Archive for the ‘Books’ Category

Getting Children to Take Their Supplements & Medications

Sunday, October 30th, 2016

take-medA common feature among children who suffer from sensory processing issues is their reluctance to take the very preparations that would help attenuate such disturbances, and the will to get their way.

Here are some tips and observations, gathered over the years at the Child Development Center of America, that may be of some use as a parent attempts to cajole junior into ‘taking his medicine.’

B-twelve lollipops simply don’t cut it. There are various strategies for those who won’t take subcutaneously administered methyl-B12, from a middle-of-the-night sneak attack, to an early morning assault. Expensive topical anesthetic agents are rarely required or helpful. Squeamish parents may hire a nurse, or ask a friend or relative. In school, we practiced on fruit. Occasionally, there have been parents who take their child to the doctor, until they become more comfortable.

Dermal creams can be an excellent alternative. Naltrexone administered in this manner may alleviate sensory issues and enable more generalized compliance. Magnesium, epsom salt baths and other agents may be quite helpful. On the other hand, every supplement does not work in a cream form, due to its composition and absorption.
This is a propitious time to mention the use of essential oils. Calming to the mind and body, these may be just the ticket for getting a mildly oppositional youngster to comply.

Many families mix preparations with preferred liquids and foods. Should a parent risk a small volume of casein or other forbidden fare? Frankly, occasionally, that may be the better option. On the other hand, some children may then refuse taking even that ONE liquid that they consider acceptable. Starting with very low doses of the offending agent may work.
We recommend oil-based products for the like; e.g. almond butter or mustard, if the supplement comes in that form. Applesauce is good for gloppy goodies.

Some children may respond to mechanical strategies, such as practicing with candy, drinking fluid first, or placing the pill in just the right part of the tongue. Another strategy involves the use of a pill swallowing cup. A non-scientific review of our experience at The Center has not found those of any real value. They look scary, and we couldn’t give them away.

Ask the occupational, behavioral or physical therapist to assist in the learning process. To the extent that the professional recognizes – and believes in – the accompanying improvements for their job, they should embrace their role in assisting the process. In a similar vein, alternative techniques practiced by chiropractors and reflexologists might include their additional expertise in helping a child acquire this skill.

Social stories may be a great aid for certain children. An artistic parent may even be able to create one (digital or analog) with your child’s pictures and voices, enabling the child to view the process and diminish anxiety. The propensity for affected children to perseverate on youtube videos might provide an opportunity to encourage an understanding and acceptance of this technique.

Most parents have already exhausted the role of bribery. Often, families have found this strategy of limited benefit after a lifelong pursuit of compliance in one or another less-daunting behaviors. From this perspective, and towards this end, this could be utilized as one of the ONLY times that your child gets the iThing.

Make sure that the child is on the most healthful diet. For parents who believe that the foods their children eat have little to affect on behavior, you should at least give a try. The end point might be as ‘simple’ as your child’s understanding and compliance.

For certain preparations, there is always the rectal route. The child may accept that oral is preferable, if they don’t bite and run for the hills (and lock the door).
Sometimes this one can backfire – literally.

Develop the right attitude. With autism, the senses of smell, taste and texture are involved. Oral-motor functioning is weak. There are medical reasons for patient refusal. One inconsequential substance may be misperceived as awful, however another foul-smelling product may not even be noticed. Plus, some therapeutic protocols may increase aggressive behaviors for brief periods. For most children, reasoning is of little value. “Because mommy says so!”

Truth be told, only ~1% refuse just about everything. Such children won’t be told, taught, or tricked. The parent has to decide how important the supplement, how likely it is to work, and weigh the consequences of continued non-compliance. But, getting a child to accept only one or two of these preparations may jump start a pathway to increased compliance in other endeavors, as well.

I never had a juvenile arthritis patient, or child with diabetes or other significant malady, where the parent didn’t bite the bullet and do whatever is necessary. To the extent that the practitioner and parent believes in results, the deed will be done.

