Archive for the ‘News-Maybe-Worthy’ Category

Patient Testimonials about Biomedical Autism Treatments

Sunday, October 4th, 2015

Every so often, my beautiful and patient wife, Jackie, reminds me that the service websites that she searches contain letters and feedback from clients. “It’s not just advertising,” Jackie points out, “there are key comments that help me make my decision.”

In the spirit of helping other potential families decide about providing biomedical interventions for their non-typically developing children, here is some recent correspondence concerning the work at The Child Development Center of America. (names changed)

Letter from a teacher:
♥ …Also, just wanted to let you know-Billie is doing AMAZING! Therpist2 is wonderful with him. Therpist1 was lovely and worked well with Billie, however, Therpist2 has been getting him to do things that I did not see last year at all. He is trying to communicate more with me and with the other students. Billie is happy and engaged in learning when Therpist2 works with him. She is a lovely lady and so good with him. I am so pleased with what he is doing in class. Tomorrow we are going to show his science project during class – he did a great job on the assignment.
Therpist2 and I were brainstorming ideas for Billie to participate in the event at the end of the year….
Posting on Facebook:
♥ Doctors don’t know everything.
In February of 2011, the lead neurologist… told us that our oldest son (then 2.5 years old) would only continue to regress to the point where he’d become so aggressive we’d have to medicate him (which he showed no aggression at the time) and that he threw up every day bc he was autistic, cried all night bc he was autistic, and while he didn’t have a crystal ball, he said he’d probably eventually need to be institutionalized. He said he was 100% confident in his diagnosis.
Through reading and research, a second opinion and holistic approach guided by Dr Brian D Udell, extensive tests on food sensitivities and bacteria imbalances (due to antibiotic abuse from his previous pediatrician) a radical change in diet, faith and determination we reversed that diagnosis and restored his health.
♥ Fabio is responding well to the B12 shots. We are at 0.08ml three times a week for two weeks now and he is doing well. The better days are the days of the shot, then 2nd and 3rd day in between shots, he gets a little silly and extremely sensitive at the mouth area (he puts all his fingers in his mouth). Would it be ok to give him a shot every other day? I feel the effect of the shot wears out the days in between and as a result we see the silly behavior and sensitivity…
♥ Hi Dr. Udell, just wanted to show you an example of a good day for Bobby outside of all the movement you constantly see in your office… On a different (positive) note, see pic below at the School Award Assembly. Bobby walked up from the back of the cafeteria and up the ramp on to stage by himself, waited for all the other kids to get in position for pic and walked down. Huge difference from last year, he had someone with him the whole time. It was great to see all that independence growth from one year to the next!
♥ I just wanted to give you my perspective on what I am observing with Pat so you can understand why I am so adamant about increasing her dose back to the 3cc’s on Fluconazole.  She was a straight A student last year on this dose and is now struggling this school year.  I don’t know what it is about this medication but, it is magic for Pat and keeps her focused and on track.
Thanks for your help…
♥ Hi Dr. Udell. I wanted to update you on Darien’s behavior, constipation and my opinions on the Diflucan. We last saw you Sept 15.
On Sept 16, his behavior got him sent home from preschool for the day.
He was miserable Sept 17-19, constantly repeating “you didn’t say something?” and “nothing hurts?” And having tons of outbursts. The 19th was the worst. I took him to a first visit with his new play therapist and he was screaming and throwing things.
I started the Diflucan on Thursday the 18th. Stating Saturday the 20th, I have had my kid back again. He has been happy. The sensory stuff is still there but very toned down from last week. Overall, I have seen a HUGE improvement this week.  Huge…
♥ We are out of probiotics and have been for a week. We have noticed an increase in crying and pain with Robert. He also had loud farts with terrible smells.
♥ Jose is doing good. He pooped with the magnesium…
♥ I wanted to share this with you, it is about Henry and his horse riding therapy. He is doing a little better every day. Thank you for being part of our journey.
♥ Just some pics of Stan…he really is doing so much better with the htp. (5-hydroxy-tryptophan)
♥ Hello from Nassau! Sheena has been doing quite well since our visit. The Benefiber is WORKING !!!! She has a poop most days. It is formed but not hard, just pointy! … So she is doing well and we are grateful. Take care and see you in May.
♥ From a non-profit foundation “dedicated to providing …children in foster care with enriching activities, opportunities and experiences.” Here’s a great resource for all of us! “10 things every pediatrician should know about children in foster care”
♥ From Dr. Robert Melillo, author of Disconnected Kids, many tweets about “10 Things All Pediatricians Should Know About Autism” and “The Law, Antibiotics, and Autism“.
Comments about this blog:
♥ Everything is very open with a very clear clarification of the issues.
It was definitely informative. Your website is very useful.
♥ I like the valuable info you provide in your articles.
I will bookmark your blog and check again here frequently.
I am quite sure I will learn a lot of new stuff right here! Good luck for the next!
♥ I read a lot of interesting articles here. Probably you spend a lot of time writing.
Patient services:
♥ Hi Dr Udell, Karen & all your wonderful staff… for your help in the process of getting Maria switched to a bus that has AC/Heat capability… We are so thankful to God for good people like you guys that care and have helped us in the journey of advocacy for our little ones so that they can have all the resources available to be able to become functional & exceptional adults someday…I demanded that they read the letter & reviewed the case again that they realized their mistake & even apologize for their ignorance. Maria can finally resume classes & continue to enjoy learning her ABCs. Thank you again, very much, for ALL THE WONDERFUL WORK YOU DO!
♥… We are just so eager to get his little gut ready for the LDN and B12 shots……again thank you for everything!!  Our regards to the whole staff….they are awesome. You definitely give parents hope…by taking the time answer all of our questions and concerns….we are so thankful… are amazing!!

