions around the country?

The prevalence of children with autism is outstripping the number of qualified, interested therapists. Economic pressures appear to dictate direct provision of services by paraprofessionals who are properly supervised. Therefore, the most efficient providers frequently observe, evaluate, and mentor the less-experienced staff. For-profit companies may find such practice difficult to maintain.

Insurance companies regularly find a way to weasel out of their commitments, many times in spite of outside mandates or even advertised benefits. Denial of payment for services may take the form of incorrect coding, credentialing, and timeliness of payment. Providers are, therefore, less likely to accept their (lack of) coverage.

There are a variety of types of behavioral intervention; including DTT, EIBI, PRT, VBI, DIR, TEACCH, OT, Sensory Integration Therapy, Speech Therapy, and PECS. Devotees of each claim superiority of their strategy. Such a smorgasbord may confuse even the most attentive parent.

Discussion
Recovery from the major challenges that accompany an autism diagnosis is an exhausting journey for the whole family. Traditional therapies are the proven tools to enable a successful transformation. They are an important consideration that must be offered to every patient. Parents should use their common sense, plus their unique understanding of the child, to assess whether the plan of action really applies. Does the suggested intervention make sense? Does the child ‘click’ with the therapist(s)?

When professionals continue to insist that 1) you are not doing the right thing at home or 2) your child can’t improve in some particular function, it’s imperative to seek additional assistance. Maybe the provider is correct, but little progress will occur if the parties continue to debate.

I often advise parents who are concerned about some ‘magic’ 25-40 hour ABA requirement, that a good OT, or PT, etc., has learned to be effective by utilizing a variety of techniques. Therefore, you can add up the various interventions, and will frequently find that you don’t need to feel guilty about that numeric stipulation.

As children improve, the challenges of proper socialization and self-control become the most difficult and lingering concern. This may require an entirely new and unique skill-set to come to the fore.

Conclusion
All interested professionals; including chiropractors, acupuncturists, alternative and traditional practitioners, can be important members of the village trying to get your child on the right track. Because the present state-of-the-art is in such flux, the correct combination of traditional and alternative protocols provides the best chance for a successful outcome.

A(nother) Laboratory Test(s) for Autism

Sunday, March 19th, 2017

A key piece of the autism puzzle appears to have been confirmed in an article published this week in the Public Library of Science Open Access Journal, Computational Biology. The title of the article is Classification and adaptive behavior prediction of children with autism spectrum disorder based upon multivariate data analysis of markers of oxidative stress and DNA methylation.

The news has already been reported in popular media as “A Blood Test for Autism“. Here is my clinical interpretation.

The Study
The data was collected from patients in previous studies, and included 83 children, aged 3-10 years, with ASD. Utilizing very dense, complicated statistics that were based on biochemical laboratory data, researchers identified neurotypical vs. autistic individuals, who already had the diagnosis, based on conventional developmental testing.

The chosen pathways evaluated abnormalities in methylation, an epigenetic function, and detoxification.

Specificity and sensitivity were very reliable, “96.1% of all neurotypical participants being correctly identified as such while still correctly identifying 97.6% of the ASD cohort.”

Discussion
Contrary to what the headlines proclaim, this is not a single test; it’s research material that is based on a number of not-yet-readily-available laboratory findings.

The biomarkers represent a final common pathway, not necessarily a cause. Although the data correlated with autism ‘scores’, it really wasn’t meant to discriminate for the various kinds of developmental challenges, such as those children who are mostly aggressive, immune, apraxic, or suffer gastrointestinal abnormalities.

Such an analysis begs the question, “Can it be used for prospective improvement – to follow course of the condition?”

Conclusion
The modern epidemic of childhood autism is extremely complicated and difficult to pin down for research purposes. This study renders a modern means to evaluate a myriad of variables. The metabolic pathways under scrutiny represent a confirmation of the roles of genes and toxins.

As with other ‘earliest diagnosis’ studies, this paper serves to solidify the concept that earlier diagnosis should lead to earlier interventions, with improved outcomes.

For those of us who are practicing ‘alternative’ medicine, it is comforting to rediscover that the treatments included in our modern arsenal of biomedical protocols are consistent with these findings.

Medical Academy of Pediatric Special Needs Spring 2017 Conference

Sunday, March 12th, 2017

At the conference with Yale prof Dr. Sid Baker – one of the originators of biomedical treatment

If practitioners wish to become more effective in the diagnosis and treatment of children who suffer developmental challenges, it will require a new paradigm. Therefore, attending conferences, such as the Simons Foundation for Autism Research, the Autism Research Institute, and the Medical Academy of Pediatric Special Needs, is essential to acquiring that knowledge.

This year’s advanced sessions introduced a completely new functional medicine topic – Hormones from Pregnancy to Teens. Dr. Cindy Schneider examined the differences between the brain anatomy, physiology, and chemistry that might explain how ASD affects males vs. females, and the consequences as we age. Additionally, there are the special complications incurred throughout puberty, with important implications regarding effective treatments.

Dr. Stephen Genuis‘ presentations, Hormone Disrupting Agents, provided a fascinating complement to that lecture. He highlighted the chronic nature of ASD, and the disrupting effects of toxic agents in our modern environment. A key component is the toxic load; if topical agents represent ounces, ingested compounds represent pounds, and the air that we breathe can be expressed in tons of potential poisonous compounds. And, it takes months or years to eliminate what takes days or weeks to ingest. He also pointed out that medical school curricula and training in toxicology is woefully inadequate.