As always, knowledgeable and experienced parents are invited to offer their stellar suggestions…

Staffing for the Autism Epidemic

Sunday, October 9th, 2016

The Child Development Center has been blessed to experience a stream of wonderful, young, eager students wishing to learn about caring for special needs pediatric patients. Some go into ‘the business’, while others have gone on to a variety of great life adventures. We are also lucky to have our superb Practice Manager, Karen Vossen, who is an exemplary role model, teaching parents and staff alike, how to handle the patients.

gabiskywalker

The Force is strong with this one

Our latest graduate, Gabriella Tabib, has chosen to pursue this line of work. Here is what she wrote about her time here at The Center:

I started working with Dr. Udell during my final year of undergraduate training. After listening to many of my peers discuss their volunteering experience, I wished to intern, as well. I could see a passion in their eyes and I wanted that, too. But where was I going to start? Fortunately, I had an idea about what I wanted to do.

First, I wanted to work with children. Children are amazing. They are imagination unhindered. They are bottled potential. The ‘abnormal’ side of child psychology is just as fascinating. In high school, I had volunteered on a horse therapy ranch, working with children who had ASD, cerebral palsy, and Down syndrome. For my internship, I wanted to work in a similar setting.

I found a place at the Child Development Center of America. My job included interacting with the children while their parents spoke with Dr. Udell about the child’s diagnosis and treatment plan. My responsibilities included measuring the child’s height and weight, conducting ATEC scores when needed, and keeping them engaged for the hour. Dr. Udell used my observations to gauge their progress.

I came to realize that I had knack for connecting with children on the autism spectrum. I began to understand how they interact in, and with, the world. I saw stimming – not as an unhindered, reflexive process – but a means of communication. I saw double swirls and single palmar creases as signs of genetic links to that patient’s condition. I also learned what it meant to have a child with special needs.

Whether your child is neurotypical or not, parenting is a monumental undertaking. It is a full-time job filled with changing diapers, answering hundreds of questions, and chasing after them as they grow up right before your eyes. But what if toilet training takes longer than necessary? What happens when the ‘whys?’ never come? Learning that your child has autism is life changing.

I watched Dr. Udell guide many parents through understanding autism and innovative treatment options. He truly cared about every patient that came through his doorway. He treated each condition on an individual basis. His first question is not, “What helped all the other children?” Rather, he asks, “What seems to be ailing this child?” It opened my eyes to the true nature of psychotherapy and medical treatment. Considering each patient individually may be more time consuming, but it offers the best results.

I am truly thankful for the time I spent with Dr. Udell. I met so many amazing children and their families. I learned so much about the future of autism diagnosis and treatment, and how I can personally make a difference. I look to the future full of hope and inspiration.

Working at the Child Development Center has solidified my passion for working with children, especially those whose diagnoses lie ‘on the spectrum’. I can proudly move forward in my career, knowing that I gained such a wealth of knowledge and support. This experience will enable me to become a top-notch mental healthcare professional for all of my present and future clients.

Many thanks to you, Gabi.
Your intelligence, optimistic personality and inquisitive nature has helped our practice, as well!

Medical Academy of Pediatric Special Needs – Fall 2016

Sunday, September 11th, 2016

This week, the Medical Academy of Pediatric Special Needs held its semiannual conference in downtown Atlanta, GA. This is ‘Ground 0’ for practitioners, researchers and professors from all over the world to meet, learn, explore and discuss a myriad of relevant topics.

Members who have been returning for 100’s of lecture hours generally choose the advanced courses. For some, the conference has become a group of ~50 experienced and knowledgeable practitioners who meet to discuss ‘workups’, basic science, relevant research and treatment protocols for those who are most affected with ASD.

Notes and Observations
Day 1 – Tough Cases
I really enjoyed our lectures by the plain-speaking Dr. John Green, of Portland, OR. Dr. Green not only reviewed those who improved because of his medical expertise, but those who got better in spite of him, those who haven’t gotten better, those who got better but he can’t figure out why, and the most frustrating – patients who improve only to suffer frequent relapses.