Perhaps, I’m just ‘preaching to the choir’. For years, reknowned ABA guru, Dr. Doreen Granpeesheh, has spoken about the improved outcome when parents combine ABA with biomedical techniques. Similarly, prominent researcher, Dr. Martha Herbert, has emphasized the whole body conditions that can be addressed in this manner.

By combining the time-tested improvements from ABA, OT, PT and S&L therapies, plus other emerging techniques, doctors can learn to successfully treat children diagnosed with ASD.

Notes from the Autism Education Summit

Sunday, September 27th, 2015
theo and me

September 26, 2015 Dr. Theoharides and me

In the beginning of the autism epidemic, conferences included practitioners and families interested in assisting patients in their journey toward recovery. As the information has become more extensive and complicated, the needs and expectations of various parties have spawned more specific meetings.

Tufts University professor, eminent autism researcher and program sponsor, Dr. T C Theoharides, invited me to lecture at this year’s Generation Rescue conference in Dallas. It was a chance to speak to, and with, a worldwide audience of over 700 parents whose children had an ASD diagnosis.

An Alternative Biomedical Approach to Autism Spectrum
A group of ~ 50 ‘newbies’ attended. The topic was chosen because I wished to simplify the issues and offer hope that, despite what the conventional doctors have declared, recovery is possible.

The take home messages were:
1. Traditional medicine only offers bandaids for very complicated signs and symptoms. When the only tool that a person has at hand is a hammer, everything looks like a nail. The usual medications are very powerful with lots of side effects, and provide little in the way of genuine relief.

2. There is more than one way to skin a cat. Many of the other ‘DAN’ practitioners seem to utilize more complicated and expensive protocols, not necessarily superior to the approach that I find most successful. A basic workup was offered to identify laboratory variances indicating less-than-optimal health. Addressing those areas and improving energy with techniques that are not difficult to understand or institute, usually leads to significant progress.

3. Ultimately, autism really IS ‘rocket science’. There are multiple causes and a variety of presentations that even experienced practitioners are hard-pressed to understand and treat. By understanding the basics, parents can lead a team of professionals to get their affected offspring on the right track towards an optimal outcome.

Other Lectures
For 3 days, there was a full roster of presentations covering cause, effects and treatments. In addition to Dr. Theoharides, world-renowned researchers and practitioners, such as Drs. Dan Rossignol, Richard Frye, Jerry Kartzinel, and Anju Usman, gave their learned and extensive points-of-view about ASD.

It is my belief that sometimes the lectures were too demanding. Although the audience was quite intelligent and knowledgable, they seemed to expect more in the way of treatment options for their child, than basic science.

