Archive for the ‘Diets’ Category

Anti-fungal Treatment for Autism?

Sunday, January 11th, 2015

According to the medical establishment, any autism treatment that does not chemically pollute the brain is ‘off-label’. However, less controversial is the topic of poor gut health in children with ASD.

Eight of the eleven originally-described patients with autism (circa 1940) had G-I symptoms. Scientific literature is fairly established (1*,2*,3*, 4*,5*, 6*) about this association.

The Theory:
Somehow, the sticking point for real scientists is the association between gastrointestinal disturbance and autistic behaviors. Those would be the real scientists who never cared for a child with autism. Or, those who never ate some bad Chinese food.

Given that the association is genuine, then, what better way to help a child recover from hyperactivity, poor focus and attention, continuous repetitive movements, ineffective sleep, chronic constipation or diarrhea, or grouchy mood, then to address that condition?

It was along that line of thinking that successful biomedical treatments were undertaken, over 50 years ago. Despite the continuing controversy of impersonal science and scientists, the remaining question for those involved with helping patients is, “What’s the best way to heal the gut?”

The Findings:
Toward that endeavor, research has documented associations with eosinophilic esophagitis, GERD (reflux), intestinal lymphadenitis (think big tonsils, but further down), and colitis. These are medical conditions with actual, established therapeutic interventions.

The Treatment:
The cause and prevention of that inflammation along the G-I tract poses an attractive therapeutic possibility. The offending agents could include food allergies, toxins, viruses, bacteria and fungus, including some imbalance of those forces, in susceptible individuals.

Some of the protocols, such as addressing toxins, avoiding allergenic agents, or prescribing antibacterial, antiviral, and anti-fungal products, have held up better than others.

The Experience:
Gut health is evaluated in each of our patients by CLIA approved laboratories. Findings consistent with fungal presence, or signs and symptoms assigned to that condition, were treated with brief courses of low dose fluconazole in patients throughout 2014. Their regular visits were documented and reviewed, including appropriate periodic laboratory studies.

This was performed under a physician’s care, with the parents’ full understanding and consent – and usually their trepidation and reluctance.

The bottom line is this: within 2 or 3 short courses, a simple, oral, antifungal medication was well-tolerated, and effective in reducing many symptoms that are generally assumed to be ‘autistic’.

Warnings:
Fluconazole can have serious side effects and drug interactions. Present practitioners should follow a written, rigorous protocol and document progress. Other sources of inflammation should be explored and addressed, as well.

Disclaimer:
This information is to be submitted for publication. This is not a recommendation for patients. Further studies are warranted and validation requires more scientific scrutiny.

Addendum:
Here’s a (typical) email that arrived as I was typing this story, “Hello Dr. Udell,
<<Jane>> is showing issues related to yeasty behavior. Last time we saw you a month ago, she seemed to have grown out of it. We then took a trip that seemed to have disturbed digestion and she has loose stools, some silly behavior etc. She was on diflucan till Dec 1st week. Do you think we need to get her on the antiyeast again?
Meanwhile, she has showed progress in other respects, increased eye contact and need to communicate more. Her babbling has increased but still no consistent words…”

When Professionals Disagree about Autism

Monday, December 22nd, 2014

Parents strive to do their best for all their children, and this is especially challenging for those with special needs. So, families seek assistance from assorted channels; including books, other parents, therapists, teachers, professional practitioners, and of course, the Internet.

Inevitably, discussions arise about the ‘best way’ to handle specific situations, including the core domain difficulties of social isolation, repetitive motions (‘stims’) and communication.

Due to the enigmatic combination of signs and symptoms that presently fall under an Autism Spectrum diagnosis, there are usually more opinions than the number of authorities involved.

Conflicting information emanates from various sources:
Often, child neurologists are negative about practitioners who offer alternative medical interventions. There has been little change in the advice that they have offered for the past 25 years. Their information is based upon children who were previously put into mental institutions with other ‘retarded’ individuals.
What is the parent of a 5-year-old with apraxia to do? “Get more therapy!” Really? That’s all you’ve got, doc?

Likewise, pediatricians are generally clueless regarding ASD. Whenever a professional concludes, “We should wait for 6 months or so, to give a diagnosis,” parents should seek more substantial advice. What other medical condition is assigned this situation? Certainly not ear, throat or sinus problems, which appear to require immediate antibiotic intervention, regardless of a fever or other confirmatory signs.

