Archive for the ‘Conferences’ Category

Autism & MTHFR Explained

Sunday, April 1st, 2018

From the work of Jill James, Amy Yasko, and others

I have attempted to write this explanation – about the MTHFR gene – for more than a year now, often surrendering because it just gets so complicated (see diagram on right – and that is a simplified version)!

However, almost daily now, I need to explain the testing and interventions that revolve around the MuthrF#$Ker gene, which produces an enzyme that can assist in the brain’s ability to process (among many other important body reactions) in patients with ASD.

So, here is my simplified version, which covers the important steps for our understanding about testing and treatment for autism:

1. Folate (natural), folic acid (synthetic), Folinic acid (active) and 5-methyl folate (active) are not exactly the same a form of Vitamin B9.

2. There are several reasons why the levels of the B9 might be reduced:
Reduced intake. Picky eaters and kids don’t usually savor green leafy vegetables or lentils.
Problems with internal state of health will affect availability. Synthetic folic acid must go through the liver, natural folate is metabolized through the intestines.
Antibodies that bind to, or block the active compound. This is why doctors check the Folate Receptor Antibody Test (FRAT). The presence of such inappropriate barriers implicates reduced activity, so administration of additional vitamin should help alleviate difficulties.
Any ‘weakness’ in the body’s inability to convert the vitamin – that includes the MTHFR gene that regulates the enzyme called methylene tetrahydrofolate reductase.

3. The most studied and concerning genetic variations are often designated as C677>T, A1298>C. Hieroglyphics aside, we  inherit a ‘C‘ and an ‘A’ from each parent, and each deviation yields a less potent enzyme, so the implication is that giving the active forms of the vitamin can be beneficial. (Dr. Google, and many labs will report variations as pertains to the risk of hyperhomocysteinemia, a medical condition observed in approximately 5% of the general population, associated with an increased risk for many disorders.) For ASD, improved communication is the goal of treatment.

4. The supplements include L-methyl folate, available as a prescription under Deplin®. A web search of this product will often result in a call from parents, “My child doesn’t have schizophrenia or depression!” Marketing. Improved outlook is just one of the treatment outcomes. As noted previously, in ASD the aim is more efficient neural processing.

5. Another intervention is available as folinic acid (<1 mg dosages) and as the prescription, Leucovorin. An Internet inquiry may stimulate a call, such as, “My child doesn’t have cancer or get chemotherapy.” Different market. At a recent MedMaps.org conference, I asked two top researchers whether they prefer one or the other active form. Each doctor replied with the opposite answer. Availability and cost help determine choice, and sometimes we try both.

Conclusion
The various forms of folate appear to be safe, effective interventions that can address weaknesses in the area of oral-motor functioning in individuals with ASD. In practice, agitation is the principle side effect, and too much ‘stimming’ or aggression is reason for discontinuance.

The gene controlling MTHFR production is important, but not the only one affecting multiple enzymatic pathways that lead to successful data processing. We are already discovering other critical genetic steps (SOD, COMT, etc.) and there are thousands of other genetic crossroads that will improve our understanding and lead to successful interventions.

For our more advanced readers – please feel free to submit any corrections, etc. that you feel might be necessary.

Medical Academy of Pediatric Special Needs Conference – Spring 2018

Sunday, March 18th, 2018

The Fall 2017 conference was ‘hurricaned’ out, so it’s been a year since I reported on the semi-annual 3-day scientific meeting of the Medical Academy of Pediatric Special Needs. This post will focus on the two most controversial topics – one, a treatment, and the other involving a popular new diagnosis.

Medical marijuana.
The less psychoactive, and legal part of pot – CBD (cannabidiol) – has been available for a couple of years now. Our experience at The Child Development Center, and the consensus of the group, was that it may be helpful for seizures, but perhaps less so for aggression, stimming and sleep. With no serious side effects, however, except for price (for high quality, measurable concentrations), it could be worth a try.

Much more effective, according to Dr. Michael Elice, are products that contain a measurable amount of THC (tetrahydrocannabinol). The presentation covered his experience with CBD+THC = medical marijuana. Utilizing the Autism Behavior Checklist as a measuring tool, he noted significant reductions in irritability, ‘lethargy’, stereotypy (stimming) inappropriate speech, and hyperactivity for a small number of children. To be fair, he also presented a child whose symptoms worsened with treatment. Overall, Dr. Elice told the audience that this intervention can be quite helpful for aggression and negative behaviors, though not for the ‘verbal diarrhea’ that many recovering children exhibit.