Jenny Group

Ryan Blair, Jenny, Jodi Gomes, Ryan&Dawn Neufeld, Jacqueline&Chris Laurita

Jenny McCarthy
Cue the music, lights, cameras, video screens and action! To this crowd, the lady is a rock-star. She definitely delivered a great message, filled with personal anecdotes, humor, empathy and hope. A panel discussion followed, consisting of famous, and not-so-famous, warrior moms and dads. This was certainly one of the conference highlights.

When I announced on Facebook that I was attending this conference, one of my ‘followers’ wrote, “I think I’m going to unlike this page now,” presumably because of the ‘misguided’ position of Generation Rescue regarding the issue of vaccine injury.  Talk about the polarized world of autism diagnosis and treatment.

Bottom line – I would definitely recommend this yearly conference to parents who have the time and resources.

Sensory Processing Issues in Autism

Sunday, September 20th, 2015

What do parents mean when they express concern that their child “has sensory issues?” Even the DSM 5.0 now lists sensory processing differences as a core diagnostic symptom. A new study appeared last week showing that children on the spectrum actually respond to odors differently.

Researchers “measured the non-verbal non-task-dependent sniff response concurrent with pleasant and unpleasant odors in 36 children—18 with ASD and 18 matched typically developing (TD) controls. We found that whereas TD children generated a typical adult-like sniff response within 305 ms of odor onset, ASD children had a profoundly altered sniff response, sniffing equally regardless of odor valance.”

SmellParents may notice that an affected child smells everything and displays unconventional preferences. Some children do not even notice yucky odors, such as oral liposomal glutathione, or refuse multivitamin preparations that seem to smell just fine.

Previously, such information has provoked the proposal of a new syndrome, e.g., Visual Processing Disorder, Auditory Processing Disorder, etc. Is this Olfactory Processing disorder?

The Other Senses

Vision – parents notice eye stimming, such as staring at ceiling fans, spinning wheels or video screens. Temple Grandin has even highlighted a problem with fluorescent lights; that the cycling annoys those who are visually affected. Therapies targeting this sense have been shown to be effective.

As a clinician, visual ‘stimming’ needs to be distinguished from absence seizures, which have a vastly different cause, treatment, and potential downstream behavioral consequences.

Taste – Many parents report that their children are extremely picky eaters. Sometimes, the problem is with texture (such as crunchy, mushy, etc.) or temperature. Patients who experience speech apraxia often have difficulties with oro-motor functioning. Chewing may be a problem that necessitates blended foods and even more restriction in variety and nutritional value.

Affected toddlers who continue to drink a great deal of PediaSure® are often either allergic and/or addicted to that product because of a leaky gut, and weaning can be a slow, difficult process.

Hearing – Sometimes, affected children put their hands of over their ears as a ‘stimming’ behavior.  It can be communicating avoidance and so affected patients are literally putting their ‘head in the sand’. Often, is it due to certain frequencies (another child crying, a siren) or amplitude (vacuum cleaner, hand drier) that seem to set off a negative or aggressive behavior.

Other times, it may be due to processing, when the child doesn’t turn to voices or their name. Weakness in cognition can be another underlying cause for this difficulty. In any case, and similar to the other sensory conditions, auditory processing is definitely disordered.

TouchTouch – It appears that many affected patients have issues about being touched. Parents may report that they can only cut the hair or nails while the child is sleeping, or not at all. Some patients have complained that their skin feels like it’s on fire, while others do not seem to even notice a significant trauma. Repetitive hand washing, or tantrums from a wet shirt may be symptom of this issue, due to the child seeking input, rather than this being an obsessive-compulsive behavior.

Challenges in this sense include proprioception – the unconscious perception of movement and spatial orientation controlled by nerves within the body – as well. Some children will bounce for hours – on anything from the trampoline to the doctor’s couch – to address this issue. Temple Grandin even invented her own ‘hug machine‘ to alleviate her difficulties in this sensory realm.

These are issues indicative of crossed/missing/inadequate signaling in the CNS. Interventions that decrease inflammation and produce more efficient metabolism improve health. That leads to changes in these sensory signs of autism; as well as speech apraxia, repetitive behaviors or aggression.

Therapies directed at reducing the patients’ sensitivities to the various and specific system that is impaired can help. They can range from Occupational Therapy to Spinal manipulation.

How about our ‘sixth’ sense?” Google describes it as “a supposed intuitive faculty giving awareness not explicable in terms of normal perception.” It’s probably present in patients with ASD more than we think.