Specialists, such as gastroenterologists, allergists, immunologists, pulmonologists and dermatologists seem to have tunnel vision, when it comes to autism. ‘Constipation’ and ‘eczema’ are descriptive terms, not astute diagnoses. Steroids are short-lived band-aids. Miralax® and Prilosec® are downright dangerous.

Psychiatrists, developmental pediatricians, and psychologists are considered experts in assigning an accurate diagnosis. However, RisperdalAbilify, and Adderall never made any child speak. Plus, there are a multitude of negative side effects.

Speech and Language Therapists are the authorities who have been on the front line of the autism epidemic. Children who do not speak are apraxic – period! Advice, such as, “He doesn’t want to speak,” is meaningless. “Mommy, I want juice,” is easier than dragging a parent to the refrigerator. The child would say it, if the circuits worked correctly.

Occupational and physical therapists should be a mainstay, until fine motor skills become age-appropriate. If there were a supplement or medication for such abilities, we would all take a pill and get piano lessons. In the meantime, it takes practice, practice, practice. Children who avoid handwriting lessons are not ‘easily distracted'; they simply don’t wish to ‘suck’ in another activity that other kids tolerate or even enjoy.

Behavioral therapists who claim that a young child is too disruptive and requires medication should seek other employment. Similarly, assigning blame to the family for inconsistent or incorrect responses is not helpful. The more challenging the behavior, the more that a professional should seek the cause and treatments.

The Internet is a collection of stories, with little supporting information. Parents should seek sites that use hyperlinks to actual studies and avoid those with quick fixes or magic remedies. If it worked, we would know about it.

Other families are helpful, for sure. However, their experience is limited to the number of children, their ages, and their condition. No matter how well-meaning, the information needs to be taken with a great deal of salt.

The solution to all of these various expert opinions, is aided by an experienced medical practitioner who has cared for many patients and listens. By taking into account the history, physical, laboratory findings, and previous treatment regimes, a framework for real progress can be constructed.

Ten Ways Pediatric Neurologists Can Help Autistic Patients

Monday, December 8th, 2014

With all due respect to the intelligence of physicians who take specialized training in child neurology, it appears that there is often some disconnect between their knowledge about autism and the approach to the families and patients affected by this modern epidemic.

10•Making the diagnosis and giving some tickets for therapies is not enough. Questions such as, “How did my child get this? How many get better? What other things can we do? Are there any tests? Where can I go for more information?” are sure to follow the diagnostic impression. At least, provide useful answers for those interrogatories.

9•The child neurologist has the opportunity to assess the risk of anesthesia versus the poor yield of an MRI. Likewise, assisting in the consideration of a short-term EEG, when there is no indication of seizure activity. Those technologies are not a diagnostic workup.

8•There is more than one kind of autism. There should be careful exploration about specific difficulties with the skin, gastrointestinal system, or frequent infections.

7•Neurologists are in a position to provide valuable assistance regarding various alternative treatments’ risks and expense. An off-hand dismissal about therapies to address other co-morbid conditions does not enhance that specialist’s stature in the eyes of the parents.

6•It might be helpful to suggest simple, possibly helpful treatments, such as dietary restrictions. What is there to lose? For the physician who is truly concerned about key deficiencies, this would be a good opportunity to check the child’s nutritional status with some blood work.

5•Doctors who continue to repeat, “You are doing a great job,” at each visit, with little documentation of change, are less likely to experience further visits.

4•In addition to the usual Fragile X-boy-test and Rett’s-girl-test, the neurologist can order a ‘chromosomal microarray’. Copy number variation affects up to 15% of ASD patients. Insurance companies pay for this. Although the results may not be valuable today, that knowledge may be quite important as our understanding about autism evolves.

3•A screening laboratory evaluation for anemia, kidney, thyroid, and liver status may yield a great deal of information. Even if the busy doctor cannot act upon abnormalities, they can be conveyed to the pediatrician.

2•Expressions such as, “I’m willing to say developmental delay,” or “We have to wait to give you a diagnosis,” are for the previous century. In young toddlers, communication is in its most formative stage. “Let’s err on the side of caution, and make sure that you get S&L, OT, ABA, right away.”