I inquired about the paucity of literature supporting medical marijuana, and studies that describe abnormal brain development when administered to youngsters. Dr. Elice responded that 1) The affected children’s brains are already demonstrating problems in development, and 2) Compared to the conventional meds, cannabis seems more efficacious with fewer side effects

No protocol was offered… the correct form, concentrations of THC/CBD, timing, and best mode of administration have yet to be elucidated. For physicians in states where pot is not legal, this treatment is not a realistic option. Even where there are medical exemptions, the process is resource intensive and tedious.

PANDAS/PANS 
Auto-immunity that affects a young child’s brain in an acute fashion, has been a popular diagnosis of late. Participants were treated to a full day of discussion by the most famous clinicians and researchers in the field. The room was packed.

The first speaker of the day was Dr. Aristo Vojdani, an Israeli researcher who practically invented food allergy testing. In fact, he began his presentation by declaring that he has learned the weaknesses of his earlier work, and the misconceptions about those tests. His take home messages were 1) Group A streptococcus is only one of many environmental trigger that contribute to symptoms, 2) Many pathogens and food components cross react with brain cells to cause problems, and 3) Accurately defining such antibodies and which receptors are affected is necessary to remove the environmental triggers.

Dr. Madeline Cunningham presented her modern view of molecular mimicry – “the sharing of antigenic determinants between the host and invading organisms.” The heart, brain, and other tissues can become the targets of the body’s response to environmental pathogens or toxins. Identifying the reactivity of brain proteins – the Cunningham Panel – may not be specific to strep, and helps explain disparate results. Tics, OCD and other neurologic difficulties are the result of a weakened blood-brain barrier and cross-reactivity.

Dr. Tanya Murphy presented, Antibiotic Treatment in PANS, Panacea or not? The specific signs and symptoms of PANS and PANDAS were elucidated. The role of Group A strep as a precipitating agent was emphasized. Specifically the rise of ASO (antistreptolysin O) often precedes the rise AntiDNAse B, but a positive culture for the organism is the best evidence. The successful role of antibiotics in general, and which ones seemed to work best was covered in detail.

A panel discussion involving these esteemed experts completed this incredibly interesting day.

Conclusions
Practicing functional and integrative medicine nowadays, with insurance stipulations and conventional dogma, presents unique challenges. The pediatric version faces even more obstacles, due to uncertainty of diagnosis, non-conventional treatments, and the vaccination issues. Without this Pediatric Fellowship, such work would be even more frustrating. The sharing of our collective experience regarding the epidemic of children with ASD and ADHD has taken diagnosis and treatment to newer and more modern levels of understanding.

As in previous years, the most valuable part of these conferences is the esprit du corps and networking of experience and ideas.

A Successful Autism Doctor Visit

Sunday, February 18th, 2018

This story is a total rip-off. The New York Times recently featured a worthwhile piece entitled, A Doctor’s Guide to a Good Appointment. In that vein, I couldn’t help but add my two cents worth of advice about how to make the best of a family’s first visit to a developmental specialist.

Finding a functional medicine specialist.
The opinion of a pediatric neurologist is a good start. But, time is of the essence and evaluations that involve months of waiting serve the patient poorly, because they represent needless delay. A trusted pediatrician can be a great help. Therapists’ views are important because they are independent observers who know the child more intimately.

However, if you still can’t put your finger on what’s wrong, and if you find that you have been going to a variety of specialists (e.g. GI, allergy, dermatologist. pulmonologist), maybe it is time to seek a modern medical viewpoint. When possible, ask other parents about their research and experience, but don’t forget that every child is unique, so this merely represents one piece of the puzzle. The most reliable web advice is to be found at the Medical Academy of Pediatric Special Needs clinician directory.

Before your visit:
Labs, X-rays, MRI’s, EEG’s, IEP’s, psychological reports, hospital records, and evaluations of all types are extremely helpful. It is understandable, however, that some parents may prefer a completely fresh, unbiased opinion, perhaps saving that data for a future visit.

At The Child Development Center, we find videos extremely valuable. Taking the time to produce a written history with your specific concerns often yields the most satisfying consultation.