Medical Academy of Pediatric Special Needs Fall 2015 Meeting

Sunday, September 13th, 2015
Hyatt Grand Regency Orlando, FL

Hyatt Grand Regency
Orlando, FL

I am proud to report my continuing perfect attendance at the meetings, since the organization’s inception 4 years ago. These semiannual conferences represent one of the handful of valuable expositions, such as SFARI, to advance the science of practical approaches to modern developmental conditions.

There are multiple courses covering a variety of subjects, up to 8 hours per day for three days, presented by the most highly respected professionals in the field.

Day 1
Take home facts of the day:
√ Depending on the practitioner (and geographic practice location), costs (especially lab $) can vary widely.

√ In unusual or resistant cases, the treating practitioners should be concerned about the gut, fungus, toxins (especially metals), PANDAS (PANS, PITANDS), and Lyme Disease.

√ Genes regulating metabolism and function are affected by methylation that leads to downstream behaviors consistent with signs and symptoms of ASD. Folic acid metabolism, including the regulatory genes (MTHFR), methyl B12,and the resulting pathways were stressed as targets of possible intervention.

√ These really creepy-looking worms could help.
HDCThe therapy is used to reset the immune system. There is a great deal of research and literature to support the claim of immune system improvement. Cases were presented where patients made remarkable progress. It doesn’t help that the ‘critters’ are harvested from insects and the name is Hymenolepis diminuta cysticercoides, HDC therapy for short.
Most important about this discussion is the fact that Dr. Sid Baker, founder of biomedical interventions and respected researcher, clinician, teacher, father figure, and guru – is the strongest proponent of this new protocol. Dr. Sidney BakerIn fact, he has a little farm that produces high quality, fresh product, at a fair price. Even so, the general consensus from the peanut gallery at this time was that it is a ‘hard sell’, except perhaps for the most trusting and/or frustrated parents.

√ Also, Dr. B recommended liberal use of magnesium and essential oils as safe and effective interventions. The group was definitely more comfortable with that advice.

Day 2


A most interesting discussion ensued when Dr. Dan Rossignol, our fearless leader, presented a ‘typical’ case of a toddler diagnosed with autism. The various ways that the experienced practitioners handled this child – from workup to treatment interventions – came to the fore. The doctors were all addressing the same problems, but went about it with fairly disparate protocols. There is no one way, at this time, to ‘skin this cat’.

Dr. Baker presented his fascinating background as an innovator in the biomedical treatment of autism. He stressed yeast problems in the GI system, and went on to explain his journey into helminthic therapy, which has produced significant results in his practice.

Complicated cases filled out the day.

A touching tribute to Dr. Jeffrey Bradstreet was presented at the Friday evening reception. Those who worked with him told their stories of an innovator, pioneer, and caring doctor.

Day 3
Dr. Stephen Genuis, Ob-Gyn, University of Edmonton professor, and the author of Chemical Sensitivity: Pathophysiology or Pathopsychology? was first to present at the plenary session, covering toxicity. He is knowledgeable and passionate about poisons in the environment. His lectures provided new ammunition to address skepticism, and the rationale for strategies to detoxify.

The toxicants of Dr. Genuis’ focus were Perfluorinated Compounds (PFCs), which are ubiquitous in homes, on carpets, non-stick surfaces, and may cause metabolic disruptions with clinical effects; from cancer to headaches. After reviewing available and tested options, his conclusion was that the most effective treatment was periodic phlebotomy (removal of blood).

Supporting and related information was presented by Dr. Ken BockDr. David Quig, and Dr. Kenneth Stoller.

After 3 days of lectures, the bottom line is that the air, food and water is not safe, and the most exciting interventions are blood-letting, worms and special oils. It’s 2015?

A Real Autism Story

Monday, September 7th, 2015

My amazing journey in this practice of Special Needs Pediatric Medicine is about to take another interesting turn. Over a decade ago, I started researching, observing and testing children for ASD, then working at the county’s first autism clinic. It became clear that conventional medicine was not prepared for the present epidemic of developmental problems.

Karen Vossen

Karen Vossen

With the assistance of my wife, Jackie, and Karen Vossen, the mother of a child with autism, we started the Child Development Center of America. Karen, our Practice Administrator, is no ordinary mom of a special needs child (if there is such a person). She is knowledgeable and determined to help other families affected by developmental disabilities. Karen has pointed out that, in that pursuit, she is better able to assist in determining the best direction and outcome for her child.