1•There are studies to show that patients can recover. Knowledge about that research and successful outcomes provides real hope for bewildered parents.

‘Tis the Season to be Yeasty

Sunday, November 30th, 2014

seasongreat“Why does the yeast keep coming back? When will we be able to stop worrying about that?” Those are oft-repeated concerns from many parents of patients with ASD, who have noted remarkable improvements when their offspring no longer suffer from fungus.

At certain times of the year, more ASD patients seem to appear who display signs and symptoms of gut yeast. This list explains some underlying causes for this phenomenon. It can be sung to the tune of the Christmas Song or Dreidel Dreidel Dreidel.

Families travel. It is unlikely that they will come upon a road sign advertising “GF/CF/SF/SCD Fried Chicken”.

Likewise, running out of magic medications or significant supplements may lead to an increased chance of a yeast outbreak.

There are relatives who do not believe that food affects behaviors. Some try to sneak forbidden substances, just to prove that ‘The Diet’ is unnecessary. By the following day, there are often many new believers.

Traditional seasonal foods are usually not part of a restricted diet. In an effort to make the situation more ‘normal’, unfamiliar foods are provided that may lead to constipation or diarrhea.

Refined sugar and high fructose corn syrup are ubiquitous in processed foods. Yummy desserts can yield yucky, yeast-disturbed sleep.

Changes in weather often accompany a higher risk of viral and bacterial illness. Fevers and ‘colds’ frequently lead to antibiotic overuse that may result in yeast overgrowth.

“You’ve got to let them be kids,” said one parent who relented about the key lime pie. Another one lamented, “I paid for that ice cream cone – for a week!”

School personnel get relaxed about the diet in susceptible kids. Daily celebrations make the forbidden fruit even more appealing.

Junior has lots of new stuff (toys, packages, etc.) to put into his mouth. This provides an opportunity for a multitude of strange flora to explore your child.

Environmental alterations take place; such as a Christmas tree, ornaments pulled from the top shelves, and warm clothing exhumed from rarely-visited closets. This provides plenty of moldy allergens to over-tax the immune system.

Schools, homes, churches, etc. turn on the heating system for the first time; expelling blasts of spores. This may occur in climates as diverse as warm, wet Florida, or the chilly nights in dry Arizona.

With autism, the extra social and academic challenges at this time of year are overwhelming. This can lead to anxiety, poor(er) eating, aggression and sleep disturbance – giving the appearance of ‘yeasty behaviors’, even if that is not the cause. Family problems can produce a similar picture.

What to do about it:
Parents should not despair about this situation. Yeast in the G-I system is one of the few causes of the signs and symptoms of autism that CAN be successfully treated with safe and effective supplements, diet and medication.

This is a great time to provide natural anti-fungals, such as vinegar, garlic, olive leaf, etc., to the extent that products are palatable and well tolerated.

Under the supervision of an experienced physician, a course of a prescription anti-fungal may be just what the doctor ordered as a holiday ‘chaser’ for ASD patients affected with yeast.

Fish Oil for Autism and ADHD

Sunday, November 16th, 2014

It seems that the less that is scientifically certain about a nutritional supplement, the more Internet pages are devoted to convincing surfers about its value to your health.

On the other hand, certain food additives hang on because they appear to have merit. Fish oil, for example, has been a mainstay. In addition to health benefits for heart disease, depression and dementia, improvements have been documented in behavior, ADHD, communication and cognitive function – many of the core symptoms of ASD.

The Basics: (for our purposes)
The brain is rich in fats. They are membrane-stabilizing, anti-oxidizing, electricity-enhancing, chemical-carrying, and account for most of the weight of our CNS.

A healthy metabolism requires dietary polyunsaturated fatty acids (PUFAs). One designation (Omega 3-6-9) describes the organic composition. Another important classification describes the size of the molecule (α lipoid acid-> EPA-> DHA).

There is evidence of differences in the PUFAs of people with ASD. The inference is that function can be normalized with dietary intervention by re-establishing typical levels and ratios.

Dietary sources:
Various mixtures derived from the ocean (cod, salmon, krill) and/or plants (flax, corn, nuts) are available. Claims about better stability, quality, purity, ingredients, absorption and disease-specific value are variously offered.