On the day of:
It may be difficult to appreciate the anxiety that all family members experience in this situation, including the child. Another stranger. More tests. Overcoming fear may require social stories, bribery, a favorite food, electronic devices, or some other tested method.

Either a picture, list, or a bag of the present medications and supplements, streamlines the visit. Plus, any archive of past meds – what worked and what didn’t – can similarly improve the efficiency of the interview.

Perhaps it goes without saying, but be sure to bring along any familiar toys, blankets, etc., so that the doctor is able to observe the children and the parents can focus on the conversation. Whenever possible, a close family member or therapist will be a valuable addition to the team.

An open discussion with the practitioner is imperative. Even the tension caused by a family’s disagreement about whether there really is a problem, is important in making an accurate assessment and creating a useful treatment plan.

Back at Home:
Perhaps this is the most difficult part. Who should you believe? Have any of the previous treatments been particularly successful? Has the child reached some plateau where he/she seems stuck? What are the alternatives? Listen to your heart.

Having reached some degree of non-conventional intervention, there may be a desire to further micromanage. Can 2 functional medicine doctors perform better than one? Although parents who attempt this course may be correct, a mixture of protocols could delay improvement. Get started with one intervention at a time, and become comfortable that nothing is causing harm. Be clear about what skills you are targeting and document progress.

Not infrequently, the treatment can involve periods of increased aggression or even regression, due to the ‘die-off’ of harmful organisms, food restriction, arduous therapy sessions, even new-found skills and sensory overload. Close contact with the practitioner (via email, phone, follow-up visits) is a must at this juncture, if the treatment plan is to be followed and successfully implemented.

Conclusion
All of the points in the ‘real’ Times article are well-taken and valuable in this instance, as well. Hopefully, this advice will serve to make the experience of taking the next step in your child’s journey even more productive.

Vintage 20th Century Autism Thinking

Sunday, February 4th, 2018

Electroshock therapy in 1950’s

Think about what is was like for ‘pioneer’ doctors at the beginning of the last century. I am certain that they were derided by the medical establishment, whose beliefs included ‘bleeding’ or electroshock therapy as treatment for every enigmatic condition. Hand washing, vaccinations and antibiotics – the science of 20th century medicine was being laid down. Germ theory and new technologies disturbed the status quo.

Why should the dawn of this era be any different? Gene theories and digital technologies are transformative. Here is my ‘top 10 list’ of the most incorrect statements that have continued to influence autism diagnosis and treatment, even as this new millennium unfolds:

Autism is a psychiatric condition. The diagnosis continues to find a home in the Diagnostic and Statistical Manual of Mental Disorders. Such an assignation furthers the crippling midcentury point of view, as determined by a Freudian psychiatrist, that ASD was due to poor parenting,

Autism is a genetic condition. Such doctrine is simplistic at best. Humans are not fruit flies, mutating from one generation to the next. Genetics represents susceptibility and phenotypic expression is determined by the environment. Loaded Gun. Trigger.

There really isn’t an Autism Epidemic. It just used to be called mental retardation.
1. Patients with ASD are usually average or above-normal intelligence, and often have skills that neurotypical kids lack (sense of direction, puzzles, memorization, e.g.).
2. The incidence of MR 30 years ago was 4 per thousand. Even if every child was misdiagnosed, it doesn’t explain why 2% of boys are now ‘on the spectrum’.
3. The increased numbers that have resulted from expansion of diagnostic criteria and improved recognition only represent a fraction of additional affected children.

Biomedical interventions are useless at best, snake oil at worst. The medical treatment of autism is into its 6th decade of successful treatment for many patients. Dr. Jill James described a significant intracellular biomarker (reduced/oxidized glutathione) 15 years ago. A medical workup and safe, useful treatments have ensued. For pediatricians who claim, “I don’t know much about autism,” it’s time to open a book, or journal, or you-tube, or podcast.

Only the traditional therapies are effective. This is a corollary to the previous erroneous statement. There’s no doubt that behavioral, speech, occupational and physical are effective treatments. However, how couldn’t it help professionals when they get to work on a healthier child, who is more likely to attend and cooperate?

The Gut-Brain connection is not real science. The association was described more than 25 years ago by a prominent Columbia University researcher, and has been a mainstay in many subsequent journals. Doctors who tell patients, “Don’t go there,” are way past their prime.