JulianSeveral years ago, Karen suggested that the Clinic should train and hire a former patient who was attending college. Any reluctance on my part was met by Karen’s comment that, “If we can’t show that patients can join the workforce, what are we doing in this practice?”

Julian was first introduced to our office when he was already an older teen, who had been considerably affected by ASD in his earlier years. His parents had pursued biomedical intervention at a time when only a few saw the value, and it has produced significant positive results.

When you speak with this exceptional young man, who is working on his second collegiate degree, he explains that he “used to have autism.” And, he’s correct. Leftover issues from those earlier years are challenges in social interactions, which he manages just fine, and some sensory stuff, such as being a picky eater. He shines in his abilities to learn new tasks and stay focused on the job at hand.

The school that Karen’s son attends is associated with a not-for-profit organization to assist graduates beyond the age of 21. Karen contacted the principal to inquire about students who might be seeking some type of job training in a professional environment. She saw this as an opportunity for Julian to mentor. He was given the task to write a job description, which was reviewed and revised a few times, until Julian got it right.

Everyone was concerned – both moms, the administrator, Karen and myself. Everyone, that is, except the principle players. We were introduced to Steven, a twenty-one year old, bright individual who is shedding his earlier signs and symptoms of autism. He works hard at maintaining eye contact and social interactions, and is eager to get into the workplace.

Before the first meeting, Karen was explaining what tasks she thought Steven would need to learn in order to get started with work. Julian stated, “Wouldn’t it be better if we sat down and spoke for a while so that we get to understand each other?” And, the two of them had an amazing conversation that led to a successful day of work, camaraderie, and exchange of knowledge. Any supervisor would have been proud of how smooth-running that day went.

Karen has done an remarkable job. Both individuals adapted to the workplace situation just fine. They taught the rest of us about how to fit in as gentle, understanding, capable and happy staff members.

So far, these young men have given us as much as we have given them. Hopefully, there will be other businesses that choose to take advantage of this special work force. This experiment indicates that Karen’s son – and others with similar challenges – will be able to succeed, as well.

Medical Marijuana for Autism

Sunday, August 30th, 2015

Families pose lots of questions, lately, about the use of cannabis products for children who experience signs and symptoms of ASD. This brief review explores the latest available evidence regarding experience, safety and efficacy.

A turn-of-the-century review about the pharmacology of cannabis products revealed two different types of receptors; one affecting neurons, and a second that acts in the immune system. This discovery led to products that are “… already used clinically, as antiemetics or as appetite stimulants… suppression of muscle spasm/spasticity… the relief of chronic pain and the management of glaucoma and bronchial asthma.” Other ingredients, the article proposed, “… may also have clinical applications, e. g. as appetite suppressants and in the management of schizophrenia or disorders of cognition and memory.”

Some useful reviews are available on the web, and even neurosurgeon Dr. Sanjay Gupta presented his learned point-of-view on a series of CNN special reports, entitled Weed.

The active ingredients include THC (tetrahydrocannabinol), the portion that produces euphoria, etc., and CBD (cannabidiol), which appears to have more medicinal effects. Both hemp oil and CBD oil are low in THC. 

For patients who have signs and symptoms of autism, their young age and sensory issues dictate only a few palatable forms of the product, which makes absorption – and blood levels – especially variable.

What improvements?
Anecdotal stories of better seizure control, decreased aggression, and increased communication appear throughout the autism community. The most famous product, Charlotte’s web, takes its name from a child with Dravet syndrome, which causes frequent convulsions, who demonstrated remarkable results that conventional medicines failed to address, and even led to severe complications.

What harm?
Little is known about the effects in children, especially those who are developmentally challenged.

On the other hand, little is really understood about the potential harm of stimulants, anti-anxiety, anticonvulsant and antipsychotic preparations, which are often prescribed by the conventional medical community.

What risks?
Parents frequently question whether their child will become addicted to the various supplements and interventions that physicians suggest. The answer to CBD oil may be in the affirmative, but depending on the symptom improvements, that may be of little concern.