Particularly as regards a condition as multifactorial and enigmatic as ASD, this situation has resulted in a myriad of possible correct, useless, or even harmful choices.

Side effects:
WebMD lists a variety of adverse reactions, the most pertinent to the ASD population being:
G-I symptoms including burping, discomfort and loose stools
•Bleeding, including nosebleeds
PUFAs affect the immune system
•Heavy metal contamination
•Allergy to the source
•Exaggerating mental disorders
•Lowers blood pressure (many patients take bp lowering meds for sleep and anxiety).

Scientific papers reporting various dosages and formulations have demonstrated cautious safety, even in research that does not support assertions of improvement.

Results:
There is more than one study that refutes any positive effects, particularly in ADHD and ASD. There are few reports of gains in speech and language. Even the evidence offered by a popular vitamin company lacks specific supporting documentation.

Many children with ASD are on restricted diets or they are finicky eaters who could use the extra nutrition, anyway. Furthermore, there is a growing body of anecdotal reports and stories of improvement from various omega products.

There is theoretical and documented evidence that supports the proposition that this relatively safe and inexpensive nutritional supplement improves CNS functioning.

Conclusions:
Since we have limited ability to produce them, PUFAs are a dietary requirement. They are Essential Fatty Acids in various combinations, with confusing nomenclature. That situation often leads to marketing opportunities.

Little is certain regarding how this group of supplements affects patients with ASD. Users mostly rely on producer advertising for information and assurances about the “best” product.

In order to assess whether “it’s working,” caretakers should pay particular attention to gains in the most documented behavioral components, such as ADHD and aggression. Being aware of safe dosing and negative effects is valuable, as well.

Perhaps not producing as noticeable an improvement as other biomedical interventions, a high-quality oil that the child can tolerate (taste, smell), at the label-recommended dose, is a reasonable nutritional supplement for ASD.

Sleep and Autism

Sunday, October 26th, 2014

Persistent, altered sleep is a common finding among young children who have signs and symptoms consistent with a diagnosis of ASD. This is a key difference from neuro-typical peers.

And, like any person, changes in quantity and quality can result in further downstream behaviors; such as, inattention, poor focus, and easy distractibility. The situation can further deteriorate into tantrums, a ‘short fuse’, aggression and injurious actions (against self and/or others).

Sleepchart

Data from Ruffwarg, et.al. Science 1966

What is disturbed sleep?
Not only do young children sleep much longer, more time is spent dreaming, which is an important physiological necessity and developmental component. Since there is practically no muscle movement during REM periods, toddlers should be sleeping “like a log.” Many affected youngsters do not exhibit such activity.

Latency is prolonged. The time that it takes to fall into a slumber should be <~1/2 hour, even accounting for a great deal of individuality. Nighttime awakening is frequent in infancy, but the child should quickly drop off again. Because this process takes time, naps include less REM sleep.

For ASD affected individuals, problems can persist even into later years.

What causes disturbed sleep?
Sleep apnea is a possibility, especially for some premies, or when allergic asthma or rhinitis are frequent occurrences. More often, signs and symptoms represent GERD (reflux), of varying degrees and varied causes. Really bad heartburn, and no way to tell anyone.

Diarrhea, constipation and bowel inflammation may cause sleep alterations, as well. Since G-I conditions exist so frequently in ASD patients, this is a significant area for positive intervention and change.

Other medical issues include frequent ear infections causing fever and pain, seizures, altered melatonin metabolism, other metabolic disturbances, methyl B12 ‘shots’, and even the stimulant medications that many physicians prescribe.

A ‘workup’ is in order for any child who displays altered sleep, not a pill.

What interventions are useful?
A quiet environment at a regimented time helps everyone achieve faster, more sound sleep.

Sensory therapies can result in significant amelioration of sleep issues. Warm epsom salt baths, reading, and brushing are further examples of effective interventions, in selected patients.

After a suitable evaluation, youngsters who suffer GERD and other G-I discomfort may get a great deal of relief by proper positioning, appropriate feeding (time and volume), and occasional mild antacids. Medications that decrease acid production, such as Prilosec or Zantac, should be avoided, because of alterations in normal gut flora.