Dr. Sid Baker, a pioneer of the biomedical movement, described his early medical experiences in Africa that morphed into his lifelong dedication to treating patients with ASD. He expressed his disappointment that so many conventional colleagues disagree with our practice.

Dr. Baker elucidated how he initiates care with new patients. He discussed increasingly resistant cases, covering topics from severe speech apraxia to the approach to children with injurious behaviors.

The first day was filled with the most frustrating and difficult cases you can imagine. Eminent practitioners Drs. James Neuenshwander, Michael Elice, and Julie Buckley challenged our diagnostic and therapeutic knowledge, attempting to navigate the complicated courses of those who improved and those who didn’t.

Day 2
Dr. Daniel Amen‘s morning lecture was entitled “3D Brain SPECT Imaging”. The takeaway message was that SPECT scans – technology – could/should/will become a mainstay for a multitude of CNS disorders. His manner and stories of research, technical evaluation, and clinical practice, were positively spellbinding and inspirational.

Dr. Theoharides presented his research and extensive knowledge about the important role of allergy in ASD. Dr. Theo continues to publish a mountain of monumental works, not only on the topics of autism and the role of mast cells, but treatments, as well.

Toxins were the subject of the afternoon’s lectures. We learned about the identification of substances in the environment that are dangerous, how they are measured, how damage is done, and the means to control and treat. For the skeptical reader, there was a plethora of supporting scientific evidence of the relationships to autism (and many other modern conditions).

As has become customary, Dr. Dan Rossignol rounded up the day with a roundup of all of the latest scientific research. Rapidly.

Day 3 – Advanced Clinical Cases
Severe behaviors and speech apraxia. For patients who are most resistant to conventional and alternative treatments, essential oils, acupuncture, and even worms were explored as possible solutions.

Throughout the afternoon, cases got even tougher! Lyme, Persistent Lyme, Non-Lyme Lyme, PANDAS, PANS, parasites… an increasing number of reasons to have signs and symptoms that are called autism. Such information extends our knowledge and leads to better diagnoses for our patients, and possibilities for treatment.

Dr. Green discussed biomarkers. Though these ‘labs’ are not specific to ASD, per se, this will become a necessary next step to document level of involvement and response to treatments.

A brand new treatment, repetitive Transcranial Magnetic Stimulation was presented by Dr. Arun Mukherjee. The jury is still out on this expensive intervention.

Conclusions
One important reason that I return to this meeting, is simply that I feel at home among like-thinking practitioners. Members don’t agree on every subject, but we are respectful and actually enjoy our practices.

In traditional medicine, conferences are basically show-and-tell affairs, where researchers report their data, previously published in medical journals. When doctors think outside the box, practitioners with diverse skills, who are scattered over the globe, discover improved results by networking in this fashion.

Patients, parents, and families can feel confident that progress is being made (slowly), as serious, dedicated doctors continue to try to unravel this modern mystery.

Finally, I am proud to report that, at this meeting, I was awarded Fellowship status in the Medical Academy of Pediatric Special Needs.

A More Complete Special Needs Practice

Sunday, August 28th, 2016

SherryjpgIn order to achieve optimal outcome in a world of constantly changing complex medical problems, a modern practice needs to embrace the benefits and safety of natural interventions.

Towards that end, The Child Development Center of America welcomes Dr. Sherry Eshraghi of Natural Health Power Works.

Sherry, a mother of a child with autism, has a Doctorate and PhD in Natural Medicine*, and is certified by the Board of the American Alternative Medical Association. She is an expert in autism and associated disorders and uses a natural, holistic approach to improve health and well-being.

This insightful and empathetic professional will complement our services by interviewing and counseling the family as a whole, providing additional health and lifestyle advice.

Sherry writes:
In order to improve the special needs child’s wellness, parents need to be healthy – physically, mentally, emotionally and spiritually.