PANDAS is not a real entity. Even now, this specific medical diagnosis, first elucidated by an NIH researcher a dozen and a half years ago, continues to be debated as in, “Do you believe in PANDAS?”

All vaccinations are safe for all people all of the time. That was the thinking as inoculation programs practically eradicated many childhood diseases in the 20th Century. But, Guillaine-Barre that complicated flu vaccinations, metabolic issues that preclude administration, seizures, allergy against ingredients, and toxicity of components can cause concern. For the next century, we need to see more non-industry funded, randomized, controlled and double blind studies that identify at-risk infants and toddlers.

Children can’t really recover from ASD. We now know that the earlier the diagnosis, the more likely it is that they will outgrow diagnostic criteria. Our goal at The Child Development Center is return to the general education student population. ‘Normal’ is a relative term – what are each child’s weaknesses and strengths?

Older people with autism can’t get better. With proper diagnosis and treatment, there are patients who achieve self control with fewer (or no) medications, develop increased communication skills, boost focus in order to learn new skills, and even manage social situations. Interventions are not false hope if they work.

Discussion
I frequently encounter parents whose pediatricians seem more concerned about their child’s current vaccination status than this mysterious, multifactorial, and sometimes debilitating developmental disorder. It’s about time they awaken to the first childhood epidemic of the new century.

Significant Autism Events of 2017

Thursday, December 28th, 2017

In the face of the exploding incidence of childhood developmental abnormalities, scientific knowledge is sorely lacking. These are my top picks for this year’s most useful human research and events that address our understanding about the cause(s) and treatment(s) of these conditions.

January
Disrupted prediction errors index social deficits in autism spectrum disorder
This BRAIN study which locates “… coding discrepancies between the predicted and actual outcome of another’s decisions…” provides, “a novel insight into the neural substrates underlying autism spectrum disorder social symptom severity… could provide more targeted therapies to help ameliorate social deficits in autism spectrum disorder.”

February
Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study
“This exploratory, extended-duration treatment protocol thus appears to be a promising approach to alter the gut microbiome and virome and improve GI and behavioral symptoms of ASD. Improvements in GI symptoms, ASD symptoms, and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact.”

March
WORLD’S LARGEST AUTISM GENOME DATABASE SHINES NEW LIGHT ON MANY ‘AUTISMS’
There were several studies, this year, that implicated the genetic susceptibility of ASD. This one is from Autism Speaks’ MSSNG project. “The omitted letters… (pronounced “missing”) represent the missing information about autism that the research program seeks to deliver.”

April – Autism Awareness month
The Pesticide Action Network and the Natural Resources Defense Council filed a complaint against the EPA, led by Trump appointee Scott Pruitt, asking a federal court to make the agency follow through on an Obama-era recommendation to ban chlorpyrifos, a pesticide linked to brain damage in children. The Trump administration reversed that recommendation last week — even though the EPA concluded in November that the pesticide is associated with autism, lowered intelligence, developmental delays, and attention deficit disorders.

Injury Mortality in Individuals With Autism
Conclusions were that, “Individuals with autism appear to be at substantially heightened risk for death from injury.”

From the FDA, this warning – Autism: Beware of Potentially Dangerous Therapies and Products

May
Autologous Cord Blood Infusions Are Safe and Feasible in Young Children with Autism Spectrum Disorder: Results of a Single-Center Phase I Open-Label Trial
Not the most rigorous study design, and safety does not imply efficacy. Nevertheless, by utilizing the infant’s own stored umbilical cord blood, “Behavioral improvements were observed during the first 6 months after infusion and were greater in children with higher baseline nonverbal intelligence quotients.”

June
Intranasal oxytocin treatment for social deficits and biomarkers of response in children with autism
The Child Development Center has been finding this treatment somewhat helpful for eye contact and socialization.

Functional neuroimaging of high-risk 6-month-old infants predicts a diagnosis of autism at 24 months of age
Functional, not merely structural connectivity was tested at a very early age. Only in the research phase, “These findings have clinical implications for early risk assessment and the feasibility of developing early preventative interventions for ASD.”

July
Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial
Dr. Naviaux reported the use of a 100 year-old medicine for African Sleeping Sickness on a small group of ASD patients. His unified theory of central nervous system dysfunction involves the ‘Cell Danger Response’ – a proposed common pathway leading to autism. This could represent the most promising research of the year.