Researching and reporting this information involves separation of the medical issues from all of the other stuff that surrounds this topic. Political, emotional, social, moral, legal and self-promotional issues are woven throughout the literature.

There are different forms of autism, various strains of hemp, diagnostic differences, and individual metabolism; any or all of which could be expected to produce a myriad of possible behavioral changes.

Even though 3/4 of physicians report being in favor of medical marijuana for needy patients, it is difficult to find practitioners to dispense these substances. Let’s not kid ourselves; we have little knowledge about the individual responses of normal people to psychotropic medications. The ASD population has far less ability to express emotion. This is basically, experimenting on children.

Based on the evidence so far, there is too little scientific evidence that it is of value for the ‘milder’ signs and symptoms of autism. Anecdotally, it appears to be quite helpful for intractable seizures, as suffered by some ASD patients. Any claims of superiority from one manufacturer to another would be difficult to verify.

If the medical community had more complete answers, families wouldn’t seek help elsewhere. For years, governmental interference from disparate agencies has crippled research for problems, such as Post Traumatic Stress Disorder, even in adults.

With the explosive increase in the numbers of individuals diagnosed with ASD, it would seem that a well-designed study to assess seizures, aggressive behaviors, anxiety, focus and communication in patients with autism should be in order.

Seven Critical Developmental Milestones for Autism

Sunday, August 23rd, 2015

Unless there is a change of heart by the powers-that-be, pediatricians will continue to leave concerns about developing autism in mom’s and dad’s hands. Since ASD is among the most common modern childhood disorders, here is an informal, but well-informed list of similar developmental variations, reported by parents of children who were later found to be ‘on the Spectrum’.

Who is at risk?
There are correlations with a positive family history for speech delays, ADHD, or autoimmune disorders, especially thyroid. Other factors include; being male, born small or prematurely, moms taking certain medications, and other health conditions (diabetes, obesity).

Not much can be done, obviously, for such situations, so parents may want to just keep a closer eye.

4 months
3monthUnusual, unrelenting screaming, or an extremely ‘good’ child – parents have reported both.

Observations about feeding are important. Moms should be concerned about a weak suck, difficulty breastfeeding, or signs of colic or reflux. For formula-fed children, frequent changes due to intolerance may cast a shadow for future development.

A diagnosis of ‘torticollis’ (a condition where the head is turned to one side), or ‘plagiocephaly’ (flattening of the head), may be an early indicator of poor muscle tone.

7 months
6monthUnusual stooling patterns, including constipation and/or diarrhea, may become evident, possibly requiring medical intervention. Persistent skin conditions, such as eczema, or other chronic illness, such as bronchitis, may join other red flags.

By this time, infants should be smiling, making sustained eye contact and turning to their name.

Muscle tone should be increasing and the child should show the ability to sit.

10 months
9monthCrawling is acquired and in a typical fashion, so that ‘army’ moves or asymmetry may be a worry. The child is typically babbling.

There should not be continued, prolonged, repetitive movement, such as rocking back and forth or head banging. Neuro-typical infants are usually watching all of the action.

13 months
12monthSome type of walking should be present and there ought to be 2 or three words.

The youngster should be exploring and showing interest in others.

The introduction of new foods is not a big struggle in most infants. Delays in any of the one-year-milestones demands an exploration by the pediatrician.

16 months
16monthThere should be added suspicion if there are repeated ear infections, or other chronic medical conditions. Also, any requirement for Miralax™ should raise concern.

Staring at wheels, ceiling fans, and other spinning objects is typically only for the briefest period of time.

Any loss of speech, or lack of progress by this age is a red flag.

20 months
20monthsIf a child has required evaluation by more than 3 doctors for medical conditions, a central theme, such as autism should be considered.

Also, parents will want to be on the lookout for children who are stuck on few foods, and/or certain textures. An addiction to Pediasure™ can be an important clue.

Children who do not seem to be keeping up with peers warrant further observation. So, for first-timers, advice from an experienced, nonjudgmental grandparent can be valuable.

24 months
24monthBy now, children are playing appropriately with toys, talking to them, and playing with others.

It would be unusual to observe lining up things, looking to the side, continuing to put their hands over their ears, or excessive toe-walking.

At this age, it should be possible to separate the child from a digital device.

Most of these signs, by themselves, are only an indication for increasing watchfulness. As behaviors persist when normal milestones are missed, concerns are heightened.