Families with autism spectrum disorders experience certain underlying conditions, such as allergies, depression, diabetes, gastrointestinal and/or autoimmune problems, toxic overload, and more. In natural and preventative medicine, the aim is to reduce the chances of those disorders manifesting themselves by providing specific diets and lifestyle changes. The modalities used are:

  1. • Nutritional counseling for the whole family, such as specific foods to be added, or avoided, in the daily diet. Bio-individual, nutritional assessment, and practical advice can be provided, in order to get our kids to eat what is good for them, taking into account that so many are extremely picky eaters.
  2. • Mind/ Body medicine that addresses, but is not limited to, stresses in the family that arise from caring for a child with special needs.
  3. • Detoxification, orthomolecular therapy, environmental health: when our body’s natural detoxification pathways are impaired, we need to detox in order to restore the body’s natural ability to get rid of toxins by itself. With orthomolecular therapy, we adjust deficiencies and excesses of minerals and vitamins in the body. In addition, we can identify possible toxic environmental exposures.
  4. • Herbal medicine: in natural medicine, you can often avoid harsh chemical drugs with herbal remedies that have less side effects. Plus, they can be used for longer periods of time and heal root causes, instead of simply suppressing symptoms.
  5. • Homeopathy and essential oils: many homeopathy protocols and essential oils can help the body heal itself.

To set up a meeting with Dr. Eshraghi, please call our office at 954 873 8413 or 305 720 9099

Rebecca Sherry Eshraghi, DNM, Ph.D.
www.naturalhealthpowerworks.com

*DISCLAIMER: Natural/ holistic health care is not intended as diagnosis, prescription, treatment or cure for any disease, mental or physical, and is not a substitute for regular medical care. Rebecca Sherry Eshraghi is a certified Doctor of Natural Medicine, not licensed in the state of Florida.

Observations on Autism Therapies

Sunday, July 17th, 2016

The purpose of biomedical treatment is better health, so that the patient can achieve the goals set by the other professionals. The bedrock of autism recovery lies in the traditional therapies, including Applied Behavioral Analysis, Speech and Language, Physical and Occupational interventions.

At The Child Development Center, we have watched thousands of children who undergo a myriad of treatments, and spoken to the parents who part with their valuable resources of money and time. These are some observations that may help other professionals achieve their goals in a more effective manner.

“Just ignore those negative behaviors.” It depends on the specifics. Sure, an annoying stim or persistent request may diminish over time. But, try overlooking a child who has gotten out of the car seat and is pulling Mom’s hair. Also, advice delivered by providers who only spend 45 minutes is not the same thing as living with a problem  24/7. The child needs to be admonished, placed at arm’s length, admonished, and repeat until they get it. Biting, pinching, punching is never cute or harmless, and must be extinguished at the earliest age.

“Try to reduce the echolalia or scripting.” Let’s get this straight – you’ve been telling the kid to speak for 2 (or more) years, and now your telling them not to speak? That’s too confusing. Scripting is only possible because the intelligent child CAN memorize long paragraphs.
Also, if age appropriate expressive language is supposed to contain, say, 1000 phrases, and the recovering child only has 300, they will probably repeat the same phrase 3 or more times just to take up the space. The content doesn’t really need to make sense.

It’s SPEECH therapy, mostly, not Speech and Language. I have yet to meet a child who is really confused by multiple languages. Spanglish is fine. It’s all communication.”I think that he has speech apraxia.” Or, “I don’t think he has speech apraxia.” Or, “I don’t think that he’s really autistic.” If a person wants to speak but can’t, it’s speech apraxia. If they also exhibit repetitive behaviors and social isolation, it’s ASD.

“He’s falling behind in academics.” Consider the developmental stage. Is the child talking, talking to his toys, taking to other children, playing with other kids? They probably know their letters, numbers, and colors, anyway. However, socialization is paramount.

“She needs more focus and attention, with less hyperactivity and distractibility.” The behavior is mostly due to immaturity. Patience and persistence pays. Watch it… someone is going to want to prescribe stimulant drugs. Administering potent medications to a toddler rarely produces the desired effect.