August
Increased Extra-axial Cerebrospinal Fluid in High-Risk Infants Who Later Develop Autism
The MRI test may assist in identifying autism risk in susceptible infants and younger siblings of affected children. However, accuracy was not optimal. Additional studies will be required to suggest whether it is worth risking exposure to anesthesia for testing.

September
Some good publicity for Planet Autism. The Good Doctor, a TV show about an autistic professional appeared on ABC. Compared to Rain Man, it represents a quantum leap in the public perception of autism. Also, Julia, a muppet with autism, joined the cast of the popular PBS children’s show ‘Sesame Street’. Plus, debuting this year was Netflix’ new comedy about an autistic teen, Atypical. Finally, you may want to check out these two offerings: Keep the Change, a love story which challenges popular misconceptions about ASD, and the more serious Deejinclusion shouldn’t be a lottery.

Combined Prenatal Pesticide Exposure and Folic Acid Intake in Relation to Autism Spectrum Disorder
Folic acid is a vitamin given to pregnant mothers to prevent spina bifida. When taken in higher doses during the first trimester, “… associations between pesticide exposures and ASD were attenuated…” Should all younger women be taking vitamin B9, or could it be too much of a good thing?

October
Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months.
Comparison of Autism Screening in Younger and Older Toddlers.
Accuracy of Modified Checklist for Autism in Toddlers (M-CHAT) in Detecting Autism and Other Developmental Disorders in Community Clinics.
These three studies evaluated a popular screening tool for autism, and found that is more accurate in children at 24 months of age than at 18 months. Pediatricians and other specialists need a superior tool to test children younger than 20 months. At The Child Development Center, we have found that the Autism Evaluation Checklist, careful observation, and a detailed history will yield a more accurate diagnosis.

November`
Association of White Matter Structure With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder
By utilizing a specialized MRI technique researchers were able to discover, “ASD traits and inattention and indexes of white matter organization, particularly in the…” tissue that connects the two halves of our brain. This technology might also identify ‘Processing’ and ‘Executive functioning’ disorders.

Subcortical Brain and Behavior Phenotypes Differentiate Infants With Autism Versus Language Delay
By combining MRI information plus behavioral assessments, scientists might be able to predict which children are only experiencing ‘benign’ speech delay.

December
Tools and techniques to improve the oral health of children with autism
By offering these suggestions, there is recognition of the need for improved mouth care in children with sensory and oral-motor issues. It’s one of the most obvious places to reduce the body’s inflammatory load.

Differences in fecal microbial metabolites and microbiota of children with autism spectrum disorders
Confirming the stool testing that functional medicine doctors utilize, “… data in this study support that children with ASD have altered metabolite profiles in feces when compared with neurotypical children and warrant further investigation of metabolites in larger cohorts.” Evidence-based medicine.

Advances on the research of the environmental risk factors of children autism
Amid all of the recent genetic research is this reminder that documents, “risks of autism in children may increase following in prenatal exposure to air pollutants, heavy metal and pesticides.”

Conclusions
Another year of more questions than answers. Why does it seem to be taking so much time for useful human studies to appear? Dollars for basic research depend on funding agencies’ understanding of this enigmatic condition. Plus, it takes more than a billion dollars to develop any new medication, so ASD is a very risky proposition.

Then, there is the Bettleheim effect (he popularized the ‘refrigerator mom’ theory), the Wakefield effect (any new idea about autism becomes suspect), the vaccine effect (just talking about ASD leads to this controversy), and the continued debate about whether there even really IS an epidemic.

However, practically everyone, nowadays, knows some family that is touched by this developmental disorder. We must continue to hope that progress will accelerate in response to the reality of a condition that affects so many of our children

Is Big Pharma Knocking Off Functional Medicine Doctors?

Saturday, November 18th, 2017

I awoke one morning recently, to this shocking Facebook post: 77th Holistic Doctor Shot Dead In Her AZ Home With Her Entire Family.

Considering the violent circumstances surrounding this daunting list of clinicians’ deaths, including Drs. Jeffrey Bradstreet, John HicksRose Polge, etc., I wondered, “Are they coming after me, as well?”

Why I’m really not worried
A small, boutique practice, such as The Child Development Center, should hardly appear on any corporate radar screen. We have taken care of thousands of patients, while pharmaceutical companies can reach multiple millions utilizing propaganda and government access.

