When faced with the diagnosis of autism or moderate-to-severe attention deficit/hyperactivity disorder, parents have limited choices. Some may be financially out-of-reach, others could be unproven or even risky. It appears that the available options fall into these categories:
Not to treat
Honestly, when the major concern is ADHD in very young patients, this could be the best alternative. Children may simply need time to gain skills, such as self-control and socialization, that come with maturity. Furthermore, if gains can be achieved by holding the child back a grade, or ‘settling’ for a non-gifted classroom, medical intervention may be overkill.
However, if behavior includes repetitive movements and restricted interests, speech delay or social isolation, the sooner that intervention is begun, the better – with or without a formal diagnosis.
The traditional disciplines, including Occupational, Physical, Speech, and Behavioral Therapies, are the proven place to start.
On the medical front, two major approaches have emerged. The protocols are pictured in the diagram below.
Traditional approach – Top Down
Conventional medical treatment involves dropping a pharmaceutical bomb, to see who ‘gets better’ when the dust settles. Parents should be particularly concerned when the neurologist or psychiatrist prescribes potent central nervous system drugs for youngsters under the age of 5.
“What is the specific diagnosis? Has an adequate workup been performed? What are the risks? Won’t these drugs affect my developing toddler’s brain? How long will my child have to take this stuff?” are all valid questions. And, if the medication is unsuccessful, there’s frequently a switch to another one, in no particular scientifically justifiable order.
When the right drug is given to the right patient, it is truly a wonderful thing. However, the success rate, especially with the initial choice, is low. The risks include alterations in sleep, linear growth, appetite and weight change, and increasing negative behaviors. None claim to induce speech, sociability or maturity.
Modern approach – Bottom up
The biomedical perspective addresses the multiple individual signs and symptoms that affect people on the spectrum. After a thorough history and physical examination, laboratory evaluation of the patient helps identify specific areas that need medical attention. Then, the safest interventions that are most likely to address aggression, low tone or ‘fog’ are chosen. Often, that may involve improving gastro-intestinal health or nutritional deficiencies.
Enabling mechanisms that unlock a human’s (?) innate ability to speak becomes paramount. Understanding the response to treatment that is displayed by certain behaviors; including aggression, focus, attention, and sleep are tricky, (?) necessary, (?side-) effects of the treatment regime itself.
It takes more of the supplements at the bottom of the diagram to achieve apparent symptomatic relief than those dropped from above. Probiotics are ingested to improve the micro-biome and bowel function, proteins enhance mitochondrial efficiency to enable better motor (and oral-motor) functioning, and dietary changes lift the veil. About such a protocol, parents often say, “They got things started.”
As prescriptions ascend toward nuclear intervention, the risks and side effects become more serious, while the improvements are only as observable as the objective of desired behaviors. So, if compliance is the goal, but fails to assist with speech, the parent may be missing a key developmental opportunity.
New parents are forced to make so many critical decisions. Among the bravest are those who seek answers for the tidal wave of Spectrum youngsters. Often, they believe that there is nowhere to turn.
That has forced an increasing number of families to become more knowledgeable than their doctor about autism. This diagram can be helpful for families and health care professionals as they formulate decisions for children with developmental diagnoses.
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