“He’s anxious.” Given that a child has difficulty connecting, that would be an appropriate response. As they improve, children will observe others at play so that they learn the correct responses. Watch it… someone is going to give antipsychotic drugs. Administering potent medications to a toddler rarely produces the desired effect.

“I can’t help this child… he’s too affected.”
Doesn’t that mean, “You need to hire a better therapist?

Sometimes, setting goals, such as, “The child will put the correct shape into the cup 3 out of 5 times,” is appropriate. Others, such as not wandering, joining circle-time, or answering to their name, should be 100%, if the child is to succeed in a neurotypical classroom.

“Mom or Dad is not doing the right thing.” The parent is not the therapist, so part of a professional’s job is to devise a solution, not criticize.

Autism recovery is molded by hard-working, highly trained professional therapists. The newly emerging epidemic of ASD has created the need to re-think solutions.

Ultimately, we are all trying to achieve the same goals of getting children on the right path.

Neurodiversity and Autism

Sunday, April 3rd, 2016

Hands2We are not going to cure cancer. Eventually, medical science will successfully treat melanoma, breast cancer, or lymphoma. One disease at-a-time, with discovery and experience along the way. Likewise, there will come an understanding of the underlying causes, treatments and prevention for all the types and conditions that appear with signs and symptoms now considered ASD.

Calling the epidemic ‘Autism Spectrum Disorder’ is, paradoxically, both accurate and imprecise. It is valid to the extent that, given our present state of ignorance, there exists an array of individuals who fit a common diagnostic category. However, it comprises too many people with a myriad of conditions. Under the present state-of-the-art, there are those who are just, well, neuro-diverse!

Maybe it’s Asperger’s syndrome (OK to say, before DSM 5.0). Perhaps, it’s extreme ADHD, with a bit of sensory issues. There is oppositional behavior disorder, visual and/or auditory, sensory processing and executive function disorder. How about social processing disorder?

The A Word
A new BBC series entitled ‘The A Word’ was recently reviewed by the New York Times. While it’s admirable to expose the public to the challenges of families who are affected by this modern malady, as a pediatrician who has been practicing for over 40 years, the comments by one reviewer (who co-authored an article with his autistic daughter) gave me cause for concern.

“Years ago, black people or gay people were on telly purely as black people or gay people. Autistic people still are — they appear on programs purely as autistic people,” he said. “It would be great to see autistic people in TV dramas who are just there, like any other character.”

ARE YOU KIDDING ME?
Who ever said, “We need to hear more tuberculosis patients on the radio?” Or, “People with polio don’t appear enough on TV.” The scientific community astutely researched, understood, and successfully treated those emerging medical conditions.

It’s not just neurodiversity
This is why a more precise diagnosis is needed. So far, I see speech apraxia and oral-motor dysfunction (including extreme feeding disorders) as THE LINE. It impedes even the brightest and most talented of individuals.

In addition to the lack of communication, aggression (against self or others) is the most perplexing and difficult-to-treat feature of ASD. In toddlers, negative behaviors usually emanate from discomfort, pain, or unmet needs. It is the discovery and treatment of such co-morbidities that enables clinicians to successfully address those youngest patients. As children age, that lack of contact and the frustration that accompanies loneliness and isolation often result in tantrums or other negative behaviors.

Discussion
By the way, the difficulty is with speech and communication, not S&L. Patients are not ‘confused’ by multiple languages, ‘spoiled’ by grandparents, or ‘isolated’ by numerous siblings. In our multi-cultural world, the most incommunicative children can follow directions given by a variety of non-English-speaking caregivers. Additionally, even sign language is difficult for those who are most affected.

I’m all for embracing the neurodiverse universe. Its inhabitants are interesting and have provided the horsepower for imagination that has helped change the world. When people who are different require special instruction or more understanding, popularizing their plight makes sense.

Conclusion
Doctors are not seeking to  ‘cure’ neurodiversity. On the contrary, we ought to learn about different brains and embrace their uniqueness. However, to the extent that autism is considered “Locked in autism silent prison,” practitioners need to understand and treat this enigmatic medical condition.

There is neurodiversity. And, there are autisms.