Planetary drug stores continue to fund and create new potentially harmful products. This grouping of functional physicians may just represent collateral damage.

Large drug companies possess the power to spread cancer in our collective being, death is but one eventuality. Considering Pharma’s great scientific strides, and enormous profits, someone ought to slip a ‘Fund for Diabetes Prevention Program’ message into the corporate suggestion box (paid for with some of the dough that insulin generates), rather than knock off a few holistic practitioners.

Any conspiracy talk is best minimized because the conversation usually devolves into a controversy regarding the childhood vaccination schedule. The Wakefield effect. More heat, less light.

The story, presented in a somewhat sensational manner, has appeared in more alt-thinking venues, such as ascensionwithearth.com, thescienceofeating.com, and healthnutnews.com. So, the message may simply be ‘preaching to the choir’, or considered ‘kooky’ and overly dramatic.

The local news station reported, “Police: AZ father kills wife, toddler, baby, himself in weekend murder-suicide…
Investigators believe the cause was financial issues. A co-worker… called police Friday after finding all four shot to death in a room.

Conclusion
I sincerely hope that these deaths are not part of some conspiracy. If it’s true, multinational drug companies are only shooting themselves in the foot, getting negative publicity that isn’t worth the effort. Pharmaceutical manufacturers are already entrapping us in a variety of ways.

So, I’m not getting a gun, or hiring a bodyguard. We’ve all got more substantial stuff to worry about, like getting kids with speech apraxia to talk.

Fundraising for Autism Research

Monday, October 23rd, 2017

(Too) many years ago, our Regional Intensive Care Unit had the honor of hosting Audrey Hepburn. At that time, we were knee-deep in cocaine exposed babies, and the entourage stopped at the incubator of a 1 pound infant who was barely visible among the wires and tubes.

I asked the famous actress, 1992 recipient of The Presidential Medal of Freedom, and tireless worker for UNICEF, if she minded that the costs of this single child’s care were expected to exceed $1 million. “Wouldn’t you be able to feed an entire village somewhere?” Her surprising answer was, “There’s enough money for both, if we care to spend it that way.”

Fast forward to a recent NYC fundraiser for Columbia Presbyterian’s Transplant Initiative. I complained to my beautiful and patient wife, Jackie, that autism doesn’t receive the same kind of attention as other medical condtions. Frankly, I was jealous. There is enough money for both, if we choose to spend it that way.

There are presently ~117,000 people requiring an organ transplant of some type. There are over 5 million people with autism. In the past several years, I have attended, and been struck by, similar begrudging feelings at benefits for the Michael J Fox Foundation for Parkinson’s Disease. Sure, it’s important to give people a ‘second chance’ at life. But, have the children who are most affected with ASD, and their families, had any real first opportunity at normalcy?

Look, I’m not trying to compare apples to oranges, but it seems that ASD should be appropriately considered as THE childhood epidemic of OUR time. A great deal more is needed by way of funding for useful investigations. I am honored to serve as a Board Member in our local Autism Society of America – Broward County, but research and medical issues are for other institutions.

Increased collaboration among national organizations, including Autism Speaks, Generation Rescue, Talk About Curing Autism Now, Autism Research Institute, The National Autism Association, and local CARD groups, can only strengthen awareness and support.

Autism is stuck in a century-old paradigm of psychological causation. Lately, parents are offered a genetic etiology that leaves them with little hope. Disparate theories and alternate interventions require evidence-based research. That includes adequate vaccine studies – among other ubiquitous toxins – to identify those infants at possible increased risk for untoward consequences.

Acknowledgement of the successes that doctors, such as myself, are experiencing every day, needs to be appropriately studied and documented. It seems that more funding might be directed toward our work, were it not for all of the controversies surrounding an autism label. Unity among the various interested parties to support ‘N of One‘ treatments may help us attain that goal. That way, more toddlers would have access to earlier medical interventions, as well as conventional therapy.

Columbia’s Transplant organization’s motto is “We don’t just practice medicine. We change it.” Practitioners who are at the forefront of effective autism diagnosis and treatment feel that way, as well.

When Mom and Dad Disagree About Autism Intervention

Sunday, October 15th, 2017

Undoubtedly, the most stressful challenge that any family might face is illness in their child. Even in cases where treatment is established, e.g. acute leukemia, there are bound to be differences of opinion about which doctor, or hospital will do the best job.