In our modern world, “Waiting until the child is three,” is not an option. The earlier that appropriate intervention is instituted, the better chance of shedding the diagnosis.

By noticing these variations in childhood development, a parent can speak to their pediatrician about formal testing for this problem.

Seeking More, Better Autism Updates

Monday, August 17th, 2015

Every day, there is more information about this enigmatic epidemic. The Newsworthy tab on this site is useful for keeping up with some of the more controversial or confusing topics.

There never seems to be enough reputable, understandable, and useful news for families seeking help for a loved one affected with autism.

As of August, 2015, here is a representation of the most salient research:

There are multiple reports that the increased number of patients with ASD is mostly the result of diagnostic changes. It’s difficult to understand WHY this is so important to the media. Cancer of the colon and breast is recognized more, as are autoimmune diseases, such as thyroid disorders. Plus, there are many medical diseases, such as chronic fatigue and restless leg syndrome, which weren’t even discovered until this century.

Though such information may be of some importance epidemiologically, it leads to confusion by affected families and skepticism by the general population. At The Child Development Center, there is a steady stream of patients who have no idea about DSM IV or DSM 5.0 criteria. Parents come seeking a trained physician who is willing to assist their non-typically developing child.

This is where some of the most important discoveries should appear. It’s not like the ‘olden days’ when ASD was thought to be due to a single, as-yet-undiscovered mutation, infectious or toxic agent.

A myriad of possible genes, on a variety of chromosomes. previously unknown or thought to be of little significance, appear to be related to increased susceptibility in higher risk populations; including males, prematures, or children with immune problems. That situation, plus a toxic environment, creates the perfect storm for our little ‘canaries in the coal mine.’

There is woefully little in the way of true new therapeutic interventions for children already affected with developmental delays such as speech apraxia, sensory processing issues, or aggressive behaviors.

Moreover, in spite of recent research indicating improvement with early intervention, the US Preventive Services Task could not recommend routine screening by pediatricians.

The variety of studies that link advanced maternal and paternal age, increased maternal weight, and various other conditions of modern life, do little to ease the concern of prospective parents.

In fact, there are NO entries on this subject in the present year.

Scientists can’t help but study this mysterious condition, in order to better understand not only ASD, but neurotypical behaviors, as well.

In spite of all the controversies that surround an autism diagnosis, medical researchers continue to make (slow) progress.

Response to Inaction by US Task Force on Autism

Saturday, August 8th, 2015

August 8, 2015
This week, the U.S. Preventive Services Task Force on screening for autism disorder in young children recommended that more research needs to be performed before they can propose the institution of a formal program.

In a 2011 special article in Pediatrics, the authors concluded, “… we believe that we do not have enough sound evidence to support the implementation of a routine population-based screening program for autism.” That same year, the American Academy of Pediatrics recommended integrating such tools as a preventive measure.

Screening Today
The most popular screening tool, the Denver Scale, was introduced 40 years ago and last revised in 1992. It was invented at a time when the most serious childhood problems were mental retardation and cerebral palsy.

According to one study, “… the test has been criticized to be unreliable in predicting less severe or specific problems.” The author of the DDST has replied, “… it is not a tool of final diagnosis, but a quick method to process large numbers of children in order to identify those that should be further evaluated.” Like the many scientific tools available to screen for autism.

Autism Screening Tools
The CDC has developed a detailed schematic mechanism for diagnostic screening. “Myths About Developmental Screening” included these facts:

… today sound screening measures exist. Many screening measures have sensitivities and specificities greater than 70%.
•Training requirements are not extensive for most screening tools…
•Many screening instruments take less than 15 minutes to administer…
•Parents’ concerns are generally valid and are predictive of developmental delays.

Success of Early Screening
Fifteen years ago, a Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Societystated, “Early identification of children with autism and intensive, early intervention during the toddler and preschool years improves outcome for most young children with autism.”

The effects of intellectual functioning and autism severity on outcome of early behavioral intervention for children with autism, published in 2007, concluded “… These findings emphasize the importance of early intensive intervention in autism and the value of pre-intervention cognitive and social interaction levels for predicting outcome.”

A 2008 study noted, “Randomized controlled trials have demonstrated positive effects in both short-term and longer term studies. The evidence suggests that early intervention programs are indeed beneficial for children with autism, often improving developmental functioning and decreasing maladaptive behaviors and symptom severity at the level of group analysis.”