If food allergies are identified, avoidance of offending agents can calm the gut and help sleep to take hold. Unusual bacteria or fungal overgrowth should be addressed with strong probiotics, and anti-fungals when indicated.

Melatonin is a popular, safe and useful supplement. After a thorough patient evaluation, a doctor should suggest dosing. Providing this valuable antioxidant at exactly the same time each evening is central to producing predictable results. When the maximum dose is not effective in maintaining sleep, adding the natural amino acid, 5-hydroxy-tryptophan, may help.

With varying doses and results, supplements such as Valerian root, chamomile, passion flower, and kava have been recommended. GABA, an over-the-counter supplement, is a neurotransmitter that can either work quite well to assist sleep, or add to excitation in certain patients.

The most basic allopathic medication is Benadryl, an antihistamine that produces sleepiness. There are blood pressure lowering medications such as Clonidine®, Intuniv® and propranolol. These should be used short-term and the ordering physician should be alert to the cause(s) of the disturbance. Only rarely should strong CNS medications such as Depakote® be utilized. Sleeping pills that were meant for adults are just that – meant for adults.

Conclusions:
Unnatural quality and quantity of nocturnal activity often accompanies an autism diagnosis.

With such a plethora of downstream negative behaviors, interventions that reverse this situation are paramount to producing an effective autism treatment protocol.

Consulting with a knowledgeable, experienced clinician will yield the most valuable results.

Perhaps the most important improvement when affected children start to get an adequate night’s sleep is the positive effect on the whole family’s next day.

MAPS Fall ’14 Conference

Saturday, September 13th, 2014

Twice a year, doctors who are interested in understanding and treating children with complicated developmental issues, convene under the direction of the Medical Academy of Pediatric Special Needs. This is our opportunity to stay up-to-date about the latest protocols, and to speak with specialists from all over the world.

In addition to introducing the biomedical approach to professionals and providing a venue for the spouse and kids, the program includes ‘advanced’ tracks. The highlights of those lectures will be reviewed.

Day 1
Dr. Anju Usman – Down Syndrome
“What does that have to do with autism?” Learning about one neurologic childhood condition helps elucidate normal vs. abnormal structure and function. Besides, there are more than a few patients who suffer from both.

The ever-changing basic science of the brain was reviewed. A medical workup is similar; requiring genetic, metabolic, immune, and gastrointestinal evaluation. Conversely, having discovered treatment for the mitochondrial issues in ASD has successfully addressed various problems for Trisomy 21 patients, as well.

Dr. Giuseppina Feingold – Cerebral Palsy and Seizures
Again, understanding seizure activity in a condition where it is not uncommon, helps our understanding about convulsions in ASD. The lecturer, a pediatrician who practices alternative medicine in a very conventional setting, described her experience with her own child, who has CP.
A thorough review on the use of HBOT for CP was presented.

Dr. Mukherjee (New Dehli) and Dr. Marois (Quebec) followed with their research and positive experience managing CP with HBOT. Somehow, their findings have been misunderstood and misrepresented by the conventional medical community, for variety of reasons.

Dr. Kenneth Stoller reviewed his clinical knowledge and experience with Fetal Alcohol Syndrome. He has successfully treated patients with HBOT and Oxytocin, and has published that research.

Case presentations and discussions – sharing our medical experiences – finished out the day. The 2000 pound gorilla in the room? (hint – it has something to do with autism). Data is lacking.

Day 2
Very exciting! This day’s lecturers are rockstars, as far as researching, teaching, publishing and treating the group of conditions that present as a post-inflammatory encephalopathy. It is rare to be among such experts, so freely discussing their findings and opinions.

The moderator, Dr. Nancy O’Hara described her extensive experience treating patients with these disorders, including her own son. Details are provided about an accurate description, differential diagnosis (“What else could it be?”), laboratory ‘workup’, treatment options (including an additional lecture covering nutritional support) and outcome.

Dr. Tanya Murphy presented a fascinating talk about the overlap between antimicrobials and psychotropic medications. Specifically, certain antibiotics can also have neuropsychiatric effects. Conversely, psychotropic drugs have effects on the inflammatory system. This finding helps explain why the disparate group of medications that we use may have similar effects.