The Life Span of Autism

Sunday, March 27th, 2016

LifeSpanLast week, Autistica, a UK “… charity which both funds and campaigns for medical research to understand the causes of autism, improve diagnosis, and develop new treatments and interventions…” released a report that received worldwide attention.

Personal tragedies, public crisis
The urgent need for a national response to early death in autism.

The Report
Based on a recent Swedish study, these points were highlighted:
• Autistic adults with a learning disability are 40 times more likely to die prematurely due to a neurological condition, with epilepsy the leading cause of death.
Those without a learning disability are 9 times more likely to die from suicide.
 Autistic people die on average 18 years earlier than the general population.
For those with autism and learning disabilities, death occurs more than 30 years before their time.

As with any new alarming finding, the media reacted. One report began, “It’s only one study, but the results are disturbing.” That was one of the least sensational interpretations.

Previous literature
Comparative Mortality of Persons with Autism in California, published in 1998, demonstrated that, “Persons with autism are subject to increased mortality risk…”

Research “… to determine which causes of death are more frequent in persons with autism, and by how much, compared with the general population…” was further documented over 15 years ago. The doctors concluded, “… excess mortality was especially marked for persons with severe mental retardation, but life expectancy is reduced even for persons who are fully ambulatory and who have only mild mental retardation.”

Five years ago, another set of authors verified those statistics and recommended, “Various national health care and state developmental disability agency initiatives to reduce risk of mortality are described.”

Likewise, the increased mortality associated with epilepsy (convulsions of various and often uncertain origins) has been previously demonstrated.

The Response
Comments following the story as reported in Science magazine followed various lines of thinking. There was anger directed at doctors, frustration with government failures, exasperation over how long this information has taken to surface, and advice about treatment.

Individuals ‘on the Spectrum’ complained of depression and outrage was expressed by many. An AutismSpeaks vice president explained that, “we need to use caution when interpreting these data…”

Discussion
What is the life span in autism? The most precise answer ought to take into account what kind of autism (genetic, immunologic, metabolic, e.g.), and whether a patient continues to experience co-morbid signs and symptoms. Over-treatment with potent pharmaceutical preparations may contribute to the cause of the increased mortality. Or, caught early with appropriate intervention, the diagnosis can be lost, so ’cause of death’ should parallel the neuro-typical. 

It’s important to get the word out about the ASD epidemic. The media attention to this particular literature, however, is somehow more urgent because of the loss of life; not family and societal costs, nor the numerous qualities that are delayed or absent in the presence of signs and symptoms of autism.

Additionally, certain basic issues, such as improving the general health of those most affected with ASD, proper housing and nutrition shouldn’t require lots of resources to study and implement. Understanding epilepsy, seizure control and psychiatric care will, obviously, take more time.

Conclusion
Autistica appears to be doing valuable work to address this modern epidemic. The recommendations that were made at the conclusion of the report may actually get some traction, especially with the backing of Deutsche Bank.

So, to the extent that this predictable and pre-reported outcome amplifies the need for better answers, media attention to this side of the story should prove helpful.

Doctors Failing to Understand Autism

Sunday, November 15th, 2015

When faced with the unknown or uncertain, physicians will often rely on language that, while sounding scientific and medical, just restates the obvious or says nothing helpful at all.

“I’m not aware of any literature on that topic.” Does that mean that the clinician has read everything and there isn’t any, or is the doctor displaying ignorance? A better answer would be, “Let me read about that and I will get back to you.”

“I don’t want to give you a diagnosis at this time.” It’s not up to the physician to decide. At least,  there could be a presentation of possible diagnoses, with the statement about a workup and interventions that the parent can initiate.

“It’s eczema. I’ll prescribe a steroid cream.” What is causing the skin rash? And, steroids will temporarily clear up any skin condition.

A 3-year-old wanders in circles and does not play with other children. “It looks like your child has developmental delay.” Stating the patently obvious is a frequent technique to deflect the physician’s lack of knowledge. The oncologist wouldn’t just say, “It’s a lump.”