When it comes to ASD however, even the diagnosis can remain in doubt. One parent, or a sibling, may have experienced “the same” symptoms, such as late speech or inattentiveness. So, the ‘watchful waiting’ advice from the pediatrician appears most prudent. A neurologist who observed your toddler for 70 seconds may have declared a normal – or dire – outcome. Who to believe? Then, there is the conventional medical community that continues to debate the condition and the ability of earlier recognition to alter the course.

Differences about the diagnosis
 Take an online questionnaire, such as the Autism Treatment Evaluation Checklist or Modified Autism Checklist for Toddlers. Although ‘experts’ may deem such surveying as ineffective, it is certainly a start. And, parents shouldn’t bother quibbling over whether Junior should get a “1” or “2” for any single answer. Observing suspicious tendencies may help convince a spouse, or doctor, that there could be real reason for concern.

 Listen to the advice of grandma or grandpa. They have raised other children, even if it was a different century. Try not to listen to advisors who have no responsibility for their opinions.

 If a therapist is already involved, ask what signs and symptoms they view as worrisome. It’s not their labels that you seek, but another professional opinion regarding suspect behavior.

 Don’t be afraid to ask the child’s teacher, or the school personnel, what they think might be different about your child. Academic staff are frequently the first to postulate a problem.

 Take videos of unusual behaviors. One parent may simply not have gotten to spend enough time to have observed a ‘stim’, or recognize activity as repetitive.

 Have the child evaluated by a trained professional. Then, insist on a precise diagnosis. Children with sensory processing, executive functioning disorder, and speech apraxia have autism.

Discrepancies about the next steps
So much inertia must be overcome to establish that first step, simply embracing traditional treatments can offer parents glimpses of improved development. OT (occupational therapy), PT (physical therapy), S&L (speech and language therapy), and ABA (behavioral therapies), must be given the time to reveal results.

At the very least, however, ask your pediatrician to make sure to perform some basic laboratory testing. Even if there is disagreement, how could it hurt to obtain a complete blood count, evaluation of nutritional status (calcium, magnesium, vitamin D, iron), and thyroid screening?

Opposition about biomedical interventions
Although the pull of the Internet is great, children are best served by contacting a physician who is involved in The Medical Academy of Pediatric Special Needs. Unfortunately, there are too few to adequately staff the burgeoning number of affected children, but, we practice state-of-the-art, evidence-based medical intervention.

By continuing our education within such a medical fellowship, and achieving a thorough knowledge of the science that appears in peer-reviewed journals, doctors have developed protocols that have been proven safe and effective. Although the costs are rarely adequately covered by medical insurance, the investment will last a lifetime. Literally.

Conclusion
Denial and delay are not in your child’s best interests. Doctors who are satisfied with the status quo will achieve that end. Modern thinking is that earlier intervention results in improved outcomes.

At The Child Development Center, our experienced and knowledgeable Practice Manager, Karen, has observed that families who seem to have the most success, “May not be on the same page, but are at least in the same book!”

The Real Cause of Autism

Sunday, October 8th, 2017

Recently, these 3 headlines appeared on my iRadar Screens:

Genetics a Cause of Autism in Most Cases: Study
 Korean-American Professor Couple Identify Major Cause of Autism
 Could multivitamin use in pregnancy protect children from autism?

Yet, the research was entitled:

The Heritability of Autism Spectrum Disorder
Mum’s bacteria linked to baby’s behavior
Antenatal nutritional supplementation and autism spectrum disorders in the Stockholm youth cohort: population based cohort study

And, the papers covered the following data:

The examiners mathematically re-analyzed decades-old Swedish registry information that strengthened the association with genetic factors. About the findings the lead author has admitted, “our results do not give any information about specific genes or other direct causes. It only informs us that genes are important…. our study cannot shed any light” on the reason for higher rates.

This was published in Nature, entitled, Maternal gut bacteria promote neurodevelopmental abnormalities in mouse offspring. “The couple found that certain bacteria in the mother’s digestive tract can lead to having an autistic child. Furthermore, they found the exact brain location linked to autistic behaviors, which can be used to find a cure for autism.” Mice are not men.

Using a similar Swedish cohort as the first study, authors reviewed supplementation with multivitamins, iron and folate. They concluded that, “Maternal multivitamin supplementation during pregnancy may be inversely associated with ASD with intellectual disability in offspring.”