A Randomized, Controlled Trial of an Intervention for Toddlers With Autism, first published in 2009, demonstrated, “… the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.”

A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders, in 2011, “… resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs…”

Research in 2014 at UC Davis demonstrated that 6/7 high-risk infants (6 to 15 months old), “…caught up in all of their learning skills and their language by the time they were 2 to 3.” Therapy was provided by instructing parents on interventions that could be done at home.

Dr. David Grossman, task force vice chairman and pediatrician, said that while early treatment is promising for the more severely affected, that hasn’t been studied in children who have mild symptoms that may be caught only in screening. So – don’t screen at all?

The USPSTF in question lists potential harms as including, “… time, effort, and anxiety associated with further testing after a positive screening result, particularly if confirmatory testing is delayed because of resource limitations. Behavioral treatments are generally thought to not be associated with significant harms but can place a large time and financial burden on the family.”

A common theme among most of the parents who are interviewed about the manner in which their child’s autism diagnosis was handled, is the wish that the pediatrician had been more knowledgeable and forthcoming about developmental red flags. The cost of autism runs into millions of extra dollars over the lifetime of individuals who continue to be affected.

When it comes to all-vaccinations-for-all, anything related to ebola, guns not-under-control, poisons in our environment, etc., the government has rarely demonstrated reluctance to recommend. When it comes to children’s health, what happened to erring on the side of caution?

The task force VP said, “… of course you should screen if the parent is concerned.”

Shouldn’t it be the doctor???

Docs, Glocks and Autism

Thursday, July 30th, 2015

gunMiami Herald
July 28, 2015
Appeals court upholds doctor-patient gun law

According to the article, “The law subjects healthcare providers to possible sanctions, including fines and loss of license, if they discuss or record information in a patient’s chart about firearms safety that a medical board later determined was not “relevant” or was “unnecessarily harassing.” The law did not define these terms.”

The law did not define these terms
It has been reported that U.S. Circuit Judge Gerald Tjoflat, the author of the majority opinion, understands that, in a patient at-risk for suicide, this might be a valid medical concern.

How about this case?

A fifteen year-old male who suffers from moderate-to-severe autism (or any other medical – psychiatric condition), takes Zoloft for aggressive behaviors, perseverates on violent video games, and doesn’t seem to grasp the line between fantasy and reality.

Would it be fair to say that a discussion by the physician with the parents about weapons in the home is appropriate?

The risk factors

  • The patient’s sex.
  • The person’s age.
  • Medication(s) use. There is even a ‘Black Box’ warning on SSRIs about the increased possibility of suicide.
  • The predilection for violent video games related to behaviors.
  • The teen’s inability to discern reality vs. fantasy. When asked, “Who is your best friend,” for example, one patient responded with the name of person who he had never met.
  • Constant bickering with parents over school.
  • A loaded gun in the house.

Such a situation might be equally as valid when a patient experiences conditions other than ASD. Indeed, people ‘on the spectrum’ are probably less likely to act with outward aggression. Certainly, a discussion about elopement is absolutely a necessity in the face of autism, as are questions about a pool safety and the ability to swim.

Surely, there are a gaggle of gun-toting attorneys who can poke holes in my case. After all, I’m just a healthcare provider.

The lawyers representing the doctors got it wrong. This is not about the first amendment rights of physicians to discuss the issue of guns. This is about public safety. And, let’s face it, when it comes to vaccinations-for-all, as an example, there’s no problem protecting the herd.

Perhaps just as certain, is the possibility that, should a shooting death occur in this scenario, a lineup of litigators would appear on the radar screen, accusing the (ir)responsible doctor of not taking the obvious and necessary steps to prevent such a tragedy. “An Accident Waiting to Happen,” might be the headline.

This is an insane law that supports the NRA’s unyielding position about the rights of gun ownership. It is proof of how corrupted our system has become, due the superabundance of lobbying money.

Gun control is what we need, in the face all the senseless shooting deaths by too many young men, who obviously have mental challenges. However bizarre, it is a standing law that has now been upheld by the Florida Court of Appeals.

More information will be required to illuminate the holes that are created by this imprecise lawyer-speak.

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Brian D. Udell MD
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