The inventor of the term, Dr. Sue Swedo, a Director at the NIMH, presented the latest about PANDAS. She described the areas in the brain where tics and OCD behaviors lie, and how this manifests as a condition for doctors to investigate, with treatment guidelines.

Professor Madeleine Cunningham, a researcher for over 35 years, gave an elegant presentation that documented the presence of autoantibodies in certain patients’ blood and the CSF, offering evidence that those chemicals signal (or are blocked from) neuronal cells. This work helps our understanding of many of the movement disorders, from Tourette’s to PANDAS.

Case presentations and videos completed the afternoon. The take home message was that doctors should stop asking the question, “Do you believe in PANDAS?”

Day 3
Inflammation

Dr. Rodney Dietert conveyed his understanding regarding the complexity of the functional immune system, and the relationship to non-communicable chronic disease. “The tie that binds,” according to the Chief of Immunology at Cornell.
He presented with the passion and knowledge that only a man who has spent his lifetime in this research could bring.

Harvard celiac researcher, Dr. Alessio Fasano, presented Intestinal Permeability, Antigen Trafficking and Inflammation. The subtitle, “The gut is not like Las Vegas, what happens in the gut does not stay in the gut,” tells the whole story.

Canadian naturopathic physician, Dr. Zayd Ratansi spoke about HBOT and Inflammation. There were lots of associations with medical conditions such as wounds, pain, trauma, cystitis and CP. The only slide about ASD and HBOT slide was Dr. Rossignol’s controversial multi-center report.

Dr. Russell Blaylock, a neurosurgeon, researcher and author, spoke about Immunocytotoxicity in CNS Disorders, elucidating how inflammation is handled in the brain.
He explained why/how systemic disturbances activate the CNS immune system. In turn, ASD patients with inflammation, perhaps elsewhere, have behavioral signs and symptoms. Comments were offered about the risks of the present vaccine schedule on the developing brain.

Although I can’t report that there was a great deal of specific day-to-day information, there was a lot of food for thought, networking, and the knowledge that there an increasing number of serious professionals working on your kids’ difficulties.

ADHD – What else could it be?

Sunday, September 7th, 2014

In medical parlance, the title = “The Differential Diagnosis of Attention Deficit/Hyperactivity Disorder”. However, a major stumbling block to understanding, treating and preventing this childhood epidemic is that it is considered a single organic entity, mostly of familial origin. Treatment usually involves strong stimulant medications, with serious side effects, in order to semi-successfully control a perplexing mix of imprecise signs and symptoms.

It’s not ‘just’ ADHD:
When I first encountered hyperactivity in the previous century, it was called ‘minimal brain disfunction’. After adjusting the name to reflect the ‘hyperactivity‘, the term ‘attention deficit‘ was added to streamline the diagnosis. Common difficulties include distractibility, poor focus, constant motion, immaturity, a ‘short fuse’ and frequent disruptive behaviors.

Combining two conditions that are poorly understood makes the problem more, not less, complicated. Other than naming it differently, I’m not quite sure that we have learned much about ADHD in the past 40 years, except for the recognition that it is increasing.

It’s not just ADHD if the child also has:
Some other chronic, concurrent physiological infirmity. Allergies, poor sleep, bowel or bladder problems are often not separate, isolated maladies. Importantly, as the associated medical conditions are successfully addressed, many of the base signs and symptoms may be ameliorated, as well.

Notably, behaviors such as aggression, anxiety and opposition may be coping mechanisms, not core deficiencies. That would explain why prescription medications are frequently ineffective, only work for short periods, or can even exacerbate symptoms.

As in all medical conditions, the diagnosis requires a ‘workup':
This week, our practice evaluated a patient who was exhibiting aggressive and oppositional behaviors. At the start of the school year, with so many children who have similar issues, the diagnosis would probably have been ADHD, and the patient sent home with an Rx for Ritalin. Except, on laboratory workup and by physical examination, he has thyroid disease!

Conditions as diverse as ASD, dyslexia, prenatal substance abuse, and even chromosomal changes may be present. Such circumstances are frequently missed due to the lack of elucidating a differential diagnosis –  what else could this child’s problem be?