Discussion
All of the information first appeared in reputable journals. The stories took a turn through leading health and science magazines, and finally popular media announced theories as if they were dogma. Often, autism research is subject to the ‘telephone game’, resulting in overstated and oversimplified claims masquerading as explanations for complicated medical concepts.

Nevertheless, these investigations represent clues, directions to be pursued, possible new treatments and even prevention. It’s so confusing because they document only baby steps in this scientific puzzle.

Conclusion 
Rather than view these studies as disparate, an alternative perspective could be something like:
If autism is the result of a susceptible individual (genetic study) affected by an environmental stress (mouse study), then utilizing a metabolic intervention (third study) might make sense.

Finally, An Anti-Anti Reflux Study

Sunday, October 1st, 2017

Perhaps my theory is full of water, but this seasoned pediatrician’s belief is that the price that modern society has paid for the successful ‘back to sleep‘ campaign has been an increased incidence of gastro-esophageal reflux (GERD). The practice was introduced to Western medicine at the end of the last century, to reduce Sudden Infant Death Syndrome (SIDS).

When newborns are kept solely on their backs, acid, mucus and food may be more likely to slosh all the way up to the back of the throat, eventually leading to the tubes that are supposed to drain to the middle ear. That has led to an increasing number of infections (otitis media), and an explosion of antibiotic use in very young children.

So, is it the reflux, the treatment of the reflux, the consequences of the reflux, or the treatment of those consequences that increases an infant’s risk of developing signs and symptoms? Aggressive behaviors, hyperactivity, lack of focus, sensory issues, and various gut disorders are commonly ascribed to ASD. Such are the complications woven into the stories of many parents interviewed at The Child Development Center.

The Literature
The practice of placing children on their back was based on observations in other countries, and theories about characteristic electro-encephalographic patterns characterizing those with increased risk of SIDS. Studies in the Netherlands confirmed the observation, and led to the AAP recommendations. No doubt, this strategy has worked for SIDS. However, could the emphasis on alteration of those sleep patterns – related to breathing – have a non-intended effect on other CNS development, as well?

Subsequent research has confirmed the increase in reflux related to infant positioning. The knee-jerk reaction by modern pediatricians has been the issuance of an Rx for antacids, in some form, from Tums to Nexium. Vitamin and mineral absorption becomes impaired. I have previously documented the pitfalls of this intervention.

This week, JAMA reported that, “… infants prescribed antacids to manage acid reflux, or spitting up, under age 1 had more bone fractures later in childhood.” Calcium absorption is believed to be the culprit. “There was a dose-response relationship between fracture hazard and duration of treatment with PPIs. Those taking them for a month or less were at a 19% greater hazard of bone breakage than infants who did not take the suppressors. Those taking the drugs for 60 days to 150 days were at 23% greater hazard and those taking them longer than 150 days were at 42% increased hazard.”

Discussion
The medical establishment altered the environment in the 1990s when we repositioned babies. Consequences have included plagiocephaly (flat head), torticollis (tight neck), and feeding difficulties. Then, we re-set the field again with antacid preparations. Present literature warning about these pharmaceuticals is probably just the tip of the iceberg.

Environmental change + Susceptible Individual = Alteration from Expected Norm

As a practicing neonatologist, nearly all of our ‘premies’ suffered up-chucking of some sort. I never ordered Prevacid, Zantac, Pantaprozole, etc. in the last century – it wasn’t available. Assiduous positioning and a small amount of Bethanecol (a drug to increase gastric tone) worked great. Ear infections in the first years of life were rare, and doctors seldom resorted to antibiotics. And, we didn’t see much autism in the follow-up clinics.

Conclusions
The Safe to Sleep® campaign offers lots of useful advice. SIDS has decreased by 50%. Some common sense is needed, however. For example, it probably is not necessary to stress the ‘supine position only’. Babies will usually drift to their sides, anyway, especially as they get older. And, if a responsible person is close, it’s pretty safe.

When reflux is diagnosed, simple positioning and an appropriate evaluation should precede any intervention that involves medication. If recurrent infections appear, the placement of ears tubes can mitigate the requirement for further rounds of drugs.

Is it really necessary to keep all infants on their back, all of the time? The ramifications of this policy need to be re-examined, as they may apply to the epidemic number of children with autism.

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Brian D. Udell MD
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