“It’s not speech apraxia.” If a toddler wants to communicate and cannot say any intelligible words, that IS the name for that symptom. The converse situation occurs when the professional says that child has autism AND speech apraxia. It’s autism.

“I’d like you to come back in 6 months to see how the child is doing.” If that is the only reason that the doctor has for your return, he should be paying YOU for the visit.

“It’s not autism, I’d say more like PDD-NOS (pervasive developmental delay – not otherwise specified).” The DSM 5.0 has been published. The medical establishment has spoken. If a child exhibits repetitive or unusual behaviors and has communication delay, it’s Autism Spectrum Disorder.

“Those special diets are risky and can lead to nutritional deficiencies.” How about checking nutritional status with some appropriate lab testing? Better, check is as part of the initial workup, especially in picky eaters.

“He’s a boy… You speak two languages… She’s spoiled… Your grandfather was that way, etc.” We are in the midst of an epidemic. The child should be thoroughly evaluated for ASD.

“Studies have not shown significant results.” That depends on what research the practitioner chooses to read and believe. And, whether a treatment is worthwhile is best determined from the parents’ point-of-view.

“We can give medication to get rid of those ‘stims’.” One, repetitive behaviors are often communication, so reprimands may cause even more frustration. Two, those drugs are potent and have serious side effects.

“We can give medication for that anxiety.” One, nervousness is frequently appropriate. The affected child is concerned about not having the skills to join the group. Simply depressing the child’s response is not necessarily a good thing. Two, those drugs are potent and have serious side effects.

“We can give… Miralax for constipation… Zantac for refluxantibiotics for everything.” How about a thorough evaluation of why?

“It’s not anything to be concerned about.” The number one lesson that any pediatrician should learn is, “Listen to your mother(s)!” Worrying is part of their job. The child’s physician should perform an appropriate evaluation.

“Those ‘autism doctors’ are just quacks who will waste your time and money.” The parents can see progress for themselves. Families will continue to search for answers when traditional therapies alone do not seem sufficient.

The parents of today’s children who show signs and symptoms consistent with the epidemic of ASD are often more well-read than the doctor. These questions should spark interest on the professional’s part to offer more than lip-service to such a serious situation.

What Pediatricians Can Do About the Autism Epidemic

Saturday, June 27th, 2015

Pediatricians are the first line of defense against childhood conditions that have lifelong effects. Traditionally, that has included the Denver Developmental Exam, frequent doctor visits in the first few years, and vaccinations to prevent childhood diseases.

News Flash
There is an epidemic of childhood conditions that include ADHD and ASD, conflicting opinions notwithstanding. That means that pediatricians ‘stand at the door’, and are responsible for prevention and treatment, no matter how much they resist this reality.

Stay up to date on pertinent literature. As the HIV epidemic began to emerge, medical science experienced a quantum leap in our knowledge about the immune system. Similarly, the increasing volume of parents who are concerned about their children’s delayed speech, lack of focus, and hyperactivity, demands more research and knowledge and less kindly reassurance, which is based on the experience of the previous century.

Carry a high index of suspicion. Five or ten minutes spent with a parent and child is not enough time to perform a thorough physical examination and elicit pertinent clinical information. The visit should include a documented nutritional summary.

Make a presumptive (if not definitive) diagnosis. Parents need information, and the child’s pediatrician is the expert. It’s fairly simple – delay in communication, repetitive behaviors and lack of socialization demand an explanation and exploration. Loss of language, lack of eye contact, and poor tone are red flags to be explored, not ignored.

Do a proper workup. At least check the blood count, thyroid, liver and kidney function. What is over-kill about exploring vitamin and mineral deficiencies in a picky eater? Then, the doctor could evaluate whether appropriate intervention makes a difference in the signs and symptoms that concern parents.

Make appropriate consultations as early as possible. In a recent UC Davis study, six of seven high-risk children who received therapy alone lost the presumptive diagnosis. Parents will be more upset with the pediatrician who says, “Let’s wait,” and improvement does not occur, than one who advises, “Let’s err on the side of caution,” even if symptoms could have abated without intervention.