Diet is important:
The studies about the effects of diet on ADHD are often difficult to interpret. The popular Feingold Diet focuses on artificial ingredients and salicylates, and has helped hundreds of thousands. WebMD provides a useful framework: overall nutritional, elimination and supplementation. Such a classification highlights the need to perform a thorough medical evaluation to eliminate much of the guesswork. If you can see it, you have a chance to beat it.

All the confusing nutrition babble aside, vigilant parents may discover offending agents and helpful substitutes. The problem is getting your kids to listen.

There isn’t just one treatment:
Stimulant medications. Three major variations. Caffeine citrate and nicotine patches can substitute.
Anti-anxiety drugs. Three on-label listings (Intuniv, Risperdal, Abilify) and numerous adult versions.
Homeopathic, naturopathic, allopathic variations.
Neurofeedback, NAET, neuro-sensoryelectrical stimulation, detoxification, etc.

Such a multitude of treatment options leaves professionals throwing darts at a moving target. The process is not exactly experimentation, but it certainly is trial-and-error. It isn’t difficult to understand why parents search the Internet for safe, effective intervention(s).

Close followup is key:
The present gestalt of listening to a parent’s concern, observing an antsy child in the office, and handing out a ticket for more over-prescribed ‘band-aids’ seems unstoppable. It’s not only the type of intervention, but how the child is evaluated and what specific signs and symptoms are successfully addressed, given the myriad of side effects.

Importantly, children are constantly growing, evolving and experiencing internal and external changes. Dosing, frequency, timing, and type of successful therapy will change dramatically over time.

Conclusion:
When a medical professional announces that your child has ADHD without a detailed history, review of systems, physical examination and appropriate laboratory evaluations, the patient is getting short-changed. It can even be made worse by over-prescribing potent pharmaceutical agents.

Parents who research the ‘net will find the landscape quite confusing. The best advice is to find a doctor with the skill, experience and time to understand this complicated diagnosis.

Ten Must-Have Back-to-School Autism Supplies

Friday, August 15th, 2014

Forget pencils and notebooks. Here is my take on the most important items that children who exhibit signs and symptoms of ASD and ADHD really need to make it through the coming season:

10. A weighted vest, and other such functional products. Neural systems are on overload, so any/all sensory reducing strategies need to be dusted off and utilized. My son, a Special Ed teacher, reports that one of his favorites is Chewelry.

9. A special request for an IEP meeting to review everything agreed upon in the last IEP, and how the child has progressed.

8. A written, visible schedule. The previous school year’s busy agenda needs a re-boot. With non-preferred activities about to consume more time, acceptance and self-control become paramount, so clear expectations are a good start.

7. Sleep. Likewise, the body’s internal rhythms have gone on a summer vacation. Warm epsom salt baths are great to pave the way at bedtime. Chamomile is fine, and more difficult problems may be ameliorated with the administration of melatonin.

6. Supplements and medications. Children with ADHD are often given drug ‘vacations’ during the break. Appropriate dosing and timing may have changed as the summer progressed, so try getting things started a week or so early.

5. Healthy food. Unfortunately, schools do not often assist in this endeavor. If junior has been slipping off the diet, or eating too much junk, get back to basics.

4. An app to disable the iPhone. Really. The time spent on iPads, computers and video games needs to become severely limited.

3. Playtime. It is very difficult to transition from a season of freedom to one of academic drudgery and endless therapy sessions. Going to the park, ballgames, and other outdoor athletic activities is a basic part of being any kid. Even though physical activity is not as preferable as that smartphone, try to make it happen.

2. Soap. Stress cleanliness and get the child into the habit of washing their hands. To the extent that the school will cooperate, tissue dispensers, hand sanitizers and bathroom etiquette could provide some barrier to the onslaught of cooties.

1. A big dose of time and patience. As students fit into the new school year, so do teachers, administrators and other professionals need time to understand each child’s strengths and weaknesses.

Everyone remembers that first day back at school; anxiety, fear, excitation, and dread. The assault on the senses, social stresses and academic expectations are an even more tremendous hurdle for students with challenges in those very areas.

Most of all, parents’ love and understanding gets us all through those first inglorious days and weeks.