Dr. Lynne Mielke rounded out the day by submitting actual case histories of young people with mysterious medical problems. Her background includes personal experience, extensive knowledge and patient care. This physician’s psychiatric/neurological point-of-view was especially insightful and provided valuable material that directly applied to the audience’s practice population.

Day 2
Another novel and exciting topic was Preconception Care: A New Standard of Care in Maternal-Fetal Medicine. Dr. Genuis discussed the increased risks of preterm birth, Caesarian section delivery, and chronic childhood illness, such as cancers, diabetes, autoimmune conditions, autism and  ADHD.
He presented the emerging research of toxicant exposures and nutritional deficiencies that continue to escalate. Metabolic disruptions may easily ensue, leading to many of the persistent disorders that are now experienced by an increasing number of children, although they may look perfectly normal at birth.

Such difficulties seem imminently preventable in the population, and there appears to be a lack of awareness in the majority of obstetricians. Even fathers who are exposed to toxic agents may become a vector for such later difficulties. Dr. Genuis then discussed the means to eliminate the myriad of  toxins – mostly by sweating, but some by other means, such as fasting or medication.

Dr. Elizabeth Mumper followed with an in-depth discussion about the lack of awareness of proper nutrition, environmental factors, the hazards of indiscriminate use of antibiotics, and poorly researched vaccinations, which appear to be significant factors leading to autism. She even offered another alternative schedule for high-risk infants and toddlers.

Nutritionist Robert Miller presented a very dense lecture, attempting to answer the complicated question, “What can be done about all of those new-fangled genetics tests?” Suffice it to say, that offering will take some time to digest.

Day 3
The lectures consisted of an assortment of the faculty’s most difficult cases. Experts included Drs. Baker, Frye, and Neuenschwander; and the audience wasn’t too shabby, either. Case histories were offered about families who experience unimaginable, incomprehensible challenges; from self-mutilation, to children attempting suicide (sometimes, successfully), to attacks on their caregivers.

The take-home items from such discussions are simply, “How can we prevent this, and successfully treat our population?”

Conclusion
It’s fortuitous that Dr. Ratajczek’s article, which examined the research about vaccine safety, was published at the time of this seminar. Participants have been wringing our hands about the ‘disconnect’ between what we (and many parents) experience every day, and conventional medicine’s dogma. The article might act as fuel-to-the-fire for some, be ignored by the majority, but represents some slight measure of vindication for our hard-working tribe.

We are getting only marginally closer to our understanding about the cause(s), treatment(s), and prevention(s) for autism. Much more research is needed. The Medical Academy of Pediatric Special Needs provides a valuable platform for presenting, evaluating, and disseminating such expertise.

Observations on an Autism Workshop

Sunday, March 5th, 2017

March 5, 2017.
Yesterday, I had the opportunity to be part of a panel for the South Florida Autism Charter Schools‘ medical workshop. In attendance were ~50 parents, and a group of 9 professionals; including dentists, a pediatric neurologist, an Ob-Gyn, a pediatrician, a psychologist and behavioral therapist.

My role was to answer questions regarding the biomedical approach to ASD.
Here are some of the things that I learned:

Parents are extremely frustrated by the lack of available services for special needs patients. “He’s too big for our MRI machine,” or “They do not know how to handle her aggression,” were common complaints. Frankly, the presenters had few useful suggestions that the families hadn’t already attempted.

Therapists and administrators wanted to be sure that parents take advantage of all available means for relief, such as following up with a medication schedule, and notifying appropriate personnel about serious issues in a timely manner.

There was a general dissatisfaction about the medical community’s lack of understanding regarding special needs families. Since the panel was composed of busy professionals willing to give up a Saturday morning, they were basically ‘preachin’ to the choir’.

Everyone agreed that the ideal situation would be a ‘one-stop shop’ for patients to get all necessary testing and treatment. Cancer Treatment Centers of America, for example, advertises that availability, and many facilities now afford such service. It may be some time before supply catches up to the demand, for special needs children, however.

I enjoyed an in-depth discussion with Dr. Jose Berthe about the proper time, types of evaluation, and medical interventions, as girls with developmental challenges get older.

Dr. Yadira Martinez-Fernandez contributed her comprehensive knowledge of autism and cardiac health. Affected children who suffer genetic or other complicated disorders, or who take certain medications, may be at an increased risk, which can be ascertained by appropriate evaluation, such as blood pressure monitoring, or an EKG.

The dental experts reviewed their approach to oral health; from how to get a successful visit, to evaluation and treatment of the common symptom of teeth grinding.

Dr. Carrie Landess provided her unique perspective and valuable insights, as a pediatric neurologist who is also the parent of a child with ASD.

My good friend and colleague, Dr. Linda Colon, offered several practical solutions for the challenged families’ concerns. The general pediatric community would find a great deal more cooperation from families, were they to adopt her thoughtful and empathetic point-of-view toward the autism epidemic.

Dr. Moodie, the Executive Director, is a fireball. Her experience, knowledge, insight, and dedication is leading to tangible changes in the care of children with developmental difficulties.

Conclusion
Parents want – and deserve – more answers, better service, and faster roads to improvement for their special needs children. The South Florida Autism Charter School is doing a great job in providing a tangible means toward those ends.

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Brian D. Udell MD
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