 Advise parents to try the gluten free – casein free diet for a few months. What is there to be afraid of? Uneasiness about creating a nutritional deficiency can be easily checked with laboratory evaluation and documentation of proper growth.

Perform an appropriate evaluation for associated signs and symptoms. Explore the cause of frequent infections, rather than responding with the knee-jerk reaction of prescribing antibiotics. Miralax® should only be given for brief periods and for occasional constipation, and isn’t even approved in children. GERD that is treated with antacid preparations can lead to vitamin deficiencies. Steroids may reduce skin rashes, but do not address to the root cause.

When a child has the diagnosis of ASD, the doctor should explore safety issues. Elopement is not uncommon, so family plans should be devised. Although learning to swim is no insurance against a tragedy, acquiring that skill helps provide some peace of mind. Incongruous laws notwithstanding, discussing gun security is a must.

Provide parents with a reading list. TheAutismDoctor.com is a good start, where discussions are presented to address the polarized world of autism diagnosis and treatment. When possible, the essays have hyperlinks to the original research. The Newsworthy tab includes the most recent and pertinent literature.

Become knowledgeable about the variety of protocols. The doctor who has read the literature (both pro and con) about alternative treatments is the only one qualified to give advice. Practitioners who assert, “I’m not aware of this or that treatment,” may be highlighting their ignorance, rather than providing up-to-date info. Therefore, unless the pediatrician knows about a therapy, the patient will surf the ‘net, and listen to the professional who does.

Aspertools for Asperger’s Spectrum

Sunday, May 31st, 2015

There is a great deal of medical information to be learned about the autism epidemic of this century. Aspertools: The Practical Guide to Understanding and Embracing Asperger’s, Autism Spectrum Disorders, and Neurodiversity is a useful book to read and keep in our growing libraries.

It’s an interesting story in it’s own right.
The author is an orthopedic surgeon, professional heavyweight boxer, writer and film maker. That background, plus his life as the loving father of a special needs child, weaves a fascinating thread throughout the text.

This book is helpful for many parental challenges, not just Asperger’s Syndrome.
“Everyone… should be encouraged to discover their passion and then pursue it. If you can make a living at it, and if you can help others while you do it, so much the better.” Dr. Reitman talks about behaviors that get “amplified” in an Asperger’s patient, so many of the insights could work with ADHD, ASD, and oppositional behaviors, as well.

It’s best read by both the Asperg-er and the Asper-gee (those interacting with an Aspie).
Each chapter is presented from multiple points of view, including an expert teacher and the author’s daughter, who has the condition (and more), and provides helpful hints and useful action plans.

It’s a great place to start for a family looking for answers.
Patients with Asperger’s Syndrome have some common challenges, for sure. However, on closer examination, there is a great deal of diversity.
Dr. Reitman covers topics such as anxiety, meltdowns, sensory issues, transitioning, repetitive thoughts and “hyper-interests”, and socialization, with common sense techniques that deserve a trial.

The book also provides insights for experienced parents.
Aspertools contains information that makes sense and is easily applied to real life situations. Understanding that video games provide (virtual) socialization and an increased level of control, provides food for thought. Additionally, there are tips for limiting choices “to avoid ‘No!'”, practical concepts, such as breaking larger tasks into smaller ones, and the importance of time management.

Neurodiversity
Historically, the difference between Asperger’s and Autism was the age of language acquisition (later in the latter). The DSM 5.0 has subsumed the diagnosis under Spectrum Disorder. The delay in typical socialization is now being recognized as a common factor.

Autism expert (and patient) Jim Sinclair first spoke about the concept of neurodiversity in 1993. Aspertools contains informative vignettes, insightful humor, pathos, and practical ways to chart a successful course for an ‘Aspie’. In short, Dr. Reitman emphasizes the need to look at the world through another’s eyes.

In some ways, being less obvious than their ASD cousins, Asperger’s patients get the short side of research and successful intervention. This text paves the way for a better life for affected families.

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