The Law, Antibiotics and Autism

Sunday, August 3rd, 2014

The Case:
A U.S. court ruled that the FDA is correct to continue to allow the administration of antibiotics to feed animals – even if they aren’t sick.
Argued: February 8, 2013 Decided: July 24, 2014

The Judges:
Robert Katzmann, Chief Judge, (has top notch credentials, and wrote the minority opinion.)
Gerard Lynch, Circuit Judge, (wrote 2-1 majority opinion). More about him later.
Katherine Forrest, District Judge, (a really rich, “celebrated litigatrix“).

The plaintiffs:
Natural Resources Defense Council – “One of the nation’s most powerful environmental groups… A credible and forceful advocate for stringent environmental protection.”
Center for Science in the Public Interest - Founded by 3 “scientists, CSPI carved out a niche as the organized voice… on nutrition, food safety, health and other issues… to educate the public, advocate government policies that are consistent with scientific evidence on health and environmental issues, and counter industry’s powerful influence on public opinion and public policies.”
Food Animal Concerns Trust – “Mission… is to improve the welfare of farm animals; address public health problems such as the safety of meat, milk, and eggs; broaden opportunities for family farmers; and reduce environmental pollution.”
Public Citizen, Inc. – “… serves as the people’s voice in the nation’s capital… To ensure that all citizens are represented in the halls of power.”
Union of Concerned Scientists – “puts rigorous, independent science to work to solve our planet’s most pressing problems. Joining with citizens across the country, we combine technical analysis and effective advocacy to create innovative, practical solutions for a healthy, safe, and sustainable future.”

The defendants:
Margaret Hamburg, commissioner of FDA. She is a Harvard-trained medical doctor, and appears to be a strong consumer advocate.
Bernadette Dunham, Director – Center for Veterinary Medicine. She was a clinician, professor, and has served as an advisor to several veterinary panels.
Kathleen Sebelius, Secretary of HHS, who took heat for the Obamacare Website debacle.

The Issue:
A lower court had decided that the FDA should have hearings about antibiotic use in animal feed. This challenge, brought by the FDA, was that they didn’t need to review the issue.

The Ruling:
The FDA won.
Rather than considering antibiotics in the feed as a public health hazard, Judge Lynch (good name) focused his ruling on “… a syntactically awkward variation that leaves the intended sequence ambiguous.” The Catch 22 is whether the drug can be withdrawn if it is thought to be unsafe, but it can’t be declared so until there is a hearing, which the FDA is not required to do.
The explanation contains 10 pages that document scientists’ concern about antibiotics in the animal feed. It is followed by 55 pages that explain why the ruling by the previous court was incorrect. “In an ideal world, Congress would have written a statute that clearly selects between one of these two possible readings. But as the statutory language is ambiguous, we must do our best to determine which of these two meanings Congress intended to convey.”

Discussion:
I asked former Florida Assistant Attorney General, Mr. Hugh Keough , about this case. “The dissent was by the Chief Judge of the District… Interesting discussion about antibiotics especially after all I’ve read from you about over prescription of antibiotics…”

“Indeed, the FDA has consistently reaffirmed that using low doses of antibiotics on healthy livestock to promote growth could accelerate the development of antibiotic‐resistant bacteria, causing “a mounting public health problem of global significance.”

The “decision allows the FDA to openly declare that a particular animal drug is unsafe, but then refuse to withdraw approval of that drug. It also gives the agency discretion to effectively ignore a public petition asking it to withdraw approval from an unsafe drug.” (Dissent).
Mr. Keough exclaimed, “17 Years ago the World Health Organization recommended ceasing! Uh, is it time to go vegetarian?”

Conclusions:
The plaintiff’s issue was the emergence of resistant strains of bacteria. However, there may be profound, as-yet undiscovered effects. Somehow, can’t the FDA see it’s way to erring on the side of caution?

In 1999, the Journal of Pediatrics, published a study documenting, “Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the behavioral problems of the non-verbal autistic patients.” If you don’t think that autism is an epidemic, and you don’t consider that childhood development could be affected by the overuse of antibiotics, then you wouldn’t ever know whether antibiotics in our food is a threat.

 Given this decision, it’s going to be a while until any change is made in this area.

 Don’t allow your doctor to prescribe antibiotics for every little illness, and don’t beg for them, either.

 Take strong probiotics – lots of colonies, with varied strains.

 Try to eat as ‘organic’ as possible (given that they are telling us the truth about ‘organic’).

 If we want better oversight, we should let our government know.

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